Questions-Answers 23R0005.pdf

LE Staff Health Insurance Services

Embassy of the United States of America

Addis Ababa, Ethiopia Solicitation 19GE5023R0005

Questions and Answers

Q1: Please advise as to whether or not I would need to be licensed in Ethiopia as a Life/Health agent, or am I supposed to secure a Health carrier that is able to work and or provide coverage in Ethiopia?

A1: Please see Section 3 Summary of Instructions as well as DOSAR 652.242-73 –

AUTHORIZATION AND PERFORMANCE (AUG 1999)

Q2: Are there any procurement goals for a Minority and woman owned small business?

A2: This is a full and open acquisition requirement.

Q3: Please confirm and provide missing claims data for the past five years, broken down by billing year, including annual net premium (for the same period), retention amounts, and the annual premiums paid. Claims information is critical to our pricing. The ratio of claims to employee growth or attrition is part of the claims analysis.

Contractual year Total claims paid (USD)

Retention amount (USD or local currency)

Total premium paid to Insurer (USD or local currency)

Net gain (local currency or

USD)

Total number of insured members dd/mm/2017 – dd/mm/2018

246,937.99 dd/mm/2018 – dd/mm/2019

270,283.90 dd/mm/2019 – dd/mm/2020

272,911.78 dd/mm/2020– dd/mm/2021

456,473.61 dd/mm/2021 – dd/mm/2022

A3: US Embassy Addis Ababa did not have a medical insurance Contract for local staff. The US Embassy was self-insured, paid local staff medical expensive. Below are the total amounts paid for medical coverage by the US Embassy Addis Ababa over the last five years:

Contractual year Total claims paid (USD) dd/mm/2017 – dd/mm/2018 246,937.99 dd/mm/2018 – dd/mm/2019 270,283.90 dd/mm/2019 – dd/mm/2020 272,911.78 dd/mm/2020 – dd/mm/2021 456,473.61 dd/mm/2021 – dd/mm/2022 492,645.00

Q4: For membership history / trends, please provide below the number of employees - employees with single coverage and with family coverage at the end of each year. Please do not provide confidential information, only the overall statistics for the group:

Contractual year

Employee Spouse Children

A4: US Embassy Addis Ababa did not have a medical insurance Contract for local staff. The US Embassy was self-insured, paid local staff medical expensive.

Q5: Have you 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.

A5: According to the medical plan: - Catastrophic conditions shall be defined as major medical conditions occurring as a result of a single/illness/accident or closely related set of major illnesses (or conditions relating to a single accident) that exceed the standard maximum coverage limit.

Per the above-mentioned definition, on average 3 – 7 employees claimed catastrophic coverage per year.

Q6: What is the name of the current provider?

A6: There is no previous contract in place.

Q7: Does current provider has “direct billing” in place also for outpatient treatments with medical facilities listed under B.2, page 13?

A7: There is no previous contract in place.

Q8: Could you please provide information about all Claims / year occurred out of country during the current coverage?

A8: We had three employees (3) for the out-country treatment during a fiscal year 2022.

Q9: Has there been any changes to the Table of Benefits over the past 5 years?

A9: There is no previous contract in place.

Q10: Are there any differences between the current Table of Benefits and new solicitation.

A10: There is no previous contract in place.

Q11: Final proposal can be submitted electronically or does the Embassy insist on hard copies?

A11: Please see page 47 of solicitation document – Section 3 A.b.

Submission shall be made electronically, i.e. by e-mail.

All documents shall be submitted in the Microsoft word or the Adobe pdf format and shall be named / numbered to appear in the e-mail(s) in the correct sequence.

The one exception is Attachment 1, the pricing schedule which shall be submitted as completed Microsoft Excel spreadsheet. The limit per e-mail is 20MB. Zipped files (.zip or .rar) are not permitted.

Q12: Health Insurance services for Locally Engaged Staff and their dependents at the US Embassy Addis Ababa, Ethiopia is a voluntary or mandatory plan?

A12: Individuals will be covered on a voluntary basis.

Q13: If voluntary, meaning all employees of the Embassy will be covered on voluntary basis – to the employees will be given the option to sign up for the health insurance - is there any guarantee of min. number of insured LES?

A13: No, the quantities are reasonable estimates only. The Government is not obligated to order the estimated quantities.

Q14: The number of insured persons is essential for the risk evaluation (premium rates calculation) and for the requested enrollment procedure (without individual medical underwriting). What is impact on the proposed premium rates and prices if, compared to the estimated figures (EXHIBIT A, EXHIBIT B, EXHIBIT C), less than 75% of the US Embassy staff and their dependents decide to be enrolled in the insurance plan?

A14: None.

Q15: All LE Staff covered under post’s medical benefit plan will pay a 10% share of the premium. The Embassy will collect 10% share of the premium?

A15: Yes, the embassy will collect the premium from the employees.

Q16: Solicitation wording doesn’t’ request offeror to have license/certificate/-accreditation, which demonstrates that the offeror is licensed/certified/accredited or otherwise authorized by the Government of Ethiopia to provide medical insurance within Ethiopia as the host country?

A16: Please see Section 3 Summary of Instructions as well as DOSAR 652.242-73 –

AUTHORIZATION AND PERFORMANCE (AUG 1999)

Q17: Would the Embassy accept a proposal from an international insurance company under an “off shore” jurisdiction?

A17: We are intending to issue a contract to a contractor to provide us with Health Insurance services. Any offeror may submit a proposal conforming with the terms and conditions of our solicitation and in accordance with the Instructions to Offerors. Award will be made to the lowest priced technical acceptable and responsible offeror.

Q18: Would 2 % tax based on James Zadroga Act be applicable to this solicitation?

A18: Yes.

Q19: Would DBA insurance be applicable to this solicitation?

A19: No, DBA is not applicable.

Q20: Would the Embassy accept proposals shown in USD or EURO?

A20: Yes.

Q21: Would the Embassy accept to pay invoices and insurance premium in USD (or EURO) to the non-Ethiopian companies?

A21: Yes

Q22: A detailed census on everyone that is to be insured on this health insurance policy is needed. Is that something we can obtain to provide you with an accurate quote?

A22: All individuals will be covered on voluntary basis. Therefore, the quantities are reasonable estimates only.

Q23: As per Exhibit A, the dependents count is 2476 and the employees count is 1182, whereas in Exhibit B, the dependents count is 2787 and the employees count is 2375. Could you please confirm the correct employee and dependents count?

A23: According to our current data the total number of dependents is 2,787 and the number of employees is 1,182.

Please see updated Exhibit A (all changes have been highlighted in red).

“0001 Exhibit A – Employee Statistic” replaces “Exhibit B - Employee Statistic” – PLEASE DO

NOT USE EXHIBIT B TO SUBMIT A PROPOSAL

Q24: Please provide average insured member counts for Health for the last 5 years – 2022, 2021, 2020, 2019 & 2018. 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.

A24: No existing insurance for health, it is self-insured program.

Q25: 3. Please provide claims data for the year 2022.

A25: $492,645.00

Q26: Please provide a breakdown of all these employees from a citizen standpoint – How many of these employees, spouses, and dependents are U.S. Nationals?

Answer: US citizen employees – 2 and we don’t have a record on the spouse and dependents nationality.

How many are Third Country Nationals?

Answer: 1

How many are local nationals?

Answer: 1,179

A26: Please note that, regardless of their nationality all locally employed staff should have the same medical insurance coverage.

Q27: We also need to know who the current insurance carrier is and we need specific details about the plan design for this group. In other words, we need a copy of the existing plan design or specs on the new plan design that the Embassy wants.

A27: Currently the Embassy self-insures all local staff. There is no existing medical insurance.

Q28: V.1.3 - Complaint procedures, 'a' .

“lack of coordination during medical evacuation.” and “extended referral periods.”

Could you explain what is meant by the two? Are we to arrange the evacuation process? and are we to refund the expenses after the evacuation is completed? Or are we? to pay to the hospital, especially if it is out of Ethiopia?

A28: These are only examples. If there is nothing stated about it in the statement of work, they are not applicable.

Q29: Currency:

It asks to put the currency we choose. In Ethiopia, we can only transact in Ethiopian Birr. However, there are fluctuations against the dollar. What do you think is best for us?

A29: If the insurance company is governed under Ethiopian laws the payment will be made by ETB.

Insurers who are internationally based may possibly be able to get their premium in foreign currency.

Q30: Please clarify if these employees are citizens of the United States of America or if they would be considered citizens of Addis Ababa, Ethiopia. In addition, would you seek a group life/group health policy or individual policies for each employee? Furthermore, is this request for insurance strictly for health insurance, or does it also pertain to life insurance?

A30: They will be considered as citizen of Ethiopia; this plan is only for group medical insurance. The insurance is managed under the LCP – Local Compensation Plan.

Q31: The annual maximum limit is USD 7,000 per covered individual on C.2.1 (page 15 of 70)*

a. is it USD 7,000 for each employee, USD 7,000 for each legal spouse and USD 7,000.00 or each dependent child or

b. Is it USD 7,000 for employee including family members (USD 7,000 per employee + family)

A31: “A” is correct, the Annual maximum limit is USD 7,000 per covered individuals (USD 7,000 is per each individual)

Q32: We have review all the solicitation document and summarized the benefit plan below. Kindly please advise on sublimit of the benefits highlighted in yellow and choose a. or b. per your benefit structure, Please see the table on the next page.

S.N. Specification Minimum

Reimbursement Rate

Sublimit

Plan Annual Maximum Limit

* Kindly advise per above question Q31

B.1.1 Hospitalization (Treatment in the Hospital for Inpatient Care):

100% -

B.1.2 Emergency Services (Trips to Emergency Room):

100% -

Note: 7,000 USD is the annual maximum limit per covered individual

B.1.3 Ambulance: 80% a. Up to Maximum of USD __no sub limit _______

b. Up to Maximum of USD 7,000.00

B.1.4 Outpatient Services: 80% a. Up to Maximum of ___No sublimit ______

b. Up to Maximum of USD 7,000.00

B.1.5 Obstetric and Newborn Care: Inpatient 100% Outpatient 80%

a. Up to Maximum of USD no sub limit ______

b. Up to Maximum of USD 7,000.00

B.1.6 Pediatric Services: Inpatient 100% Outpatient 80%

a. Up to Maximum of USD __No sub limit _______

b. Up to Maximum of USD 7,000.00

B.1.7 Prescription Drugs Inpatient 100% Outpatient 80%

a. Up to Maximum of USD __No sub limit _______

b. Up to Maximum of USD 7,000.00

B.1.8 Preventive and Wellness Services and Chronic Disease Management:

80% a. Up to Maximum of USD ___No sub limit ______

b. Up to Maximum of USD 7,000.00

B.1.9 Hearing Aids: 80% Hearing Aid Apparatus: Limited to one apparatus per ear up to a maximum of USD 1,500 per covered individual per three-year period.

B.1.10 Optical Care: 80% a. Examinations and Treatment:

80% Coverage

b. Prescription lenses and frames or contact lenses:

Covered up to a maximum of USD 300 per covered individual every two years.

B.1.11 Dental Care: 80% a. Examinations and Treatment:

Dentist’s fees, x-rays, examinations and treatment, cleanings, fillings, extractions, false teeth, crowns, and bridges up to a maximum of USD 3,200 per covered individual per contract year.

b. Orthodontia: Treatment is

A32: “B” is the answer, the annual maximum limit is USD 7,000 per covered individuals. no sub limit for the above listed. Note: for HIV/AIDS: 100% up to USD 10,000 per contract year per covered individual. (Please see the blue and yellow highlighted parts in the table) covered only if treatment begins before age 18, or if required as the result of an accident. A maximum of four years of orthodontia treatment will be covered up to a maximum of USD 2,400 per covered individual over his/her lifetime.

B.1.12 Reproductive Health: 80% a. Up to Maximum of USD _no sub limit ________

b. Up to Maximum of USD 7,000.00

B.1.13 Mental Health and Substance Abuse Care:

50% a. Up to Maximum of USD __No sub limit_______

b. Up to Maximum of USD 7,000.00

B.1.14 Rehabilitative and Habilitative Services and Devices:

50% a. Up to Maximum of USD _No sub limit________

b. Up to Maximum of USD 7,000.00

B.1.15 HIV/AIDS: 100% $10,000 covered individual per year

a. Additional USD 3,000.00 into the annual limit of

USD 7,000.00

b. Separate additional USD 10,000.00 for this benefit

B.1.16 Catastrophic Coverage 100% Additional coverage equal to 7000 USD per covered individual per contract year.

B.1.17 Out-of-Country Medical Treatment: 100% a. Up to Maximum of USD __No sub limit, 100% is only for in patient

b. Up to Maximum of USD 7,000.00

B.1.18 Transportation for Out-of-Country Treatment:

80% a. Up to Maximum of USD ____no sub limit _____

b. Up to Maximum of USD 7,000.00