Responses to Vendor Questions RFP 19AQMM21R0015.xlsx

XLSX spreadsheet 24 KB Posted Mar 11, 2021

Attached to: Health Insurance for South Central Asia (SCA) Region Locally Employed Staff
Solicitation number: 19AQMM21R0015
Issued by: Department of State Office of Acquisition Management

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Other files

File	Type	Posted
Question Set 4.docx	DOCX document	Apr 28, 2021
19AQMM21R0015 - A0001 - add Exh B.1.pdf	PDF	Apr 19, 2021
19AQMM21R0015.pdf	PDF	Apr 7, 2021
Hospitals List.docx	DOCX document	Apr 7, 2021
Responses to Vendor Questions RFP 19AQMM21R0015 Set 2.xlsx	XLSX spreadsheet	Apr 1, 2021
Spreadsheet for Central Asia and Afghanistan GMC Insurance.xlsx	XLSX spreadsheet	Dec 15, 2020
19AQMM21R0015 DRAFT RFP Central Asia and Afghanistan Global Medical Coverage Insurance.docx	DOCX document	Dec 15, 2020
DRAFT RFP Central Asia and Afghanistan Post Demographic Exhibits.docx	DOCX document	Dec 15, 2020

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Responses

	Vendor	Question	Response Owner	Response
	dhig GmbH	May I kindly ask for information about the current insurers of the US Missions in Afganistan, Tajikistan, Turkmenistan, Uzbekistan, Kyrgyzstan and Kazakhstan?	GTM/OE	There is currently no insurer. Employees receive reimbursement from the US Mission after filing claims.
	dhig GmbH	Does an offeror have to submit a proposal for all countries mentioned in the draft solicitation or can the offeror provide a proposal for one or more countries, but not all of them?	A/OPE	If the proposal does not include all six countries the bid will be deemed unacceptable.
	dhig GmbH	Would the US Diplomatic Mission accept an international approach ( a consortium of international insurance companies ) or do you insist on local insurance providers in each and every country. I am asking this question, as for example Tadjikistan, Turkmenistan and Afghanistan are quite limited and tough markets for the insurance
industry.	A/OPE	This technical approach is acceptable. However, there will be only one prime contractor. The prime contractor will be responsible for managing its subcontractors/joint venture partners. The USG will only have privity of contract with the prime contractor
	dhig GmbH	Would the US Diplomatic Mission insist on a network of medical facilities in all the countries where the insured persons can et cashless treatment?	GTM/OE	Obviously this is the preferred outcome. However, if this solution isn't possible then other solutions are acceptable as long as they meet the solicitation requirements.
	Cigna Europe	Pricing Form: We see different bi-weekly rates per country, but can you confirm all countries join together and they cannot opt out?	A/OPE	As per the contract all Embassies are required to participate
	Cigna Europe	Pricing Form: We won’t bill bi-weekly, that would be too expensive for a local plan. Can we suggest monthly or quarterly billing?	GTM/OE	Quarterly and monthly billing is acceptable.
	Cigna Europe	We need to provide a fixed admin fee for each period, so we can already apply an indexation on the admin fee for each future period. But in this admin fee we should also include our risk margin. Meaning the risk premium we provide is more a claims fund type.	A/OPE	all admin/etc costs should be included in the section B pricing
	Cigna Europe	Premium is fixed for first year (first 12 months) afterwards we can change rates based on the experience.
	But this is strange on the evaluation criteria, you state:

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. How can we fill out our rates for the next years if we apply experience rating?	A/OPE	Base + 4 option years should be priced out. EPA adjustments may be accomplished IAW Section B.4 after the base year performance period.
	Cigna Europe	On page 4 of the word document (“19AQMM21R0015...”) you refer for bi-weekly retention amounts per separate premium paid to an attached excel spreadsheet. But on the spreadsheet we only see “Rate per premium”. While in the word document they also show per country a table per year and split by employee, employee’s spouse and dependent child. The excel sheet is splitting up the “Rate per premium” in self, self+1 and family. Question where do you want to see the retention amounts and where should we put the premium amounts? And in what format?	A/OPE	Please provide as an additional table.
	Cigna Europe	It looks like the It looks like the “Excess Coverage” for Turkmenistan is “Optional” and 100% payable by the local employees. We see on the rating sheet that there is nowhere to include the applicable “cost” for this coverage. Please advise.	GTM/OE	The Excess Coverage should not be included in the cost of the contract. The cost for the excess coverage should be a rider to the contract. And invidivual employees will opt-in and deal directly with the vendor.
	Cigna Europe	On the claims data:

Can we ask more accurately what we mean with paid vs incurred?

“Are the claims data shared in the RFP actually paid in the mentioned periods or are they incurred during that period? For example: Afghanistan claims for the period 10/1/2016 – 9/30/2017 = $503,033.95. Are these claims actually paid in the period 10/1/2016 – 9/30/2017? Or are those claims also paid beyond that period but is the incurrence date in the period 10/1/2016 – 09/30/2017?”	A/OPE	As per solicitation "Fully completed and legitimate employee insurance claims are paid within 30 days of submission."
	Cigna Europe	Can you please provide month by month claims data since October 2016 for each country to be insured.	A/OPE	See Charts Provided by year in RFI 19AQMM20N2020
	Cigna Europe	Please share claims data per type of expense per year for the full period between October 2016 – November 2020	A/OPE	See Charts Provided by year in RFI 19AQMM20N2020
	Cigna Europe	Please share claims data per country of care per year for the full period between October 2016 – November 2020	A/OPE	See Charts Provided by year in RFI 19AQMM20N2020
	Cigna Europe	Please share claims data per insured person per year for the full period between October 2016 – November 2020	A/OPE	See Charts Provided by year in RFI 19AQMM20N2020
	Cigna Europe	Can you please provide the number of claims for each corresponding periods as noted above.	A/OPE	See Charts Provided by year in RFI 19AQMM20N2020
	Cigna Europe	Can you please highlight claims that are above USD10,000 for the corresponding periods as noted above.	A/OPE	See Charts Provided by year in RFI 19AQMM20N2020
	Cigna Europe	Please share membership split per person and per employee for the split “Self”, “Self plus one” and “Family”	GTM/OE	See the Spreadsheet for Central Asia and Afghanistan GMC Insurance provided in the solicitation
	Cigna Europe	Please share month by month membership for the full period between October 2016 – November 2020	A/OPE	There is insignificant variance in the membership month by month
	Cigna Europe	You shared the number of employees by salary range? Why are salaries important? We might have missed it while scanning through the documents.	GTM/OE	The salary range is provided for the informational purpose only.
	Cigna Europe	Page 58 suggests “The claims paid by the incumbent contractor...” Does this mean that this plan is already insured? We were under the impression this was a self-insured scheme.	GTM/OE	All six posts are on direct reimbursement; this is a standard solicitation language.
	Cigna Europe	Please confirm if coverage is required on a World Wide basis or only local + out of country of care is not available.	GTM/OE	The mandatory requirements are based on in country care. If posts elected for out of country travel/medical treatment the coverage would extend out of country (See out-of-country medical treatment definition in the solicitation for additional information).
	Cigna Europe	Who are the “Official Residence Expenses (ORE)” staff? Does the census and claims data include information for these staff?	GTM/OE	ORE employees are not employees of the U.S. mission. They are employees of the principal representative, Ambassador, Chief of Mission in whose home they work. They are included as riders and employers pay the premiums directly to the provider.
	Cigna Europe	Previously it would appear that the maximum reimbursement for any one country was USD22,859 and that has now increased to USD27,000. When did this increase happen?	GTM/OE	Kazakhstan's medical reimbursement cap increased in October 2020.
	Cigna Europe	With in the tender documents it mentions that a 2.00% excise tax is payable. Who has to pay this amount? If the contractor does it need to be shown separately or included within the fixed admin fee?	A/OPE	2% tax should be inclued in the overall cost of the contract.
	Cigna Europe	(“19AQMM21R0015...”), please note that we should only offer a profit sharing option over full duration, for contract (5 years) and not do so on annual basis
L.4.3.3.	Profit Sharing Credit

The offeror shall indicate whether any insurance plan offered will be subject to participation in any profit sharing credit program, pooling agreement (including multinational agreements) or any other premium credit procedure. If this is applicable, please describe. This is for evaluation only to distinguish between otherwise equally priced, technically acceptable proposals and will not be considered in determining the lowest-priced offeror.	A/OPE	you may offer a profit sharing option either on a full duration or on a annual basis. It is up the the offeror to decide.
	Cigna Europe	Some services that you are listing will be very expensive to offer (weekly claims pick up in 6 different countries, all documents to be translated in each language, bi-monthly billing...) considering our experience with local plans would you allow us to suggest a second option? This way you will have one matching all your criteria and another one at what we would assume be more reasonable in terms of level of services and pricing.	A/OPE	Thank you for your observation. We are very much interested in using industry best practices. We are soliciting industry to provide any and all other nonconforming best practices and cause undo expenses.
	Cigna Europe	We agree on covering your staff members in Afghanistan considering we won’t have their real names and will therefore not be able to screen check them. We assume that the US Government is doing the necessary checks. Can you confirm that you also check the dependents? IF not we would need you to disclose their names to ensure we are avoiding any potential OFAC breach.	GTM/OE	All incoming employees have a health screening check at the local German medicalclinic. They are required to pass the health screening before receivingthe final offer of employment. Embassy confirms the dependents by requiring the employees and dependents to submittheir national identification documents (Tazkira, Passport or Birth certificate) in addition to official marriage certificates.
	Sky Intl Ins	May a company bid on only one country or is USG planning to issue only one contract award for all countries to one provider who will team with local providers?	GTM/OE	There will be one contract covering all six countries.
	Sky Intl Ins	Is there an incumbent on this project? If so, please identify the prior solicitation/contract award number.	GTM/OE	There is no incumbent contractor
	Sky Intl Ins	Is there a legacy/active system (database/digital) in-place? If so, is the awardee expected to inherit said system, modify said system or roll-out our system?	GTM/OE	There is no legacy system in place.
	Sky Intl Ins	IAW the solicitation, the following are cited: “JAMES ZADROGA 9/11 VICTIMS HEALTH AND COMPENSATION ACT OF 2010 NOTICE: UNLESS A WAIVER OR EXCEPTION APPLIES, PAYMENTS SUBSEQUENT TO THIS PROCUREMENT ARE SUBJECT TO AN EXCISE TAX OF 2% PERSUANT TO 26 U.S.C. 5000C.” -- Article “B.2.1 VALUE ADDED TAX. - The Government will not reimburse the Contractor for VAT under this contract. The Contractor shall not include a line for VAT on Invoices as the U.S. Embassy has a tax exemption certificate with the host government.” Please clarify the following:

a. In Afghanistan, VAT is not payable per se, however, BRT is enforced on all contracts. Will USG issue a letter to be submitted to the Afghanistan Revenue Department (ARD) validating exemptions from Afghan BRT taxes?

b. Income Tax withholdings on salaries are also enforced. Will USG issue a letter to be submitted to the Afghanistan Revenue Department (ARD) validating exemptions from Afghan Income Taxes?	A/OPE	Please see Solicitation Clause 52.229-12 TAX ON CERTAIN FOREIGN PROCUREMENTS (JUN 2020) for a full discription
	Sky Intl Ins	Is there an existing or standard format for Contract Data Requirements Lists (CDRLs)?	A/OPE	No standard format required; the bidders are free to use their company format
	Sky Intl Ins	Is there an existing or standard format for Contractor Manpower Reporting Application (CMRA)	A/OPE	No standard format required; the bidders are free to use their company format
	Sky Intl Ins	Will the contractor be permitted a post-award in-person audit of Locally Employed Staff (LES) and Official Residence Expense (ORE) Staff to perform an initial “headcount” and validation roster?	GTM/OE	Post validates and provides the accurate headcount
	Sky Intl Ins	Is there an existing number of “Riders” for informational purposes as this should be considered when addressing “Adequate financial resources” and/or “7. Describe how, and at what monetary level, the offeror will maintain an adequate reserve level to pay claims.”	A/OPE	The riders are a nominal amount when compared to the overall contract value, therefore, offerors should focus on maintaining adequate reserve levels to cover the overall contract value.
	ICA	Is it possible to share with us breakdown (if available) for In Patient, Out Patient for Afghanistan and Uzbekistan.	GTM/OE	See TAB 2
		Are they any internet restrictions we should be aware of? Similar plans use online claiming for costs effectiveness, speedy process but also to avoid fraud and abuse. Could this be considered?	GTM/OE	Yes, that could be offered as a solution. We recommend that if offered online claims submission system be optimized for mobile devices.
		Some requirements are not possible to meet such as: “inform the plan member within 2 days whether a claim has missing documents”- this would only be possible through an online process.	GTM/OE	updated the language to say 5 days
		Eligibility exchange seems not to be automated. Can we suggest an alternative as we have ad hoc web managing tools (training would be supported)	GTM/OE	any trianing would be highly supported
		How will we communicate with members? We do send a member booklet with an id card usually by email. Would this be feasible (please note that if not this would drive the costs significantly)	GTM/OE	Communication via email is fine; please stipulate in the proposal your indsutry practices
		Shall we foresee different languages than English when servicing your members? Shall we expect calls or direct communication with your members if they do not use the online claiming and web communications tools?	GTM/OE	Yes, some employees will have limited English and would require translation services. The employees should have access to the customer service line.
		Marketing material: ok to be translate but can we agree on shipping a stock (total lives +extra 15% of additional stock), share with you the hard file so you are free to print upon demand if needed?	GTM/OE	Yes, that is acceptable; another option is to provide a digital version for us to share with the employees through the Embassy internal network
		Out of country medical coverage: who will decide on this? We are used to making this type of decision and arrange for treatment outside the country of residence when treatment is not available. Can you use our experience on this one?	GTM/OE	it should be upon the employee to determine whether s/he wants to use "out of country treatment" option. While on paper SCA countries may have robust medical system, the quality of the services leaves much to be desired. So, the employees should have the flexibility to get treatment out of country; however, the coverage will be at the pre-determined level and the pre-set cap will apply. Prior notification could be required by the company in advance of travel.
		As explained in the previous RFI some countries may be challenging to manage and reimburse claims (e.g Kazakhstan) -		Central Asia as a region has limited or no medical insurance providers; we understand that it will be challenging to withstand a program in this region.
		Last but not least – Would it be possible to sign an umbrella contract or master policy with the Department of State in Washington and then invoice separately each of these entities? Like most international insurers we don’t own licenses in these countries and would be more comfortable from a Legal perspective. Just so you know we could operate and have the contract sitused in these countries if we were also covering the expat population but since these are exclusively locals we would need to have the contract signed outside of these territories. Please note that the administration, reporting and all the specific requirements to this RFP could be met under this legal set-up.	A/OPE	It is for the Offerors to establish the appropriate and legal structure to perform this contract.
		Economic Price Adjustment clause refers to retention amounts. Prior Department of State solicitations for Embassies include a retention table. Would it make sense to include in the solicitation, the retention table within the EPA section of the SCA solicitation?	A/OPE	Retention amounts are provided by the contractor . Since Posts never had a commercial LES health contract there is nothing to share.
		There needs to be a separate solicitation for each country because of license requirements as mentioned in H.6.2. Please let us know if this is possible.Usually most of the employee group insurance plans are limited employees within each country. It makes it easier for all stake holders to manage and administer within a country. Laws, currencies, languages render locally administered solutions simpler.So, issuing separate solicitations for each Post/Country is highly recommended. In other words,there is on one insurance company or contractor who has licensed for business or to provide insurance services in all the countries you have mentioned in the Solicitation	A/OPE	With the regional contract solicitation the intent is to use the economy of scale to our advantage and attract multinational companies that otherwise would not cover individual missions. There will be a contract line item for each country.
		Prior Department of State solicitations for Embassies included claims being paid out at Usual and Customary Rates (UCR). Would DoS not want to protect all parties from arbitrary and devious billings from healthcare providers? Typically, outside the provider network the insured member pays for the services and the member will be reimbursed at the Usual Customary Reasonable Rate (UCR) prevailing for the main service area for the group plan. Please note, UCR rates are used for settling these claims to prevent out-of-network healthcare providers price gouging and billing at arbitrary inflated rates that are not in line with the UCR costs in the region/area. Using UCR rates for settling claims ensures that US tax payer money is NOT inadvertently used for paying claims at inflated un-fair ratesof truant healthcare providers.	GTM/OE	That is not something we the USG sets as it is usually the insurance providers, or sometimes host government that would establish/recommend such rates.
		We strongly recommend LES members traveling overseas for leisure or work obtain separate travel medical insurance. Please note DoS worker’s compensation insurance will cover for injuries and incidental sickness (i.e. Zika, Malaria) resulting from overseas official work trips.The healthcare costs in other countries (for example in US or Germany) is very different from the health costs in Tajikistan. It is simply not possible to charge premiums based on Tajik healthcare costs and then later pay out claims at US or Germany health rates.Please see Enclosure 1 that provides detailed suggestions for overseasclaims.	GTM/OE	LE Staff do receive travel insurance when travelling for work.
		Usually most of the employee group insurance plans are limited employees within each country. It makes it easier for all stake holders to manage and administer within a country. Laws, currencies, languages render locally administered solutions simpler. So, separate solicitations for each post is highly recommended.	GTM/OE	With the regional contract solicitation the intent is to use the economy of scale to our advantage and attract multinational companies that otherwise would not cover individual missions. There will be a contract line item for each country.
		The current solicitation verbiage inadvertently permits members to enroll and dis-enroll the insurance plan at their own will.Enrollment (and dis-enrollment) at random will most certainly contradicts the basic principle of an insurance contract which is commonly referred to as ‘adverse selection’ (wherein predominantly the un-healthy members enroll without broad enrollment of the overall population). If the insurance industry were to permit members to enroll (and dis-enroll) for coverage at any timethen we have a situation where all but one member can enroll under the employee group plan while the remaining members simplyenroll when medical services are required and then terminate coverage after obtaining the service.The US insurance market, including the insurance of the US Federal Government employees offers specific open enrollment period with support for certain life changing events; it does not support members entering and leaving the plan; please seehttps://www.opm.gov/healthcare-insurance/healthcare/plan-information/changes-you-can-make-outside-of-open-season/(also see https://www.verywellhealth.com/why-cant-i-sign-up-for-health-insurance-whenever-i-want-1738675)	GTM/OE	Each current active eligible employee and their eligible dependents are enrolled for health benefits under this contract upon award and thereafter during the performance period of this contract. Please advise where you found reference in regards to enrollment and re-enrollment in the solicitation.

&1#&"Times New Roman"&10&K000000SBU - CONTRACTING AND ACQUISITIONS

TAB 2

Afghanistan

2015-2016

Row Labels	Count of Type of Claim Subset 1
General Eye Care	118
Hospitalized	219
Lens	17
Non-Hospitalized	4306
Travel (Air fare) Expenses	22
(blank)
Grand Total	4682

2016-2018

Type of Care	Count of Type Of Claim:Type Of Care Subset 1
	34
For ambulance Service	110
General Eye Care	120
Hospitalized	24
Lens	62
Medical Examinations	296
Non-Hospitalized	4646
Tuberculosis/Toxoplasmosis, HIV/AIDS	1
(blank)
Grand Total	5293

2018-2019

Row Labels	Count of Type Of Claim:Type Of Care Subset 1
	21
For ambulance Service	147
General Eye Care	149
Hospitalized	34
Lens	85
Medical Examinations	769
Non-Hospitalized	4993
Travel (Air fare) Expenses	1
Tuberculosis/Toxoplasmosis, HIV/AIDS	3
(blank)
Grand Total	6202

2020-2021

Type of Care	Count
	467
General Eye Care	93
Hospitalized	154
Lens	59
Medical Examinations	369
Non-Hospitalized	2856
Travel (Air fare) Expenses	29
Tuberculosis/Toxoplasmosis, HIV/AIDS	2
Grand Total	4029

&1#&"Times New Roman"&10&K000000SBU - CONTRACTING AND ACQUISITIONS

File details come from the government source that posted it. Updated Mar 11, 2021.