Questions Answers - Health Insurance Zagreb.pdf

Health Insurance for LES

Embassy of the United States of America

Zagreb, Croatia

Combined Synopsis and Solicitation 19GE5021R0013

Questions and Answers

Q1: 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

Contractual year Total claims paid (local currency)

Retention amount

(local currency)

Total premium paid to

Insurer (local currency)

Net gain

(local currency)

Net gain

USD or EUR 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

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

A1: This is a first-time post is contracting this service, historical data is not available.

Q2: 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

A2: The U.S. Embassy in Croatia does not currently provide any health insurance coverage to its staff. Instead, most staff rely on government-provided health services. As a result, the Embassy receives health information when it results in long-term absences and under other miscellaneous circumstances.

The Embassy confirms that the following cases were reported in the last two years:

- Orthopaedic surgeries

- Traumatic accidents

- Cancer and oncology cases

- Hospitalization for more than 10 days

Q3: What is the name of the insurance company that currently provides coverage?

A3: There is no previous contractor.

Q4: 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.

A4: There is no preference in terms of which hospitals and Med Facilities will be covered.

We would like to have as much choice as possible. Have in mind that most employees live in Zagreb and surrounding area.

Q5: Could you please provide information about the Claims you have had outside of Croatia during your current coverage?

A5: This is a first-time post is contracting this service, we have no previous experience in claims outside of Croatia.

Q6: Has there been any changes to the Table of Benefits over the past 5 years?

A6: This is a first-time post is contracting this service.

Q7: Would the Embassy accept proposals in EUR where premium are also paid in EUR ?

A7: The Embassy can pay foreign or “third country” vendors in EUR. However, for vendors who have their business established in Croatia, usually there is no reason to make payments in EUR.

Q8: Can also claims be paid in EUR or is there a need to be paid in the local currency?

A8: Same as above.

Q9: Is there going to be a pre proposal conference? If yes, may I kindly ask to be given access to it?

A9: No Pre-Proposal-Conference is planned so far.