19GE5026R0020 QAs Letter.pdf

RFP No.19GE5026R0020 - Amendment 0001 U.S. Embassy Valletta, Malta

Health Insurance for LES Questions and Answers Letter

SBU - CONTRACTING AND ACQUISITIONS

Questions and Answers (Q&A)

RPSO has received the following Questions (Q) and is hereby providing the following

Answers (A).

1. Q: Request for Loss Experience (Five-Year Overview)

For actuarial and pricing purposes, we would appreciate receiving aggregated loss experience data for the past five (5) contractual years. No personal or confidential data is required. Understanding claims development in relation to changes in insured population is essential for responsible underwriting.

Q: Request for Financial Overview

A:

Contractual Year Total Claims Incurred (EUR)

(September 2021 to August 22) 94,691.94

(September 2022 to August 23) 132,017.26

(September 2023 to August 24) 148,551.85

(September 2024 to August 25) 158,288.12

(September 2025 to August 26) No available

Q: Request for Membership Overview

A:

Contractual Year Employees Spouses Children

(September 2021 to August 22) 87 36 50

(September 2022 to August 23) 96 47 52

(September 2023 to August 24) 109 59 65

(September 2024 to August 25) 106 58 64

(September 2025 to August 26) 99 59 60

2. Q: High-Cost / Catastrophic Cases

For underwriting assessment purposes, could you please indicate whether, during the past five years, the group experienced any major cases such as:

Aggregated confirmation (without personal details) would be sufficient.

A:

• Open-heart surgery - No

• Organ transplants - No

• Major orthopedic surgery - Yes

• Oncology treatments (chemotherapy/radiotherapy) - Yes

• Severe trauma - No

• Hospitalizations exceeding 10 consecutive days - No

• Individual treatments exceeding EUR/USD 10,000 - Yes

3. Q: Preferred Medical Providers

Is there an established list of preferred hospitals, clinics, or medical providers typically utilized by LES employees? If yes, kindly share.

A: The preferred hospital is St. James Hospital.

4. Q: Overseas Claims

Could you please advise whether claims are frequently incurred outside Malta, and if so, provide general information on volume or trend?

A: All claims have been incurred in Malta.

5. Q: Significant Reduction of Staff

The contract references a minimum premium equivalent to one employee.

In case of a substantial reduction of LES staff (e.g., more than 25% compared to the initial insured population), could you please clarify how the contractor’s risk is addressed?

A: The U.S. Embassy does not foresee reduce of more than 25% of the workforce.

Offerors are reminders the data provided under Attachment Exhibit A – Employee statistic and Attachment 1- Pricing are an estimate for reference only and based on current information.

The Government is providing a revised employee statistic and pricing sheet via amendment 0001

6. Q: James Zadroga Act

If applicable and not waived, kindly clarify how the 2% tax under the James Zadroga

Act is administratively handled?

A: The Government will withhold 2% from applicable payments in accordance with

IRS implementing guidance.

The withholding is remitted by the Government to the Internal Revenue Service (IRS).

The Government will not adjust contract prices after award to account for the excise tax.

7. Q: Defense Base Act (DBA)

Please confirm whether DBA insurance is applicable under this contract

A: DBA insurance and FAR 52.228-3 are not included under this solicitation.

8. Q: Residency Requirement for Dependents

For covered dependents (e.g., students), is residency in Malta required to maintain eligibility for coverage?

A: Yes, it is.

9. Q: Benefit Adjustments

Would benefit enhancements or additional services be permitted during the contract term if not initially specified in the RFP?

A: Possibly.

10. Q: Payment Currency

Please confirm the preferred premium payment currency (USD or EUR).

A: Offeror shall refer to section I – The schedule, Subsection B.5

11. Q: Proposal Deadline

In the event that answers to clarification questions or amendments are issued shortly before the submission deadline (e.g., less than ten working days), would an extension of the proposal due date be considered

A: Offers shall be submitted no later than 14:00 hours Central European Time

(C.E.T.) on March 17, 2026,

12. Q: Direct Billing

Is establishment of a local medical network and direct billing arrangement mandatory for outpatient services?

A: Direct billing arrangements for outpatient services is not mandatory.

13. Q: OTC Medication

Please confirm whether over-the-counter medications and supplements are excluded from reimbursement, even if prescribed

A: Generally, health insurance providers will not cover expenses for over-the-counter remedies that do not require a doctor’s prescription, such as vitamins and cold remedies. If a vitamin supplement is prescribed at a level that requires a prescription, it would be covered. If a doctor writes a prescription, “take an aspirin a day”, a health insurance provider is not going to reimburse that expense.

However, if a doctor prescribes a medicine that is prescription strength but is available over the counter that would be covered.

14. Q: Attachment 1 – Pricing

We note that Attachment 1 – Pricing does not appear to include a retention table.

Will an updated version be issued?

A: There are no retention fees under this requirement.

15. Q: Pre-Existing Conditions (C.1.1.17)

Section C.1.1.17 refers to extension of coverage for pre-existing conditions to covered employees. Should this provision also apply to covered dependents?

A: Yes. Coverage of preconditions is extended to all covered individuals.

Offerors shall dispose of page 14 original provided and replace it with page 14 provided via Amendment 0001

16. Q: Premium Contribution

Please clarify if employees contribute toward:

a) Their own premium?

b) The premium for covered dependents?

A: The Government will provide fully funded task orders to the successful contractor to cover all individuals covered under the insurance policy unless otherwise specified in the contract.

17. Q: Electronic Delivery of Documents

Would electronic delivery of policy documentation and ID cards be acceptable instead of hard copies?

A: Yes.

18. Q: Electronic Claims Submission

Section D.3(b)(i) references physical submission of claims via drop box.

Would secure electronic submission (online platform or email) be acceptable?

A: Yes.

19. Q: Section V.8 – Certification on Contractor Employees

With reference to Section V.8, kindly clarify whether this certification applies exclusively to employees newly engaged under the resultant contract, rather than existing staff already employed

A: The certification requirement in Section V.8 applies to all employees who will perform work under the resultant contract, regardless of whether they are newly hired or existing employees of the Contractor