19BB2118R0005_Questions_and_Answers_0001.pdf

Questions and Answers 001:

Solicitation No: 19BB2118R0005

1. Question: Is DBA insurance a requirement if not operation in a Government facility?

Answer: The requirement to obtain DBA insurance has been removed. See solicitation Amendment 0001.

2. Question: Can payments be made via employee bank account?

Answer: No. Section H, page 32 requires settlement be made 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 benefits and deductions, if any.

3. Question: Should monthly claim reports contain medical diagnosis of employee?

Answer: Employee Claims Report. The report will 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 claim has not been paid.

4. Question: Can you provide claim experience data for 3 years including any payments made over BBD$10,000.00 including diagnosis?

Answer: Paid Claims Experience

Total Period 2016 – 2017 Period 2015-2016 Period 2014- 2015

BB Dollars

$202,916.24

$229,186.78

$184,027.64

US Dollars

$100,453.58

$113,458.80

$91,102.79

5. Question: I am wondering if an incumbent exists for the potential requirement: U.S.

Embassy Bridgetown - Health and Life Insurance outlined under 19BB2118R0005. If so, could you please provide the following information? :

Vendor name:

Contract number Value Date of Award Expiration Date

Answer: Previous Contract award was posted on FBO.

Vendor name: Sagicor Life Inc.

Contract number: SBB21013C0001

Please see www.FBO.gov for additional information.

https://www.fbo.gov/spg/State/WHA/Bridgetown/SBB21012R0001/listing.html

6. Question: Please provide the following:

• Age/DOB

• Sex- Female or Male

Dependent status i.e., Coverage for:

• Employee (E)

• Employee & Spouse (E/S)

• Employee & Children (E/C)

• Employee, Spouse & Children (E/S/C)

Answer: See Solicitation Amendment 0001, Section J.

7. Question: Please provide the last three full years and the current partial year of premium's billed and loss data by year of account for health and for life insurance including the following:

a. three + years premium paid

b. three + years number of incurred claims

c. three + years amount of incurred claims

d. three + years total membership on the last day of the contract year. Membership is the total number of employees + spouses + dependents.

Answer: The total membership is 250

Claim Experience for 5 years

Period Premium Billed Paid Claims Loss Ratio 2013-2012 $299,476.48 $160,540.13 53.61% 2014-2013 $301,143.82 $144,269.66 47.91% 2014 – 2015 $295,748.37 $184,027.64 62.22% 2015-2016 $371,411.40 $229,186.78 61.71% 2016-2017 $383,007.46 $202,916.24 52.98%

8. 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, three but not hospitalized.

9. Question: Does this solicitation contain requirements similar to the current contract? If not what are the differences?

Answer: See question 5.

10. Question: Have there been any claims in excess of $10,000 within the last year? If yes please indicate the number and amounts of such claims.

Answer: Yes, approximately 2 claims, amounts total BDS$45,000.00.

11. Question: Are their dependent children to be covered who are studying outside the country? If yes please provide the country and number of dependent children studying there.

Answer: Yes, Canada - 1 child.

12. Question: Life insurance retention table specifies Basic Life, Accidental Death & Dismemberment and Partial & Total Disability Coverage, whereas the price tables for the base and 4 option years specify only Basic Life and Accidental Death & Dismemberment. Please clarify.

Answer: The disability column was a typo. See Solicitation Amendment 0001.

13. Question: Do the above claim numbers include claims from ORE employees?

Answer: Yes

14. Question: Did the Premium history for health insurance above include the VAT? If it did then what % VAT was included in the historical health premiums?

Answer: No VAT. The U.S. Embassy currently has a tax exemption certificate with the host Government.

15. Question: Advise if 2016 benefit schedule for health insurance is the same as the benefit schedule currently being requested under 19BB2118R0005; and if not advise us on the differences. Alternatively, you can simply provide the previous solicitation document.

Answer: Yes, the benefit levels are the same.

16. Question: The number of employees listed under Section B.2.3 adds up to 120 (53+33+34) while the number of employees needing life insurance in Section J totals 123 and the number of employees in the age census table is listed as 108. Could you please clarify the discrepancy.

Answer: Pricing schedule B.2.3. has been adjusted in the amendment, totals remain the same = 123 staff + 4 ORE staff – 127

17. Question: Could you please provide the complete employee census that includes age, gender, nationality etc.

Answer: See Solicitation Amendment 0001, Section J Exhibits.

18. Question: Could you please provide the age range of all the spouses. The table in Section J mentions 12 male and 26 female spouses and the last column only mentions there are 0 males spouses in 1-30yr range and 7 female spouses in the 1-36yr range.

19. Question: Could you please provide the age range of all the dependent children.

20. Question: Are there any persons who are currently hospitalized? If Yes, please provide number (we do not need the names or identification, we just need to know the total number of people hospitalized to assess the risk).

Answer: No.

21. Question: Are any major illnesses (Hemodynamics, Open Heart Surgery, Orthopedic Mayor Surgeries, Organ Transplant, Traumatic Accident, Cancer and Oncology Cases) being treated? If Yes, please provide number (we do not need the names or identification, we just need to know the total number of people hospitalized to assess the risk).

Answer: See Question 8

22. Question: Are there any pregnant employees/spouses. 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 pregnant to assess the risk to price accordingly).

Answer: Yes, three

23. Question: Are there any large losses (in excess of $10,000) within the last year to date? 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 large losses and the amounts to assess the risk and price accordingly).

Answer: See Question 10

24. 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: This information is not available.

25. Question: Please advise whether any of the persons covered are required to carry firearms and if so, please indicate them appropriately in Exhibit A or in the census.

26. Question: Are any persons not actively at work? If Yes, please let us know the total 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 not actively at work to assess the risk and price accordingly).

Answer: No

27. Question: Are there any Disabled Lives? If Yes, indicate in Exhibit A or just let us know the total 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 disabled people to assess the risk and price accordingly).

28. Question: When is this plan likely to commence?

Answer: We anticipate awarding a contract to commence on August 01, 2018.

29. Is there a limit to the number of trips per calendar year under section C.1.1.12 Transportation for Out of Country Treatment and under the Air Ambulance benefit in section C.1.1 Hospitalization?

Answer: Benefits Levels are stated in document

C.1.1.12 Transportation for Out of Country Treatment - All reimbursements for transportation expenses are subject to the annual maximum limit.

Hospitalization: 90% reimbursement of room and board for award room or semi-private room with a maximum of 400 local currency per day. 80% reimbursement of hospital medical expenses including laboratory tests, x-rays nursing care, operating room costs, intensive care, and prescription medicines. 60% reimbursement for land ambulance and 80% reimbursement with a maximum of 15,000 USD for air ambulance.

30. In section C.1.1.8 Optical Care;

i. Is there a percentage reimbursement payable under this benefit?

ii. Does the $700 reimbursement for eye examination cover frames?

iii. Is the maximum benefit payable per calendar year $1,000? ($700 eye exam; $300 lenses)

Answer:

I. No percentage reimbursement payable under this benefit.

II. No, Frames are not included in $700 reimbursement.

III. Yes maximum benefit payable per calendar year $1,000.

31. In Section C.1.1.9 Dental Care is there a calendar year maximum benefit payable?

Answer: Dental care falls under the Maximum Annual Reimbursement

32. In Section C.1.1.11 Medical Expenses Incurred out of country, can the insurer include a pre-approval requirement for non-emergencies?

Answer: Section C.1.1.11 Medical Expenses Incurred Out of Country

(b) the individual’s attending physician certifies in advance that such treatment is medically necessary and unavailable locally.

33. Section H.5 Report Requirements: Can the insurer provide a listing that contains either the Employee Name and excludes the diagnosis or alternately, include the diagnosis and exclude the Employee name?

Answer: The report will 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.

34. Can you explain in greater detail the requirement to have Defense Base Act (DBA) insurance in section L.2 Summary of Instructions? How will this be administered? Do we include those premiums costs in the Health premiums we charge?

Answer: See Question 1.

35. For part (b) Plan Administration of section L.4.3.1 Management Approach, will the persons converting from the Group plan to an Individual policy be resident in Barbados?

Answer: This information is not available at this time.

36. Section B.4.1 and section B.8.1 state that prices may be adjusted upward or downward based on the experience rating of the Mission (s) covered by the contract and specifically excludes all riders in B.1.1., that is the Official Residence Expense (ORE) staff. Does this mean that the premiums for the ORE staff cannot change or will they be subject to any adjustments made based on the experience of the Mission (s)?

Answer: Section B.4.1 Premium Adjustment Based on Experience - For health insurance, prices may be adjusted upward or downward based on the experience rating of the Mission(s) covered by this contract, and it specifically excludes all riders in B.1.1.

Section B.8.1 Premium Adjustment Based on Experience: For life insurance, prices may be adjusted upward or downward based on the experience rating of the Mission(s) covered by this contract, and it specifically excludes all riders in B.1.1