Questions and Answers June 26.pdf

RFP19PE5023R0005 – LES Health and Life Insurance Services

Questions and Answers

1.Q: For US Embassy employees, do they require health insurance providers available in both Peru and USA? Or any registered insurer (insurance provider) in Peru?

1.A: Section C.1, second paragraph: “Health insurance coverage set forth in this section shall be provided to the USG from primary health insurance providers registered as an “Empresa

Prestadora de Salud” (EPS) or designated representatives licensed for this purpose in Peru.”

2.Q: For life insurance, are US Embassy employees available for USA-based policies, only? Or can both USA and Peru policies be represented?

2.A: U.S. Embassy employees are not eligible for USA-based life insurance policy. The U.S. Embassy provides local employees with life insurance in accordance with Peruvian law and a supplemental life insurance. Please refer to the Request for Proposal Part II Group Life

Insurance (Pages 20 – 25)

3.Q: If both policies can be represented, which priority would the RFP be formatted so that I can include an "alternative version" to represent an alternative option? Example: Priority is on USA-based policies and RFP would represent this lowest cost. The alternate version would represent the lowest cost available between USA and Peru policies.

3.A: An alternative version or option changing the minimum requirements is not acceptable.

4.Q: If life policies offered must be USA-based, how does a USA-based life insurance agent get registered with the appropriate Peruvian agency or government office?

4.A: It is the offeror’s responsibility to obtain all required permits and registration required by the

Peruvian Government and provide such information as part of their technical proposal. H.6.1.

General. The Contractor shall take all such steps as are necessary, and obtain and pay for all permits, taxes and fees as are required by the Peruvian government to establish and/or operate a commercial venture locally. A contract with the U.S. Government conveys no special privileges or immunities to the Contractor.

5.Q: Does the USA-based insurance agent have until the start of the award to get registered with the appropriate Peruvian agency or government office?

5.A: 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, at no additional cost to the Government. The Contractor shall perform this contract in accordance with local laws.

6.Q: Is the government entity submitting the RFP on behalf of the insurance agent required to also be registered with an appropriate Peruvian agency or government office? Example: I am the government entity submitting the RFP on behalf of the insurance agent submitting the lowest cost available and writing policies. The insurance agent is registered but I am not. Please advise.

6.A: Section C.1, second paragraph: “Health insurance coverage set forth in this section shall be provided to the USG from primary health insurance providers registered as an “Empresa

Prestadora de Salud” (EPS) or designated representatives licensed for this purpose in Peru.”

7.Q: Can we find out the number of insurance agents/people attend this event? My purpose is to know how many people are potentially interested in submitting an RFP. In other words, competitive bidding details.

7.A: No. This information cannot be disclosed.

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

2018. 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.

8.A: Estimated insured member counts from 2018 to 2022 is 1,350.

9.Q: Is the claims data provided under Section J-Exhibit A of the solicitation a combined claims data for Health and Life? If yes, please provide a breakup of Health and Life claims data separately.

9.A: Claims data under Section J-Exhibit A corresponds to health care portion only.

10.Q: Please confirm the correct estimated payroll amount to be used when calculating the premiums, as there is a discrepancy between the estimated monthly payroll for "Life Insurance by Law" and "Supplemental Life Insurance" stated in the price tables under Section B.6.

10.A: The amount of the supplemental life insurance will be corrected to S/ 4,451,778.72. It is the same amount as the Life Insurance by Law. Amendment 1 has been issued to reflect this change.

11.Q: In the price tables under Section B.6, the column “Premium (per 1000 USD)” indicates the currency as USD, whereas the Estimated Payroll and Total Premium columns indicate the currency as Soles. Please confirm the currency in which the “Premium” column must be updated.

11.A: The price tables under Section B.6, column “Premium” should read: “Premium (per 1000 Soles).

Amendment 1 has been issued to reflect this change.

12.Q: Please provide the salary census data that includes the age, gender, and annual salaries (include currency) of the employees, as the life insurance coverage is based on the employee salaries.

12.A: Please see Exhibit K attached.

13.Q: When is this plan likely to commence?

13.A: Effective starting date of the contract is October 1, 2023

14.Q: In order to make an economic proposal, it is necessary to have essential information, which is in the custody of your current insurer “Empresa Prestadora de Salud” and it is information that is requested for all public or private tenders.

The details of the required information reports are listed below and it is expected to be received in MS Excel format:

HEALTH INSURANCE reports:

14.a.Q: Monthly premium and claims summary:

• Summary of population, premiums and claims by month of the last 5 years.

• This report must be sent with separate information between the Embassy and

Riders

14.a.A: Please see Exhibits G, H, I and J attached. Premium information cannot be disclosed.

14.b.Q: Claims report:

• Worksheet detailing the claims of the last 5 years, containing at least the following information:

✓ Date of attention/service

✓ Company name

✓ Patient (for confidentiality the real name of the patient is not included, but a label or coding is required to identify the different patients). For example: Patient 1, Patient 2, etc.

✓ Patient age

✓ Patient gender

✓ Name of the provider or clinic where care was performed.

✓ Coverage name which the care was performed.

✓ Diagnosis

✓ Diagnosis code CIE10

✓ Description or name of the health plan in which the patient is located

✓ Benefit paid in soles (S/.)

14.c.A: Please see Exhibit G attached. Some information requested may not be disclosed.

14.d.Q: Report of current insured members:

• Worksheet with information on current insured members that contains at least the following information:

✓ Members code

✓ Description of the type of member: employee, spouse, child, etc.

✓ Member's full name

✓ Birth date

✓ Gender

✓ Age

✓ Description or name of the health plan in which the member is located

14.d.A: Please see Exhibit J attached. Some information requested may not be disclosed.

14.e.Q: Warranty Letters Report:

• Worksheet with information from the last 3 months of the letters of warranty that contain at least the following information:

✓ Warranty letter date

✓ Amount S/.

✓ Diagnosis

✓ Diagnosis code CIE10

✓ Members code

✓ Patient (for confidentiality the real name of the patient is not included, but a label or coding is required to identify the different patients). For example: Patient 1, Patient 2, etc.

✓ Name of the provider or clinic where care was performed.

✓ Company name

✓ Description or name of the health plan in which the patient is located.

14.e.A: Please see Exhibit L attached. Some information requested may not be disclosed.

14.f.Q: Current health plan: The health plan for the 2022-2023 period that applies to the different groups of current members is required, containing the current co-payments and coinsurance for Coverage, insured sums or limits applicable to each coverage and the current premiums for family composition.

14.f.A: Offerors need to provide their proposals based on the requirements stated under the Request for

Proposal 19PE5023R0005.

Life Insurance by Law reports:

14.g.Q: Annual premium and claims summary: Summary of premiums and claims by year for the last 5 years.

14.g.A: Information cannot be disclosed.

14.h.Q: Claims report: Worksheet detailing the claims of the last 5 years, containing at least the following information:

✓ Date of attention/service

✓ Company name

✓ Patient (for confidentiality the real name of the patient is not included, but a label or coding is required to identify the different patients). For example: Patient 1, Patient 2, etc.

✓ Coverage name

✓ Diagnosis or cause of death

14.h.A: Please see Exhibit M attached. Some information requested may not be disclosed.

14.i.Q: Additional Information:

• Confirm if it is necessary to incorporate additional coverage. If required, the name of the coverage and the insured sum to be considered must be stipulated.

14.i.A: No additional benefits required.

14.jQ: Confirm the highest monthly salary declared under this insurance. The member's name is not required, but it is necessary to confirm the highest amount of the monthly return.

14.j.A: The highest monthly salary amount is S/. 32,201.92

14.k.Q: Confirm the maximum age of the affiliates declared under this insurance.

14.k.A: Please see Exhibit K attached.

Supplemental Life Insurance reports:

14.l.Q: Annual premium and claims summary: Summary of premiums and claims by year for the last 5 years.

14.l.A: Information cannot be disclosed.

14.m.Q: Claims report: Worksheet detailing the claims of the last 5 years, containing at least the following information:

✓ Date of attention/service

✓ Company name

✓ Patient (for confidentiality the real name of the patient is not included, but a label or coding is required to identify the different patients). For example: Patient 1, Patient 2, etc.

✓ Coverage name

✓ Diagnosis or cause of death

14.m.A: Please see Exhibit M attached. Some information requested may not be disclosed.

14.n.Q: Additional Information: Confirm if it is necessary to incorporate additional coverage. If required, the name of the coverage and the insured sum to be considered must be stipulated.

14.n.A: Not required.

14.o.Q: Confirm the highest monthly salary declared under this insurance. The member's name is not required, but it is necessary to confirm the highest amount of the monthly return.

14.o.A: The highest monthly salary amount is S/. 32,201.92

14.p.Q: Confirm the maximum age of the affiliates declared under this insurance.

14.p.A: Please see Exhibit K attached.

15.Q: B.2. PRICES - The estimated amount of Premiums without Riders is stipulated. However, it is requested to confirm the way the premium for Riders should be presented and if this premium is part of the calculation to evaluate the winner of the contest.

15.A: Premiums for Riders must be the same as for all other employees actually employed/enrolled.

16.Q: B.3 ADMINISTRATIVE RETENTION AMOUNTS - It is required to explain with as much detail as possible what you mean by Retention Amount and what is the purpose of defining it.

16.A: The retention amount is part of the premium and may include, but not be limited to, such costs as overhead and general and administrative costs. It will also include any profit. Essentially, it includes all costs except the actual portion of the premium intended to fund claims paid to the health care provider/claimant.

17.Q: B.6 GROUP LIFE INSURANCE RATES

“… The fixed prices/premium rates are stated in Peruvian Soles per one thousands of salary to provide life insurance …”. It is reported that Life Insurance policies are issued with a rate that is applied to the total declared payroll, which will be equivalent to the economic proposal sent in the corresponding table.

17.A: Please see answer No. 11 above.

18.Q: It is requested to confirm if there is a representative of the insurer at the headquarters of the US

Embassy, in order to facilitate the service and communication with the insured.

18.A: The current service provider has a broker operating as their representative. C.1 paragraph 2, states: Heath insurance coverage set forth in this section shall be provided to the USG from primary health insurance providers registered as an “Empresa Prestadora de Salud” (EPS) or designated representatives licensed for this purpose in Peru. If a company prefers to work through a broker or have a broker operate on their behalf, this shall be permitted. The agreement between the broker and the company shall be submitted as part of this offer. The contract for the services will be between the USG and the company providing the services.

19.Q: C.1.1 Employee and Dependent Health Service Benefits

The minimum coinsurance for coverage is stipulated, but the co-payment to be considered has not been defined. Please confirm if there is a minimum and/or maximum co-payment for each coverage.

19.A: There is no minimum and/or maximum co-payment for each coverage. Offeror must determine it.

20.Q: C.1.1.9 Hearing Aids: 80% Minimum Coverage

A limit of US$1,500 has been established, but coverage caps are required to be in the same currency as the entire health plan. It is requested to stipulate the limit in soles so that all insurers trade under the same parameters.

20.A: The limit in Soles is S/.5,700.00 Amendment 1 has been issued to reflect this change.

21.Q: C.1.1.10 Optical Care: 80% Minimum Coverage

A limit of US$ 300 has been established, but coverage caps are required to be in the same currency as the entire health plan. It is requested to stipulate the limit in soles so that all insurers trade under the same parameters.

21.A: The limit in Soles is S/.1,140.00. Amendment 1 has been issued to reflect this change.

22.Q: C.1.1.11 Dental Care: 80% Minimum Coverage

A limit of US$ 3,200 has been established, but coverage caps are required to be in the same currency as the entire health plan. It is requested to stipulate the limit in soles so that all insurers trade under the same parameters.

Orthodontia: A limit of US$ 2,400 has been established, but coverage caps are required to be in the same currency as the entire health plan. It is requested to stipulate the limit in soles so that all insurers trade under the same parameters.

22.A: Dental Care - The limit in Soles is S/.12,120.00. Amendment 1 has been issued to reflect this change.

Orthodontia - The limit in Soles is S/.9,120.00. Amendment 1 has been issued to reflect this change.

23.Q: C.1.1.15 HIV/AIDS: 100% up to USD 10,000 per contract year per covered individual. A limit of

US$ 10,000 has been established, but coverage caps are required to be in the same currency as the entire health plan. It is requested to stipulate the limit in soles so that all insurers trade under the same parameters.

23.A: The limit in Soles is S/.38,000.00. Amendment 1 has been issued to reflect this change.

24.Q: C.1.7 PRE EXISTING CONDITIONS

“Coverage of pre-existing conditions will be extended to all employees actually employed/enrolled and dependents, parent, retirees and RIF employees at the time the contract is signed. If an employee wishes to enroll or re-enroll at a later date, pre-existing conditions will not be covered”. It is clarified that the guidelines of local law regarding the treatment of pre-existing conditions primes over what it is requested in this document.

24.A: Under medical plans with GMC benefit levels, LE Staff employees and their dependents will be covered for pre-existing conditions.

25.Q: C.2.1.2. Mandatory Life Insurance (Peruvian Law 688)

“Employees receive the following levels of life insurance coverage after nine (9) months of service”. Within Peruvian law it is stipulated that Life Insurance coverage must be granted from the first day of work.

25.A: Amendment 1 has been issued to reflect this change.

26.Q: G.5 REFUNDS TO THE GOVERNMENT. Could you specify in which scenarios and times the return would be made to the Embassy?

26.A: G.5 explains under what situations would the contractor be required to reimburse the Embassy.

27.Q: G.6 “VALUE ADDED TAX (VAT). The Contractor shall include VAT as a separate charge on the

Invoice and as a separate line item in Section B”. It is requested to confirm that the VAT refers to the IGV that is applied as a tax in Peru.

27.A: Correct. VAT refers to the IGV tax applied in Peru.

28.Q: B.2.8. Grand Total of Base plus All Option Years - The amounts in this table should included IGV?

(page 5)

28.A: Correct. Total amount under B.2.8 shall include IGV tax.

29.Q: MINIMUM AND MAXIMUM AMOUNTS - What topic are you referring to, the minimum and maximum amounts in the paragraph? During the base year of the contract, and during the year of the option that could be exercised, the Government of the United States (USG) will place orders for a minimum total of S/.160,000.00. This reflects the minimum contract guarantee for each performance period. The amount of all orders, for base years and all option years will not exceed

S/.40,000,000.00 This reflects the contract maximum."

29.A: Minimum and maximum amounts stipulated are the estimated amounts guaranteed under the contract.

30.Q: HEALTH INSURANCE SERVICES - The mentioned waiting period is for current members, as new members should apply waiting period (page 12)

30.A: All Embassy employees are covered from their first day of employment at the Embassy.

31.Q: C.1.1.1 Hospitalization (Treatment in the Hospital for Inpatient Care): 100% Coverage – The health plan is made up of networks of clinics, in this case all the networks must be 100% or there will be the opportunity to narrow it down to a single network? (page 13)

31.A: Correct. All networks must be 100%. The health plan is setup for various networks which shall include basic, medium and high-level clinics.

32.Q: C.1.1.4 Outpatient Services (ambulatory or reimbursement): 80% Minimum Coverage In outpatient services: we can put deductible

32.A: Yes. Offeror may determine it.

33.Q: C.1.1.4 Outpatient Services (ambulatory or reimbursement): Chemotherapy and radiation treatments are cancer treatments but are in outpatient benefit. Do you want to change it? (page

14)

33.A: Chemotherapy and radiation treatments may be covered under outpatient or under hospitalization.

34.Q: C.1.2 Annual Maximum Limit: we must also consider it for diagnostics (page 14)

34.A: The annual maximum limit is to be considered for all health benefits offered under this plan.

35.Q: C.1.1.5 Obstetric and Newborn Care: Inpatient: 100% Coverage; Outpatient: 80% Minimum

Coverage, we can put deductible? (page 14)

35.A: Yes. Offeror may determine it.

36.Q: C.1.1.15 HIV/AIDS: 100% up to USD 10,000 per contract year per covered individual: Can we consider the national currency? (page 16)

36.A: The limit in Soles is S/.38,000.00. Amendment 1 has been issued to reflect this change.

37.Q: C.1.6 Brochure Requirement: The benefits requested in dollars can be changed to the national currency.

37.A: Yes.

38.Q: C.1.1.16/ C.1.1.17/ C.1.1.18: What does the word RESERVED mean? (pag 18)

38.A: RESERVED means that it does not apply.

39.Q: C.1.6 Brochure Requirement Brochure requested can be digital (pag 18)

39.A: Yes, the brochure can be digital.

40.Q: SECTION E: Actually, who receives the claims is SUSALUD (pag 27)

40.A: All claims regarding unacceptable performance will be processed by the COR and forwarded to the Health Insurance provider for solution.

41.Q: SECTION F: We must attach the clauses or are they only referential (pag 29)

41.A: Clauses under Section F are part of this RFP. No need to attach these clauses.

42.Q: C.1.1.9 Hearing Aids: 80% Minimum Coverage, Is the hearing aid benefit eligible for reimbursement and with a maximum annual coverage limit? (page 14)

42.A: The hearing aid benefit may be on a reimbursable basis following the criteria under C.1.1.9 (page

14)

43.Q: C.1.1.11 Dental Care: 80% Minimum Coverage, Can the dental care benefit be provided on credit and reimbursement and with a maximum annual coverage limit?

43.A: The Dental Care benefit may be provided on credit and reimbursement following the criteria under C.1.1.11

44.Q: C.1.1.19 180 Day Coverage for Dependents After Employee’s Death :For the benefit of medical coverage for the death of the holder. Will the dependents continue to receive the medical service for 180 days, so these days interfere with the end of the contract? (page 16)

44.A: The 180 days of coverage for dependents after employee’s death as long as the contract with the health provider is in effect.

45.Q: Send the detail of insured consigning date of birth and salary.

45.A: Please see Exhibit J attached. Complete information cannot be disclosed.

46.Q: If it cannot be sent with that detail, complete the following table:

Age Range Number of persons Amount of return 18-35 36-45 46-50 51-55 56-60 61-65 over 65

46.A: Please see Exhibit J attached.

47.Q: Please detail in greater depth the premium adjustment mechanism that could be carried out as of year 2.

47.A: It’s the offerors responsibility to present a complete offer and projected premiums for each one-year option period.

END OF QUESTIONS AND ANSWERS