QandA_19MJ1926R0001 final.pdf

Questions & Answers

Solicitation # 19MJ1926R0001

1. Premium Adjustment Based on Experience (Five-Year Overview)

Current 5-year contract was awarded with a value of €928,168. Yet actual claims over just 4 of those 5 years already reached €865,200.30, a loss ratio of roughly 93%, before even accounting for retention.

Please provide details of any premium adjustments approved during the current contract, including:

• annual renewal increases,

• the basis for those increases (experience, inflation, census, benefit changes or other),

• whether the adjustments applied prospectively or retrospectively.

Answer: Annual prices were executed as per schedule set forth in B.2 PRICES. The solicitation establishes the methodology for Economic Price Adjustments (EPA) under Section B.4. As stated, during the current performance period, one EPA was applied. EPAs are authorized under FAR 16.203 and FAR 52.216 4, which govern the basis, calculation, and timing of price adjustments. Adjustments under these authorities are generally applied prospectively, unless expressly permitted otherwise in the contract.

2. Financial Overview (Health Insurance)

Contractual Year

Total Claims Paid

(EUR)

Total Premium Paid to Insurer

(EUR)

8/29/2021- 08/28/2022

144,446.71 181,956.06

08/28/2022- 08/28/2023

231,033.63 183,793.74

08/28/2023- 08/25/2024

239,863.34 185,608.28

08/25/2024- 08/23/2025

252,920.94 187,480.54

Base +4 (2025/26) 189,329.66

TOTAL 868,264.62 928,168.28

Could you please provide:

a) aggregated claims breakdown by major benefit category, if available (e.g. inpatient, outpatient, maternity, dental, optical, pharmaceuticals, mental health, catastrophic cases, overseas treatment)

b) missing claims data for Base + 4 contract year

Please distinguish between:

c) paid claims

d) incurred claims (if available)

Answer: If available, the Government may release aggregate, de-identified claims data to offerors. Any such data will be stripped of all Personally Identifiable Information (PII) and Protected Health Information (PHI) in accordance with HIPAA de-identification standards (45 CFR 164.514(b)) and the requirements of Montenegro’s Personal Data Protection Act

(PDPA).

3) Membership Overview (Health Insurance)

Contractual Year Employees Spouses Children 8/29/2021-08/28/2022 08/28/2022-08/28/2023 08/28/2023-08/25/2024 08/25/2024-08/23/2025 Base +4 (2025/26)

Understanding paid premium and claims development in relation to changes in insured population is essential for responsible underwriting.

Answer: Section J covers membership Overview (Male/Femail/Age ranges for employee, spouse and dependent children.

4. Provided AGE RANGES

Could you please provide ages of estimated employees and their dependents in 5 years age ranges.

Answer: Section J covers Age ranges for employee, spouse and dependent children at the Washington approved ranges. The Government has not determined that lower age range information is necessary for preparation of offers.

5. High-Cost / Catastrophic Cases under Health Insurance

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

• Open-heart surgery

• Organ transplants

• Major orthopedic surgery

• Oncology treatments (chemotherapy/radiotherapy)

• Severe trauma

• Hospitalizations exceeding 10 consecutive days

• Individual treatments exceeding EUR/USD 10,000

Please provide the amount of the top 10 largest individual health insurance claims incurred during the last five contractual years (without personal data). Aggregated confirmation (without personal details) would be sufficient.

Answer: We can not provide this level of detail.

6. Preferred Medical Providers

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

Answer: No, there is no established list of preferred hospitals, clinics, or medical providers in Montenegro. The Embassy does not maintain or endorse a specific network of preferred providers for use by Locally Employed Staff (LES) under this contract. Employees and their eligible dependents are free to seek care from the licensed healthcare provider of their choice, and covered services will be reimbursed in accordance with the benefit levels and terms specified in Section C of the solicitation.

7. Utilization outside Montenegro

Please provide approximate percentage of

• claims incurred in Montenegro

• Former Yugoslavia countires

• EU

• other countries

Answer: If available, utilization data for medical services performed outside Montenegro may also be released in aggregate, fully deidentified form, consistent with HIPAA and Montenegro PDPA requirements. No identifiable personal or health data will be disclosed.

8. James Zadroga Act

Please confirm whether offerors should include any amount relating to the withholding provisions under FAR 52.229-12 / 26 U.S.C. §5000C in their proposed prices, or whether any applicable withholding will be administered separately during contract performance in accordance with the contract clause.

Answer: The James Zadroga 9/11 Health and Compensation Act is a U.S. statute applicable solely to 9/11related medical monitoring and benefits. It does not apply to this solicitation or the LES Health Insurance program in Montenegro.

9. Defense Base Act (DBA)

Section L of the solicitation requires offerors to include Defense Base Act (DBA) insurance premium costs for employees working under the contract. All contractor employees who would perform services under this contract (e.g. policy administration, customer service, claims coordination and contract management) are locally employed in Montenegro.

Could the Embassy please confirm whether the requirement to obtain DBA insurance applies to such locally employed personnel, or whether the reference to DBA is intended only for categories of personnel that are legally subject to the Defense Base Act?

Answer: The Offeror shall include Defense Base Act (DBA) insurance premium costs covering all employees working on the contract, to include:

• American citizens;

• Individuals hired in the United States or its possessions, regardless of citizenship;

• Host Country Nationals (HCNs); and

• Third Country Nationals (TCNs) working overseas.

This requirement applies to all personnel performing services under the contract — including the locally employed personnel in Montenegro described in your question (policy administration, customer service, claims coordination, and contract management). Offerors shall obtain DBA insurance directly from a Department of Labor-approved provider, as listed at: http://www.dol.gov/owcp/dlhwc/lscarrier.htm

Offerors should include the associated DBA insurance premium costs for all such employees in their proposed prices, consistent with the requirements of Section L.

10. Residency Requirement for Dependents

For covered dependents (e.g., students), is residency in Montenegro mandatory required pre-condition to maintain eligibility for coverage?

Answer: No.

http://www.dol.gov/owcp/dlhwc/lscarrier.htm

11. 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?

Answer: The Contracting Officer will consider whether an extension of the proposal due date is warranted , taking into account the nature and complexity of any amendment or clarification issued and the amount of time offerors reasonably need to incorporate that information into their proposals.

If the Contracting Officer determines that an amendment or set of answers issued close to the current due date (14 August 2026, 17:00 CET) materially affects the ability of offerors to prepare a responsive proposal, the Government may extend the proposal deadline. Any such extension will be communicated to all prospective offerors in writing through a formal solicitation amendment, in accordance with FAR 52.215-1, Instructions to Offerors— Competitive Acquisition (incorporated by reference in Section L).

Offerors should not assume an extension will be granted and should plan to submit a complete, compliant proposal by the current due date unless and until a written amendment states otherwise. If you have concerns about the time available to respond to a particular clarification or amendment, you are encouraged to raise that concern promptly with the point of contact identified in the solicitation (PodgoricaSolicitations@state.gov), so the Contracting Officer can consider it.

12. Direct Billing

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

Answer: No. The solicitation does not require the Contractor to establish a local provider network or direct billing arrangement for outpatient services. The contract is a reimbursement model, not a direct billing model.

13. OTC Medication

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

Answer: C.1.1.7. Medications prescribed by a licensed health care provider that are medically required are reimbursable. 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, contraceptive medication.

14. Premium Contribution

Please clarify if employees contribute toward:

a) Their own premium? Yes

b) The premium for covered dependents? YES

Answer: Employees contribute toward the premium depending on the plan they choose.

15. Electronic Delivery of Documents

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

Answer: Yes, it is acceptable.

16. Electronic Claims Submission

Section H.4.b.1. references physical submission of claims via drop box.

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

Answer: Yes.

17. To ensure your organization receives the most competitive and comprehensive employee benefits proposal, we will need an employee census rather than summary employee statistics.

While statistical reports provide a general overview of your workforce, insurance carriers use individual census data to accurately evaluate risk, determine eligibility, calculate premiums, and develop benefit recommendations tailored to your employee population.

Without a complete census, insurers are often unable to provide firm quotations and may instead offer assumptions-based estimates that can result in inaccurate pricing, limited plan options, or coverage that does not adequately meet the needs of your employees and their families.

Please note that the requested census does not require personally identifiable information (PII) such as employee names, Social Security numbers, addresses, telephone numbers, email addresses, or employee identification numbers. The information requested is demographic and underwriting data only and is the standard information required by international insurance carriers.

For your convenience, I have attached an Excel template containing the required fields. You are welcome to use this template or provide the information in your existing format, provided it includes the following data for each employee requesting coverage:

• Date of Birth

• Gender

• Coverage Tier (Employee Only, Employee + Spouse, Employee + Child(ren), Family, etc.)

• Home Country (Country of Citizenship)

• Host Country (Country of Assignment)

If the RFP includes Group Life Insurance and/or Long-Term Disability coverage, please also include:

• Annual Salary

• Occupation or Job Title

Providing a complete census at the beginning of the procurement process enables participating insurers to prepare accurate proposals, present the broadest range of plan options, and ensure that your organization receives pricing and coverage designed to best protect your employees and their eligible dependents.

Answer: Section J covers Age ranges for employee, spouse and dependent children at the Washington approved ranges. The Government has not determined that lower age range information is necessary for preparation of offers.

Part 2 Solicitation # 19MJ1926R0001

18. Are Montenegrin nationals employed as LES by the U.S. Embassy Podgorica registered with and covered by the Montenegro Health Insurance Fund (FZO) / mandatory public health insurance system?

Answer: Yes, all Locally Employed Staff (LES) are registered and covered by Montenegro Health Insurance Fund.

19. Do LES employees and/or their dependents currently use the public healthcare system/FZO for any medical treatment, or are their medical expenses generally handled exclusively through the Embassy’s private medical insurance?

Answer: LES and their eligible dependents can choose whether they want to use the public healthcare system (FZO) or rely on the Embassy’s private medical insurance.

Both options are available to them.

20. Is there any coordination between the Embassy’s private medical insurance and the

FZO/public healthcare system, for example where certain medical services are first provided or covered through the public system?

Answer: No, there is no coordination between the private medical insurance and the public healthcare system.

21. Where an employee receives treatment at a private medical facility, is there any practice of subsequently claiming reimbursement of eligible medical expenses from FZO?

Answer: No.

22. To your knowledge, has the current or any previous Embassy health insurer recovered, directly or indirectly, any portion of medical claims from FZO or another part of Montenegro’s public healthcare system?

Answer: Not to our knowledge.

23. If available, could you please provide an indication of the approximate proportion of healthcare utilized by LES employees and dependents through the public/FZO system compared with the Embassy’s private medical insurance?

Answer: The Embassy does not have information.

24. Considering the importance of the responses to offerors’ questions for preparation of the proposal, would the Embassy consider extending the proposal submission deadline if the answers are not published at least five working days before the current submission deadline?

Answer: The Contracting Officer acknowledges the importance of Government responses to offeror questions in the preparation of a responsive, well-priced proposal. Consistent with FAR 52.215-1, Instructions to Offerors—Competitive Acquisition (incorporated by reference in Section L), the Contracting Officer will evaluate whether an extension of the proposal submission deadline is warranted based on the nature, scope, and timing of any clarifications or amendments issued to this solicitation.

If the Contracting Officer determines that responses issued close to the current due date materially affect offerors' ability to prepare a compliant proposal, the Government will extend the proposal deadline by formal written amendment issued to all prospective offerors.

Offerors shall not assume that an extension will be granted and must plan to submit a complete, compliant proposal by the current deadline of 14 August 2026, 17:00 CET, unless and until a written solicitation amendment states otherwise.

25. During the proposal conference, the Procurement Supervisor clarified that, at this stage, offerors are only required to obtain a quotation for the cost of Defense Base Act (DBA) insurance, while the actual policy needs to be purchased only by the successful offeror following contract award.

Could you please confirm whether offerors are expected to:

• include the DBA quotation as supporting documentation with the proposal; and/or

• include the quoted DBA insurance cost in the offered premium/contract price?

Answer: Offerors should include the DBA insurance quotation as supporting documentation with their proposal.

The quoted DBA cost must be incorporated into the overall offered premium/contract price, but the actual policy purchase is deferred until after contract award.

To ensure the Government has adequate time to prepare and issue responses, and to provide all offerors a sufficient and equitable window to incorporate Government responses into their proposals, the deadline for submission of additional offeror questions has passed. No further questions will be accepted or answered under this solicitation. This is consistent with the timing principles in FAR 5.203 and FAR 52.215-1(b), which contemplate that offerors submit questions with sufficient lead time to allow a reply to reach all prospective offerors before the submission of proposals.

All official communications, clarifications, and amendments will continue to be transmitted exclusively through PodgoricaSolicitations@state.gov. Oral explanations or instructions given before award are not binding on the Government.

mailto:PodgoricaSolicitations@state.gov