19PK3324R7000Q_A.pdf

Q-7) Can you please provide clarification regarding coverage limits for Official Resdince Expense

(ORE) staff?

Ans) The Official Residence Expense (ORE) Staff receive the same annual maximum limits and benefit levels as locally employed staff of the Mission.

Q-8) How do we interpret the interaction between the catastrophic coverage providing an additional

$2 million per covered individual per contract year for major medical conditions and the minimum 50% coverage requirement under C.1.1.1 for rehabilitative and habilitative services and devices? Specifically, what will be the coverage limit for these services? Additionally, considering that long term rehab is mentioned in the exemption class without a specific period, how should the duration for long-term rehab be defined?

Ans) Per section C, catastrophic coverage is an additional coverage equal to PKR 2,000,000 per covered individual per contract year. Catastrophic conditions shall be defined as major medical conditions occurring as a result of a single/illness/accident or closely related set of major illnesses (or conditions relating to a single accident) that exceed the standard maximum coverage limit. As such, once the insured reaches their annual maximum limit, they can then make claims based on the authorized benefit reimbursement levels up to the maximum limit authorized under catastrophic coverage (PKR 2 million). Reimbursement will be based on the percentages established under the minimum benefit levels. For example 100% for Preventive and

Wellness Services and Chronic Disease Management, 50% reimbursement for Mental

Health and Substance Abuse Care, 80% reimbursement for Reproductive Health, 80% reimbursement for optical and dental care of the total medical expenses.

Q-9) The data mentions the number of ORE staff only. Is family of ORE staff also included?

Ans) Yes, the family of ORE staff are also included/covered.

Q-10) Can you provide clarification on the eligibility criteria, particularly for children older than 26 who are disabled? Given that disability encompasses a wide spectrum, will disability be measured according to the Government of Pakistan's assessment (NADRA)? Additionally, since NADRA's assessment is limited to physical or visible disabilities, how will other types of disabilities be evaluated?

Ans) A normal child will be covered until the end of the contract year in which s/he reaches age

26 based on NADRA CNIC. There is no limit of children.

Furthermore, the clarification on the eligibility criteria of disabled child, an unmarried child determined to be incapable of self-support due to a physical or mental condition will continue to be eligible to participate in the medical plan as long as the condition persists, the child remains unmarried, and the LE Staff maintains coverage.

Q-11) Optional additional coverages are mentioned? Can you provide examples of the types of additional insurance options other than Insurance policy for parents that employees might purchase?

Ans) The most commonly requested additional insurance option is an insurance policy for parents. However, the employee may also be interested in an insurance policy for a second spouse or unmarried children over 26 years of age. However, such policies and costs will be borne by the employee not the U.S. Pakistan Mission.

Q-12) As per the "OBSERVANCE OF LEGAL HOLIDAYS AND ADMINISTRATIVE LEAVE" policy, if the Contractor's employees work on a holiday, the government will not provide any additional compensation for holiday pay or premium rates?

Ans) U.S. Mission Pakistan will not pay any additional costs if the Contractor requires its employees to work on observed holidays.

Q-13) Bid documents stipulate that the exchange rate from USD to PKR will be applied according to the rate specified in the mission-issued documentation. Will this exchange rate be accessible to the insurer for calculation purposes?

Ans) Invoices will be paid in the currency of the submitting company, either PKR for local companies and USD for U.S. Companies. There should be no issues related to currency exchange rates given local companies must submit their invoices in PKR.

Local companies should submit their proposals in PKR.

Q-14) Several clauses in the tender documentation, specifically C.1.1.18, C.1.1.19, C.1.1.20, and C.1.1.21, which detail coverage information, are currently reserved. Will these clauses be disclosed?

Ans) Reserved clauses will have no applicability to this solicitation for services. These clauses are maintained only to preserve the sequential numbering.

Q-15) As per section B.2.2.1 U.S. government can choose any of the caps prior to award or may modify the contract to shift to any reimbursement cap any time during the life of the contract. Does this mean that this change can be done in middle of the policy year or only at the time of change of year/renewal?

Ans) We, the U.S. government (USG), will pick one of the three Caps at the time of award. If the USG decides to shift to a different reimbursement cap, it will occur at the start of an option year. The Contractor will be provided as much advance notice as possible.

Q-16) Why is there a maximum and minimum amounts clause added on page # 9 in B.2.8.b (USD 500,000 to USD 5 M)? Wouldn’t this limitation clash with clause B.4 i.e. economic price adjustment of health premium based on past year’s claim experience. What if any particular year’s claim experience is higher than the embassy’s own assessment and the adjusted premium for the next year breaches the maximum amount threshold mentioned earlier?

Ans): Solicitation clause B.2.8.b. (Contract Minimum and Maximum Amounts) provides minimum guarantee (USD $500K) worth which USG shall place orders and maximum amount ($5M) will serve as the maximum amount the USG may place for orders in any contractual year. It has no relationship with the Economic Price Adjustment (EPA).

Q-17) What will happen if value of PKR appreciates in comparison to USD over next 5 years, will the same limit apply or not?

Ans): The solicitation calls for a reimbursable threshold in PKR, therefore any exchange rate fluctuations will have no impact upon these thresholds.

Q-18) Hearing Aid, Optical and Dental Care cases, the limits for implants is per individual basis whereas the limits provided in the main contract are per family basis. Isn’t this a contradiction?

Ans) There is no contradiction - the solicitation is clear on annual limit/cap which is per family. However, there is a sub cap per individual that cannot be exceeded.

Q-19) Catastrophic coverage has been introduced in the current solicitation document which wasn’t there in the last solicitation document. It is doubling the annual limits in almost all cases because the qualification criteria is somewhat fluid. It would be ideal if the qualification definition is elaborated in a little bit more concrete way.

Ans) Catastrophic coverage is an additional coverage equal to PKR 2,000,000 per covered individual per contract year. Catastrophic conditions shall be defined as major medical conditions occurring as a result of a single/illness/accident or closely related set of major illnesses (or conditions relating to a single accident) that exceed the standard maximum coverage limit. As such, once the insured reaches their annual maximum limit, they can then make claims based on the authorized benefit reimbursement levels up to the maximum limit authorized under catastrophic coverage (PKR 2 million). Reimbursement will be based on the percentages established under the minimum benefit levels. For example 100% for Preventive and Wellness Services and Chronic Disease Management, 50% reimbursement for Mental Health and Substance Abuse Care, 80% reimbursement for

Reproductive Health, 80% reimbursement for optical and dental care of the total medical expenses.

Historical data – There were only fifteen employees who met the maximum reimbursement threshold in last five years.

Q-20) For optical care, previously frames were not covered along with non-prescribed lenses or tinting of eyeglasses. This year, cost of frames is covered as per section C.1.1.10 however there is no detail provided related to other two.

Ans) We are not comparing our existing contract with this solicitation. The interested offerors must submit their price proposals based on optical care benefits mentioned in the solicitation. However, at a minimum, the offeror must meet the minimum benefit levels as identified in the statement of work. However, it must be noted that offerors may submit bids above the minimum benefit levels.

Q-21) We need to have further elaboration about section C.1.1.12 related to reproductive health.

Particularly confusion is related to fertility and infertility treatment.

Ans) The section C, clause C1.1.12 is about reproductive health benefits. The treatment related to reproductive health care is covered but not limited to prescribed contraceptive devices, preventive care and routine examinations, voluntary sterilization, and diagnosis and treatment of conditions which may cause infertility.

However, the following are exclusions and limitations of reproductive health benefits.

Assisted reproductive technology (ART), fertility treatments, and reversal of sterilization are not covered.

Advanced reproductive technology (e.g., in-vitro fertilization, intra-cellular sperm injection, artificial insemination, microsurgical epididymal sperm aspiration, testicular sperm extraction, cryopreservation, etc.).

Q-22) In section C.1.3 exclusions and limitations, please provide answers:

a) Only elective cosmetic surgery is part of exclusion, previously all cosmetic surgeries were excluded

b) Previously non-prescribed medicine were part of exclusion, currently only non-prescribed services or supplies are part of exclusion. Also need to check for non-prescribed lab tests.

c) Previously family planning was part of exclusions, and it is not mentioned this time.

d) Previously unlawful action, dangerous sport and injuries suffered during service in armed forces was excluded and it is not mentioned this time.

Ans) The Contractors must provide the quotation based on the current solicitation of the health insurance contract regardless of previous contract coverage. The exclusions are covered below and as a reminder exclusions also include “services or supplies which have not been prescribed or approved by a certified health care provider.”

Exclusions to Coverage:

There is no reimbursement for elective cosmetic surgery; spa cures; rejuvenation cures;

massage; exercise therapy; long-term rehabilitative therapy; non-medical hospital charges

(e.g., telephone, television, etc.); home help, family help, or similar household assistance; fees of persons who are not certified health care providers; advanced reproductive technology (e.g., in-vitro fertilization, intra-cellular sperm injection, artificial insemination, microsurgical epididymal sperm aspiration, testicular sperm extraction, cryopreservation, etc.); or services or supplies which have not been prescribed or approved by a certified health care provider.

Exclusions to coverage may be amended if provided in an off the shelf plan and is the lowest-cost and technically acceptable. Removal of any exclusions require prior authorization.

Q-23) Please elaborate section C.1.9.7 in detail.

Ans) Section C, clause C.1.9.7 relates to optional additional coverage or other insurance plans.

“The Contractor shall provide, at no additional cost to the U.S. Government, an option for covered employees to purchase additional insurance coverage or other available insurance products (Example:

Insurance policy for parents). This additional coverage is paid for by the employee and not the USG. The

Contractor should provide the same benefits and terms as listed above in section C.1.” The insurance company should coordinate directly with the employee to collect the cost of additional or other types of insurance plans.

The most common additional health insurance options are insurance policy for parents, health insurance of overage dependents/children above 26 years of age or second spouse etc.

Q-24) Maximum age for dependent children is mentioned as 26 in section C.1.4.1.1.2 whereas it is 23 in section C.3.0

Ans) It is typo error, the maximum age for normal dependent children is 26 years. Please consider it 26 years in section C.3.0. as well. We will amend the RFQ to correct this typo.

Q-25) Exhibit F says claim experience of last 5 Years but it only provides claim experience of 4 years and the most important year i.e. the recent most year is missing.

Ans) It is typo error, all the data that was available is provided in the solicitation.

Q-26) Apparently there must be some errors in the claim data provided in Exhibit F as the claim figures drop to 50% in year 2 as compared to year 1 and then rises by 150% in year 3 and then drops to merely

10% in year 4 as compared to last year. Considering these anomalies, we request you to please contact your current insurer and arrange updated claim experience and share with all interested insurance companies.

Ans) There was a typo mistake in the figures of claims paid history in Section J, Exhibit F of the solicitation, please see updated claim history below.

Claims Paid Out for the Past 4 Years.

Contract Periods Total

Claims

Total Claims

Bill Amount

Total Claims

Amount Paid Deduction

July 1, 2019 - June 30, 2020

21,107

150,609,613

146,937,054

3,672,559

July 1, 2020 - June 30, 2021

10,363

94,169,635

87,838,870

6,330,765

July 01, 2021 - June 30, 2022

22,817

233,573,384

204,168,103

29,405,281

July 01, 2022 - June 30, 2023

27,453

290,324,882

254,161,753

36,163,129

81,740

768,677,514

693,105,780

75,571,734

Q-27) Section H.3 page 28: Will every employee be allowed to select different coverage, to his/her choice?

Ans) No, it is not optional for employees to choose the coverage of their choice. There will be same level of coverage for all the employees.

Q-28) Section B.2.3: Exact data of lived required

Exact ages have not been provided, only age brackets have been shared. Likewise, number of insured lives in previous years, with benefit limit(s) for previous years have not been shared, as regards the previous years’ utilization history. Likewise, type of utilization, disease burden, frequency etc. has also not been shared. This gives all new insurers a disadvantage, to begin with, as against the current insurer.

Claims detail report of previous years, along with number of insured lives at beginning and end of each year must also be shared. Likewise data was 2023-24 has not been shared, whilst policy year in from

July – June each year, as per the shared details.

Ans) Employee statistics of insured population are available in Section J, Exhibit A. However, per question requirement please see below available data.

Data of insured population by age range has been provided in Section J, Exhibit A. However, we are unable to provide the data by exact ages due to Privacy issues.

The average number of insured employees from 2019 to 2024 is 1450. Please see below the average breakdown of previous years insured employees and annual cap.

Contract Periods Average

Insured

Employees

Annual Cap

July 1, 2019 - June 30, 2020 1390 PKR600,000/-

July 1, 2020 - June 30, 2021 1410 PKR600,000/-

July 01, 2021 - June 30, 2022 1435 PKR1,000,000/-

July 01, 2022 - June 30, 2023 1450 PKR1,000,000/-

July 01, 2023 - June 30, 2024 1450 PKR1,250,000/-

Mission-wide current employees’ breakdown according to categories are given below:

Mission-wide Employees

Breakdown Self (Single employees)

Self Plus One (married without child or self & one child)

Family (Married, 3 or more individual/family members)

Total Employees 1451

The available updated claims paid data of the past 4 years are below:

Claims

Total Claims

Bill Amount

Total Claims

Amount Paid

The new insurers can provide the figures based on available data, market research and their experience.

Q- 29) Section C.1.1.8 Preventive and Wellness Services and Chronic Disease Management: Minimum

Coverage: 100%

Counselling or preventive care designed to prevent or detect medical conditions and care for chronic conditions such as asthma and diabetes. Examples include, but are not limited to:

physicals, immunizations, and cancer screenings.

As per the wording shared in RFP, preventive and wellness services and chronic disease management is a broad subject. This may also cover home treatment, hospice services, etc.

Kindly elaborate scope of coverage under this clause. We need details either from the policy document or coverage for chronic disease management or wellness

Ans) The details are available in Exhibit D C.1.1.8, please see below:

C.1.1.8 Preventive and Wellness Services and Chronic Disease Management:

Counseling or preventive care designed to prevent or detect medical conditions and care for chronic conditions such as asthma, heart disease, arthritis, different types of cancers, epilepsy, chronic obstructive pulmonary/lung diseases, BP, and diabetes. Examples include, but are not limited to: physicals, immunizations, immunizations against serious illnesses like the flu and COVID-19. and cancer screenings etc. It also involves education and counseling that can help the employee make positive lifestyle choices that protect their overall health and well-being.

Preventive strategies for many chronic diseases include intervening before the disease occurs (primary prevention), detecting and treating disease at an early stage (secondary prevention), and managing disease to slow or stop its progression (tertiary prevention).

Q-30) Section C.1.1.16 Catastrophic Coverage:

Assume a patient is admitted in hospital and the annual capped amount for the family reaches. Our understanding is that this patient will continue to avail coverage from catastrophic coverage and once his hospitalization ends, the per family cap will ensue. Is this correct? Otherwise, will the catastrophic coverage limit initiate and all expense of the family, for hospitalization, OPD or wellness, preventive care will continue till catastrophic coverage limit exhausts? Details required for cases in which catastrophic coverage shall initiate.

Ans) The catastrophic coverage will start when any employee has utilized/reached the original annual maximum limit and s/he is still under treatment for the catastrophic illness that falls under the definition of catastrophic. Coverage continues until both annual limit and catastrophic coverage limits are exhausted. The Contractor may work with the employee, medical providers, and hospitals to seek additional details regarding medical information.

Q-31) Section C.1.3 Exclusions and Limitations: There is no coverage for expenses that will be reimbursed or paid directly under a host country medical program or workers’ compensation program, the U.S. workers’ compensation program, or post’s LE Staff workers’ compensation program.

Are these people part of data? And if they are included, will they be deleted if they come under these programs?

Ans) Employees in these categories are not part of the data. Any employee seeking medical treatment or reimbursement from any Pakistani or USG workers’ compensation programs (i.e. free of cost) then these expenses will not be covered under the health insurance plan. In this case, the employee will not submit the claim for reimbursement to the Contractor.

Q-32) Section C.1.9.6 Medical records are considered protected, personally identifiable information.

The Contractor shall not require medical records to pay panel facilities or reimburse covered employees.

Bills for services and receipts showing payment shall be sufficient in most circumstances.

Insurance companies are custodian of information categorized under PII and SPII. In the RFP, no requirement for demonstrating information security protocols has been sought from the insurer. For medical adjudication of claims, medical records are a mandatory requirement. NDA can be signed to ensure protection of data.

Ans) Medical records refer to medical examination history and lab tests reports of any employee. For further clarification, to avail hospitalization facilities on panel or non-panel outlets, the employee will provide the doctor’s prescription/notes, in which the doctor recommends specific treatments or hospitalization for proper treatment. However, employees are not responsible for providing the detail history of illnesses or any medical reports to avail hospitalization facilities. This is the same for OPD/IPD claims reimbursement, the employee will provide the doctor’s prescription, discharge slip, medicines and lab test charges bill or receipts when submitting reimbursement of claims. However, employees are not required to provide test reports. In case where bills or receipts are not considered accurate for the payment of claims, the Contractor shall contact the COR to discuss.

Q-33) 52.232-19 AVAILABILITY OF FUNDS FOR THE NEXT FISCAL YEAR (APR 1984)

Funds are not presently available for performance under this contract beyond 30 September of each Government Fiscal Year. The Government's obligation for performance of this contract beyond that date is contingent upon the availability of appropriated funds from which payment for contract purposes can be made.

Payments are to be made after each quarter. What will happen with payments for the last quarter in this case?

Ans) The USG will issue task orders with estimated numbers related to FAR clause 52.232-19. The USG will issue task orders/obligated upfront with the estimated number of employees in the beginning of each quarter and will modify the task orders to match the actual covered employees at the conclusion of each quarter. This will eliminate the possibility of coverage without availability of funds.

Q-34) SECTION J, Exhibit F

Beginning of year and End of year lives for each policy year required, for which expense details have been shared. Also benefit structure for each policy year is required

Ans) The benefit level for each contractual year were same. Refer to question # 28 for rest of the requested information.

Q-35) EXHIBIT D

Section C.1.1.1 Hospitalization

Clarity required regarding coverage of following from Hospitalization:

preventive routine mammography, HIV(Human Immunodeficiency Virus) testing, PSA(prostate-specific antigen) testing, pap smear, and tissue matching tests

Nebulizer with kits

All equipment, supplies, and tools to include but not limited to: blood pressure apparatus;

thermometer, glucometers; needles, strips for diabetics, and pacemakers etc

Ans) During hospitalization treatment covered medical charges shall include but are not limited to these tests, equipment and supplies. It means that during the hospitalization, these lab tests, equipment and supplies are covered in this health contract.

Q-36) B.2: The Offeror shall include Defense Base Act (DBA) insurance premium costs covering employees. The offeror may obtain DBA insurance directly from any Department of Labor approved providers at the DOL website at http://www.dol.gov/owcp/dlhwc/lscarrier.htm

For how many individuals does DBA insurance is required?

Ans) It is offerors determination regarding how many of its employees will work to support this contract.

However, the USG requirement will be at-least four (4) individuals to be present at our premises. These include at least one dedicated representative for the Embassy and each consulate (Karachi, Lahore and

Peshawar). Depending on the location, the offeror’s customer support representative will be required daily or may conduct 1-3 visits per week for a designated timeframe.

Q-37) F.2 PERIOD OF PERFORMANCE. The performance period of this contract is one year beginning on January 1, 2025 with four (4) one-year options to renew.

Policy period is starting from 1st January 2025 to 31st Dec 2025. However, claims ratio provided is for June to July. Are the policy dates been changed? Or Currently policy is on 6 months extension?

Ans) In the current contract, the policy period is also one year with four (4) one-year options to renew, however, the insurance coverage under the resultant contract will begin January 01, 2025 and will continue for twelve (12) months The current contract was extended for six (6) months (July 1 to December 31, 2024). This is why the coverage period is changed

Q-38) ANTI-MONEY LAUNDERING AND COMBATING THE FINANCING OF TERRORISM

(AML/CFT) REGULATIONS

As per the AML/CFT act, following mandatory documents are required from EMBASSY/ FOREIGN

MISSIONS for setting up the policy

• Photocopy of valid Passports / CNICs of authorized person to transact the policy

• Photocopy of Passport/CNICs of Senior Persons and Ambassador/Consulate General of Embassy

• KYC Undertaking (Template Attached)

• Approval from GoP to work as Ambassador in Pakistan OR Authorized Card to the Ambassador to work as Ambassador in Pakistan

• Any document issued from their Ministry of Foreign Affairs (MoFA)

• Other documents submitted to Bank for open their account related to AML.

Will the embassy provide these documents?

Ans) The USG will not provide the above-mentioned documents as they are not part of the solicitation.

Q-39) In Exhibit F:

• Claims of 2022-23 are only 24.7 Million, whereas the previous year’s claims are more than 100

Million. Please share the reason.

• Claims of 2023-34 are missing. Kindly share the detailed claims report.

• Beginning and ending year lives of all last five years are required.

Ans) There was a typo error in Section J, Exhibit F of the solicitation. Please see the updated claim history below.

Claims

Total Claims

Bill Amount

Total Claims

Amount Paid

Q-40) How to determine the amount of retention?

Ans) It is the responsibility of offeror to calculate their premium. The sum of cost of funds to pay the premium and retention amounts (administrative cost) will be your premium cost. To understand retention amount better refer to clause B.3.2 (page 10 of the RFP).

Q-41) Would Zadroga be in retention money, or will it be inclusive in premium cost?

Ans) It is not an input for the retention amount. It is your determination whether to include in your premium cost. The USG will deduct the 2% from each invoice.

Q-42) What is the HIV percentage of coverage for employees and also provide if you have any historical data from prior contract?

Ans) Currently, there are no cases of HIV/AID. However, we cannot predict the future.

Q-43) Can an insurance company submits its price proposal in USD?

Ans) No. Insurance provider based in Pakistan cannot submit proposals in USD. However, offshore based companies may submit their proposals in USD. Refer to section G.3, page 25 of the solicitation.

Q-44) With reference to the ordering procedure, who will choose the category in which the employee fall?

Ans) U.S. Embassy, Islamabad.

Q-45) Will DBA Insurance reimbursable?

Ans) Yes.

Q-46) Is Embassy Islamabad responsible for payment of ORE staff?

Ans) Refer to section B.1.1 page 2

Q-47) How many company representative should required onsite?

Ans) At least one dedicated representative for the Embassy and each for consulate (Karachi, Lahore and

Peshawar). The Contractor can also assign a back-up representative in-case of extended absences of the primary representative.

Q-48) Is premium adjustment applicable?

Ans) In no circumstances can the premium be adjusted except for conditions noted in the Economic Price

Adjustment clause. Refer to section B.4.

Q-49) Category for employees (self plus one) should be included in the section B of the RFP?

Ans) Self plus one category is already mentioned in section B of the solicitation.

Q-50) What will be criteria for addition or deletion of employees?

Ans) Per clause C1.8.1 of the solicitation, “The COR will make subsequent additions or deletions to this list in writing and provide the revised list to the Contractor”

Explanation: The Contractor will be informed of the addition or deletion of employees within 2-5 days of their joining or departing the Embassy or Consulates. Subsequently, the Contractor will be responsible for removing or adding employees and issuing new insurance cards.

Information regarding the addition and deletion of family members will be provided to the Contractor biweekly. Information regarding the deletion/disenrollment of an enrolled employee will be provided to the Contractor during the final week of the employee’s employment. Subsequently, the Contractor will be responsible for deactivating/canceling the insurance card and notifying medical providers of the employee’s final date of eligibility.

Q-51) What does this mean for third party evaluation with reference to EPA?

Ans) It refers to requests to invoke the Economic Price Adjustment clause under section B.4 of the solicitation. The data and/or information the Contractor will provide to support their request must be vetted/audited by an independent and certified auditing entity.

Q-52) Please provide data for reimbursement claims?

Ans) The last four years claims history is available under Section J, Exhibit F of the solicitation. There was a typo error, please see the updated claim history below.

Claims

Total Claims

Bill Amount

Total Claims

Amount Paid

Q-53) Is credit facility required for both OPD and IPD?

Ans) Per clause C.1.8.1 of the solicitation, yes, credit facility is required for both OPD and IPD as well as radiological, laboratory and pharmacy services.

“The Contractor shall provide a network of panel facilities that provide all services, to include prescription medications, listed under C.1.1 to employees and beneficiaries on credit/without out-of-pocket payments.

These facilities shall accept direct payment of bills from the Contractor in lieu of payment by covered employees and beneficiaries. These facilities must provide inpatient, outpatient, radiological, laboratory, and pharmacy services. The network of panel facilities shall provide adequate geographic coverage for the metropolitan areas of Islamabad/Rawalpindi, Karachi, Lahore, and Peshawar.”

Q-54) If an employee submits a claim during the policy period and the claim is paid, but the employee then leaves the job, will the insurance company receive a refund?

Ans) There is no need of adjustment for paid claims because the employee is entitled to health benefits until his/her last working day. Insurance companies will also receive the premium of said employee until the date of resignation.

Q-55) What will be category if the employee and the spouse both works in the Embassy?

Ans) Per clause C1.4.1.1.1 of the solicitation, in cases where LE Staff and their legal spouse both work for the mission and both are eligible to participate in the medical plan, one will be designated as the lead/main provider for family members for the purposes of the medical plan, and the other will be considered a legal spouse. The premium will be paid based on the employee’s choice of medical plan category.

Q-56) How many wives will be covered under the new Health Insurance Contract?

Ans) Per clause C1.4.1.1.1 of the solicitation, a limit of one legal spouse as defined by local law per employee will be covered.

Q-57) According the SECP, premium has to be paid in advance where as the RFQ states it will be paid at the conclusion of the period. Please clarify this?

Ans). Please refer to Section G.4.2 of the solicitation.

Q-58) Is treatment abroad covered?

Ans) No, the travel and treatment cost outside of the country is not covered.

Q-59) Please clarify, what do you mean by employee pool?

Ans) The “employee pool” refers to the number of locally employed staff members that will be covered by the health insurance provider. B.4.2.1 Employee Pool. – This clause is only in effect if the Contractor included details in its offer regarding a pooling arrangement, of which this contract is a part.

Before any adjustment is made under this price adjustment clause, the Contractor must include in its proposal for adjustment, details setting forth how the pool impacts the request for equitable adjustment.

Q-60) Please clarify Section L.4.3?

Ans) It includes instructions to offerors on how to construct and what to include in their technical proposals. Read this section twice to understand better.

Q-61) Please explain Section C. 1.9.5

Ans) In clause C.1.9.5. of the solicitation, the term “valid claims” means that an employee will provide a doctor’s prescription, lab tests receipts and medicines/pharmacy receipts for reimbursement of claim. If there are any receipts missing, the Contractor will request the employee to provide the missing receipts.

Without providing missing receipts, the claim will not be reimbursed. The claim reimbursement amount will be adjusted against the annual benefit cap of the year in which the treatment was taken regardless of the claim submission date.

Q-62) Please provide below information:

• Details Disease wise Claim history sheet on insurance company format

• IPD Claims Year Wise

• Maternity Claims year Wise

• OPD Claims Year wise

• Exact date of birth of each insured

Ans) The last four years claims history is available under Section J, Exhibit F of the solicitation. There was a typo error. Please see the updated claim history below. Unfortunately, the claims history is not available by disease or sub-categories. Date of birth is PII and cannot be provided.

Claims

Total Claims

Bill Amount

Total Claims

Amount Paid