Questions_and_Answers_19RS5019R0002.pdf

Questions & Answers Solicitation No 19RS5019R0002

Health Insurance Services for Locally Employed Staff (LES) of US Mission Russia

Question 1: We note that Exhibit D - The List of Acceptable Medical Facilities, Section “Clinics” of the solicitation has “Medical Centers MedSwiss” listed as one of the recommended clinics. This clinic is only serviced by Reso Garantiya insurance provider.

Does this mean that the Embassy gives any sort of preference to Reso Garantiya insurance company?

Answer 1: No. Amendment No. 0002 to the solicitation will be issued to modify the Exhibit D - The List of Acceptable Medical Facilities, Section “Clinics” to remove “Medical Centers MedSwiss”.

Question 2: Do you have any detailed information for the number of Russian nationals who are employees of the US Embassy and Mission in Russia who will receive the health insurance? Are all employees on the solicitation US citizens? Or is there a break out of the numbers of Russian citizens and US citizens? This affects pricing for the health insurance companies I am consulting and our underwriters would like to have additional information on this issue.

Answer 2: The prospective offerors are advised that specific information on nationalities and citizenships is not releasable by Mission Russia. The contract for health insurance services resulting from this solicitation is intended for all locally employed staff and must comply with Russian Federation laws and regulations.

Question 3: Do you have any information on the current health insurance used by the employees such as the name of the provider of the insurance and the plan name? Also do you have any claims history information for the current health insurance plan in place?

Answer 3: The current health insurance service provider is PAO Rosgosstrakh, and the plan is customized for Mission Russia.

Question 4: Claims Activity in Prior Periods - The number, and amount, of claims paid in prior years is one of the most important elements an insurance company uses to price insurance. We find that claims information is usually provided in the initial solicitation and if not there then provided after requested by a prospective contractor.

Please provide the last three full years and the current partial year of loss data by year of account including:

a. three + years premium billed

b. three + years number of incurred claims

c. three + years amount of incurred claims

d. three + years total number members on June 30. This is the total number of employees + spouses + dependents on June 30 of each year.

I've included below an example of an illustration of the information we are asking for. This illustration assumes the contract year ends on June 30.

Health Insurance Claims Illustration

Period Premiums Billed Number of Claims

Incurred

Amounts of Claims

Incurred Total Number of Members on June 30

July 1, 2018 to Whatever date you have (please indicate date) July 1, 2017 – June 30, 2018

July 1, 2016 – June 30, 2017

July 1, 2015 – June 30, 2016

Answer 4:

Health Insurance Claims

Period Premiums Billed, $

Number of Claims Incurred

Amounts of Claims Incurred, $

Total Number of Members on June 30

July 1, 2018 – September 30, 2018

137 228 432 152 145

570 (on July 1, 2018) -

508 (on September 30, 2018)

July 1, 2017 – June 30, 838 298 1169 871 998 1726 (on July 1, 2017) -

570 (on June 30, 2018)

July 1, 2016 – June 30, 2017 1 925 957 1519 2 114 508 1757

July 1, 2015 – June 30, 2016 1 905 814 1489 1 935 354 1763

Question 5: We would like to know if you have been informed of Catastrophic cases presented last year, such as: Hemodynamics, Open Heart Surgery, Orthopedic Mayor Surgeries, Organ Transplant, Traumatic Accident, Cancer and Oncology Cases (Radio and Chemotherapy), and hospitalizations with more than 10 days.

Answer 5: Catastrophic cases presented last year (July 1, 2017 – June 30, 2018): Hemodynamics – 13 cases, Traumatic Accident – 7 cases, hospitalizations with more than 10 days – 22 cases.

Question 6: Does this solicitation number 19RS5019R0002 contain requirements like the current contract? If no what are the differences?

Answer 6: The requirements listed in this solicitation are the same as those in the current health insurance contract for Mission Russia.

Question 7: Have there been any claims more than $10,000 within the last year? If yes, please indicate the number and amounts of such claims.

Answer 7: There have not been any claims more than $10,000 within the last year.

Question 8: Are there dependent children to be covered who are studying outside the country? If yes, please provide the country and number of dependent children studying there.

Answer 8: No. Please see Section C, Paragraph C.1.2: There is no reimbursement for medical expenses incurred outside of the Russian Federation. There is no reimbursement for round trip transportation expenses to travel out of country for medical treatment.

Question 9: What is the deadline for submitting questions for this solicitation?

Answer 9: The deadline for submitting questions for this solicitation is 17:00 Moscow time, January 21, 2019.

Question 10: Section C.1.1 states that “proposals that contain more benefits (even if there is no increase in cost) or fewer benefits than stated in the solicitation will be deemed technically unacceptable”. However, cover page to the solicitation states that “Proposals that contain more benefits (even if there is no increase in cost) or fewer benefits than those stated in the solicitation may be deemed technically unacceptable”. Please clarify which one it is. Is it allowable to submit proposals with benefit levels that differ from/exceed those stated in the solicitation?

Answer 10: The correct statement should read: “Proposals that contain more benefits (even if there is no increase in cost) or fewer benefits than those stated in the solicitation may be deemed technically unacceptable”. Amendment No. 0002 to the solicitation will be issued to modify Section C, Paragraph C.1.1 to delete the last sentence in the paragraph.

Question 11: Census information – The solicitation includes an employee age and gender bracket. However, we also need to know the following for the ORE and AECA employees:

• Number of Locally Employed Staff (LES)

• Locally hired US citizens

• Third Country Nationals (TCN’s)

Answer 11: The prospective offerors are advised that specific information on nationalities and citizenships is not releasable by Mission Russia. The contract for health insurance services resulting from this solicitation is intended for all locally employed staff and must comply with Russian Federation laws and regulations.

Question 12: Experience Data from current plan for last 3-5 years

a) Prognosis of large claimants

b) All claim reports updated through November 2018 including large claimant report

c) Claims by location

d) Have any policy changes been made during the experience period? If so, what are they?

e) Network utilization data – In vs out of network %

Answer 12:

a) Mission Russia does not have any prognosis of large claimants information available.

b) See the tables below.

c) See the tables below.

Period Location TOTAL Number of claims

MOSCOW

2015-2016 441 2016-2017 453 2017-2018 373 claims

YEKATERINBURG

2015-2016 98 2016-2017 123 2017-2018 82 claims

VLADIVOSTOK

2015-2016 96 2016-2017 100 2017-2018 70

d) No significant policy changes have been made by Mission Russia during the current contract term.

e) No data is available.

Question 13: In what country will the policy be issued – US or Russia?

Answer 13: U.S.

Question 14: Who will be the primary policy holder? US government, ACEA, ORE?

Answer 14: U.S. Government.

Question 15: Is the solicitation, including the Scope of Work, available in Russian?

Answer 15: No. The Embassy does not issue any solicitation documents in any language other than English.

Question 16: Will the Embassy be able to sign the Contractor-provided contract?

Answer 16: The Embassy is only authorized to sign US Government issued contracts.

Question 17:

a) There seems to be a discrepancy in the Payment section of the solicitation. Section G.4.2 states that “Contractor may submit invoices monthly or quarterly for payment to be made at the beginning of the month or quarter for which insurance coverage is provided in accordance with FAR 32.404”. Section G.7.3 and G.8.1.1 state that “premiums will be paid on quarterly basis, and invoices are to be submitted after the conclusion of each quarter”. Please clarify 1) the frequency of payments 2) if the Contractor may submit invoices for payment at the beginning of the month/quarter instead of after.

b) Section G.4 seems to suggest that payment must be split up by the type of service (outpatient care, pre-employment exams etc.) and will be made by the Embassy at different times (beginning of the month, end of the quarter etc). We can’t split invoices based on the type of service. Can we submit one invoice and if so, when should it be submitted?

Answer 17: The Contractor should submit one invoice at the end of the quarter the services were provided

in. Advance payments cannot reflect the actual number of covered employees as it fluctuates during the quarter. Amendment No. 0002 will be issued to correct this discrepancy.

Question 18: With regards to the childbirth and delivery services (Section C.1.1.4), how does the insurance provider get reimbursed for providing the service? If the Government only pays the first $2,000, is the service provider responsible for billing the insured individual for the balance directly?

When does this bill get paid? Is the insurance provider responsible for providing the service if the insured person doesn’t pay her part of the bill?

Answer 18: As stated in Section C, Paragraph C.1.1.4(a): “The Government is responsible for the first USD 2,000.00 per occurrence, which will be paid against separate invoices submitted by the Contractor.

Should the cost of the services provided exceed USD 2,000.00, the insured person shall pay the difference directly to the Insurance Company”. The invoice will be provided by insurance provider to the employee directly.

Question 19: Exhibit D lists medical centers “MEDSI” as acceptable clinics. MEDSI is a network of clinics that have regular medical facilities and premium ones where services cost a lot more. Which of MEDSI clinics does the Embassy consider minimally acceptable?

Answer 19: Medical facilities to be offered by the prospective service provider must meet the requirements listed in Solicitation No 19RS5019R0002. All facilities must be well equipped, meet standards of quality and customer service of those listed in Exhibit D. See Section C, Paragraph C.1.9 for the detailed information.

Question 20:

a) Section C.1.9.1.1. states that “The Government has determined that only a few clinics in Moscow and in other cities, where U.S. Missions are located, can meet US Government requirements.” Section C.1.9.1.3 states that “The Contractor may also propose other medical facilities to be used as primary clinics, if these clinics offer services equal to those offered by acceptable clinics shown in Exhibit D”. Section C.1.9.2.1 states that “The Contractor shall not use other clinics not accepted by the Government”. Please clarify this discrepancy.

b) Section C.1.9.1.2. states that “Contractor shall propose clinics noted in Exhibit D for use by eligible participants in each city covered by this contract. The Contractor may also propose other medical facilities to be used as primary clinics, if these clinics offer services equal to those offered by acceptable clinics shown in Exhibit D. The Offeror shall demonstrate and prove why other facilities are as well equipped, meet standards of quality and customer services, as those listed in Exhibition D”. How can the offeror demonstrate or prove that other facilities, if proposed by the Contractor, are equal to those or are as well equipped as the ones listed in the solicitation?

Answer 20:

a) To clarify Section C.1.9.2.1 stating that “The Contractor shall not use other clinics not accepted by the Government”: after the contract award, the Contractor will not add, remove or replace any medical facilities listed in the contract without prior Government approval.

b) The Contractors may provide any licenses, certificates, descriptive material, brochures or other supporting documentation to show that the list of offered medical facilities meets or exceeds the requirements listed in the solicitation.

Question 21: In Pricing Schedules of Sections B.2.3(a), B.2.4(a), B.2.5(a), B.2.6(a), and B.2.7(a) – the total estimated number of employees and eligible dependents in CLIN 01 should equal to the total estimated number of employees and eligible dependents in CLIN 02, but it doesn’t. Please double check.

Answer 21: Amendment No. 0002 to the solicitation will be issued to correct the discrepancy. The total number in CLIN 02 of Sections B.2.3(a), B.2.4(a), B.2.5(a), B.2.6(a), and B.2.7(a) should read “324”.

Question 22: Section C.1.1.5(1) states that outpatient care shall include annual check-ups. What must an annual check-up consist of? Is there a required list of clinics where the check-ups must be provided?

Answer 22: Scope of annual check-ups should comply with the standards established in the Russian Federation. There is no required list of clinics for annual check-ups.

Question 23: Section C.1.8(g) states that “outpatient surgical operations requiring general anesthesia” are not covered under the contract. Please clarify. Does this mean that no surgeries done with general anesthesia are Contractor responsibility?

Answer 23: No OUTPATIENT surgical operations will be done if general anesthesia is required. Surgery is considered as an “inpatient service” and should not be provided at a clinic. Surgical operations are to be performed at a hospital facility only.

Question 24: Section C.1.8(l) states that oncological diseases are not covered under the contract (a limitation). However, Section C.1.1.5(25) states that outpatient care covers dynamic monitoring of chronic disease as prescribed by a physician, to include tumor markers. Please clarify the extent of Contractor responsibility with regards to diagnosis and treatment of oncological diseases. What about

HIV/AIDS?

Answer 24: It’s not the intent of the contract resulting from this solicitation to provide treatment of oncological diseases. Dynamic monitoring of chronic disease as prescribed by a physician, including tumor markers, is included. As soon as an oncological disease is diagnosed, the Contractor is no longer responsible for its treatment and associated expenses. Treatment of HIV/AIDS is not covered under the contract resulting from this solicitation (see Section C, Paragraph C.1.8.1, Item (m)). However, if childbirth and delivery services are requested, the Contractor is responsible for providing accommodation in the best specialized hospitals in two-person bedroom, meals, drugs, dressings, brief courses of anti-retroviral drugs during childbirth to prevent the transmission of HIV to the employee’s child (see Section C, Paragraph C.1.1.4(a) (iii).

Question 25: What is meant by pooling agreement in this solicitation (Section B.4.2.1)? How important is it for this contract?

Answer 25: Pooling is a practice where a health insurance provider may group together companies or organizations (commercial and/or government) to establish separate insurance rates for that pool.

Therefore, any rate changes for one group within the pool may affect all other pool members. The prospective offerors need to describe the pooling arrangements, if applicable, in their proposals. See Sections L, Paragraphs L.4.3.4 and L.4.2.1 for additional information.

Question 26: What information must be reported to the Embassy by the Contractor as part of the contract? Some information regarding claims and treatments received is confidential and is not releasable under the local laws.

Answer 26: If requested by the Government, the Contractor will be responsible for providing all reports listed in Section H, Paragraph H.5, unless the requested information is not releasable under the laws of Russian Federation.

Question 27: Who will be signing the Embassy contract? Is it the Ambassador?

Answer 27: The contract will be signed by the warranted Contracting Officer of the Embassy.

Question 28: Must the contractor’s call center operators and the primary Contractor Administrator be able to speak English?

Answer 28: Only the authorized Contractor Administrator (primary liaison with the Embassy/Consulate) must be able to understand spoken and written English. There is no such requirement for call center operators.

Question 29: Section C.1 states that “The Government pays 90% and the employee pays 10% of the premium costs for both employee and eligible dependent coverage; however, for employees who are regularly scheduled to work less than 30 hours per week, there is no Government contribution for dependent coverage, and the employee will pay 100% of the premium cost for dependent coverage if s/he wishes to enroll his/her eligible dependents”. Can the Embassy provide a breakdown for how many covered persons work over 30 hours per week and how many work less than 30 hours per week?

Answer 29: The prospective offerors are advised that specific information on the number of Mission Russia employees working under and over 30 hours per week is not releasable. Since dependents of Mission Russia employees who work less than 30 hours are not covered under this contract, and US Government is not responsible for premiums, these dependents are not included under the estimated number of personnel in Section B.

Question 30: In enrollment in this medical insurance plan mandatory for the Embassy LES? What does a compensation package for an Embassy LES consist of?

Answer 30: The enrollment in the medical insurance plan to be covered under the contract resulting from this solicitation will be voluntary. The prospective offerors are advised that specific information on the compensation package or other benefits offered to Mission Russian employees is not releasable.

Question 31: Cover page states that proposals must be submitted on paper in a sealed envelope. If we submit a proposal on paper, do we need to submit an electronic copy as well?

Answer 31: No.

Question 32: Section L.2 states that Volumes 1 and 2 must be submitted in 2 copies each, and Volume 3 in 4 copies. Please confirm that this is the required number of copies we must provide.

Answer 32: Amendment No. 0002 to the solicitation will be issued to update Section L, Paragraph L.2.

Only one copy of each volume will need to be submitted by the prospective offeror.

Question 33: Section G.6 states that “the Contractor shall include VAT as a separate charge on the Invoice and as a separate line item in Section B”. Our company doesn’t have VAT that can be separated from the quoted price. What do we put in the CLINs that ask for separate VAT?

Answer 33: If the prospective offeror operates its business with VAT, that VAT will need to be included as a separate line item on the Price Proposal in Section B, Paragraph B.2 Prices. If the prospective offeror does not have VAT, the VAT line item should have “0” or “N/A”.

Question 34: What is meant by a retention amount (Section B.3)? Is this the company’s administrative expenses or is this something else? We normally express retention amounts as a percentage, is this allowed?

Answer 34: As stated in Section B, Paragraph B.3.1: “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”. As stated in the NOTE TO OFFEROR in the same paragraph, “the fixed retention amount shall NOT be expressed in terms of a percentage of the premium”.

Question 35: What is meant by “drug therapy” in Section C.1.1.1?

Answer 35: In Section C.1.1.1. “drug therapy” means that health care facility provides the required medication to treat the diagnosed disease while the patient is in inpatient care (at the hospital).

Question 36: Are reimbursement amounts listed in Section C.1.1.9 a strict requirement or can they be changed?

Answer 36: The reimbursement amounts listed in Section C.1.1.0 are a strict requirement.

Question 37: Section C.1.5 states that “an eligible child will be covered until the end of the contract year in which he/she reaches age 21, or age 23 if a full time student”. How does one prove a student status? Is a 23 year old person still considered a child? We consider a person a child until s/he reaches the age of 18.

Answer 37: Mission Russia will be responsible for verifying dependents’ status and for enrolling eligible children only.

Question 38: Section C.1.7.1 states that “the Contractor shall provide a document (brochure/pamphlet/other written document) in Russian that sets forth a complete listing of the health insurance benefits to be provided under this contract”. Do these brochures have to be on paper or can they be sent electronically?

Answer 38: The Government will accept either the paper or electronic brochures.

Question 39: Please clarify Section C.1.9.2.2. Do you mean specialized medical centers such as research institutes?

Answer 39: Yes.

Question 40: Section E.2 states that performance threshold allows “no more than 3 customer complaints per month”. This is hard to predict. Please clarify how this requirement is enforced.

Answer 40: Section E.2 describes the formal process for monitoring contractor performance. If more than three formal complaints about required services not being performed per month are received and documented by the Contracting Officer Representative (COR), the Government has the right to take appropriate action as described in the Inspection clause.

Question 41: The format in which information on the number of employees in Exhibit A is provided is not full enough. Can we request information in our own format?

Answer 41: “Information provided in Exhibit A will not be tailored for each offeror as all offerors must get the same information. Premiums can be proposed based on information provided”.

Question 42: According to Section B.4.1, after the first twelve months of the contract, “the Contractor or the Government may request an adjustment in premiums on an annual basis”. If that is the case, what is to prevent the prospective offerors from manipulating prices for years 2-5 of the contract in their proposals in hopes of providing the lowest priced proposal and later claiming economic price adjustments to recoup their losses?

Answer 42: As stated in Section B.4.1, any economic price adjustments for this contract shall be subject to mutual agreement of the parties. Any economic price adjustment requests made by the Contractor must be supported and justified. The Government reserves the right to have an independent third party review the balance sheet and claims and make recommendations regarding the appropriateness of the requested adjustment.