Q&A-MPak_LE_Staff_Health_Ins_Pre-Sol_(19R5897).pdf

Q&A from Pre-Proposal Conference for U.S. Mission Pakistan Locally Employed Staff Page 1 of 7

To: Prospective Offerors

From: Jamison F. Pixley – U.S. Government Contracting Officer

Date: January 17, 2019

Subject: Questions & Answers for solicitation #19PK33-19-R-5897 for U.S. Mission Pakistan Locally

Employed Staff Health Insurance

Q.1) Local law under SECP clause 58 requires the employer to pay the insurance provider in advance.

Will the USG honor the local law?

Ans: Yes, We will pay the insurer at the beginning of cover period. Upon receipt of task order the insurer will submit invoice which will be paid within thirty days from the day the invoice is received. (see G.4.2).

Q.2) What is the retention amount? How it should be calculated?

Ans: Retention amount includes all costs except the actual portion of the premium intended to fund claims paid to the health care provider/claimant. It is not directly impacted by Economic Price

Adjustment, which allows the contractor and Government under certain circumstances to revise premium rates upward or downward based on claim experiences. During price revisions these retention amounts play an important role and cannot be revised. Therefore, it is in the benefit of the Government and contractor to have this amount as fixed cost instead of percentage.

The retention amount is part of the premium and may include, but not be limited to, such costs as overhead and general, administrative costs, and profit. Refer to the solicitation section B.3 for more details. (see B.3 of the solicitation for further details)

Q.3) What kind of ear surgery will be covered under this contract? Are Hearing Aids covered?

Ans: 100% reimbursement of ear surgery and related tests for ear surgery as mentioned in C.1.1.1.

Hospitalization clause. All types of ear surgery should be covered per the contract, to include tests related to ear surgery. Hearing aids are not covered, but all tests and procedures related to the prescription of hearing aids are covered.

Q.4) Solicitation does not include any percentage for non-panel hospitalization. What will be the percentage of reimbursement for non-panel hospitals?

Ans: There is no separate threshold or percentage for panel and non-panel hospitalization. All expense shall be reimbursed in accordance with C.1.1.1.

Q.5) Will the related medicines for dental care be reimbursed? Reimbursement of 60% for dental care will be based upon particular bill amount or on total limit?

Ans: Yes, all medicines related to dental care will be reimbursed. The 60% reimbursement rate for dental care will be based on each medical bill.

Q.6) Is there any HIV case recorded in past five years? If not, then what is the significance to have it in the contract?

Ans: USG cannot share this information. .

Q&A from Pre-Proposal Conference for U.S. Mission Pakistan Locally Employed Staff Page 2 of 7

Q.7) PKR 600,000 Per annum/per family is the limit for maximum benefit level. Is it further divided into IPD, OPD, or any other categories?

Ans: There is no bifurcation of the maximum benefit level. The total amount of claims paid under any section, such as general hospitalization, maternity, dental treatment, OPD etc., in a contractual year shall not exceed claims paid to the maximum limit of Rs.600, 000.00.

Q.8) Will the resultant policy exclude treatment through non-licensed physicians/clinics, Hakeem, Quakes and homeopathic?

Ans: Yes, resultant contract shall neither cover treatment from non-licensed physicians nor the treatment from homeopathic doctors, Hakeems and Quakes are covered.

Q.9) Is expense incurred at non-panel facilities, reimbursable on 100% basis?

Ans: Yes, as per benefit level.

Q.10) When this contract is expected to be awarded?

Ans: We expect to award this contract prior to June 2019.

Q.11) Can an offeror submit their proposal in both electronic and hard copy?

Ans: No, electronic copies are not acceptable. Proposals must be submitted in hard copies and must be received within due date/time.

Q.12) Will the same terms/conditions be applicable to the riders? Who will be responsible for payments related to their premium?

Ans: Yes, same terms/conditions shall be applicable for riders. Their employer will be responsible for payment of their premium. (See C1.3.3.1 and G.4.4)

Q.13) There are two paragraphs carrying the same number G.4.2, which one is applicable?

Ans: We will amend the solicitation to delete “Alternate A.”

Q.14) Can you share claim history of 2018?

Ans: Claims that were reimbursed between Dec. 2017 and Dec. 2018 are worth PKR

151,009,161.

Q.15) What is the number of US citizens (expats) to be insured?

Ans: Currently numbers are less than ten.

Q.16) What is the number of Third Country Nationals (TCNs) to be insured?

Ans: Currently no TCN is under coverage.

Q&A from Pre-Proposal Conference for U.S. Mission Pakistan Locally Employed Staff Page 3 of 7

Q.17) What is the number of locally employed nationals to be insured?

Ans: 1,490 plus.

Q.18) What is Defense Base Act Premium Cost? (Section B.2. Prices)

Ans: The Defense Base Act (DBA) provides workers' compensation protection to employees working outside the United States under a contract with the United States government for public works.

The DBA is an extension of the U.S. Longshore and Harbor Workers' Compensation Act

(LHWCA) which provides disability compensation and medical benefits to employees and death benefits to eligible survivors of employees of U.S. government contractors who perform work overseas.

Q.19) Will the US Embassy provide any Sale Tax/VAT exemption?

Ans: Yes, U.S. Embassy will get the exemption certificate from MFA upon receiving of the pro forma invoice from the contractor.

Q.20) Is Federal Insurance Fee (FIF) applicable or not?

Ans: Although we are not aware of this fee but we have never paid such fee in the past.

Q.21) Advise if previous benefit schedule for life/health/disability insurance is the same as the benefit schedule currently being requested?

Ans: This solicitation is for health insurance only. The benefits are almost same except in some areas.

a. If so, please provide a description of benefits.

Ans:

All prescribed drugs are covered.

C.1.1.4 HIV/AIDs Spouses are also covered.

Optical limited to two prescription lenses.

Tandem Couple: Limit will be 1.2 million.

Q.22) Are there any persons who are currently hospitalized?

a. If yes, please provide number of the patients?

Ans: USG cannot answer this question due to privacy issues and we believe it won’t help calculating premium.

Q.23) Are any major illnesses (i.e. hemodynamics, open heart surgery, orthopedic major surgeries, organ transplants, traumatic accident, cancer and oncology cases) being treated?

a. If yes, please provide number?

Ans: USG cannot answer this question due to privacy issues.

Q.24) Are there any pregnant employees/spouses?

Q&A from Pre-Proposal Conference for U.S. Mission Pakistan Locally Employed Staff Page 4 of 7

a. If yes, please provide number.

Ans: USG cannot answer this question due to privacy issues and we believe it won’t help calculating premium

Q.25) Are any employees currently disabled?

a. If yes please provide total number

Ans: USG cannot answer these questions due to privacy issues.

Q.26) Current vendor information:

a. Name

b. Contract number

c. Value

d. Date of award

e. Date of expiration.

Ans: a. Askari General Insurance Company Limited

b. SPK33014D5698

c. PKR. 640,468,376.00

d. December 1, 2013

e. May 31, 2019

Q.27) What currency should proposers use in submitting bids?

Ans: The offeror should use PKR to propose their price. However, U.S. offerors may offer and be paid in

US dollars as cited in Section B.

Q.28) Can you provide number of insured employees in last three years with breakdown of Single, Married/Family Status?

Ans: Refer to the following chart

MARITAL STATUS 2016 2017 2018

Married 1328 1349 1356

Single 154 158 132

Grand Total 1482 1507 1488

Q.29) Percentage of local nationals.

Ans: out of 1,503 employees only less than 10 are other than local nationals.

Q.30) Are there dependent children to be covered who are studying outside the country?

a. If yes, please provide the country and number of dependent children studying there.

Q&A from Pre-Proposal Conference for U.S. Mission Pakistan Locally Employed Staff Page 5 of 7

Ans: Out of country treatment is not covered.

Q.31) Location(s) of insured employees.

Ans: Islamabad, Lahore, Karachi and Peshawar. All these stations are within Pakistan.

Q.32) Kindly provide claims history for health insurance for the current year and each of the last 5 years?

Ans: See chart chart below for 2013 to 2017, and refer to the answer for question 15 for 2018

Claims History for the Current Health Contract (AGICO) - Mission Wide

Contract Periods Total

Claims

Total Claims

Bill Amount

Total Claims

Amount Paid Deduction

Dec 1, 2013 - Nov 30, 2014 24535 112,732,366 104,465,176 8,267,190

Dec 1, 2014 - Nov 30, 2015 23277 107,562,757 95,059,397 12,503,360

Dec 1, 2015 - Nov 30, 2016 22751 113,820,561 103,389,716 10,430,845

Dec 1, 2016 - Nov 30, 2017 22749 138,708,438 126,836,467 11,871,971

Total 93312 472,824,122 429,750,756 43,073,366

Q.33) Do the claims include claims from ORE employees? (if applicable)

Ans: Yes, ORE Employees are also included.

Q.34) Kindly provide premium history for health insurance for the current year and each of the last 5 years as per below chart, Ans: Refer to the following table.

Year

Premiums paid (PKR)

Dec. 1, 2013 to Nov. 30, 2014 34,141,899

Dec. 1, 2014 to Nov. 30, 2015 70,398,553

Dec. 1, 2015 to Nov. 30, 2016 122,883,414

Dec. 1, 2016 to Nov. 30, 2017 158,963,256

Dec. 1, 2017 to Nov. 30, 2018 166,885,061

Q.35) Provide employees data based on age groups.

Ans: Refer to the following table below

Age Group Male Female Total

20 - 25 8 0 8

26 - 30 75 15 90

31 - 35 207 31 238

36 - 40 268 54 322

Q&A from Pre-Proposal Conference for U.S. Mission Pakistan Locally Employed Staff Page 6 of 7

41 - 45 302 32 334

46 - 50 241 15 256

51 - 55 138 5 143

56- 60 100 2 102

61 - 65 1 1 2

Total 1339 154 1495

Q.36) We need more clarity on coverage limit Rs.600, 000/- per family.

Ans: This is the maximum threshold health insurance provider shall either reimburse or provide health care service through their panel network to an insured employee and/or family in case the employee is married. There is no bifurcation of the maximum threshold. The total amount of claims paid under any section, such as general hospitalization, maternity, dental treatment, OPD etc., in a contractual year shall not exceed claims paid to the maximum limit of Rs.600,000.00.

Q.37) Is there any sublimit for following categories?

Hospitalization

Obstetrical Care/Maternity care limit.

Outpatient Limits

Dental care limit. Need clarity either 60% is sub limit of 600,000/- or 60% of the claimed expense will be reimbursed. Same clarity required on Optical care and Psychiatric treatment.

Is there any monetary sublimit for Room & Board capping?

Ans: There is no sublimit for any category. 60% of the claimed expense will be covered in case of dental same pattern will be used to reimburse optical expense.

Q.38) How does DISCOUNT FOR PROMPT PAYMENT ACT work?

10 CALENDAR DAYS % ?

20 CALENDAR DAYS % ?

30 CALENDAR DAYS % ?

CALENDAR DAYS % % ?

Ans: Under the prompt payment act U.S. Government is obligated to pay vendors/contractors within thirty days upon receipt of satisfactory supplies/services and submission of invoice. Above mentioned discount will be offered by the offerors (insurance provider) such as if we (U.S. Government) pays within ten days how much discount insurance provider can offer to the government. This discount will not affect their proposal price.

Q.39) Please clarify about total number of employee as the provided data on page 36 is different from the data on page 03.

Census:

Page 3 141 + 1362 = 1503 Single & Married

Page 36 144 +1391 = 1535 Single & Married

Ans: 1503 is the number of current employees.

Q.40) What is the maximum limit for re-imbruement of HIV Aids Medication in PKR?

Q&A from Pre-Proposal Conference for U.S. Mission Pakistan Locally Employed Staff Page 7 of 7

Ans: Maximum limit for HIV Aids is USD 10,000. It shall be calculate using prevailing exchange rate of US dollar to PKR of the day claim payment.

Q.41) As per section C.1.1.1 please clarify the following:

Which Apparatuses?? Brand /pricing benchmark??

Which equipment will be subject to exclusion?

Ans: There is no specific brand and pricing benchmark. Whatever equipment is prescribed by the physician/surgeon shall be reimbursable. See Exhibit D (C.1.1.1. & C.1.1.2) for second part of question.

Q.42) Need clarification on section C.1.10 Optional Additional Coverage.

Ans: Although the extended family members of an insured employee are not covered as rider in the contract the employee may contact insurance provider directly to have insurance coverage for extended family members.

Q.43) How will insurance premiums be paid, monthly or quarterly?

Ans: All payments under this contract will be made at the beginning of each quarter. See G.4.2.

Q.44) How will employee's account details will be furnished to reimburse the claims?

Ans: HR Office Islamabad will provide the account information of Mission wide employees for reimbursement purposes.

Q.45) Please explain Excusable Delays P34 (e) of the solicitation?

Ans: Excusable Delays when cause is beyond Contractor's reasonable control and was not caused by the fault of Contractor or any Subcontractor.