Questions and Answers.docx

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

19LG7524R0001

Question 1: Please provide five years of loss data (table 1) by year of account including annual net premium (for the same period), incurred claims and membership history. For membership history (Table 2) please provide the number of Employees with single coverage and with family coverage at the end of each year. Please do not include any confidential information, just the overall statistics for the group. Claims information is critical to our pricing and the relationship of claims to employee growth or shrinkage is part of the claims analysis.

Table 1

dd/mm/2018 – dd/mm/2019 dd/mm/2019 – dd/mm/2020 dd/mm/2020 – dd/mm/2021 dd/mm/2021 – dd/mm/2022 dd/mm/2022 – dd/mm/2023

Table 2 Please, provide headcounts for the last 5 years:

Answer:

Table 1

* Forecasted amount **Retention and net gain information is not public and therefore not available.

Table 2

Question 2: 1. We would like to know if you have 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.

Answer: The Embassy has not been informed of any catastrophic cases of more than 10 days hospitalization.

Question 3: What is the name of the current provider?

Answer: IF P&C Insurance AS Latvijas Filiale.

Question 4: Does current provider has “direct billing” in place also for outpatient treatments with medical facilities?

Answer: Yes.

Question 5: Could you please provide information about all Claims / year occurred out of country during the current coverage?

Answer: Under our current policy, there is no reimbursement for medical expenses incurred outside Latvia.

Question 6: Has there been any changes to the Table of Benefits over the past 5 years?

Answer: No. Health Insurance Services as defined by Section C of the contract did not change over the current contract’s duration (5 years).

Question 7: Are there any differences between the current Table of Benefits and new solicitation?

Answer: Yes. Section C.1.1. of the solicitation lists our new required health service benefits:

C.1. HEALTH INSURANCE SERVICES

The Government of the United States of America requires Health Insurance coverage for its employees as described herein.

C.1.1 Employee and Dependent Health Service Benefits C.1.1.1 Hospitalization (Treatment in the Hospital for Inpatient Care): Minimum Coverage - 100% Services and supplies provided during hospitalization, including services provided by a licensed healthcare provider, bed & board (semi-private accommodations), operating room, recovery room, intensive care, imaging and diagnostic testing, general hospital nursing care, physical therapy, as well as drugs and medicines administered while in-patient. When private accommodations are provided, coverage will be limited to the cost of a semi-private room unless otherwise covered in an off the shelf plan.

See Mental Health and Substance Abuse care (C.1.1.13) for details concerning inpatient psychiatric care. See Outpatient Services (C.1.1.4.) for details concerning professional services.

C.1.1.2 Emergency Services (Trips to Emergency Room): Minimum Coverage - 100% Services provided for conditions that could lead to serious disability or death if not immediately treated, such as accidents or sudden illness.

C.1.1.3 Ambulance: Minimum Coverage - 80% Professional ground transport to move a patient from the place where s/he is injured or becomes ill to the nearest hospital able to provide treatment or to move a patient from one medical facility to another.

C.1.1.4 Outpatient Services: Minimum Coverage - 80% Services provided by a licensed health care provider on an ambulatory or outpatient basis (without being admitted to a hospital), including surgeon's fees and other medical services provided at a hospital, clinic, doctor's office, medical facility, etc. Examples include, but are not limited to:

Annual physical examinations Specialist consultations and treatment, including second surgical opinion Minor surgical interventions Chemotherapy and radiation treatments Immunizations recommended by local authorities and/or the World Health Organization Diagnostic tests and diagnostic imaging See Rehabilitative and Habilitative Services and Devices (C.l.l.14.) for details concerning physical therapy.

See Mental Health and Substance Abuse Care (C.1.1.13.) for details concerning psychiatric therapy.

C.l.1.5 Obstetric and Newborn Care: Minimum Coverage - Inpatient: 100%; Outpatient: 80% Care and services that women receive during pregnancy (prenatal care), throughout labor and delivery, and post-delivery, and outpatient care for newborn babies. Hospitalization during pregnancy and/or delivery will be covered as Hospitalization (treatment in the hospital for inpatient care). All other treatments will be considered Outpatient Services.

C.1.1.6 Pediatric Services: Minimum Coverage - Inpatient: 100%, Outpatient: 80% Primary and preventive routine care services for covered dependent children, including, but not limited to:

physical examinations, developmental assessments, laboratory tests, and immunizations recommended by local authorities or the World Health Organization.

C.1.1.7 Prescription Drugs: Minimum Coverage - Inpatient: 100%, Outpatient: 80% Medications prescribed by a certified health care provider that are medically required. Examples include, but are not limited to prescription antibiotics to treat an infection, medication used to treat an ongoing condition, such as high cholesterol; prophylaxis; or contraceptive medication.

C.1.1.8 Preventive and Wellness Services and Chronic Disease Management:

Minimum Coverage - 80% Counseling or preventive care designed to prevent or detect medical conditions and care for chronic conditions such as asthma and diabetes. Examples include, but are not limited to: physicals, immunizations, and cancer screenings.

C.1.1.9 Hearing Aids: Minimum Coverage - 80% Examinations and Treatment: 80% Minimum Coverage Hearing Aid Apparatus: Limited to one apparatus per ear. The maximum coverage is EUR 1,374.00 per covered individual per three-year period. 80% Minimum Coverage: with applicable cap.

C.1.1.10 Optical Care: Minimum Coverage - 80% Examinations and Treatment: 80% Minimum Coverage Prescription lenses and frames, or contact lenses: The maximum coverage is EUR 274.80 per covered individual every two years. 80% Minimum Coverage; with applicable cap.

C.1.1.11 Dental Care: Examinations and Treatment-Minimum Coverage: 80%, with annual cap;

Orthodontia-Minimum Coverage: 80%, with contract lifetime cap Examinations and Treatment: Dentist's fees, x-rays, examinations and treatment, cleanings, fillings, extractions, false teeth, crowns, and bridges. The maximum coverage is EUR 2,931.20 per covered individual per contract year.

Orthodontia: Treatment is 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 per covered individual. The maximum coverage is EUR 2,198.40 lifetime limit.

C.l.l.I2 Reproductive Health: Minimum Coverage - 80% Prescribed contraceptive devices, preventive care and routine examinations, voluntary sterilization, and diagnosis and treatment of conditions which may cause infertility. Assisted reproductive technology (ART), fertility treatments, and reversal of sterilization are not covered (see Exclusions to Coverage).

See also Exclusion to Coverage (b)(C.l.3.)

C.1.1.13 Mental Health and Substance Abuse Care: Minimum Coverage - 50% Inpatient and outpatient care provided to evaluate, diagnose and treat a mental health condition or substance abuse disorder. This includes behavioral health treatment, counseling, and psychotherapy. Services must be provided by a licensed psychiatrist, psychoanalyst, psychologist, or psychiatric social worker. Inpatient care for alcohol and substance abuse must be provided at a facility licensed for detoxification and rehabilitation.

C.1.l.14 Rehabilitative and Habilitative Services and Devices: Minimum Coverage - 50% 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, etc.) 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.

C.l.l.15 HIV/AIDS Medications to suppress opportunistic infections (such as tuberculosis or toxoplasmosis for covered individuals who have HIVIAIDS). Brief courses of anti-retroviral drugs during childbirth to prevent the transmission of HIVIAIDS to the child. Generally, excludes medication for the long-term suppression of HIVIAIDS through the combination of anti-retroviral drugs in locations with inadequate local healthcare infrastructures.

See also Exclusion to Coverage (b)(C.l.3.)

Question 8: Final proposal can be submitted electronically or does the Embassy insist on hard copies?

Answer: Proposals must be submitted electronically to Riga-ProcurementSection@state.gov. Please refer to Section L, Paragraph L.3 in the solicitation.

Question 9: Health Insurance services for Locally Engaged Staff and their dependents at the US Embassy Riga, Latvia, is a voluntary or mandatory plan?

Answer: Locally Engaged Staff and their dependents’ participation in the Health Plan is voluntary.

Question 10: 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?

Answer: 99 percent of Locally Engaged Staff and their dependents currently participate in the voluntary Health Insurance plan. Please see B.2.3 through B.2.5 for the estimated number of participants. There is no minimum guarantee of the number of insured staff or dependents.

Question 11: 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, less than 75% of the US Embassy staff and their dependents decide to be enrolled in the insurance plan?

Answer: This is a fixed price with economic price adjustment requirements type contract under which the Embassy will issue firm, fixed-price task orders. Please refer to section B.2 in the solicitation.

Question 12: 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?

Answer: Any premium split will be determined once proposals are in hand and the impact on staff is better understood. The Embassy will collect any share from local staff and pay the vendor directly as explained in G.4.3 U.S. Government Employees. The Government shall make payments directly to the Contractor for all Government employees, whether or not the employee is contributing to the basic premium amount.

Question 13: Would the Embassy accept a proposal from an EU member state insurance company passported in all 27 member states?

Answer: The offeror must hold a license/certificate/-accreditation, which demonstrates that the offeror is licensed/certified/accredited or otherwise authorized by the Government of the Republic of Latvia or its agent (e.g., insurance commission, board) to provide health insurance coverage to persons (to include organizations, companies, groups) within the host country. If the offeror is not licensed/certified/accredited or otherwise authorized by the Government of the Republic of Latvia it must demonstrate that it is licensed/certified/accredited by a government other than the Republic of Latvia to provide health insurance for persons in the Republic of Latvia and must demonstrate its capacity to provide health benefits in the Republic of Latvia. Please refer to Section L, Paragraph L.4.3 in the solicitation.

Question 14: Would 2 % tax based on James Zadroga Act be applicable to this solicitation?

Answer: The 2 % tax based on the James Zadroga Act applies to this solicitation. However, the offeror may seek relief by submitting a completed W-14 and completing the parts related to exemptions (i.e., international agreements/qualified income tax treaties, international procurement agreements, or goods/services produced/performed in the U.S.).

Unless exempted, there is a 2 percent tax of the amount of a specified Federal procurement payment on any foreign person receiving such payment. See 26 U.S.C. 5000C and its implementing regulations at 26 CFR 1.5000C-1 through 1.5000C-7.

The Offeror would claim an exemption from the withholding by using the Department of the Treasury Internal Revenue Service Form W-14, Certificate of Foreign Contracting Party Receiving Federal Procurement Payments, available via the internet at www.irs.gov/w14. Any exemption claimed and self-certified on the IRS Form W-14 is subject to audit by the IRS. Any disputes regarding the imposition and collection of the 26 U.S.C. 5000C tax are adjudicated by the IRS as the 26 U.S.C. 5000C tax is a tax matter, not a contract issue. The IRS Form W-14 is provided to the acquiring agency rather than to the IRS. Please refer to Section K, Paragraph K.14(b) in the solicitation.

Question 15: Would DBA insurance be applicable to this solicitation?

Answer: DBA insurance is not applicable as Latvia is listed on Department of Labor waiver.

Question 16: Eligible dependents – is it meant that they should reside within the same country as their parents or do they need to be covered under the insurance even though they reside temporary in a different country due to studies?

Answer: Coverage is optional for dependents (see Section C.1.4.1.2 for definition of dependents). The solicitation does not specify whether medical expenses incurred outside of Latvia are covered. Prevailing local practice is allowed, and the offeror may make a determination whether there will be reimbursement for medical expenses incurred outside Latvia.

Question 17: The HIV/AIDS benefit under section C.1.1.15 does not specify the annual maximum limit. Could you please provide the annual maximum limit for HIV/AIDS coverage?

Answer: There is no specified annual maximum limit for HIV/AIDS benefit under section C.1.1.15 and this benefit, if selected by post, does not count toward the maximum annual coverage per covered individual employee, dependents) per contract year. There is no reimbursement for expenses that will be reimbursed or paid directly under a host country medical program or workers' compensation program, the U.S. workers' compensation program, or post's LE Staff workers' compensation program.

Question 18: Please provide average insured member counts for the last 5 years – 2023, 2022, 2021, 2020 & 2019. 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:

Question 19: When is the plan likely to commence?

Answer: The Government anticipates that this contract will be awarded and in place by October 1, 2024.

Question 20: You ask to provide prices for 5 years. Are the prices for additional 4 years indicative (not binding) or real (binding)?

Answer: The prices are binding and cannot be changed. The only exception is for an Economic Price Adjustment as described in Section B.4

Question 21: What is the maximum coverage for dependents? Are there differences in coverage amounts for employee and dependent?

Answer: The maximum coverage for dependents is the same one as for employees: EUR 6,000. Please refer to Section C, Paragraph C.1.2 in the solicitation.

Question 22: What is rehabilitative services and devices? How can we decide what is treatment and what is rehabilitative service for children?

Answer: Rehabilitative services and devices are described in C.1.1.14. Rehabilitative and habilitative services are therapeutic services that are provided to children and adults with disability (genetic conditions, conditions present from birth or gained after trauma or serious illness) to enhance the individual’s ability to function. Therapy can take place in in-patient or out-patient setting. Rehabilitative devices are devices that patients need to aid in their recovery after an injury or illness, maintain function or prevent its loss, sustain their health, or help them gain new skills for independence. Examples of rehabilitative devices may include walkers, canes, crutches, glucose monitors, low vision aids, communication devices, wheelchairs, etc. Rehabilitative services and devices are prescribed by health practitioners.

Question 23: What is a minimum and maximum of the policy premium?

Answer: Policy premium is determined by the prospective offeror in their proposal. The solicitation does not proscribe minimum and maximums for policy premiums. Please refer to Section B in the solicitation.

Question 24: Are the medical services provided only in Latvia or also in other countries for the citizens of Latvia?

Answer: The solicitation does not specify whether medical expenses incurred outside of Latvia are covered. Prevailing local practice is allowed, and the offeror may decide whether there will be reimbursement for medical expenses outside Latvia.

Question 25: For evaluation of proposals, what is the most important for you: the good and wide range of benefits (good quality) or the good price?

Answer: Proposals will be evaluated in two phases: a technical evaluation to determine the acceptability of the offer to the solicitation technical requirements; and a price evaluation to determine the total evaluated price proposed by each offeror. The award selection will go to the lowest priced, technically acceptable, responsible offeror. In the event of equal proposals, the offeror proposing the most generous plan, in terms of benefit to the Government will receive the award. Please refer to Section M in the solicitation.

Question 26: How will proposals be evaluated if each company provides different levels of different benefits? What will be more important: price or benefit levels?

Answer: Please see the answer to Question 25.

Question 27: What is the current policy premium price?

Answer: That information will be of no value for the new contract as the benefit levels are different.

Question 28: Optical care: It is mentioned that the maximum coverage is for every two years. Is it possible to provide a one-year limit in the proposal?

Can we provide prices per annual caps (yearly prices) instead of two-year cap (Optical care) and four-year cap (Orthodontia)?

Answer: Yes, a one-year limit may be calculated proportional to the multiple year cap. The bids may be based on what is reasonable and customary in the country.

Question 29: Dental care (Dentistry): What do you mean by treatment? Dentistry is quite wide.

Answer: Examinations and Treatment: Dentist’s fees, x-rays, examinations and treatment, cleanings, fillings, extractions, false teeth, crowns, and bridges. (C.1.1.11)

Question 30: Is Orthodontia additional treatment? It is mentioned separately. Is there any age limitation for that?

Answer: Yes, orthodontia is in addition to the dental care cap. Orthodontia treatment is 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 per covered individual. The maximum coverage is EUR 2,198.40 lifetime limit. A one-year limit may be calculated proportional to the four-year cap, but it may not exceed the four-year limit. Please refer to Section C, Paragraph C.1.1.11 in the solicitation.

Question 31: Are all policy premiums paid by the Embassy? Is there a split payment between the Embassy and an employee? It might change the risks if employees will pay themselves.

Answer: Any premium split will be determined once proposals are in hand and the impact on staff is better understood. The Embassy will collect any share from local staff and pay the vendor directly as explained in G.4.3 U.S. Government Employees. The Government shall make payments directly to the Contractor for all Government employees, whether or not the employee is contributing to the basic premium amount.

Question 32: If we miss something when submitting the proposal, will you exclude us or give a chance to submit the necessary information additionally?

Answer: The Government intends to evaluate proposals and award a contract without discussions with offerors. Therefore, the offeror’s initial proposal should contain the offeror’s best terms from a cost or price and technical standpoint. The Government reserves the right to conduct discussions if the Contracting Officer later determines them to be necessary. If the Contracting Officer determines that the number of proposals that would otherwise be in the competitive range exceeds the number at which an efficient competition can be conducted, the Contracting Officer may limit the number of proposals in the competitive range to the greatest number that will permit an efficient competition among the most highly rated proposals as prescribed in FAR 52.215-1, "Instructions to Offerors - Competitive Acquisition” . Please refer to Section M in the solicitation.

Bids may be based on what is reasonable and customary in the country.

Question 33: How do we know about prescribed / not prescribed services?

Answer: Offerors may determine the required health documentation to justify medical services received. Such documentation must be in sync with local prevailing practice. See Section C.l.3 Exclusions and Limitations.

Question 34: What services are included in dentistry?

Answer: Please see the answer to Question 29.

Question 35: Can we provide maximum amounts, more than is requested as minimum amount?

Answer: Coverage limits may be lower or higher than set forth in the solicitation document as long as the amounts are based on what is standard market practice.

Question 36: Can benefits be adjusted if something is not offered, not included in the original proposal?

Answer: The Technical Evaluation Panel may ask the Contracting Officer to conduct negotiations with offerors within the competitive range, if necessary. Please refer to Section M in the solicitation.

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