19HA7020R0002 - Questions and Answers for LES Health and Life Insurance Services.pdf

SBU - CONTRACTING AND ACQUISITIONS

U.S. Embassy Port au Prince

Q&A for LES Life & Health Insurance

1. Is it an oversight for the solicitation to have omitted the traditional UCR (Usual Customary

& Reasonable) clause?

No

2. Is it an oversight for the solicitation to have omitted the traditional Maternity sublimit?

No

3. For the Outpatient Services, what is the sublimit for: Medical Visits, Dialysis sessions, Physical Therapy, Psychiatric Therapy, Dentist Visits?

Section C.1.1 Employee and Dependent Health Service Benefits provides all the health benefits that the participants are entitled to.

4. Can you please clarify with a terminology adapted to the local reality and specify if the health service should be provided by a physician or a licensed provider?

All the clauses in our solicitation reference “Health Care Provider” whose definition is clearly stated on 29 CFR § 825.125 - Definition of health care provider

5. Is it an error to have omitted the traditional OTC (Over the Counter) drugs?

No. Please see paragraph C.1.1.7 that talks about prescription drugs.

6. What should be considered OTC (Over the Counter) drugs?

The term OTC Drugs is not referenced anywhere in the solicitation.

7. Is it a mistake to have indicated benefits in US DOLLAR in the following sections: Hearing

Aids, Prescription Lenses and Frames, Dental Care, Orthodontia; HIV/AIDS whereas the premium is in Haitian Gourdes? What exchange rate should we use for the conversion?

It is not a mistake. The insurer will use the prevailing exchange rate to convert the transaction amount to local currency.

8. Is the solicitation referring strictly to the legal requirement of an “ambulatory” medical clinic or do you expect a medical clinic which would support, overnight stays? Can the solicitation be specific?

The Embassy is only seeking to comply with the Haitian Labor Law with states in its article 477- “Employers in agricultural, commercial, industrial and other enterprises of any kind employing 200 or more wage earners shall engage the services of one or more medical practitioners, whose task shall be to prevent any danger to the workers’ health, or risks of danger or infection, see that industrial health standards are observed and provide first aid for casualties. The medical practitioners shall be assisted by one or more nurses according to the size of the enterprise.”

9. In clause C.1.8, you only ask the insurer to “be prepared to lease space, furnish equipment, and provide medical staff per local law.” Space rental and equipment furnishing will greatly affect the price of the contract. Can you please confirm that it is the responsibility of the insurer to provide the space and the equipment?

It is the responsibility of the insurer to provide all that is needed to offer first-aid care to the local staff. Clauses B.2.(3-7).3 shall include all costs associated with operating and delivering the employee Health Clinic benefit in compliance with local law to include staff, office supplies and equipment (computer, etc.), support services

(internet, etc.), medical equipment and supplies and medication. The Embassy will provide a temporary facility while looking for a more permanent space inside or outside the Embassy compound. A list of Government furnished properties will be appended as an exhibit into the package. The Contractor shall physically inventory all Government-Furnished Property in its possession at least annually or as requested by the COR. An amendment to the solicitation will be issued to update the requirements and add a separate line item for the health clinic.

10. Can the Health Clinic portion be subcontracted?

See clauses 52.237-7, 652.204-70, 652.242-73.

11. Will the service to be provided by the Health Clinic free of charge for the patient?

Yes. The Embassy is only complying with the Haitian labor law that states that

“Enterprises employing more than 200 wage earners shall have a permanent medical service with a dispensary as a minimum requirement.”

12. Are the dependents included in the Health Clinic Services?

No. Only the employees will have access to this clinic. C.1.8 will be revised to remove the dependents.

13. Can the Life indemnity of 1,250,000 be listed clearly as 1,250,000 “Gourdes”?

This will be noted on our solicitation amendment.

14. In the case accidental death, what is the total indemnity? Is it 1,250,000 + 1,400,000 =

2,650,000 gourdes?

Please section C.2.1.2

15. It takes a certain amount of time to investigate a claim. Will such a time be taken into consideration?

This falls under missing information in section H.4 (b) (2).

16. Are holidays included in the two-week time frame?

The two-week timeframe embraces all days, including intermediate Saturdays, Sundays, and legal holidays.

17. What happens when a claim is missing documents?

Please see section H.4 (b) (2)

18. Is “Invalidity” included in the contract?

No

19. What does “XOF” stand for in Exhibit B of SECTION J?

It should read GOURDES. This will be noted on our solicitation amendment.

20. Concerning the Zadroga act, will the Embassy be retaining the 2% from the payment or will the company be the one to pay it?

Please see clause K.13 52.229-11 TAX ON CERTAIN FOREIGN

PROCUREMENTS—NOTICE AND REPRESENTATION (JUN 2020) paragraph

(b).

21. Is HIV care inside the one million gourdes per employee or is it separate?

Please see clause C.1.2 Annual Maximum Limit

22. Can the “Period of Ineligibility” be clarified? What happens during that period?

Employees and their dependents are not entitled to health benefits during any period of employment for which premiums are not paid.

Additionally, employee's dependents are not entitled to health benefits during any period of employment during which the employee was not eligible to participate.

During a period of extended Leave Without Pay (LWOP) or unpaid leave beyond one pay period, the employee is responsible for the full cost of the insurance premiums for self and dependents. The Mission will pay the premiums directly to the Contractor and will collect the full cost from the employee on a quarterly basis. Alternatively, the employee may elect to have coverage cease if they prefer not to pay the premium.

23. Section C.1.5.2 and C.2.6.2. For insured employees that would withdraw from their insurance by means of non-payment of premiums during a given time, upon reinstatement, would that person be subject to all clauses related to preexisting conditions?

The employee and eligible dependents are entitled to all benefits as long as the premium is paid for.

24. If a person has a pre-existing condition for the hearing aid that was already paid for, should they be reimbursed under this contract?

Please see C.1.5.1 Term of Eligibility and Effective Date.