GMC_-_Q&A_-Solicitation__19N10219R4652-0731.pdf

QUESTIONS & ANSWERS ON SOLICITATION #19N10219R4652 FOR GMC

Note to Offerors:

The information contained within these questions and answers is provided for information purposes and under no circumstances shall it be construed to change any terms and conditions or requirements within the solicitation. If any answer does address a change in the solicitation, it will reference an Amendment. In addition, for any answer provided regarding the claims data incurred under the existing contract, please be advised that this data may not be indicative of future claims and could change. Also, offerors are advised that there are changes in requirements in this solicitation which were not in the previous contract.

Therefore, it is each offeror’s decision on whether to use or not to use this information. However, under no circumstances shall the U.S. Government be liable for this data or shall it become basis for a request to adjust the premium rates once the contract is awarded. Rather, offerors are advised any adjustments to contract premium rates shall be in accordance with the Price Adjustment clauses (See 52.216-1) of the contract awarded.

1. What is the spread of your staff?

Ans. The Employees are in Lagos and Abuja while the employees’ dependents are at various states within Nigeria.

2. What is the timeline between the solicitation and the contract award?

Ans. The timeline is approximately 3 months

3. I need more clarification on the retention

Ans. Retention amount is a fixed amount that is part of the premium amount in section B. See

Section B.3.1

4. What is the process requirement for SAM registration?

Ans. It starts with logging on to the website at https://www.sam.gov and following the prompt in filling out the necessary details of your organization.

5. Can you shed more light on the catastrophic clause?

Ans. Catastrophic is a case beyond ordinary medical treatment, rather a traumatic condition; and in most cases the participant’s maximum limit would have been exhausted, in treating the case and at that point the catastrophic rate applies. See Section C.1.2.3 for details

6. Under G.4.4, (Page 29), do you want the riders included in the proposal?

Ans. Yes the riders must be included but not with a different rate. The rates you will provide in section B.2.3 through B.2.7.1 shall cover those under rider.

7. Is SAM registration for individual person or for the organization?

Ans. It is for Organizations.

8. Explain more on the quality assurance clause on complaint management https://www.sam.gov/

Ans. Quality assurance is one of the measures that Government uses in assessing the performance of contractors. See section E. 2

9. Please explain more about the payment cycle/interval.

Ans. Payment interval is within 30 days from the date of invoice submission.

10. Will the annual premium be paid monthly or quarterly?

Ans. Payment shall be on quarterly basis.

11. Will the retention be payable or just the utilization?

Ans. Retention amount is not payable, only the Utilization fee will be paid – See section B.3 for details.

12. Please explain more on the payment in arrears vs payment in advance.

Ans. Payment is made based on utilization. At the end of every quarter, the contractor sends in his utilization report while the Government prepares a document called Task Order using the actual amount incurred within the stipulated time and such amount is paid to the contractor for the quarter.

This is what is referred to as payment made in arrears.

13. How do we handle the administrative costs?

Ans. HMOs determines its best administrative cost in order to have the winning proposal.

14. What are the cost elements to be stated in the quarterly invoices for payment?

Ans. The cost elements to be stated are: the period payment covers and the total amount.

15. What are the medical insurance claims, to be submitted weekly?

Ans. The medical claims to submitted weekly are those claims paid out pocket by the employee –

See Section H.4.for details

16. What is the procedure for co-payment?

Ans. All benefits have percentages apportioned to them. See Section C

17. Is there a maximum limit for each employee?

Ans. Yes, See C.1.1.17

18. What is meant by discount for prompt payment?

Ans. Not applicable in this contract.

19. How do we know your preferred hospitals?

Ans. Our preferred list of hospitals shall be made available on FedBizOpps and the Embassy website – See Section C.1.9, and Exhibit C.

20. Exhibit B has claims history for the past 2 complete years. Could you please provide claims history for health Insurance for the years 2016-17, 2015-16 and 2014-15 as well? 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

Ans. This is GMC, which is entirely new and different from previous Health Insurance Solicitations therefore we do not have past records. Offerors are encouraged to de-emphasis on the provided claims history so we advise that offerors may use the annual maximum limit and the exhibits in Section J as a guide in their proposals.

21. Do the above claim numbers include claims from ORE employees

Ans. No, ORE was not in the previous solicitations, it has just been included in GMC.

22. Premium history for health Insurance for the current year and EACH of the last 5 years - 2019

(till now), 2018, 2017, 2016, 2015, and 2014. 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.

Ans. Answer to question 20 refers, no premium yet. Prospective offerors are advised there are changes in the benefits and requirements set forth in this solicitation versus the Government’s requirements in the current contract. Therefore, offerors should carefully review the benefits and requirements in this solicitation and not focus on the current contract which will be irrelevant on award of a new contract resulting from this solicitation.

23. Average insured member counts for the current year and EACH of the last 5 years - 2019 (till now), 2018, 2017, 2016, 2015, and 2014. 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.

Ans. Exhibits A, D, & E show the average members that will count under this GMC.

24. 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).

Ans. Not known

25. Confirm that the Coverage for Retirees and Extended Family Members (abbreviated as

REFM) classified as Rider Coverage (as in Section G.4.4) will have the same benefits defined in the solicitation but are subject to a different set of rates. The REFM rates will have to be different from the main group because (a) the solicitation does not define REFM risks (i.e.

requirements) by providing claims history of Retirees & Extended Family Members (b) the solicitation does not permit Economic Price Adjustment to include claims from Retirees &

Extended Family Members (Section B.4.1 excludes claims from all Riders). It is common industry practice for pricing (and its adjustment at renewal) to account for the true (i.e.

complete) claims experience and not just a subset of the overall claims.

Ans.Please ignore, not part of the provision.

26. Section M.2. Implies that both ‘Catastrophic Coverage’ and ‘Out of Country Treatment &

Travel’ are Optional coverages but pricing tables in Section B permit pricing only for

Catastrophic Coverage Option and not for the ‘Out of Country Treatment & Travel’ option.

Please clarify the above contradiction

Ans. It is not a contradiction, this means that the rate will not be part of the premium but when such a case arises the rate provided under catastrophic shall apply – See sections B.2, C.1.2.3, and M.2 for details.

27. When is the last date for submission of questions

Ans. The last day for submission of questions shall be July 23, 2019 by 8:00am WAST (GMT+1)