Questions and Responses to RFP 19AQMM21R0260 Health Care Insurance Services Santo Domingo.pdf

Questions Due: 8 October 2021 / 12:00 Noon (EST) * Responses Released: 26 October 2021 / 2:00 p.m. (EST)

Solicitation Number: 19AQMM21R0260 Department of State (DOS): Healthcare Insurance Services Santo Domingo – Questions and Responses

QUESTION

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#, TITLE, &

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VENDOR QUESTION(S)

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DOS RESPONSES

Solicitation Number 19AQMM21R0260 – Questions and Responses Page 1

SBU - CONTRACTING AND ACQUISITIONS

Technical

C.1 –

DESCRIPTION

SPECIFICATIO

N/WORK

STATEMENT.

C.1.1.15 - HIV/AIDS: 100% up to USD 10,000 per contract year per covered individual

¿Do yoy have empleoyees with this condition? If so, please indicate: amount, age and what policy does it belong to? Employees or pensioners.

we hope to receive the information to pay for the coverage

Such information as health conditions falls under HIPAA regulations for the

United States. The U.S. Embassy does not track or request such information and cannot request nor provide this information for public release.

DESCRIPTION

SPECIFICATIO

N/WORK

STATEMENT.

C.1.1.17 - C.1.1.18 - C.1.1.21 Reserved

Please clarify what they refer to as “Reserved” and the repercussions that this may have in the future for the catalog of coverage they requesting.

we hope to receive the information to pay for the coverage

Sections marked as “Reserved” are placeholders only for future requirements, to preserve numbering scheme, if required.

The solicitation has been amended to clarify under 19AQMM21R0260-0001

DESCRIPTION

SPECIFICATIO

N/WORK

STATEMENT.

Page 12.

C.1.1.9 Hearing Aids: Minimum Coverage – 80%

Examinations and Treatment: 80% Minimum

Coverage Hearing Aid Apparatus: Limited to one apparatus per year up to a maximum of DOP$ 90,000.00 per covered individual per three[1]year period. 80% Minimum Coverage: with annual cap

This coverage is not clear to us. Is the coverage of the hearing aid from RD$90,000 to 80%? The part of the minimum coverage with an annual ceiling on the hearing aid. What are included in hearing exams and treatments?

we hope to receive the information to pay for the coverage

Examinations and Treatment must be covered at a minimum of 80%, and the cap is tied to the Annual Maximum limit of the policy as described in C.1.2.

The Hearing aid Apparatus (actual device) is limited to one apparatus per year per covered individual. The coverage is a minimum of 80% with maximum of DOP90,000.00 every three years.

Hearing exams and treatments includes but it is not limited hearing exams, audiologist visits and exams, ear cleaning treatments, compacted wax removals, etc.

Questions Due: 8 October 2021 / 12:00 Noon (EST) * Responses Released: 26 October 2021 / 2:00 p.m. (EST)

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Solicitation Number 19AQMM21R0260 – Questions and Responses Page 2 instructions, conditions abd

Notices

L

Form W -14 is not available on the web *

You can find the W-14 form at the IRS website here https://www.irs.gov/forms-pubs/about-form-w-14

C

C.1.1.7 Prescription Drugs:

What is the maximum Prescription Drugs per year per person?

Prescriptions Drugs shall be covered at a minimum of 100% for Inpatient and Emergency, 80% for Outpatient.

As described in C.1. HEALTH

INSURANCE SERVICES “Unless otherwise specified the annual maximum for any benefit will be tied to the Annual

Maximum limit for the policy found in

C.1.2. ANNUAL MAXIMUM LIMIT”

C.1.1.15 HIV/AIDS: 100% up to USD 10,000 per contract year per covered individual

What would it be the limit of medications for

HIV?

The coverage for this benefit is 100% per covered individual up to USD 10,000.00 per contract year.

Cost

Do they have different rates for people who have the Basic Plan in another company / ARS?

As per M.8. Price Evaluation, will be based on the premiums submitted in the Section B, for all employees regardless of

Basic Plan affiliation.

https://www.irs.gov/forms-pubs/about-form-w-14

Questions Due: 8 October 2021 / 12:00 Noon (EST) * Responses Released: 26 October 2021 / 2:00 p.m. (EST)

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Solicitation Number 19AQMM21R0260 – Questions and Responses Page 3

If you offer a discount/incentive on the premium based on Employee’s affiliation to the basic plan through your ARS, you may state this as part of your proposal.

In accordance with book 1, Chapter 1 Article 3 and Article 4 of Dominican Law 87-01, Employees have free choice of providers for their medical coverage.

Furthermore, this plan is NOT mandatory for our employees and the numbers described in the pricing tables are only estimates based on currently enrolled employees. In accordance with the local regulations the USG shall not demand, ask, or otherwise request employees to change their basic plan providers.

C.1.3 Exclusions and Limitations

Medical expenses outside the Dominican Republic will not be reimbursed?

Correct, As noted in in C.1.3 – Exclusions and Limitations “There is no coverage for medical expenses incurred out-of-country. There is no reimbursement for out-of-country treatment.”

C.1.1.9 Hearing Aids

You will be covered for “one device only” this coverage is for 3 years?

Limited to ONE apparatus per year. 80% Minimum Coverage up to a maximum of

DOP$ 90,000.00 per covered individual per three-year period.

J001

J001 - EXHIBIT A – EMPLOYEE STATISTICS

Number of affiliates with Basic Plan?

In accordance with Dominican Law all

Local Employees, we have an estimated 700 employees, are covered under their

Questions Due: 8 October 2021 / 12:00 Noon (EST) * Responses Released: 26 October 2021 / 2:00 p.m. (EST)

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Solicitation Number 19AQMM21R0260 – Questions and Responses Page 4 respective Basic plan under various insurance company.

Both

Section J-005, Exhibit E, page

1. Please provide five years of loss data(table 1) by year of account including annual net premium (for the same period), incurred claims and membership history. For membership history(Table 2) please provide the number of Employees with single coverage and with family coverage at the end of each year. Please do not include any confidential information, just the overall statistics for the group. Claims information is critical to our pricing and the relationship of claims to employee growth or shrinkage is part of the claims analysis.

Table 1

Contractu al year

Total claims paid

(local curren cy)

Rete ntio n amo unt

(loca l curr ency

Total premi um paid to

Insure r

(local curre ncy)

Net gain (local curre ncy)

Net gain

USD

or

EUR

dd/mm/20 16 – dd/mm/20

17 – include this information under J-006 and J-007 of 19AQMM21R0260-0001

Questions Due: 8 October 2021 / 12:00 Noon (EST) * Responses Released: 26 October 2021 / 2:00 p.m. (EST)

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Solicitation Number 19AQMM21R0260 – Questions and Responses Page 5 dd/mm/20

18 –

19 –

20 –

Table 2

Contractual year Single Self plus

ONE

Family plans dd/mm/2016 – dd/mm/2017 dd/mm/2017 – dd/mm/2018 dd/mm/2018 – dd/mm/2019 dd/mm/2019 – dd/mm/2020 dd/mm/2020 – dd/mm/2021

Questions Due: 8 October 2021 / 12:00 Noon (EST) * Responses Released: 26 October 2021 / 2:00 p.m. (EST)

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Solicitation Number 19AQMM21R0260 – Questions and Responses Page 6

Exhibit E, page

1. We would like to know if you have been informed of Catastrophic cases, 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

Such information as health conditions falls under HIPAA regulations for the

United States. The U.S. Embassy does not track or request such information and cannot request nor provide this information for public release.

Exhibit E, page

Could you please provide information about the Claims you have had out of country during your current coverage?

No out of country claims were received during the current coverage

Section C, page

10-13

Have there been any changes to the Table of

Benefits over the past 5 years?

Yes, as noted in Section C.1.1, Employee and Dependent Health Service Benefits.

Section B pages7-10

Would the Embassy accept proposals in USD where premium are also paid in USD from non US companies?

No, per B.2 Prices, a ll prices shall be in Dominican Pesos.

Section B, pages 7-10

Can also claims be paid in USD or is there a need to be paid in the local currency?

In accordance with the G.3.Payment shall be made in Dominican Pesos.

Section B pages 7-10, Section K page 28, provision 652.229-70 -

Would 2 % tax based on James Zadroga Act be applicable to this solicitation?

This solicitation is estimated to fall into the JAMES Zadroga 9/11 Victims Health and Compensation Act of 2010, unless a Waiver or Exception applies.

See Clause 52.229-12 – Tax on Certain Foreign Procurements (FEB 2021) and

52.229-11 – Tax on Certain Foreign Procurements – Notice and Representation (JUN 2020) in Section A

52.252-1 - Solicitation Provisions Incorporated by Reference (Feb 1998)

Questions Due: 8 October 2021 / 12:00 Noon (EST) * Responses Released: 26 October 2021 / 2:00 p.m. (EST)

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Solicitation Number 19AQMM21R0260 – Questions and Responses Page 7

In Accordance with Section L: “The Offeror shall submit a completed IRS

Form W-14, found at https://www.irs.gov/forms-pubs/about-form-w-14, to ensure compliance with

FAR 52.229-11;”

clarify website under

19AQMM21R0260-0001

Section L, page

46 Section 2 Understanding of the REquirement , paragraph 12

Is there a preferred list of Hospitals, Clinics or other Medical Facilities that the Embassy employees prefer? If yes, please provide a list of these facilities

This is the list of the frequently used

Clinics and Hospitals by our employees in the Dominican Republic, for doctor’s appointment and diagnostics and imagining services.

For Santo Domingo:

• Centro de Medicina Avanzada

Dr. Abel González

• CEDIMAT

• Hospital General Plaza de la

Salud

• Hospiten - Santo Domingo

• MedicalNet

• Centro de Obstetricia y

Ginecología

• Clínica Corazones Unidos

• Clínica Abreu

• Centro Médico Vista del Jardín

• Centro Médico de

Gastroenterología, Especialidades Médicas, Questions Due: 8 October 2021 / 12:00 Noon (EST) * Responses Released: 26 October 2021 / 2:00 p.m. (EST)

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Solicitation Number 19AQMM21R0260 – Questions and Responses Page 8

Laboratorio e Imágenes

Diagnosticas.

• CECANOT, Centro Cardio-

Neuro-Oftalmológico y

Trasplante

• Centro Médico Moderno

• Centro Médico Dominicano

• Braca Centro de Estudios

Diagnósticos

• HS Medical Center

• Women’s Care Center

• Clínica UCE

• MedPediátrica

• Reabilitek

• Laboratorios: Referencia, Amadita, Patria Rivas

• Farmacias: Carol, GMC, Los

Hidalgos, Farmax.

Odontología

• Salud Bucal

• Cedensa

• Denta Sana

• Amerident

• Odonto-Dom

• OralDent

For Santiago:

• Unión Medica del Norte

• Centro Médico HOMS

Questions Due: 8 October 2021 / 12:00 Noon (EST) * Responses Released: 26 October 2021 / 2:00 p.m. (EST)

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Solicitation Number 19AQMM21R0260 – Questions and Responses Page 9

• Clínica Corominas

For Punta Cana:

• Centro Médico Punta Cana

• Punta Cana Doctors (this is a clinic)

• IMG – International Medical

Group

This is not a definitive list and service should be available throughout the country.

The solicitation has been amended to include this information under J-008, 19AQMM21R0260-0001

Questions Due: 8 October 2021 / 12:00 Noon (EST) * Responses Released: 26 October 2021 / 2:00 p.m. (EST)

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Solicitation Number 19AQMM21R0260 – Questions and Responses Page 10

Section L, page 47, Licensing

Insformation

Would the Embassy accept a proposal form an internationally licensed insurance company under an off shore jurisdiction or does it insist on a locally licensed insurance company only?

In accordance with Section L.4.2 Technical Proposal – Section Four

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 Dominican Republic 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 Dominican Republic it must demonstrate that it is licensed / certified / accredited by a government other than the Dominican Republic to provide health insurance for persons in the Dominican Republic and must demonstrate its capacity to provide health benefits in the

Dominican Republic to meet the minimum requirements and other conditions set forth in this solicitation”

Failure to demonstrate that the offeror is an authorized insurance company permitted to write and administer health insurance policies in the Dominican

Republic shall be grounds for rejection of the proposal.