Approved Qs and As RFP 19ES60-23-R-0002.pdf

Embassy of the United States of America Antigua Cuscatlan, El Salvador, C.A.

Minutes from RFP 19ES60-23-R-0002 Pre-Conference dated February 9, 2023.

Introduction

All attendees were welcomed and introduced the Contracting Officer, Human Resources Officer, Human Resources Specialist, Human Resources Assistant, and Contracting Specialists.

Solicitation Package

Important information on how to present complete offers was highlighted, amendments, DBA insurance, Zadroga Act, registration in SAM.GOV and NDAA among others.

Questions

The attached questions were asked before and after the conference by the prospective offerors.

Conclusion

The Pre-Proposal Conference concluded, and attendees were thanked for their presence and expression of interest in serving the U.S. Government. The meeting was adjourned.

Contracting Officer

Enclosure:

Questions and Answers

RFP Nr. 19ES60-23-R-0002 LES Health and Life Insurance Services

Questions and Answers

1. C.2.1.1 Amount of Employee Life Insurance: please confirm that there is no minimum insured amount per employee. Under this year's conditions approximately 60% of the employee's insured amounts are lower than $55 ,000, the previous period 's insured amount.

Answer:

Death Benefit:

The following benefit will be paid to the participant's named beneficiaries or estate upon the death of the participant:

1. Natural Death: 24 times the monthly basic salary up to a maximum of USD 200,000.

2. Accidental Death: 36 times the monthly basic salary up to a maximum of USD 200,000.

3. Accidental Dismemberment: 25% - 100% of the accidental death benefit, depending on the loss, up to a maximum of USD 200,000.

If disbursement occurs, the benefit will be payable according to the following schedule of benefits. If the same insured employee suffers subsequent dismemberment(s), the benefit will be payable according to the schedule of benefits and shall not be cumulative of a previous dismemberment insurance claim. The loss of a hand or foot means the complete severance at or above the wrist or ankle joint. The loss of sight means the total and irrevocable loss of sight.

Accidental Dismemberment Coverage Amount Dismemberment Benefit - for Loss of Percent of Accidental Death Benefit Both Hands 100% Both Feet 100% The Entire Sight of Both Eyes 100% One Hand and One Foot 100% One Hand and the Entire Sight of One Eye 100% One Hand 50% One Foot 50% Entire Sight of One Eye 50% Thumb and Index Finger of Same Hand 25%

Disability Benefit:

(1) Total and Permanent Disability: 24 times the monthly basic salary up to a maximum of USD200,000.

(2) Partial Disability: 12 times the monthly basic salary up to a maximum of

USD200,000.

If a participating employee is separated from USG employment due to total and permanent disability, the employee will be paid a lump sum equal to 50% of the disability benefit within three (3) months after submitting proof of permanent and total disability, but not before the employee has been totally and permanently disabled for a period of six (6) months. Subsequently, the employee will be paid the remaining 50% of the disability benefit in ftxed monthly installments over 24 months starting one month after the initial lump sum payment is received.

2. C.2.1.2 Amount of Accidental Death and Dismemberment Coverage and C.2.1.3 Partial and Total Disability Coverage indicate insured amounts different to those indicated in the tables in section B.6. Please confirm the correct insured amount for these coverages.

Answer:

As section B.6 indicates, it reflects the estimated payroll (bi-weekly in thousands).

C.2.1.3 indicates the benefit levels.

3. Indicate if there is a detailed description of the annual physical examinations requested as part of C.1.1.4 Outpatient Services or if the contractor is free to propose the services included.

Answer:

No, there is no detailed description. As section C.1.1.4 indicates it covers:

Outpatient Services: 80% minimum coverage. Services provided by a certified healthcare provider on an ambulatory or outpatient basis (without being admitted to a hospital), including surgeon's fees and other medical services that may be provided in a hospital, clinic, doctor's office, medical facility, etc.: Examples include, but are not limited to:

Annual physical examinations Specialist consultations and treatment, including second surgical opinion.

Minor surgical interventions.

Chemotherapy and radiation treatments Immunizations recommended by local authorities and/or the World Health Organization.

Diagnostic tests and diagnostic imaging.

4. Specify maximum age for services requested in C.1.1.6

Answer:

Up to 21 years old but not include the 22nd birthday.

5. Provide more detail on the scope of the "developmental assessments" requested in C.1.1.6

Answer:

Developmental assessment varies by age, and it can include motor development, physical growth curves, nutrition, stimulation, etc. As per the C.1.1.6 it encompasses developmental assessments as per the World Health Organization or local authorities.

6. Provide more detail on the scope of the services requested in C.1.1.8

Answer:

Preventive and wellness and chronic disease management includes but not limited to physicals, immunization and any medical care required and recommended by the World Health Organization.

7. Confirm that there is an increase in Dental Care maximum covered amount per individual per contract year from USD500 to USD3,200 compared to the previous period.

Answer:

Current benefit levels:

Dental Care: 60% of expenses/or preventive expenses. 50% reimbursement/or major, minor and orthodontia treatment. 50% of expenses for wisdom teeth surgery. Dental treatment due to injuries suffered, including replacement of natural teeth due to an accident, which also includes 80% reimbursement for proper placement of broken jaw.

The limit amount per year is $500.00 per patient.

Solicitation new levels:

Dental Care: 80% minimum coverage of expenses for dental services (with annual cap) including dentists' fees, x-rays, examination and treatment, cleaning,fillings, extractions,false teeth, crowns, and bridges up to a maximum of $3,200.00 per covered individual per contract year. 80% minimum coverage of expenses for orthodontia treatment is covered only if treatment begins before age 18, or if required as the result of an accident. A maximum off our years of orthodontia treatment will be covered per patient up to a maximum of US$2,400.00.

8. Provide examples of the "devices" mentioned in C.1.1.14

Answer:

Rehabilitative and habilitative devices refers to tools and equipment that can help people with temporary or permanent disabilities successfully complete day to day activities. Devices to help gain or recover mental or physical skills lost due to injury, disability or a chronic condition, and devices needed for habilitative reasons. Examples include but are not limited to speech therapy, hearing aids, glasses, wheelchair, prostheses according to the World Health Organization.

9. Item G.4 requests the contractor to present original (physical) invoices including three copies. Please confirm if digital invoices are acceptable.

Answer:

As per RFP's terms, Section G.4, submission of invoices should be in original not electronically.

10. Please clarify the number of months that correspond to the claims paid out amount shown for year 2022 in Section J, Exhibit C

Answer:

52 Months.

11. Confirm if there will be an insurance broker involved and if the contractor should consider its commission in the cost of the service provided.

Answer:

All bidders must consider all costs in their proposals.

12. Provide details of claims for the last 5 periods for Life Insurance in (Excel format preferably), which must contain the following information:

a. Detail separated by Effective Date including the period to which said claims correspond with dates "from - to" -November 2018

b. Employee number or employee code - We are not allowed to disclose this information.

c. Name of the affected employee - We are not allowed to disclose this information.

d. Name of the affected dependent (in the case of funeral expenses)-N/A

e. Dates of occurrence. - November 2018

f. Paymentdate. - 2018and2019

g. Cause of death and - Disease of the circulatory system

h. Amounts indemnified while alive.- NIA not part of Life Insurance

i. Coverage affected in the policy.- Life coverage US$ 55,000.00

13 . Provide details of claims that are pending payment and that are already known or that are in the Company's possession (reserves) for the Basic Life Insurance, which must contain the following information:

a. Validity including the period to which these claims correspond with dates "from - to"

b. Employee number or employee code

c. Name of the affected employee

d. Name of the affected dependent (in the case of funeral expenses)

e. Dates of occurrence.

f. Payment date.

g. Cause of death and

h. Amount pending payment.

i. Indemnified amounts.

j. Coverage affected in the policy.

Answer:

No claims pending.

14. Provide the list of insured (preferably in editable Excel) format that includes the following information, name of the insured, date of birth, age, gender and insured amount.

Answer:

Refer to Section J Exhibits A and B.

15. Confirm the admission ages for new staff:

Answer:

• Maximum entry age - 64 years

• Reduction of sum insured. - NIA

• Termination ages for life insurance and additional benefits - 65 years old

16. Provide details of the claims paid (preferably in Excel format), including those of the medical network (including pre-authorizations), for Hospital Medical Insurance, which must contain the following information:

a. Effective date including the period to which said claims correspond with dates "from to"

b. Employee number or employee code

c. Name of the affected employee or patient

d. Type of person affected if it is the owner or the dependent.

e. Dates of occurrence of the claim.

f. Claim payment date.

g. Diagnosis or cause of the claim

h. Amount of Expense Presented

i. Amount of Expense not covered.

j . Amount of the deductible applied to the covered expense.

k. Coinsurance amount applied to the covered expense.

1. Amount of the final value paid.

m. Origin of the claim or expenses if it was through the network or outside the network.

n. Origin of the claim or expense if it was local or abroad.

Answer:

Refer to attachment Section J - Exhibit D - Claims information 2017-2023"

17. Provide details of the claims that are pending payment and that are already known or that are in the hands of the Company (reserves) or the pending claims in the hands of the Medical Network (including pre-authorizations), for Medical Insurance Hospital (preferably in Excel format) which must contain the following information:

a. Effective date including the period to which said claims correspond with dates "from -to"

b. Employee number or employee code

c. Name of the affected employee or patient

d. Type of person affected if it is the owner or the dependent.

e. Dates of occurrence of the claim.

f. Date of payment of the claim.

g. Diagnosis or cause of the claim

h. Amount of Expense Presented

i. Amount of Expense not covered.

j. Amount of the deductible applied to the covered expense.

k. Coinsurance amount applied to the covered expense.

1. Amount of the final value paid.

m. Origin of the claim or expenses if it was through the network or outside the network.

n. Origin of the claim or expense if it was local or abroad.

Answer:

NIA

18. Provide the list of insured indicating the name, date of birth, age, gender and sum insured.

Answer:

Refer to Exhibit J of the solicitation.

19. Provide the detail of single employees and with family broken down by each category, which must be considered for the presentation of the economic offer.

Refer to Exhibit J of the solicitation.

20. Clarify which type of sum insured is required for this tender: Annual sum insured or Lifetime Maximum. And what is the modality in the current policy.

Answer:

For Health Insurance: Annual Maximum Limit- The maximum annual reimbursement per patient per contract year, not including expenses covered under C.1.1.15, is $90,000.00 per patient per contract year.

Death Benefit:

The following benefit will be paid to the participant's named beneficiaries or estate upon the death of the participant:

1. Natural Death: 24 times the monthly basic salary up to a maximum of USD 200,000.

2. Accidental Death: 36 times the monthly basic salary up to a maximum of USD 200,000.

3. Accidental Dismemberment: 25% - 100% of the accidental death benefit, depending on the loss, up to a maximum of USD 200,000.

If disbursement occurs, the benefit will be payable according to the following schedule of benefits. If the same insured employee suffers subsequent dismemberment(s), the benefit will be payable according to the schedule of benefits and shall not be cumulative of a previous dismemberment insurance claim. The loss of a hand or foot means the complete severance at or above the wrist or ankle joint. The loss of sight means the total and irrevocable loss of sight.

Accidental Dismemberment Coverage Amount Dismemberment Benefit - for Loss of Percent of Accidental Death Benefit Both Hands 100% Both Feet 100% The Entire Sight of Both Eyes 100% One Hand and One Foot 100% One Hand and the Entire Sight of One Eye 100% One Hand SO% One Foot 50% Entire Sight of One Eye 50% Thumb and Index Finger of Same Hand 25%

Disability Benefit:

Total and Permanent Disability: 24 times the monthly basic salary up to a maximum of

USD 200,000.

Partial Disability:

12 times the monthly basic salary up to a maximum of USD 200,000.

If a participating employee is separated from USG employment due to total and permanent disability, the employee will be paid a lump sum equal to 50% of the disability benefit within three (3) months after submitting proof of permanent and total disability, but not before the employee has been totally and permanently disabled for a period of six (6) months. Subsequently, the employee will be paid the remaining 50% of the disability benefit in ftxed monthly installments over 24 months starting one month after the initial lump sum payment is received.

21. For the Medical Expenses insurance, indicate the ages they have in the current policy for (minimum required):

a. Maximum entry age: 64 years old.

b. Reduction of sum insured: NIA

c. Age of termination: 65 years old in most cases. Exceptions can be granted on a case-by-case basis.

22. Indicate which is the medical NETWORK that currently has the policy, and which is required for the new validity.

Answer:

A medical network is not required. SISA is the company that currently has the contract for Health and Life Insurance/or US Embassy employees.

23. Inform how much is the waiting period of the pre-existing conditions for the new inclusions in the medical expenses policy.

Answer:

No waiting period. Nobody with pre-existing conditions can be excluded.

24. Does the deductible in the current policy apply inside and outside the NETWORK? Or just off the network?

Answer:

The level of benefit and coverage applies inside and outside the network.

25. Confirm if there are cases of insureds suffering from the following diseases: cancer, chronic renal failure, cardiovascular diseases, diabetes, treatments for continuity of organ transplants, any type of chromosomal syndromes, AIDS or any other serious disease.

Answer:

Refer to attachment Section J - Exhibit D - Claims information 2017-2023" for medical information.

26. What is the required World or Central American territorial scope?

Medical expenses incurred out of country will be covered for employees and dependents when (a) an illness or injury occurs when the individual is out of the country and treatment is medically necessary before the individual returns home or (b) the individual's attending physician certifies in advance that such treatment is medically necessary and unavailable locally. Reimbursement will be made at the same percentage rate and subject to the same annual maximum limit as for expenses incurred in country.

Transportation for out of country treatment is a covered expense for employees and dependents. The patient's attending physician must certify in advance that the treatment is medically necessary and unavailable locally. 80% of the patient'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 be covered if the patient's attending physician certifies that an attendant for the patient is necessary ( e.g., a parent in the case of a patient who is a minor or a family member to make medical decisions in the case of a patient who is unconscious.) All coverage for transportation expenses are subject to the annual maximum limit.

27. Expand how the hospital credit operates in the current policy and as required for this policy.

Answer:

The current contract offers:

100% reimbursement of room and board for a wardroom or semi-private room. 100% reimbursement of room and board for a private room, not to exceed 100% of the cost of a semi-private room. 100% reimbursement of hospital medical expenses including laboratory tests and x-rays, nursing care, operating room costs, intensive care, prescription medicines, and physical therapy. 80% reimbursement of ambulance service.

Current contractor has a network of hospitals which provide 100% coverage when employees are hospitalized for inpatient care. The insured presents the insurance card to the hospital/facility and the hospital communicates directly with the insurance company. The insured employee does not pay for covered expenses. Expenses that are not covered, are billed to the insured.

28. What is the reimbursement percentage in the current policy?

Refer to question 30.

29. What is the deductible amount in the current policy?

Refer to question 30.

30. What is the amount in the current policy for the coverage of Lenses?

Answer:

For questions 28-30 please see below:

EMPLOYEE AND DEPENDENT HEALTH SERVICES BENEFITS

Hospitalization: 100% reimbursement of room and board/or a wardroom or semi private room. 100% reimbursement of room and board for a private room, not to exceed 100% of the cost of a semi-private room. 100% reimbursement of hospital medical expenses including laboratory tests and x-rays, nursing care, operating room costs, intensive care, prescription medicines, and physical therapy. 80% reimbursement of ambulance service.

Professional Services and Treatment: 100% reimbursement of doctors ' and surgeons' fees incurred while hospitalized, at a hospital on an out-patient basis, at a clinic or doctor's office, or at home. Anesthesiologist fees will be reimbursed to a maximum of 35% of the surgeon 'sfee. 80% reimbursement/or medical services and expenses when not hospitalized such as laboratory tests and x-rays, prescription medicines, physical therapy, routine annual physical examination, and inoculations.

Prescription Drugs and Medicines: 100% reimbursement when hospitalized, and 80% reimbursement when not hospitalized, of the cost of medicines and drugs for which a prescription is legally required. Expenses incurred/or medicines, vitamins, cold remedies, etc. , that are available over the counter without a prescription will not be reimbursed even if prescribed by a physician.

For Employees Only: 100% reimbursement/or medications to suppress opportunistic infections, such as tuberculosis and toxoplasmosis for employees who have HIV/AIDS.

For employee and employee's covered spouse/partner: 100% reimbursement/or brief courses of anti-retroviral drugs during childbirth to prevent the transmission of HIV to the employee's child.

The maximum limit/or expenses reimbursed under Section C.1.1.4 is up to a separate limit of US$] 0,000.00 per patient per contract year.

Obstetrical Care: 70% reimbursement when hospitalized, and 80% reimbursement/or prenatal and postnatal care.

Family Planning: Not covered.

Hearing Aids: 40% reimbursement of the cost of a hearing aid apparatus and related examination. Limited to one apparatus per year per patient in a three-year period.

Optical Care: 40% reimbursement/or eye injury or sickness.

Dental Care: 60% of expenses/or preventive expenses. 50% reimbursement/or major, minor and orthodontia treatment. 50% of expenses for wisdom teeth surgery. Dental treatment due to injuries suffered, including replacement of natural teeth due to an accident, which also includes 80% reimbursement for proper placement of broken jaw.

The limit amount per year is $500.00 per patient.

Psychiatric Treatment: 80% reimbursement.

Medical expenses incurred out of country will be covered/or employees and dependents when (a) an illness or injury occurs when the individual is out of the country and treatment is medically necessary before the individual returns home or (b) the individual's attending physician certifies in advance that such treatment is medically necessary and unavailable locally. Reimbursement will be made at the same percentage rate and subject to the same annual maximum limit as for expenses incurred in country.

Transportation for Out of Country Treatment is a covered expense for employees and dependents. The patient's attending physician must certify in advance that the treatment is medically necessary and unavailable locally. 80% of the patient's transportation expenses by the least expensive, appropriate means of transportation to the nearest city with adequate medical facilities will be reimbursed. 80% of the transportation expenses of an attendant will be reimbursed if the patient's attending physician certifies that an attendant/or the patient is necessary, e.g., a parent in the case of a patient who is a minor or a family member to make medical decisions in the case of a patient who is unconscious. All reimbursements for transportation expenses are subject to the annual maximum limit.

Annual Maximum Limit - The maximum annual reimbursement per patient per contract year, not including expenses covered under C.J.1.4, is $90,000.00 per patient per contract year.

31. Confirm if the benefits requested in the bases, both for life and for medical expenses, are those that they currently have (minimum required), or if there are new benefits. If there are new benefits, please detail them as follows:

Actual Benefit (minimum required) New Benefit

Please see answer to questions 28-30 For new benefit levels please refer to C.1.

and C.2

32. Please confirm if there must be 100% adherence to the bidding bases or some coverage may be limited or the wording of conditions may be changed by the bidding Company, only subtracting points from the technical evaluation.

Answer:

100% adherence to the bidding bases and none of the wording can be changed.

33. Please inform if added values can be added to the offer and if they will be taken into consideration for the evaluation score.

Answer:

Added values will be taken into consideration to the evaluation scores.

34. please reconfirm Embassy of the United States of America would be willing to work with TECNISEGUROS as a broker.

Answer:

This is a full and open competition bidding process.

35. Please inform what is the budget allocated for contracting the Life Insurance and Medical Expenses.

Answer:

The Government cost estimate is confidential and may not be shared with offerors.

36. Regarding Life Insurance, please clarify how you obtained the amount of $542,141.00 under the concept of biweekly payroll, if according to information submitted the annual payroll is $11,705,883 .57?

Insured employees are paid 26 times per year on a bi-weekly basis.

37. Confirm if we can include the general and special conditions of our insurance policy.

The terms and conditions that will be included in the contract are the ones already detailed in our RFP.

38. Maximum annual limit that you currently have contracted for any illness is $10,000?

Answer:

This is the only limit of $10,000 in the current contract.

For Employees Only: 100% reimbursement/or medications to suppress opportunistic infections, such as tuberculosis and toxoplasmosisfor employees who have HIV/AIDS.

For employee and employee's covered spouse/partner: 100% reimbursement/or brief courses of anti-retroviral drugs during childbirth to prevent the transmission of HIV to the employee's child.

The maximum limit for expenses reimbursed under this section is up to a separate limit of US$10,000. 00 per patient per contract year.

39. Health Coverage, what is the maximum annual limit that you currently have contracted for any illnesses?

Answer:

Annual Maximum Limit - The maximum annual reimbursement per patient per contract year, not including expenses covered is $90,000.00 per patient per contract year.

40. The benefits requested are those currently contracted. If there is any change in benefit, please detail it one by one.

Answer:

No, the benefits requested are not all the same. Refer to questions 28-30.

41 . The data of the life sum insured for each employee Life and Health Claims Report

Refer to questions 12 and 15.

42. Life: ID number of the insured, cause of death, claim incurred date, claim paid or received date, Claim Amount Paid, claims from the last three years or, failing that, confirm if there are no claims.

Answer:

No claims.

43. Health: ID* number of the insured, claimed by employee/spouse/children, type of payment (in-network, out-of-network), diagnostic, claim incurred date, claim paid or received date, Claim Amount Paid, claims detail for the year 2022. *The ID can be any consecutive number; it is only to identify how many claims are from an employee.

Answer:

Refer to question 15.

44. Is the limit of $300 for the coverage of glasses that they request only for insured holders?

Or does it apply to each member including the family group?

Answer:

Optical Care: 80% minimum coverage for eye examination and treatment. For prescription lenses and frames or contact lenses, 80% minimum coverage with annual cap: covered up to a maximum of USD $300 per covered individual every two years

45 . Please confirm that it is not necessary to include the Defense Base Act insurance premium costs if the offeror does not have any American citizens, individuals hired in the United States or its possessions regardless of citizenship, Host Country National (HCNs) and Third Country Nationals (TCNs) working overseas.

Answer:

The DBA is required for all US government contractors for their employees when working overseas/US territories. The DBA covers all employees, regardless of nationality, not limited to any specific profession.

46. Details of the claims history of the policies for the last three periods that includes :

number of certificate of the insured that presented the claim, date of the claim, diagnosis and amount paid; it would be very helpful that the information can be presented in a spreadsheet format.

Refer to question 15.

4 7. Confirmation if an Insurance Broker has been appointed for the service or your confirmation will be in a direct relationship with the insurance company during the service and the further option years of contract.

Answer:

This is a full and open competition to all bidders.

48. How many employees paid by the Insurance Company has the US Embassy in El Salvador used to have? The presence of these employees is permanent and in what is the Schedule? The employees will have a defined space in your office?

Answer:

Please see Section J, Exhibit A of solicitation. Employees are hired indefinitely. Most employees have a defined workspace, the only exception are employees whose work requires them to be out of compound such as Chauffeurs, Facilities, etc.

49. Please provide the list of employees in spreadsheet format as informed in the Section J, Exhibit A.

Answer:

Refer to Section J, Exhibit A.

50. We are reviewing the RFP and we cannot find what the insured sum for this contract would be. This is the part that we think is unclear: C.1.2 Annual Maximum Limit - The maximum annual coverage per covered individual per contract year, not including expenses defined under Exclusions and Limitations (C.1.3), or those covered under C.1.1.15 , HIV/AIDS is equivalent to $10,000.00.

Answer:

An RFP amendment to Page 18, Part C.1.2 will be issued to read as follows:

Annual Maximum Limit: The maximum annual coverage per covered individual per contract year, not including expenses covered under HIV/AIDS benefits if selected by post, is USD$90,000 for health insurance.

51. Please provide average insured member counts for Health & Life for the last 5 years - 2021 , 2020, 2019, 2018 & 2017. It is standard practice in the insurance industry (and in other Department of State insurance solicitations) to provide this information to ensure equal/fair opportunity for all offerors in an open solicitation.

Answer:

Refer to questions 12 and 15.

52. Please confirm if the claims amount mentioned in Section J, Exhibit C includes health and life claims. If yes, please give a breakup of the health and life insurance claims separately from 2018 to 2022.

Answer:

Refer to questions 12 and 15.

53. When is this plan likely to commence?

Answer:

This Embassy expects to award the new contract on August 1, 2023

54. Sums insured for the life of each collaborator.

Answer:

Refer to question 1.

55. Report of Life and Health Accidents of the last 3 periods. Excel format.

Answer:

For Life no claims in the last three years. For health, refer to attachment Section J - Exhibit D- Claims information 2017-2023"

56. Life Claims Rate: Insured's identifier number, cause of death, date incurred, date paid or received, amount paid, claims from the last three years or, confirm if there are no claims.

There are no claims.

Answer:

Refer to question 12.

57. Health Accident Rate: Identifier number of the insured, relationship, type of payment (in network, out of network), diagnosis, date incurred, date paid or received, amount paid, detail for the year 2022.

Refer to attachment Section J -Exhibit D- Claims information 2017-2023"

NOTE:

The claims paid by the incumbent contractor are provided for informational purposes only and under no circumstances shall it be construed to change any terms or conditions or requirements within the solicitation. Under no circumstances shall the U.S. Government be liable for this data or shall it become the basis for a request to adjust the premium rates after contract award.

58. List of insured in Excel format.

Answer:

We are not authorized to provide names but please refer to Section J, Exhibit A/or information on employee statistics.

59. Last year l Which Insurance Company have you work with for Life and Health Insurance?

Answer:

The incumbent of the current contract is SISA Vida, S.A.

60. In Health Insurance, 1.,The minimum coverage of 100% for Hospitalization and Emergency Services is referring to full coverage without deductible or are you asking for "100% credit hospitalization"?

Answer:

100% full coverage without deductible is the minimum benefit level and we welcome proposals that provide 100% credit for hospitalization.

61. 1.,The amount solicitated for HIV/AIDS is in addition of the annual plan?

Answer:

The maximum annual coverage per covered individual per contract year, not including expenses covered under HIV/AIDS benefits if selected by post, is $90,000. (amount grandfathered from previous annual maximum rate).

62. Could you divide the amount of claims paid per year per type of insurance, in this case it would be life and health insurance.

Refer to attachment Section J - Exhibit D - Claims information 2017-2023"

63. Also, could you add the amount of claims paid per year and per diagnosis?

Answer:

Refer to attachment Section J-Exhibit D- Claims information 2017-2023"

64. In Life Insurance, Section J, Employee Statistics, is the data in the ANNUAL BASIC RATE column refer to each employee ' s annual salary?

Answer:

Yes.

65. For life coverage, please confirm if the total sum insured is USD23 ,3 82,107.14

Answer:

Refer to Section C.2.1

66. For Accident coverage, please confirm if the total sum insured sum is

USD33 ,581 ,204.71

Answer:

Refer to Sections C.1 and C.2.1

67. For Total Disability coverage, please confirm if the total sum insured is

USD23 ,382,107.14

Answer:

Refer to Sections C.1 and C.2.1

68. For Partial Disability coverage, please confirm if the total sum insured is USDl 1,705,883.57

Refer to Sections C.1 and C.2.1

69. What is the definition of Partial Disability?

A condition constituting less than total disability. Incapacity preventing full performance of duties of an occupation because of an accident or illness.

70. In life insurance, the sum insured is established based on each person's salary. In this case, the sum may change over time. How are these increases in the insurance policy amount handled, since they generate an increase in the premium to be charged from the moment the changes occur, considering that Section B.6 refers to fixed prices for collective life insurance?

Answer:

This is a firm ftxed price type of contract which includes an Economic Price Adjustment (EPA) clause, see Part B.8 Prices may be adjusted upward or downward based on the experience rating of the Mission(s) covered by the contract and it specifically excludes all riders in B.1.1.

71. What is the premium payment frequency?

Answer:

Refer to part G.4.2 Frequency of Payments - Invoices may be submitted monthly with payments being made monthly by the Government. Also, refer to part H.3 Ordering Procedures.

72. Please specify the annual maximum insured amount per insured person for Health Insurance:

Answer:

Annual Maximum Limit:

The maximum annual coverage per covered individual per contract year, not including expenses covered under HIV/AIDS benefits if selected by post, is USD$90,000 for health insurance.

73 . Does deductible apply, and the amount is US Dollars (if any).

No, deductible does not apply.

74. Are the maximum rates for medical fees based on the insurance company's established tariff table (medical consultations, surgeries, anesthesiologists, etc.)?

Answer:

No medical rates apply. Insurance company's benefit levels must be as established in solicitation document.

75 . What is the current outpatient care limit?

Answer:

Current outpatient care limit is as follows:

Hospitalization: 100% reimbursement of room and board/or a wardroom or semi private room. 100% reimbursement of room and board for a private room, not to exceed 100% of the cost of a semi-private room. 100% reimbursement of hospital medical expenses including laboratory tests and x-rays, nursing care, operating room costs, intensive care, prescription medicines, and physical therapy. 80% reimbursement of ambulance service.

Professional Services and Treatment: 100% reimbursement of doctors' and surgeons' fees incurred while hospitalized, at a hospital on an out-patient basis, at a clinic or doctor's office, or at home. Anesthesiologist fees will be reimbursed to a maximum of 35% of the surgeon's fee. 80% reimbursement/or medical services and expenses when not hospitalized such as laboratory tests and x-rays, prescription medicines, physical therapy, routine annual physical examination, and inoculations.

Prescription Drugs and Medicines: 100% reimbursement when hospitalized, and 80% reimbursement when not hospitalized, of the cost of medicines and drugs for which a prescription is legally required. Expenses incurred/or medicines, vitamins, cold remedies, etc., that are available over the counter without a prescription will not be reimbursed even if prescribed by a physician.

For Employees Only: 100% reimbursement/or medications to suppress opportunistic infections, such as tuberculosis and toxoplasmosisfor employees who have HIV/AIDS.

For employee and employee's covered spouse/partner: 100% reimbursement/or brief courses of anti-retroviral drugs during childbirth to prevent the transmission of HIV to the employee's child.

The maximum limit/or expenses reimbursed under Section C.1.1.4 is up to a separate limit of US$10,000.00 per patient per contract year.

Obstetrical Care: 70% reimbursement when hospitalized, and 80% reimbursement for prenatal and postnatal care.

Hearing Aids: 40% reimbursement of the cost of a hearing aid apparatus and related examination. Limited to one apparatus per year per patient in a three-year period.

Optical Care: 40% reimbursement/or eye injury or sickness.

Dental Care: 60% of expenses for preventive expenses. 50% reimbursement for major, minor and orthodontia treatment. 50% of expenses for wisdom teeth surgery. Dental treatment due to injuries suffered, including replacement of natural teeth due to an accident, which also includes 80% reimbursement for proper placement of broken jaw.

The limit amount per year is $500.00 per patient

Psychiatric Treatment: 80% reimbursement.

Medical expenses incurred out of country will be covered/or employees and dependents when (a) an illness or injury occurs when the individual is out of the country and treatment is medically necessary before the individual returns home or (b) the individual's attending physician certifies in advance that such treatment is medically necessary and unavailable locally. Reimbursement will be made at the same percentage rate and subject to the same annual maximum limit as for expenses incurred in country.

Transportation for Out of Country Treatment is a covered expense for employees and dependents. The patient's attending physician must certify in advance that the treatment is medically necessary and unavailable locally. 80% of the patient's transportation expenses by the least expensive, appropriate means of transportation to the nearest city with adequate medical facilities will be reimbursed. 80% of the transportation expenses of an attendant will be reimbursed if the patient's attending physician certifies that an attendant/or the patient is necessary, e.g., a parent in the case of a patient who is a minor or a family member to make medical decisions in the case of a patient who is unconscious. All reimbursements for transportation expenses are subject to the annual maximum limit.

Annual Maximum Limit - The maximum annual reimbursement per patient per contract year, not including expenses covered under C.1.1.4, is $90,000.00 per patient per contract year.

76. Is there a pre-certification process for elective medical procedures?

Answer:

NIA

77. What medical provider network do you use?

The current medical provider we use is SISA network.

78. Are the coverages that are not 100% based on reimbursement?

Answer:

We welcome proposal that include credit or coverage on a reimbursement basis.

79. Submit claims for the last five years separately by Life and Health insurance.

Answer:

Refer to questions 12 and 15.

80. Please indicate the exact period to which the reported claims of the last 5 years belong.

Answer:

Refer to questions 12 and 15.

81. Submit the total of outstanding claims payment to date, separated for Life and Health

Answer:

NIA - Claims are paid within two weeks or less of submission.

82. Is it essential to include a discount for prompt payment of the premium?

Answer:

Refer to FAR clause 52.232-8 Discounts for Prompt Payment. Offered discounts for prompt payment will not be considered in the evaluation of offers. However, any offered discount will form a part of the award and will be taken if payments is made within the discount period indicated in the offer by the offeror.

83. What is the validity of the policy?

The life of the contract is 1 base year plus 4 optional years.

84. Please clarify the meaning of the DBA?

The Defense Base Act or DBA is an insurance required for all US Government contractors for their employees regardless of nationality, when working overseas/US territories. The awardee will have to obtain the DBA insurance from an authorized carrier at: www.dol.gov/agencies/owcp/dlhwc//,scarrier

85. Can limitations or exclusions be included in the offer?

Answer:

Only limitations or exclusions that are specified in the RFP are to be included in the offer.