Questions_and_Answers.docx

Questions & Answers Solicitation for Health Insurance Services for LES, Riga, Latvia

19LG7518R0001

Question 1: Date contract is expected to start.

Answer: The anticipated award of the base year is 2019.

Question 2: Advise if previous benefit schedule for life/health/disability insurance is the same as the benefit schedule currently being requested.

A. If so, please provide a description of benefits.

Answer: The previous benefits are the same as required in the solicitation document. The required benefits are listed in Section C, Paragraph C.1.1.

Question 3: Are there any persons who are currently hospitalized?

A. If yes, please provide number.

Answer: No.

Question 4: Are any major illnesses (i.e. hemodynamics, open heart surgery, orthopedic major surgeries, organ transplants, traumatic accident, cancer and oncology cases) being treated?

A. If yes, please provide number.

Answer: No.

Question 5: Are there any pregnant employees/spouses?

A. If yes, please provide number.

Answer: Yes. 1 employee, 2 spouses.

Question 6: Are there any catastrophic cases (in excess of $10,000) within the last year to date?

A. If yes, please provide numbers.

B. Status of claim – paid/incurred.

Answer: There are no catastrophic cases in excess of $10,000 within the last five years.

Question 7: Are there any HIV/AIDS cases?

A. If yes, please provide total number.

Answer: No.

Question 8: Are any employees currently disabled?

A. If yes please provide total number

Answer: No.

Question 9: Current vendor information:

Answer:

· Name- IF P&C Insurance AS Latvijas Filiale

· Contract number- SLG75014D0001

· Value- EUR 1,712,483.45

· Date of award – January 24, 2014

· Date of expiration. January 31, 2019.

Question 10: What currency should proposers use in submitting bids.

Answer: Please see Section B, Paragraph B.5.

Question 11: Membership each of last 3 years by Single, Married and Family Status.

Answer: Please Section B, paragraph B.2.3. and the data in Section J, Exhibits A, B and C.

Question 12: Percentage of local nationals.

Answer: 100%

Question 13: Are there dependent children to be covered who are studying outside the country?

A. If yes, please provide the country and number of dependent children studying there.

Answer: No. Health insurance coverage is valid only within territory of Republic of Latvia. Section C, Paragraph C.1.2.4.

Question 14: Location(s) of insured employees.

Answer: All the insured employees are located in the Republic of Latvia.

Question 15: Claims history for health insurance for the current year and each of the last 5 years.

Answer:

Total amount of insurance claims (USD)

Question 16: Do the above claim numbers include claims from ORE employees? (if applicable)

Answer: No.

Question 17: Premium history for health insurance for the current year and each of the last 5 years.

Answer:

US Embassy Riga Premium Cost History FY 2012-2017

Question 18: Did the premium history for insurance include the VAT?

A. If so, what percentage of VAT was included in the historical premiums?

Answer: None. Please See Section B, paragraph B.2.

Question 19: Did the premium history for insurance include Insurance Premium Tax (IPT)

A. If so, what percentage of IPT was included in the historical premiums?

Answer: No.

Question 20: Census Data

Answer: Please see Section J, Exhibits A, B and C.

Question 21: Claims Activity in Prior Periods - The number, and amount, of claims paid in prior years is one of the most important element an insurance company uses to price insurance. We find that claims information is usually provided in the initial solicitation and if not there then provided after requested by a prospective contractor.

Please provide the last three full years and the current partial year of loss data by year of account including:

· three + years premium billed

· three + years number of incurred claims

· three + years amount of incurred claims

· three + years total number members on June 30. This is the total number of employees + spouses + dependents on June 30 of each year.

I've included below an example of an illustration of the information we are asking for. This illustration assumes the contract year ends on December 31.

Health Insurance Claims Illustration (example)

January 1, 2018 to Whatever date you have (please indicate date)

January 1, 2017 – December 31, 2017

January 1, 2016 – December 31, 2016

January 1, 2015 – December 31, 2015

Answer: Please see Answers on Question 15 and Question 17.

Question 22: 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.

Answer: None.

Question 23: Does this solicitation number 19LG7518R0001 contain requirements like the current contract? If no what are the differences?

Answer: Please see the Answer on the Question No. 2

Question 24: Have there been any claims more than $10,000 within the last year? If yes, please indicate the number and amounts of such claims.

Answer: Please see the Answer on the Question No. 6.

Question 25: Are their dependent children to be covered who are studying outside the country? If yes, please provide the country and number of dependent children studying there.

Answer: Please see the Answer on the Question No. 13.

Question 26: Please clarify how proposal should be submitted. Your cover letter says to email the proposal to Riga-ProcurementSection@state.gov but then says no electronic submissions shall be accepted. Please confirm no electronic submissions shall be accepted.

Answer: Please see Section L, Paragraph L.3 and Amendment 19LG7518R0001-0002.

Question 27: Claims history for health Insurance for the current year and EACH of the last 5 years - 2018 (till now), 2017, 2016, 2015, 2014, and 2013. 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.

Answer: Please see the Answer on the Question No. 15.

Question 28: Do the above claim numbers include claims from ORE employees?

Answer: Please see Answer on Question No. 16.

Question 29: Premium history for health Insurance for the current year and EACH of the last 5 years - 2018 (till now), 2017, 2016, 2015, 2014, and 2013. 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.

Answer: Please see the Answer on the Question No. 17.

Question 30: Did the Premium history for health insurance above include the VAT? If it did then what % VAT was included in the historical health premiums?

Answer: Please see the Answer on the Question No. 18.

Question 31: Average insured member counts for the current year and EACH of the last 5 years - 2018 (till now), 2017, 2016, 2015, 2014, and 2013. 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.

Answer: Please see the Answer on the Question No. 20.

Question 32: Advise if 2016 benefit schedule for health insurance is the same as the benefit schedule currently being requested under 19LG7518R0001; and if not advise us on the differences. Alternatively, you can simply provide the previous solicitation document.

Answer: Please see the Answer on the Question No. 2.

Question 33: Are there any persons who are currently hospitalized? If Yes, please provide number (we do not need the names or identification, we just need to know the total number of people hospitalized to assess the risk).

Answer: Please see the Answer on the Question No. 3.

Question 34: Are any major illnesses (Hemodynamics, Open Heart Surgery, Orthopedic Mayor Surgeries, Organ Transplant, Traumatic Accident, Cancer and Oncology Cases) being treated? If Yes, please provide number (we do not need the names or identification, we just need to know the total number of people hospitalized to assess the risk).

Answer: Please see the Answer on the Question No. 4.

Question 35: Are there any pregnant employees/spouses. 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 pregnant to assess the risk to price accordingly).

Answer: Please see the Answer on the Question No. 5.

Question 36: Are there any large losses (in excess of $10,000) within the last year to date? 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 large losses and the amounts to assess the risk and price accordingly).

Answer: Please see the Answer on the Question No. 6.

Question 37: Are there any 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).

Answer: Please see the Answer on the Question No. 7.

Question 38: When is this plan likely to commence?

Answer: Please see the Answer on the Question No. 1.

Question 39: Would you please let us know if the staff to whom the health insurance services applies has the status of Diplomat or similar or if they are local employees without any specific status?

Answer: They are the local employees without any specific status to whom the health insurance services apply.

Question 40: Section C/Specification/Paragraph C.1.1.9: What type of services are meant under the physical therapy? (list all if possible).

Answer: Treatment prescribed by a Physical Therapist or doctor. The goal of physical therapy is to ease pain and help a person to function, move, and live better. Treatment includes, but is not limited to exercises or stretches guided by the therapist, massage, heat or cold therapy, warm water therapy, ultrasound to ease muscle pain, rehab to help one regain mobility or learn to use an artificial limb, practice with gadgets (for example, a cane or a walker) that help one move or stay balanced

Question 41: Section C/Specifications/Paragraph C.1.2.1.: What is understood by long-term rehabilitation therapy?

Answer: Please see Section C, paragraphs C.1.1.1 through C.1.2.13.

Short term rehabilitation is usually for a few weeks. However, when it becomes extended due to a patient’s inability to resolve the issue it may extend into a longer period of time and at that point is considered long-term rehabilitative therapy. There is no defined length of time because it is patient specific. The determination of short term or long term should be made by a licensed physician.

Question 42: Submittals: One of the documents needed for submission is “evidence that the offeror can provide the necessary personnel to perform the service.”

Please, define, what type of document is needed to submit to follow this requirement?

Answer: Please see Section L, paragraph L.4.3.

Question 43: Section L/Conditions to offeror/Paragraph L.4.3(b)-What is meant by “offeror must demonstrate”. How the information shall be demonstrated?

Answer: In whatever means, the offeror determines that they are demonstrating their ability to meet the requirements of this solicitation. Please review Section L, paragraph L.4.3 (b.)

Question 44: Section L/Conditions to offeror/Paragraph L.4.3.2.1(d)-total dollar amount of past performance customer’s insurance policy is confidential information. Shall this subparagraph be considered as non-compliance to requirements?

Answer: The purpose of this information is to determine if you have contracts that are comparable to the requirements in this solicitation. We do not require data that is personally identifiable.

Question 45: B.4.2. Premium Adjustment Based on Laws - The rates may also be adjusted during the performance period of the contract as a result of laws enacted by the host Government, if such change in the laws has a direct impact on the cost to the Contractor to perform this contract at the contracted rate. In that event, the Contracting Officer may enter into negotiations with the Contractor to modify the contract to adjust the premium rate. The Contractor agrees to provide all documentation necessary to support any requested adjustment.

Questions: Can the laws be those of the risk insurance provider’s, i.e. French laws?

Answer: No.

Question 46: H.6.2. Licenses and Local Laws The Contractor shall possess all permits, licenses, and any other appointments required for the prosecution of work under this contract, all at no additional cost to the Government. The Contractor shall perform this contract in accordance with local laws.

Questions: We will respond to the solicitation under the Freedom of Service (right to provide business services on a cross-border basis within the European Economic Area (EEA). For insurance contracts, this means that the contract can be underwritten in an EEA member state that is different from the member state where the risk is located.)

Answer: See Section L, paragraph L.4.3.2.2.

Question 47: Is it the intention that the award will be formalized by an insurance contract negotiated between the insurer and the Government? That is because the terms proposed in the RFP are general in their nature as opposed to an insurance contract dedicated to this type of services with specific provisions.

Answer: Please see Section L, paragraph L.4.3.1 (a)(ii).

Question 48: Page 8 – reference C1.1.10 of the TOB: do the “other benefits” have a medical or custodial nature?

Answer: Please see Section C, paragraph C.1.1.11.

Question 49: Page 8 - Conditions and limitations: can the insurer propose its own exclusion terms?

Answer: No. Please see the answer to the question 47.

Question 50: Page 10 – Brochure requirement: the RFP says that the brochure in English and Latvian will have to be provided no later than 30 days after the date of contract award. Could you please clarify if that means 30 days after the signature of the insurance contract as the brochure will actually reproduce key elements of the contract?

Answer: As Section C, Paragraph C.1.7.2 states:” The contractor shall provide the document described in C.1.7.1 to the COR not later than 30 workdays after date of contract award.

Question 51: Page 13 – performance threshold: It is specified that service must be performed in a way that the government received no more than 2 complaints per month. Can the provider propose alternative KPIs?

Answer: No.

Question 52: Can the Insurer refuse the following highlighted terms on the assumptions that the insurance contract would not be ruled by the laws of Latvia?

652.242-73 AUTHORIZATION AND PERFORMANCE (AUG 1999)

(a) The Contractor warrants the following:

(1) That it has obtained authorization to operate and do business in the country or countries in which this contract will be performed;

(2) That it has obtained all necessary licenses and permits required to perform this contract; and,

(3) That it shall comply fully with all laws, decrees, labor standards, and regulations of said country or countries during the performance of this contract.

(b) If the party actually performing the work will be a subcontractor or joint venture partner, then such subcontractor or joint venture partner agrees to the requirements of paragraph (a) of this clause.

Answer: No, please see Section L, paragraph L.4.3.1 (a).

Question 53: Type of coverage, effective date of coverage and Table of Benefit.

Kindly provide us with the following information:

· Effective date of Coverage

· Existing Table of Benefit

· Proposed Table of Benefit

· The Existing insurer

· Structure of Premium required

· The Current Premium

· The Target Premium

Answer:

Please see the answers to questions 1, 2 and 9.

Question 54: Please confirm whether the table of benefit has changed over the past 3 years.

Answer: Please see the answer to question 2.

Question 55: Please confirm if the plan will be a Voluntary Insurance plan or a Compulsory plan.

Answer: Voluntary.

Question 56: Type of cover: Please confirm whether this is a 1st Euro-basis plan or a Top-up plan.

Answer: Your question is not clear. The scope of this contract is not a Top-up plan. The scope of this contract is to provide primary medical health insurance.

Question 57: Kindly provide us with the current terms and conditions or a copy of the current Contract.

Answer: Please see sections A through J. please see the answers to questions 2, 9, 13, 15, 16, 17, 18, and 19 which provide information on the current contract.

Question 58: Census data - Please provide us with the following information:

· Breakdown per age scale

· Number of retired people in the plan

· Number of insured with per country with local coverage involved

· Provide with the detailed demographic data of the persons currently covered under the plan and if possible the evolution since 2013

· Evolution of the insured members over the past 3 years

· Number of staff/dependents/retirees

Answer:

Number of insured individuals/Calendar Year:

CY2017: employees – 133; dependents – 177 CY2016: employees – 131; dependents – 174 CY2015: employees – 129; dependents – 171 Please see answers to questions 11,13,14, and 17. Retirees are not included in this solicitation.

Question 59: Claims report and current premium

Please provide us with:

· the current premium

· the number of claims per year under the group medical insurance

· the « line-by-line” detailed medical consumption per treatment if available

· Detailed claims history (breakdown per year/month of occurrence ) over the past 3 years

· Number of Inpatient/Outpatient/Dental care/vision cases and reimbursements per country of treatment for the past 5 or 3 years.

· the annual accounts and the profits and loss statements of the medical plan or should this not available, the detailed statements of income (premiums)

· Claims report over the past 3 or 5 years (claims per year of occurrence and claims paid)

· The renewal terms and the change of benefits for the 5 or 3 past years.

· the consumption of claims split per category of reimbursement (compulsory vs. voluntary) and per country over the past 3 years

Answer: Please see the answers to questions 15 and 53, all other information is not tracked by the US Government.

Question 60: Peak files

Please provide us with:

· High cost files detailed

· detailed peak files over the 5 past years

· Details of any large ongoing claims, e.g. nature of condition, expected cost of claims, medical prognosis

Answer: Please see the answer to question 17.