19MK8020R00001 Questions and Answers Volume 2.pdf

American Embassy Skopje

RFP number 19MK8020R0001

Title: LES Supplemental Health Insurance

Questions and Answers, dated May 7, 2020

Proposals receiving end date May 18, 2020/17:00h

Q1: Claims Activity in Prior Periods – The importance of receiving detailed information about historical claims cannot be overstated. The ability to accurately project future claims is the most important issue a prospective insurance company faces when submitting proposals for this solicitation.

We appreciate you have provided the amounts of paid claims for the past two (2) years ending January

31, 2020. However, there are additional details we need to properly understand the past and accurately predict the future. These are details that your current insurance company has and without having them we will be at a significant disadvantage.

Please provide additional information crucial to the development of our rates as follows:

• Please provide claims details including the following information:

o Incurred Date o Type of Insured (Main Insured/Spouse/Children) o Birthdate o Type of Event/Benefit/Coverage use o Paid Amount

In case that this information could not be provided in detail:

• Please provide claims information for the period of February 1, 2020 to the latest period you have the information and please specify that date. Grouped the data by policy period.

• Please provide the number of claims incurred in each period.

• Please indicate the number of claims in excess of US$ 10,000 and the aggregate amount of these claims for each year presented.

• Please indicate maximum, minimum and average claim per policy period.

A1: Please check table below:

Claims in Excess of USD$ 10,000

Total Paid

Amount

(MKD)

Total

Number of claims

Maximum

(Greatest)

Paid

Claim

Minimum

(Lowest)

Paid

Claim

Average

Paid

Claim

Total

Paid

Amount

Number of claims

Feb 1, 2020 -

N/A N/A N/A N/A N/A N/A N/A

Feb 1, 2019 -

Jan 31, 2020 19,000,000 3,097 492,100 160 6,181 N/A N/A

Feb 1, 2018 -

Jan 31, 2019 18,314,317 3,310 414,500 140 5,533 N/A N/A

Q2: Premiums

• Please provide the premium billed in all of the last 2 years, grouped by policy period.

• Please provide average number members during all periods. This is the average number of employees

+ spouses + dependents.

(1) Please advise if the amount includes VAT included let us know the percentage.

A2: Please check table below:

Policy Period

Total Premium (1) Number Main

Insureds (Average)

Number of

Spouse

Number of

Children

2/2020 - 4/2020 MKD 3,633,011.20

Please look at Exhibit A for average numbers as the numbers do not change drastically from year 2018 to 2020.

2/2019 - 1/2020 MKD 21,965,263.80

2/2018 -1/2019 MKD 22,253,209.00

VAT doesn’t apply for this type of service in North Macedonia.

Q3: Exposures

Please Include the detail of the actual Census including:

• Gender

• Type of Insured (Main Insured/Spouse/Children)

• Birthdate

A3: Details described in Exhibit A.

Q4: Limits:

Are there any limits on the number of Children who can be covered?

A4: There is no limit on the children that can be covered.

Q5: Annual Maximum Limit

“ C.1.2 Annual Maximum Limit - The maximum annual reimbursement per covered individual per contract year, not including expenses covered under HIV/AIDS benefits if selected by post, is MKD

615,000.”

The options are being required according to the following groups. Are they "individual covered group"? So, the Maximum for the group is MKD 615,000?

A5: Please check the maximum annual reimbursement for associated groups below:

• Self-Only: One covered individual: The maximum annual reimbursement per contract year, not including expenses covered under HIV/AIDS benefits if selected by post, is MKD 615,000.

• Self Plus One: Two individuals: The maximum annual reimbursement per contract year, not including expenses covered under HIV/AIDS benefits if selected by post, is MKD 615,000 x 2.

• Family: Three or more individuals: The maximum annual reimbursement per contract year, not including expenses covered under HIV/AIDS benefits if selected by post, is MKD 615,000 x number of family members.

Q6: HIV/AIDS. Is this coverage in addition of the general Annual Maximum Limit?

C.1.1.15 HIV/AIDS: Medications to suppress opportunistic infections (such as tuberculosis or toxoplasmosis for covered individuals who have HIV/AIDS). Brief courses of anti-retroviral drugs during childbirth to prevent the transmission of HIV/AIDS to the child. Generally excludes medication for the long-term suppression of HIV/AIDS through the combination of anti-retroviral drugs in locations with inadequate local healthcare infrastructures.

100% up to MKD 567,000 per contract year per covered individual.

A6: Yes, HIV/AIDS benefits, as prescribed in paragraph C.1.1.15 are in addition to the annual maximum limit from paragraph C.1.2, in amount up to MKD 567,000 annually.

Q7: Eligibility

“C.1.5 Eligibility

C.1.5.1 Term of Eligibility and Effective Date

Each current active eligible employee and their eligible dependents are enrolled for health benefits under this contract upon award and thereafter during the performance period of this contract. Each new eligible employee and eligible dependents will be enrolled upon entering on duty with the United

States Government. An employee is considered active ("on the rolls") whenever such employee is on approved leave, whether paid or unpaid.”

According to Section J, the population includes, at least, two (2) people older than 66, and the maximum permanence ages are not defined. We would like to know the following information.

A7: Please check table below:

Main Insured Spouse Children

Minimum Acceptance Age: No limit No limit No limit

Maximum Acceptance Age: No limit No limit 26

Maximum Permanence Age: No limit No limit No limit

For LE Staff the eligibility is tied to employment and not age and a child is covered until the end of the contract year in which s/he reached age 26, unless special circumstances exist

Q8: Minimum coverage: What does this mean?

A8: Section C - DESCRIPTION/SPECIFICATION/WORK STATEMENT specifies either 100% or minimum required coverage for each type of coverage. This allows you to offer your off-the-shelf insurance that might already include more than the required minimum coverage.