Questions and Answers Santiago GMC Solicitation 19C180020R0003.pdf

Questions & Answers Santiago GMC Solicitation 19C180020R0003

1) Out of country medical treatment: medical expenses incurred out-of-country should be covered under the same conditions as if they were incurred in-country. This means that any insured can choose to make their treatment out-of-country without any restriction? So this is an international health insurance?

Answer: Out /of Country Medical Treatment is identified as C.1.1.16 on the solicitation. “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-country”. Insured parties who receive medical services in a more expensive out-of-country facility will exhaust their annual maximum more quickly than those receiving services in-country.

An offerer may choose to provide optional off-the-shelf travel insurance to supplement this policy, however, this coverage will be managed as a private transaction between insured and offerer, outside the scope of this solicitation.

2) Isapre´s coverage is not mentioned in the solicitation. Do we have to understand that this insurance is a primary health insurance and not a supplemental one? Should we consider to cover the whole health cost or we apply the reimbursement rate over the cost after Isapre or Fonasa?

Answer: All employees under the contract are covered by local health insurance (Isapre or Fonasa) per local labor law. Therefore this supplemental medical insurance is applied to the expenses that are not initially reimbursed by Isapre or Fonasa.

3) Pre-existing conditions should be covered for all insured? even the ones who hasn't being insured before, including new employees or new dependents?

Answer: Pre-existing conditions are not excluded from coverage under this solicitation. On commencement of the policy, existing employees and their dependents will be accepted with full coverage for pre-existing conditions. New employees and their dependents will be accepted with full coverage for pre-existing conditions. Offerer may propose to limit changes to coverage to pre-determined open enrollment period(s), (within 60 days of hire, annual open-enrollment window, etc.) provided that this does not infringe on the ability to make changes to coverage in response to qualifying life events.

4) The reimbursement for room and board in hospitalization, should be up to semi-private accommodations. When a hospital does not have semi-private accommodation, which costs do we have to consider?

Answer: Under GMC -- semi private rooms are the minimum standard. The solicitation also states “When private accommodations are provided, coverage will be limited to the cost of a semi-private room unless otherwise covered in an off the shelf plan.” Offerers should propose market-based solutions (including their own off-the-shelf policies) for dealing with facilities that do not offer semi-private accommodations.

5) Medical settlement is asked to be by issuance of checks in the name of the employee. Is it allowed to be transferred to the employee bank account?

Answer: Yes, settlement can be transferred to each employee’s bank account.

6) Can you please provide the current health insurance plan, including reimbursement rates, caps and conditions?

Answer: The incumbent contractor is a local medical service provider and has delivered the full range of required services subscribed under fixed premium rates.

Potential offerers may contact the incumbent contractor directly for specific information regarding their health insurance plans to the extent furnishing the information is permissible under local laws. Please note, the current contract benefit schedule for health insurance is not identical to the benefit schedule being requested under this solicitation.

7) Can you please provide detailed information about claims paid in the last 12 months, including claims per person and per benefit (hospitalization, out-patient, drugs, etc.)?

Answer: Details of the claims made by named individuals are considered confidential, therefore they will not be provided. Total claims paid information for 2016 - 2019 are contained in solicitation, Attachment F. We will request a list of chronic conditions for which claims were submitted during the past 12 months.

The Embassy has obtained the total claims paid and types of benefits information from the incumbent contractor but cannot certify as to whether this data will be indicative of future claims. Therefore, it is each offerer’s decision on whether or not to use this information. However, under no circumstances shall the U.S. Government be liable for this information or shall it become the basis for a request to adjust the premium rates once the contract is awarded. Rather, offerers are advised any adjustments to contract premium rates shall be in accordance with the Price Adjustment clauses of the contract.