Appendix_A_(Questions_and_Answers).docx

Questions and Answers Health Insurance Services Solicitation 19EG3019Q0010

1. QUESTION: Clarification of Number of employees, spouses and dependent children provided in Section J and Number of Employees listed in Section B.

In Section J the solicitation provides the ages for 1,108 employees, 530 spouses and 1,804 dependent children. For a grand total of 3,422 members.

If we add the ORE employees and their dependents and the Employee Association Employees and their dependents who are on a rider these numbers increase to 1,160 employees, 571 spouses and 1,871 dependent children. For a grand total of 3,602 members.

We are trying to reconcile these numbers with Section B where single employees (self only) are listed as 1,400 and Family plan is listed as 3100.

a) QUESTION: Please clarify the number of employees presented in Section B.

ANSWER: Please see amendment 0001 for changes in section B.2 (Part 1: Price-Health Insurance) of the solicitation to reflect the number of plans. The price for a Family Plan will be the same regardless of size; a family of two, three, four or more will all have the same cost structure.

Note that the number of employees presented in Section B.2 is an estimate based on the number of employees as of the date the statement of work was finalized. This number varies as employees depart and arrive. (This number changes on a daily basis—it is an estimate.)

b) QUESTION: Please confirm that ORE employees and the Employee Association Employees are not included in Section B.

ANSWER: Confirmed. ORE and Employee Association (AECWA) employees are not included in Section B. Please see ORE Staff and AECWA Staff attachments.

c) QUESTION: Please confirm that the 1,400 employees in Section B presented as single employees (self only) are really all of the embassy’s employees and not just the single employees.

ANSWER: Please see amendment 0001 for changes in section B.2 (Part 1: Price – Health Insurance) to identify the number of employees who are insured as single (self only) and those insured under the family plan.

d) QUESTION: Please confirm that the number of employees listed in Section B as Family plan in the amount of 3100 represents the number of employee spouses and dependent children.

ANSWER: Please see amendment 0001 for changes in section B.2 as we have revised the figures to show only the number of employees who are insured under a Family Plan.

e) QUESTION: Please either revise Section B to agree with the Employee statistics presented in Section J or please revise Section J to agree with the numbers presented in Section B.

ANSWER: The data in Section B (Part 1: Price-Health Insurance) and J (List of Exhibits/Attachments that include Employee Statistics) do not match as information in one is an approximation and the other is a snapshot in time. Section B provides all authorized positions which includes positions that are currently vacant. Section J provides accurate data, however, accurate data only for a snapshot in time. These statistics include spouses, children, and males/females.

2. QUESTION: Claims Activity in Prior Periods - The number, and amount, of claims paid in prior years is one of the most important elements an insurance company uses to price insurance. We find that claims information is usually provided in the initial solicitation and if not there then provided after requested by a prospective contractor.

Please provide the last three full years and the current partial year of loss data by year of account including:

a. three + years premium billed

b. three + years number of incurred claims

c. three + years amount of incurred claims

d. three + years average number members during the year. This is the average number of employees + spouses + dependents for each period.

ANSWER: Please see available claims data (attached as six separate PDFs).

3. 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, there have been multiple Catastrophic cases in the last year. Details of the types of cases are not retained as the information is considered sensitive/private to the employee.

4. QUESTION: Is the proposal for local or International PMI cover?

ANSWER: The Statement of Work (reference C.1.1.17 in the solicitation) provides for local and out-of-country medical expenses. Preauthorization is not required for out-of-country medical treatment. However, the level of coverage is same as in-country. Bids can be placed with commercially-available off the shelf products that meet the minimum required coverage stated in the Statement of Work (reference C.1 through C.8 in the solicitation).

5. 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: Yes, there have been claims more than $10,000 within the last year. Anything above 200,000 EGP may be considered Catastrophic and there have been Catastrophic claims. (Also see Question #3.)

6. QUESTION: Are there 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: Unknown as this information is not collected by the HR Office.

7. QUESTION: Does this solicitation number 19EG3019R0001 contain the same requirements as the current contract? If not, please provide Section C of the current contract.

ANSWER: No. As per the Freedom of Information Act (FOIA), a copy of the previous SOW is being provided in Appendix E. There is a difference between the previous and the current SOW.

8. QUESTION: We are only able to issue terms for one year, does the proposal require the following years to be priced as well?

ANSWER: Without pricing for the five years, your offer will be disqualified. Your offer must include base year and the four option years.

9. QUESTION: Can we include a disclaimer that the pricing of the options may be dependent on the options?

ANSWER: The Embassy understands the question to inquire if pricing can be adjusted on an annual basis. If this is the correct interpretation of the question, the answer is “no.” (It is not the Department of State’s procedure to revisit pricing on an annual basis.)

10. QUESTION: Can we change the premium adjustment but not the retention based on a high number of claims? (P.8 line 4 b4–it says you can change the premium.)

ANSWER: The premium can be adjusted under certain criteria as explained in B.5 but the retention amount can NOT be adjusted for any reason as per B.4 & B.5

11. QUESTION: Can we change the premium adjustment but not the retention based on a high number of claims? (P.8 line 4 b4–it says you can change the premium.)

ANSWER: The premium can be adjusted under certain criteria as explained in B.5 but the retention amount can NOT be adjusted for any reason as per B.4 & B.5

12. QUESTION: Submission of Proposals. The cover letter to the solicitation advises that the proposal must be submitted by email to CairoContracts@state.gov on or before May 27, 2019 however, in Section L.# there is no mention of electronic submission of proposals. Please confirm proposals may be submitted by email?

ANSWER: Section L.3 has been revised. Please submit all offers electronically by June 24, 2019 to CairoContracts@state.gov.

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, there have been multiple Catastrophic cases in the last year. Details of the types of cases are not retained as the information is considered sensitive/private to the employee.

14. Can we apply to be equivalent to EGP currency in the contract?

ANSWER: The Embassy understands this question to inquire if the Statement of Work can be amended to state only one currency throughout (either EGP or USD). If that is a correct interpretation, the answer is “no.”

15. QUESTION: Overall is in EGP, why is the optical/dental details in USD? Providers and direct billing will not understand the limit in USD. Two currencies in the same contract is confusing.

ANSWER: The contract is authorized by our Washington, D.C. headquarters. The ceiling is based on local currency and on employee salary rates. Some coverages are denominated in USD.

16. QUESTION: Maternity coverage: total from ceiling (confirmed).

ANSWER: The Embassy interprets the statement to be an inquiry related to obstetrics and newborn care. If that is a correct interpretation, insured employees have the right to have the ceiling provided in the Statement of Work (Reference C.1.2 in the solicitation) (365,000 EGP). The Obstetric and Newborn care is subject to the annual limit coverage. Obstetric and Newborn care can potentially rise to the catastrophic ceiling.

17. QUESTION: What about premium collection for the additional? This is important since we don’t have direct contact with the employee.

ANSWER: The Embassy interprets this question to refer to the optional, excess coverage in the Statement of Work (Reference C.1.1.20 in the solicitation). If that is a correct interpretation, this excess coverage is a new option and the process for payment of the employee-paid premium has not yet been finalized.

18. QUESTION: If someone is enrolled and has catastrophic case, on the spot he has option to choose, or do they chose beforehand?

ANSWER: This excess coverage is a new option and the process for employee election has not yet been finalized. Since the coverage is linked to the contract year, the Embassy is discussing providing annual enrollment only.

19. QUESTION: Hospital accommodation: The contract requirements detail semi-private room at the hospital. This is not standard in Egypt.

ANSWER: The Statement of Work (Reference C.1.1.1 in the solicitation)states semi-private as the base (the minimum). We can consider an off-the-shelf option for private accommodation.

20. QUESTION: page 6–what’s the difference between the coverage for base year and CLIN/rides.

ANSWER: The Rider CLIN are the line items (Contract line item number). Riders are for non-Embassy employees (that is, affiliated but not official Embassy employees) and are managed independently. The Embassy’s preference is that the two independent groups will be priced the same as the Embassy employees.

21. QUESTION: We have the option to not quote for them?

ANSWER: No, bidders must provide a quote for B.3 (the riders).

22. QUESTION: Mental health and substance abuse care: is this part of the current coverage? We need last years’ table of benefits.

ANSWER: This is a new coverage and therefore, there is no data.

23. QUESTION: Section C 1.1.0 outpatient services question: What are surgeon fees and outpatient? Do you mean consultation fees?

ANSWER: This is a typical coverage in the United States. This concept covers minor surgeries done in a day in an outpatient room that does not require a hospital admission.

24. QUESTION: Annual physical examinations, does that mean an annual checkup is covered?

ANSWER: Yes, an annual check-up is covered under out-patient services.

25. QUESTION: Who is tracking utilization rates? Every insurance company assigns acct manager to their clients, and the POC is responsible for anything that might occur throughout the contract (additions, delays, claim management issues, etc). Is there no contact person to assist acct manager?

ANSWER: The Human Resources (HR) Office has a relationship with the medical insurance vendor. Employees can contact the HR Office in extreme cases (delays, something is wrong, etc). However, the HR Office does not track utilization rates. We do not manage the medical part. We only intervene from a contractual point of view, if there is any benefit or contract item not fulfilled. We review the contract and inform the Vendor’s portfolio manager to take remedial action. We do not interfere in the daily claims.

26. QUESTION: Section c 1.7 p 15. In the definition of dependent, the child definition is in legal conflict with Egyptian coverage (adoption and foster).

ANSWER: The Embassy requested, but did not receive, the specific legal citation.

27. QUESTION: P. 15 1.8.2 references section 1.7.1, but that does not exist. The clause isn’t clear—does it refer to dependents?

ANSWER: This is a typographical error and has been corrected in the solicitation. (It should be C.1.8.1.)

28. QUESTION: Which template do we use in the SAM registration? Template 1 and 2: states that one of them is for registered/in US, and in US have branches everywhere. How does a local company do this registration?

ANSWER: Attached are some guidance on SAM registration for local companies.

29. QUESTION: P. 33 liability. As an insurance company that doesn’t have its own medical facilities, normally insurance companies build their networks by starting contracts with other medical providers (hospitals, service providers, etc). They are not under our control (they are a separate entity that is contracted with us). If that is the case, any medical mistakes during diagnosis or treatment, the insurance company is not liability for it, correct?

ANSWER: If the insurance company does not own its own medical facilities or issue medical services, then 52.237-7 does not apply.

30. QUESTION: Kindly provide us with 3-5 years claims experience, and Table of benefits corresponding to these claims.

ANSWER: Please see available claims data (attached as six (6) separate PDFs).

31. QUESTION: Detailed utilization as of figures for outpatient, inpatient, Dental, optical, maternity & emergency.

ANSWER: Please see available claims data (attached as six (6) separate PDFs).

32. QUESTION: Population related to each claims year.

ANSWER: Please see all available claims data (attached as six (6) separate PDFs). Additional information is not available.

33. QUESTION: Please indicate cases above 15K US and whether still ongoing or complete.

ANSWER: The data is not available.

34. QUESTION: Please indicate any outside of Egypt claims and the amounts.

ANSWER: The data is not available.

35. QUESTION: Please provide data as dates of birth not by age bracket.

ANSWER: Please see attached Cairo Employee Data, Cairo Dependent Data, and Cairo USAID Employee and Dependent Data spreadsheets, which include date of birth (DOB), Gender, and Marital status.

36. QUESTION: Please confirm that ORE & AECWA are included in the data provided, if not please provide estimated number and full details as of age and sex.

ANSWER: Please see attached report (spreadsheet) for both ORE and AECWA.

37. QUESTION: In section H.4 / (a) 4: regarding issuing cheques what about bank transfer to the employee’s accounts.

ANSWER: The Embassy views this as a Vendor prerogative and the solicitation will be amended accordingly to include EFT or check.

38. QUESTION: Point C.1.2 Annual Maximum limit: please confirm is the limits for Dental, optical, HIV included in this amount.

ANSWER: Both Dental and Optical (Reference C.1.1.10 and C.1.1.11 in the solicitation) have an annual limit within the overall total annual limit. For Dental, the $3,200 annual limit is subject to the annual overall limit of the EGP 365,000. The same for Optical, the $150 annual limit for this service is included in the total annual coverage of the EGP 365,000. However, the HIV/AIDS Medications (Reference C.1.1.15 in the solicitation) have an additional limit above the total limit of the EGP 365,000.

39. QUESTION: H.4 : The Contractor shall maintain his own reference library of technical reference works and local laws and regulations, including current tariffs and registries, what is meant by technical reference.

ANSWER: This refers to a medical technical reference.

40. QUESTION: H.4 – b- 2 : 2. The Contractor shall date stamp and screen all claims submitted on the day of receipt. If there are any missing documents or information thereby disallowing said claim to be payable, the Contractor shall notify the employee within two days, with a copy to the COR (if notification is written, please note that each account has an account manager that is responsible for revising the claims, however we can provide an administrator that take the documents from the employees and revise it to maintain 95-98% of the claims are correct.

ANSWER: Embassy relies upon the contractor to implement this requirement in the contract.

41. QUESTION: L.4.3.2.1. Experience and Past Performance: we can provide a list of our customers including embassies but we can’t provide details of the policy, is it ok?

ANSWER: The information required is stated in L.4.3.2.1.

42. QUESTION: Out-of-Country Medical Travel: please clarify is the ticket included or not.

ANSWER: Yes, the transportation tickets expenses are covered. 80% of covered individual’s transportation expenses by the least expensive, appropriate means of transportation to the nearest city with adequate medical facilities will be covered. 80% of the transportation expenses of an attendant will also be covered, but only if the covered individual's attending certified health care provider certifies that an attendant for the patient is necessary.

43. QUESTION: Please confirm that payment to the insurance company can be four quarterly installments not bi-weekly.

ANSWER: As per Section G.4.2, the payment will be on monthly basis.

44. QUESTION: Page 14, C.1.1.20/C1.2: - Please clarify whether the expected ceiling is as follows: Base ceiling 365,000 EGP per year + Expanded ceiling 365,000 EGP+ Reimbursement limit 365,000 EGP + Optional Ceiling 365,000 EGP per year to be set only at the start of the contract if requested, meaning that each member is entitled to 1,460,000 EGP in total if they elect to pay for the optional ceiling and still needed both the expanded ceiling and reimbursement.

ANSWER: The basic limit is EGP 365,000. Catastrophic cases add an additional limit of EGP 365,000. Plus, employees may elect an Optional Limit of EGP 365,000 (paid by the employee). The total is EGP 1,095,000 including the Optional Limit, if elected by the employee, and EGP 730,000, if the Optional Limit is not elected (Reference C.1.1.19, C..1.1.20 and C.1.2 in the solicitation).

45. QUESTION: Page 24, H.3: Please note that significant changes to the census, either by size or shift in mean age group, may prompt re-pricing.

ANSWER: This is a firm fixed-price, with economic price adjustment, contract for which there is no re-pricing except under a certain criteria detailed under B.5.

46. QUESTION: Page 32, 52.217-9: Due to the conflict between this clause and the Egyptian Insurance law 10 of the year 1981, please confirm that the term of the contract cannot be extended beyond one year, but can be renewed for as long as the client desires.

ANSWER: The Embassy requested, but did not receive, the detailed citation and clause in the Egyptian law from the prospective bidder/contractor who posed the question in order for us to answer it. The Embassy is unaware of any conflict with Egyptian law.

47. QUESTION: Page 34, 52.237-7(e): Please confirm that this clause does not include Network changes due to the constant updates that the service provider network undergoes.

ANSWER: If the insurance company does not own the medical facilities or issues services, 52.237-7 will not apply.

48. QUESTION: Page 39, Section J: Since this section is the only breakdown provided, please understand that the offer will be calculated based on these tables unless a more detailed and updated census is provided. It is understood that the census list may change over time but tailored offers rely on relating census lists and benefits in order to form a quotation.

ANSWER: This is a firm fixed-price, with economic price adjustment, contract for which there is no re-pricing except under a certain criteria detailed under B.5. Please see available claims data (attached as six (6) separate PDFs).

49. QUESTION: Please provide us with the following: (a.) Detailed Consumption for the past 3 years, that will help in getting competitive premium.

ANSWER: Please see available attached claims data in 6 separate PDFs.

50. QUESTION: (b.) Authorization letter if possible (Copy attached).

ANSWER: We cannot sign an authorization letter for a broker to be our exclusive representative.

51. QUESTION: Active list if possible (Date of birth, Gender, Relation).

ANSWER: Please see attached Cairo Employee Data, Cairo Dependent Data, and Cairo USAID Employee and Dependent Data spreadsheets, which include date of birth (DOB), Gender, and Marital status.

52. QUESTION: C.1.1.3 Ambulance: Minimum Coverage 80%, All in-patient is 100% except ambulance - is it applicable on system?

ANSWER: The ambulance is not considered in-patient. The Ambulance and the In-Patient are two different coverages.

53. QUESTION C.1.1.4 Out-patient, Immunizations recommended by local authorities and/or the World Health. Need to discuss immunization is not covered as a default.

ANSWER: The bidder should abide at least by the minimum coverage requirement for the outpatient services in the Statement of Work (Reference C.1.1.4 in the solicitation).

54. QUESTION: C.1.1.11, Orthodontia Treatment. New coverage - ceiling continue for 4 years?

ANSWER: Yes, The maximum limit for orthodontia treatment is $2,400 for the four years. (Reference C.1.1.11 in the solicitation)

55. C.1.1.12, Need clarification is it excluded for all or the sentence is divided?

ANSWER: Under Reproductive Health (C.1.1.12), prescribed contraceptive devices, preventive care and routine examinations, voluntary sterilization, and diagnosis and treatment of conditions which may cause infertility are covered. The Statement of Work (SOW) identifies what is not covered: “Assisted reproductive technology (ART), fertility treatments, and reversal of sterilization are not covered.” Also C.1.3 states: “Advanced reproductive technology (e.g., in-vitro fertilization, intra-cellular sperm injection, artificial insemination, microsurgical epididymal sperm-aspiration, testicular sperm extraction, cryopreservation, etc.)” are not covered.

56. QUESTION: C.1.1.13, All types for psychiatric treatment?

ANSWER: The Statement of Work does not specify any exclusion.

57. QUESTION: C.1.1.18, Is that means that in case of poor treatment - Transportation fees will be covered plus medical cost?

ANSWER: Embassy is unclear what inquirer means by “Poor Treatment.” The Statement of Work includes out-of-country medical transportation and the insured receives medical coverage (Reference C.1.1.18 in the solicitation).

58. C.1.6.2 and C.1.6.3, What about premium collection?

ANSWER: Historically the Embassy has facilitated payment to the Vendor for the insured covered as Riders (C.1.6.2). As regards section C.1.6.3, please refer to answer of question number 17.