Questions_and_Answers.docx

Questions and Answers Health Insurance Services Contract RFP No. 19GR1019R0012 Athens, Greece

Q1. Claims Activity in Prior Periods:

a. Please confirm the currency presented in Euros.

b. Please confirm the claims amounts represent incurred claims. If these amounts represent paid amounts, please provide the incurred amounts for these periods.

c. For the amounts presented for the period 2018 – 2019 please confirm the start date of this period is September 1, 2018 and please provide the end date.

d. We note your comment “In addition, please be advised that the benefits under this solicitation have changed and that this data may not be indicative of future claims”. Please provide schedule C of the current contract so we can see the difference in the benefit schedules.

A1.

a. The current contract is in Euros (local currency).

c. The policy year is from March 1 to February 28 or 29 of each year.

d. See Attachment 1.

Q2. 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.

A2.

· 4 cancer cases with hospitalization days more than 10.

· 1 orthopedic case with hospitalization days more than 10.

Q3. Does this solicitation number 19GR1019R0012 contain the same requirements as the current contract? If not please provide section C from the current contract.

A3. Please see Attachment 1.

Q4. Have there been any claims more than $10,000 within the last year? If yes, please indicate the number and amounts of such claims.

A4. There were 13 cases with amounts above 10,000€.

Q5. 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.

A5. Yes, 3 dependent children study in UK.

Q6. Date contract is expected to start.

A6. It is anticipated that the new contract shall commence on September 1, 2019.

Q7. Advise if previous benefit schedule for life/health/disability insurance is the same as the benefit schedule currently being requested.

A7. Please see Attachment 1.

Q8. Are there any persons who are currently hospitalized? If yes, please provide number.

A8. This information is not available.

Q9. Are any major illnesses (i.e. hemodynamics, open heart surgery, orthopedic major surgeries, organ transplants, traumatic accident, cancer and oncology cases) being treated? If yes, please provide number.

A9. There are 6 continuous cases for the last two years.

Q10. Are there any pregnant employees/spouses? If yes, please provide number and status of claims – paid/incurred.

A10. See A2, above.

Q12. Are there any HIV/AIDS cases? If yes, please provide total number.

A12. No.

Q13. Are any employees currently disabled? If yes please provide total number.

A13. No currently disabled employees.

Q14. Please provide current vendor information.

A14.

a. Name - METLIFE A.E.A.Z.

b. Contract number – SGR100-14-D-0005

c. Value - € 1,983,908.20. The current contract included CSR active employees, who retired.

d. Date of award – March 1, 2014

e. Date of expiration – February 28, 2019. Current contract was extended for 6 months thru August 31, 2019.

Q15. What currency should proposers use in submitting bids?

A15. Price proposals should be submitted in Euros.

Q16. Please provide the percentage of local nationals.

A16. 88.1% are Greek citizens and the remaining percentage are U.S. citizens.

Q17. 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.

A17. Please see A5, above.

Q18. Please specify the location(s) of insured employees.

A18. Athens and Thessaloniki.

Q19. Claims history for health insurance for the current year and each of the last 5 years.

A19. Please see A1, above.

Q20. Do the above claim numbers include claims from ORE employees?

A20. ORE employees are not included in the contract.

Q21. Please provide the number of insured persons, per category, for the years 2015, 2016, 2017 and 2018.

A21.

2015 2016 2017 2018 CSR Annuitants

LE Staff

Q22. Provide the premium history for health insurance for the current year and each of the last 5 years.

A22.

B.2.3. BASE YEAR OF CONTRACT:

CSR Annuitants

Annual Rates:

Non-CSR LE Staff

TOTAL PRICE FOR BASE YEAR

€ 356,862.97

B.2.4. FIRST OPTION YEAR OF CONTRACT:

Annual Rates:

CSR Annuitants

Non-CSR LE Staff

TOTAL PRICE FOR FIRST OPTION YEAR

€ 374,857.67

B.2.5. SECOND OPTION YEAR OF CONTRACT:

Annual Rates:

CSR Annuitants

Non-CSR LE Staff

Employees

B.2.6. THIRD OPTION YEAR OF CONTRACT:

Annual Rates:

CSR Annuitants

Non-CSR LE Staff

B.2.7. FOURTH OPTION YEAR OF CONTRACT:

Annual Rates:

CSR Annuitants

Non-CSR LE Staff

Q23. Did the premium history for insurance include the VAT? If so, what percentage of VAT was included in the historical premiums?

A23. No VAT (24%) shall be included in the premiums. The U.S. Embassy is exempt from the payment of VAT (24%).

Q24. Section B.2.1, Value Added Tax: Please specify if it concerns also the tax that incurs tariff’s hospitals.

A24. Given that the invoices are issued in the name of the insurers (employees-pensioners) and not in the name of the U.S. Embassy, Law 1268/30-11-2011 (by virtue of which the US Government is exempted from the payment of VAT) does not appear to apply in the case in question.

Q25. Please clarify if the financial proposal shall include commission/fee to potential independent third party (consultant and/or broker). If yes, please define (as % and euros for base year and option years).

A25. The U.S. Government shall only pay the Retention Amounts stated in Section B.3.2. No other payments shall be approved and accepted.

Q26. Is IKA (now EFKA) the Primary Insurance Fund of all the covered persons under the contract, or there are any subcategories of employees that have not IKA insurance?

A26. There is one subcategory: The locally-hired Ordinarily Resident American employees (“OR” employees) paying into U.S. Social Security and not insured under IKA (now EFKA). 22 employees belong in this category. For all the other employees EFKA is the Primary Insurance Fund.

Q27. SECTION J – EXHIBIT C. Why you distinguish the employees in “IKA” and “OR”. What is the difference between these two categories? What is the meaning of the “OR” initials?

A27. “OR” (Ordinarily Resident) are the locally-hired US Citizens who are permanent residents of Greece and are contributing into U.S. Social Security and not insured under EFKA. All the other locally hired employees are insured under EFKA.

Q28. SECTION J – EXHIBIT D

· Please clarify whether clams statistics correspond to full 12-month periods.

· Please provide the average number of covered persons per category per period.

· Please confirm that the plan specifications and provisions, remained unchanged within each period starting from 2014.

· Please confirm that the initial effective date of the contract was 01/09/2014.

· Please confirm that all claims data, refer to claims paid and are not included claim reserves for incurred and not reported or submitted and not paid cases.

· Please specify whether the 2018-2019 claims data is for a full 12 month period or has been projected on 12 months basis, based on the real claims experience of 5 or 6 months.

· Please provide further analysis of claims reported, such as

1. Split of the table that indicates the claims amounts in the following categories: ANNUITANTS – IN HOSPITAL PAYMENTS & ANNUITANTS – OUT OF HOSPITAL PAYMENTS and idem for the EMPLOYEES.

1. Split of the table that indicates the number of claim cases (in & out of hospital) to the cases refer to annuitants and the relative ones that refers to employees

1. Claims analysis per type of coverage per period, that is:

· For the in Hospital Payments = Room & Board, Hospital Services, Surgical fees

· For the Out of Hospital Payments = Diagnostic X-Ray, Dr.Visits, Prescribed Drugs, Various Out of Hospital Services and/or Therapies.

1. Number of cases and amounts paid for serious incidents.

1. Number of Cases and Claims paid per period, up to 10,000€, from 10,000€ - 20,000€ and over 20,000€ A28. Please refer to the answers provided above.

Q29. As per the price tables, Number of employees and dependents under Non-CSR LE Staff are 265 and 357 respectively. Whereas, as per Exhibit C under Section J, Number of employees is 263 and number of dependents is 353. Please clarify.

A29. Τhe price tables in Section B are estimated quantities. The number of insured employees in Exhibit C under Section J, are actually covered in the current contract. See also Section H.3.

Q30. Provide Premium history for health Insurance for the current year and EACH of the last 5 years - 2019 (till now) 2018, 2017, 2016, 2015, 2014. 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.

A30. Please see A22, above.

Q31. Did the Premium history for health insurance above include the VAT? If it did then what % VAT was included in the historical health premiums?

A31. Please see A23 and A24 above.

Q32. Provide Average insured member counts for the current year and EACH of the last 5 years - 2019 (till now) 2018, 2017, 2016, 2015, 2014. 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.

A32. Please see A21, above.

Q33. Advise if 2018 benefit schedule for health insurance is the same as the benefit schedule currently being requested under 19GR1019R0012; and if not advise us on the differences. Alternatively, you can simply provide the previous solicitation document.

A33. Please see Attachment 1.

Q34. Are there any current HIV/AIDs cases. If Yes, please provide number (please note we are not seeking protected private information, we do not need the names or identification; we just need to know the total number of people who are currently being treated for HIV/AIDs to assess the risk and price accordingly).

A34. Please see A12, above.

Q35. Plan 1 - CSR Annuitants What is the coinsurance or rate (i.e. 100% or 80%) of Coverage for Emergency Services (emergency room services provided for conditions that could lead to serious disability or death if not immediately treated, such as accidents or sudden illness)?

What is the coinsurance or rate (i.e. 100% or 80%) of Coverage for Rehabilitative services (e.g., recovering skills, such as speech therapy after a stroke or physical therapy after an accident) and habilitative services (e.g., developing skills, such as speech therapy for children) that help develop skills needed for everyday life. 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?

Can you confirm that there is no 180 Day Coverage For Dependents After CSR Annuitant’s Death.

Plan 2 - Employee & Dependents (non CSR Annuitants) Please clarify if Out-of-Country Medical Treatment is applicable for leisure or official work trips?

Please confirm that benefits under Out-of-Country Medical Treatment requires certification for overseas treatment from Greek doctor due to lack of local Greek facilities.

A35. Section C clearly states the benefits provided to each insured group.

Q36. When is this plan likely to commence?

A36. Please see A6, above.

ATTACHMENT NO. 1

SECTION C

DESCRIPTION/SPECIFICATION/WORK STATEMENT

(FROM CURRENT CONTRACT)

PART I – CSR Annuitants

C.1. HEALTH INSURANCE SERVICES

The Contractor shall insure that health care under this contract does not exclude HIV/AIDS care, unless exclusion has been authorized by HR/OE/CM.

Medical Coverage:

The insurance company will reimburse covered medical expenses incurred, subject to the stated limits. Payment will be made for reasonable and customary expenses of covered benefits. The medical treatment must be prescribed or provided by a physician or nurse licensed in Embassy Athens, the United States, or in the country in which the treatment or prescription is received. Coverage of expenses will be made in Euro.

Deductible:

90 Euro, for each insured person, must be paid out of pocket per policy year.

Hospitalization:

80% coverage of room and board expenses for a ward room, private, or semi-private room up to a maximum of 210 Euro/day in Greece and 400 Euro/day outside of Greece. A maximum of 480 Euro/day is given for stay in the ICU for a maximum of 8 days. 80% coverage of hospital medical expenses including laboratory tests and x-rays, nursing care, operating room expenses, intensive care, prescription medicines, and physical therapy.

80% coverage of ambulance service up to a limit of 350 Euro per year.

80% coverage for nursing home care up to a maximum of 14 days following a hospitalization up to a limit of 45 Euro per night.

For CSR Annuitants: It is the responsibility of the Contractor to ensure all in-hospital medical expenses are submitted to the National Organization for Health Care (EOPYY) or any other insurance carrier as applicable, prior to the acceptance of submitted expenses for reimbursement.

Professional Services and Treatment:

80% coverage 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.

80% coverage for medical services and expenses when not hospitalized such as laboratory tests and x-rays, prescription medicines, physical therapy, routine annual physical examinations, and inoculations. A maximum limit of 80 Euro is covered per doctor’s visit for examinations and 65 Euro per visit for physical therapy.

80% coverage of out-of-hospital medical supplies. The supplies include diabetic supplies (strips and needles for the measurement of blood sugar levels, orthopedic supplies (splint, neck brace, orthopedic shoes, waist belt and other pertinent to the above mentioned supplies).

Prescription drugs and medicines:

80% coverage for the cost of medicines and drugs for which a prescription is legally required. Expenses incurred for medicines, vitamins, cold remedies, etc., that are available over the counter without a prescription will not be reimbursed even if prescribed by a physician.

Obstetrical Care:

The Mission does not cover expenses for obstetrical care.

Family Planning:

The Mission does not cover expenses of prescribed contraceptive devices and drugs, voluntary sterilization, diagnosis and treatment of infertility, fertility drugs, reversal of voluntary sterilization, infertility treatment after voluntary sterilization, genetic counseling and assisted reproductive technology.

Hearing Aids:

The Mission does not cover the cost of a hearing aid apparatus and related examinations.

Optical Care:

The Mission does not cover expenses for eye examination, treatment, prescription eyeglass or contact lenses. Diseases of the eye will be covered under Section G of the plan.

Dental Care:

The Mission does not cover expenses for dental services including dentists' fees, x-rays, examination and treatment, cleaning, fillings, extractions, false teeth, crowns, and bridges.

Psychiatric Treatment:

80% coverage of expenses for psychiatric treatment up to a limit of 65 Euro per visit.

Medical Expenses Incurred Out of Country:

Medical expenses incurred out of country will be covered for employees and dependents when (a) a life threatening condition 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.

80% coverage for repatriation, evacuation or transportation of mortal remains up to limit of € 1,800.

Expenses not covered:

Expenses will not be covered for elective cosmetic surgery; spa cures; rejuvenation cures; massage; exercise therapy; long term rehabilitative therapy; eyeglass frames; non-medical hospital charges such as telephones or television; home help, family help, or similar household assistance; fees of persons who are not licensed physicians or nurses; or services or supplies which have not been prescribed or approved by a physician or nurse.

No coverage of will be made for expenses that will be reimbursed or paid directly under a host country medical program, the U.S. workers' compensation program, or any Greek workers' compensation type program.

No coverage of will be made for expenses related to an illness or injury that is a result of an unlawful action on the part of the patient; the practice of a dangerous sport; excessive or illegal use of alcohol or drugs; a self- inflicted wound; or service in the armed forces of any country.

Maximum Annual Coverage:

CSR Annuitants: The Insurance company will reimburse covered expenses up to a limit of €15,000 per person per contract year. The maximum annual reimbursement for outpatient expenses per person per contract year is €1,800.

II. Non-CSR Locally Employed (LE) Staff

C.2. HEALTH INSURANCE SERVICES

The Government of the United States of America requires Health Insurance coverage for its non- CSR LE Staff and their dependents as further described in C.2.1.A. and B. in Greece. The Government has determined that the prevailing practice by employers in Greece is to provide for their employees health insurance protection and that the cost of such insurance protection is usually borne by the employer. The specific health benefit coverage under this contract is set forth in Section C.2.1 and the Exhibits in Section J.

The Contractor shall insure that health care under this contract does not exclude HIV/AIDS care unless exclusion has been authorized by HR/OE/CMD.

C.2.1 Health Services Benefits

The health benefits under this contract are as follows. Reimbursement of covered expenses is limited to the stated percentages of reasonable and customary costs. Proposals that contain more benefits (even if there is no increase in cost) or fewer benefits than stated in the solicitation may be deemed technically unacceptable.

Reimbursements or payments shall be made for the following covered benefits, subject to reasonable and customary costs in the locality where treatment was provided.

A. Eligible Employees:

Eligible employees are LE Staff who are:

Working on a full time or part time basis under non-temporary direct hire appointments, personal services agreements, or personal services contracts and paid under the terms of the Local Compensation Plan including Ordinarily Resident Americans who pay U.S. Social Security. Participation will be voluntary.

Not eligible are employees who will receive retirement benefits under the U.S. Civil Service Retirement (CSR) System; working under temporary appointments; those working under a PSC or PSA that is time limited to less than one year; non-personal services contract personnel and their employees, supplied by an independent contractor licensed to do business in Embassy Athens who provides services to other local organizations as well as to the U.S. Mission; employees of USAID institutional contractors; Peace Corps personal services contractors as indicated in MS 743; and Recreation Association employees.

B. Dependent Coverage

Expenses incurred by an enrolled employee's eligible dependents are covered under this plan. For the purposes of this plan, an employee's dependents are defined as the employee's legal spouse (limit one) and each unmarried, economically dependent child who primarily resides with the employee unless away at school.

Child is defined as the employee's natural child, adopted child, stepchild, or foster child. An eligible child will be covered until the end of the calendar year in which the child turns age 18, or in the case of a child who is a full-time student, until the end of the calendar year in which the child turns age 25. There is no age limit for an eligible child who is physically or mentally handicapped so as to be unable to live independently. There is no limit on the number of children covered per employee.

Parents, grandparents, siblings, and other relatives are not eligible dependents.

C. Coverage after Retirement:

Employees who were covered under the medical insurance plan at the time of retirement are not eligible to receive coverage for themselves or their dependents after retirement.

D. Premium Expenses

For active employees who are regularly scheduled to work 30 or more hours per week: the USG will pay 100% of the premium cost for employee and dependent coverage.

For active employees who are regularly scheduled to work less than 30 hours per week: the USG will pay a prorated share of the premium cost for employee and dependent coverage, based on the number of hours the employee is regularly scheduled to work.

During a period of leave without pay or unpaid leave beyond one pay period the employee is responsible for the full cost of premiums. Alternatively, the employee may elect to have coverage cease if he/she prefers not to pay the premium.

E. Medical Coverage:

The insurance company will reimburse covered medical expenses incurred, subject to the stated limits. Payment will be made for reasonable and customary expenses of covered benefits. The medical treatment must be prescribed or provided by a physician or nurse licensed in Embassy Athens, the United States, or in the country in which the treatment or prescription is received. Coverage of expenses will be made in Euro.

F. Deductible:

120 Euro, for each insured person, must be paid out of pocket per policy year.

G. Hospitalization:

90% coverage of room and board expenses for a ward room, private, or semi-private room up to a maximum of 200 Euro/day. A maximum of 250 Euro/day is given for stay in the ICU for a maximum of 14 days.

80% coverage of hospital medical expenses including laboratory tests and x-rays, nursing care, operating room expenses, intensive care, prescription medicines, and physical therapy.

50% coverage of ambulance service.

For non-CSR LE Staff: It is the responsibility of the Contractor to ensure all in-hospital medical expenses are submitted to the National Organization for Health Care (EOPYY) or any other insurance carrier as applicable, prior to the acceptance of submitted expenses for reimbursement. This is not applicable to locally-hired Ordinarily Resident American employees paying into U.S. Social Security.

H. Professional Services and Treatment:

90% coverage 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.

80% coverage of for medical services and expenses when not hospitalized such as laboratory tests and x-rays, prescription medicines, physical therapy, routine annual physical examinations, and inoculations. A maximum limit of 55 Euro is covered per doctor’s visit for examinations.

I. Prescription drugs and medicines:

90% coverage for the cost of medicines and drugs for which a prescription is legally required. Expenses incurred for medicines, vitamins, cold remedies, etc., that are available over the counter without a prescription will not be reimbursed even if prescribed by a physician.

J. HIV/AIDS coverage (for active employees only):

100% coverage of expenses for medications to suppress opportunistic infections, such as tuberculosis and toxoplasmosis for employees who have HIV/AIDS; as well as brief courses of anti-retroviral drugs during childbirth to prevent the transmission of HIV to the employee's child. This expanded coverage generally excludes medications for the long-term suppression of AIDS through the combination of anti-retroviral drugs at those posts with inadequate local healthcare infrastructures. This expanded coverage does not apply to dependents.

K. Obstetrical Care:

Coverage of expenses for obstetrical medical care when hospitalized and not hospitalized is as follows:

Normal Delivery: 600 Euros Cesarean Delivery: 800 Euros Miscarriage: 300 Euros

80% coverage of expenses is covered for prenatal and postnatal doctor visits.

L. Family Planning:

The Mission does not cover expenses of prescribed contraceptive devices and drugs, voluntary sterilization, diagnosis and treatment of infertility, fertility drugs, reversal of voluntary sterilization, infertility treatment after voluntary sterilization, genetic counseling and assisted reproductive technology.

M. Hearing Aids:

The Mission does not cover the cost of a hearing aid apparatus and related examinations.

N. Optical Care:

The Mission does not cover expenses for eye examination, treatment, prescription eyeglass or contact lenses. Optical Care is only covered in accidental cases.

O. Dental Care:

The Mission does not cover expenses for dental services including dentists' fees, x-rays, examination and treatment, cleaning, fillings, extractions, false teeth, crowns, and bridges.

P. Psychiatric Treatment:

The Mission does not cover expenses for psychiatric treatment.

Q. Medical Expenses Incurred Out of Country:

Medical expenses incurred out of country will be covered for employees and dependents when (a) a life threatening condition 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.

R. Transportation for Out of Country Medical Treatment:

Transportation for out of country treatment will be a covered expense for employees only. The employee's attending physician must certify in advance that the treatment is medically necessary and unavailable locally.

50% 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.

50% of the transportation expenses of an attendant will be reimbursed if the patient's attending physician certifies that an attendant for the patient is necessary, e.g., a family member to make medical decisions in the case of a patient who is unconscious.

Transportation expenses are subject to the annual maximum limit.

S. Expenses not covered:

Expenses will not be covered for elective cosmetic surgery; spa cures; rejuvenation cures; massage; exercise therapy; long term rehabilitative therapy; eyeglass frames; non-medical hospital charges such as telephones or television; home help, family help, or similar household assistance; fees of persons who are not licensed physicians or nurses; or services or supplies which have not been prescribed or approved by a physician or nurse.

No coverage of will be made for expenses that will be reimbursed or paid directly under a host country medical program, the U.S. workers' compensation program, or any Greek workers' compensation type program.

No coverage of will be made for expenses related to an illness or injury that is a result of an unlawful action on the part of the patient; the practice of a dangerous sport; excessive or illegal use of alcohol or drugs; a self- inflicted wound; or service in the armed forces of any country.

No coverage will be made for expenses incurred after an employee leaves the service of the U.S. Mission.

T. Maximum Annual Coverage:

The insurance company will reimburse covered expenses up to a limit of 15,000 Euro per person per contract year. Expenses incurred under paragraph 2.J of the plan are subject to a separate annual maximum limit of USD 10,000 per employee per contract year.