Questions and answers 1 solicitation 19SP5020R0005.docx

QUESTIONS AND ANSWERS

SOLICITATION 19SP5020R0005 – Health Insurance Services.

1. Are the requirements in the existing contract the same than the ones included in the solicitation?

The requirements are set forth in Section C of the solicitation. The existing contract terms are different to the ones included in this solicitation.

2. What is the monthly premium in the existing contract?

If any interested party wants to obtain any part of a signed contract to include the premiums, it can be obtained through the Department of State Freedom of Information office. Their address is:

U. S. Department of State Office of Information Programs and Services

A/GIS/IPS/RL

2201 C Street N.W., Suite B266 Washington, D.C. 20520-0000

3. Shall the premium be the same for the different option years or can it be different? change?

It is up to the offerors to have different prices for the different years. Offerors must provide their prices for all five years.

4. Please provide percentage claims rate. i.e. % of total expenses versus total premium for the last three years.

Year 2016-2017 - 91% Year 2017-2018 - 91% Year 2018-2019 - 104.9%

5. Will the Government pay 100% of the premium or will the Contractor bill for 90% and the remaining 10% will be charged to the employee?

The Government will pay 100% of the premium for Employees, spouses and children. The 10% employee’s share of the premium will be collected in form of payroll deductions. Please see Section G.4.3 of the solicitation.

6. Please confirm the different collectives covered in the insurance. Our understanding is as follows:

Collective 1 – Employees, spouses and children Collective 2 – ORE employees Collective 3 – Retirees

That is correct. Offerors shall take into consideration that ORE employees and retirees will be covered under riders to the contract as defined in Section C.1.4.3. of the solicitation.

7. Shall we offer the same premium for employees, spouses and children?

Offerors shall decide whether or not they quote the same premium for employees, spouses and children.

8. With regard to Administrative retention amount, we understand that this portion of the premium is not subject to price adjustment. Please confirm.

That is correct. All explanations concerning Administrative Retention amounts are explained under Section B.3 of the solicitation.

9. Will award be made to the lowest priced proposal technically acceptable? Will price be the only factor for award?

Award selection criteria is defined in Section M.3. of the solicitation.

10. Will technical improvements offered be evaluated for contract award?

Evaluation factors for award are described in Section M of the solicitation.

12. Where are all Embassy employees and their dependents geographically located? Is everyone in Madrid?

U.S. Mission Spain has employees in Madrid, Barcelona, Sevilla, Palma de Mallorca, Las Palmas de Gran Canaria, Fuengirola (Málaga), and Valencia.

13. Are all the employees listed on the supporting documents local Spanish Nationals? Or some are US citizens?

There are employees from Spain and from other countries.

14. Will the coverage be only for the country of Spain or need global (including US)?

Please see below excerpt of Section C

C.1.1.17 Out-of-Country Medical Treatment

Medical expenses incurred out-of-country will be covered at the same benefit levels and subject to the same total maximum annual limit as for medical expenses incurred in-country.

15. The documents provided under the “statistics” have employee and dependent age; however, no date of births. How can I obtain that info? As well as smoker status.

Ages and genders of covered employees are provided. List of all eligible employees and dependents with relationship to employee including Dates of birth will be provided to the awardee.

The Embassy has no information on smoker status.

16. Who is your current insurance provider and how can I obtain a current billing statement?

Embassy´s current Provider is CIGNA LIFE INSURANCE COMPANY OF EUROPE, S.A./N.V., SUCURSAL EN ESPAÑA. Billing statement may not be disclosed.

17., after reading thoroughly the document We need clarification on whether Reimbursement type of Health insurance should be offered for the EEUU Embassy employees and their dependents.

This is not a reimbursement type insurance.

18. There is a limit of 64.000,00 €. Should be this limit apply to every insured person?

AIDS expenses has a different limit (10.000,00€). Are there any other expenses with a different limit?

Please see below excerpt of Section C:

C.1.2 Annual Maximum Limit - The maximum annual reimbursement per covered individual per contract year is 64.000,00 €, not including expenses defined under Exclusions and Limitations (C.1.3) and C.1.1.16, Catastrophic Coverage, or those covered under C.1.1.15, HIV/AIDS, and C.1.1.21, Excess Coverage is equivalent to sixty four thousand (64,000.00) Euros

20. Reimbursement type of Health insurance, in case in needed to offer it, which geographical scope has?

This is not a reimbursement type of Health Insurance.

19. Do we have to offer Reimbursement type of Health insurance for retired employees and older than 65 years old?

This is not a reimbursement type of Health Insurance.

Coverage for retirees is included in sections B.1.1. and C.1.4.3. Coverage for employees is included in section C.1.1.

20. Do we have to offer the same premium for retired people than for employees? There are 15 employees older than 65 years old. Is it compulsory to offer the same premium to then than the premium offered to younger employees?

In accordance with Section B.1.1. retirees will be included in the contract only as a rider at the prices specified in the proposal. It is up to offerors to offer different premium prices for retirees. Premium are to be included in Sections B.2.3., B.2.4., B.2.5., B.2.6. and B.2.7. Premiums for retirees are not included in the total price of the proposal.

With regard to employees over 65 years old, premium must be provided in accordance with Sections B.2.3., B.2.4., B.2.5., B.2.6. and B.2.7.

21. Is there any temporal limit for reimbursement of expenses out of Spain? 90 days?

Response to this question is contained in below excerpt of section C of the solicitation

C.1.1.17 Out-of-Country Medical Treatment

Medical expenses incurred out-of-country will be covered at the same benefit levels and subject to the same total maximum annual limit as for medical expenses incurred in-country.

22. (B.4 item) Premium Adjustment Based on Experience:

Can the contractor fix a CRP in the contract? CRP means “Clausula de Renovación de primas”. It´s a mathematical formula based in claims amount and the % comparing that amount with premium and internal and external expenses.

Economic price adjustment shall be made in strict conformance with Section B.4. ECONOMIC PRICE ADJUSTMENT – HEALTH INSURANCE PREMIUMS

23. Following the instructions of the document, billing of premiums has to be done in a family basis instead of using an insured person criteria. Could you give us more information about this topic? What about claims?

Billing of premiums shall be made in accordance with Section G.4.

24. Talking about premiums. Is the any limitation related with the number of dependent children for every family?

There are no limitations on the number of dependent children for every family other than the ones stated in section C.1.4.1.1.2

25. 52.2.17-8 OPTION TO EXTEND SERVICES: Following that chapter we have the obligation to continue with the coverage even if the contract finalized, what is the maximum time period of extension? Is it 6 months or up to the maximum 5 years of the contract? How are we going to calculate the premiums?

52.217-8 OPTION TO EXTEND SERVICES (NOV 1999)

The Government may require continued performance of any services within the limits and at the rates specified in the contract. The option provision may be exercised more than once, but the total extension of performance hereunder shall not exceed 6 months. The Contracting Officer may exercise the option by written notice to the Contractor within the performance period of the contract.

Premium prices to be applied if this clause is executed are the ones established in 4th option year of the contract.

26. MEDICAL COVERAGES- It´s needed to include in our offer all the vaccines (Those recommended by local authorities and OMS). Could you provide us more information about this item?

Immunizations recommended by local authorities and/or the World Health Organization have to be covered as stated in Section C.1.1.4.

C.1.1.4 Outpatient Services: Minimum Coverage - 80%

Services provided by a licensed healthcare provider on an ambulatory or outpatient basis (without being admitted to a hospital), including surgeon’s fees and other medical services provided at a hospital, clinic, doctor’s office, medical facility, etc. Examples include, but are not limited to:

· Annual physical examinations

· Specialist consultations and treatment, including second surgical opinion

· Minor surgical interventions

· Chemotherapy and radiation treatments

· Immunizations recommended by local authorities and/or the World Health Organization

· Diagnostic tests and diagnostic imaging

27. Medicines and Pharmacy. Has to be prescribed by a doctor. Every kind of medicine? What about oncologic medicine in an outpatient basis?

C.1.1.7 Prescription Drugs: Minimum Coverage -Inpatient/Emergency: 100%, Outpatient: 80%

Medications prescribed by a licensed health care provider that are medically necessary to treat a specified diagnosis. Examples include but, are not limited to prescription antibiotics to treat an infection, medication used to treat an ongoing condition, such as high cholesterol, prophylaxis, contraceptive medication.

28. The document includes Preventive check –up . Could you explain the extension of those? Every prevention check –up? Or is there a list?

Preventive services are included in Section C of the solicitation. See Sections C.1.1.6, C.1.1.8., C.1.1.11, C.1.1.12.

29. OPTICAL CARE. We believe that the coverage description in no consistent. It says “Covered up to a maximum of 270€ every two years.” Then, “80% minimum coverage”. And then “annual cap”. We don’t understand that coverage, could you give us more details?

C.1.1.10 Optical Care: Minimum Coverage – 80%

Prescription lenses and frames or contact lenses: 80% of expenses incurred for prescription lenses, frames and contact lenses are covered subject to the annual cap up to a maximum of 270 Euros per covered individual every two years.

Examinations and Treatment: 80% of expenses incurred for examinations and treatments are covered subject to the annual cap.

30. Related with Dental care, the document includes “Preventive/diagnosis services”. Could you be more explanatory about it? Is there a list of those services?

C.1.1.11 Dental Care: Minimum Coverage–80%

Preventive /Diagnostic Services (Dentist fees, Check-ups, Oral exams, cleanings, X-rays, fluoride application, sealants, extractions, non-orthodontic space maintainers, etc.)

Restorative Services and Orthodontia will be paid by the individual.

31. Related with Reproductive Health. Are all kind of contraceptive devices included if those are prescribed?

Please see below excerpt of Section C

C.1.1.12 Reproductive Health: Minimum Coverage - 80%

Prescribed contraceptive devices, preventive care and routine examinations, voluntary sterilization, and diagnosis and treatment of conditions which may cause infertility. Assisted reproductive technology (ART), fertility treatments, and reversal of sterilization are not covered (see Exclusions to Coverage).

32. Fertility treatments are not included. Can we include with reduced deductibles?

Please see below excerpt of Section L.4.3. Volume 3, Technical Proposal

Instructions to Offerors

The technical proposal must be submitted in four separate parts as described below.

Part 1, Health Insurance Services: Section C.1 defines the required minimum benefits and corresponding reimbursement rates. These are the minimally acceptable levels of coverage. If offerors choose to include additional benefits or higher reimbursement rates than the required minimums this is acceptable; however, evaluations will be based on meeting the stated minimums only. For each benefit listed, proposals must clearly state its reimbursement rate. Any proposal that reduces a benefit definition or offers lower than the minimum required reimbursement rate may be determined technically unacceptable. The resultant contract will contain the actual proposed reimbursement rates or increased benefit offerings if they exceed the solicitation’s minimum requirements.

Multiple proposals - If an offeror has multiple plans available that meet or exceed the minimum benefit levels and wants to propose them, a separate proposal with its respective prices must be submitted individually for each.

Suggested format – It’s the offeror’s responsibility to ensure their proposal is clear and meets all requirements. An example of an acceptable format for Part 1 is to submit a table that lists the Section C benefit definitions in one column and in the adjoining column list the proposed reimbursement rate.

33. Could you be more explanatory about “Employee assistance Program” (EAP) (C1.1.20)

C.1.1.20 Employee Assistance Program (EAP)

An Employee Assistance Program (EAP) is a voluntary, work-based program that offers free and confidential assessments, short-term counseling, referrals, and follow-up services to employees who have personal and/or work-related problems.

34. (C.1.3) “There is no coverage for coverages that will be reimbursed under a host country medical program….” Can we understand that if Spanish Social Security covers it, means the insurance company doesn’t have to pay for it? Could you be more explanatory about it? Can you explain what is included in the US workers Compensation Program?

This means that the Contractor will not cover expenses if they have also been reimbursed/covered by host country medical program, or worker´s compensation program, U.S. Workers compensation program or post LES worker´s compensation program.

35. “Mental Health and substance abuse” Is there a list of substances? Can we include a deductible or a copayment?

The Contractor must comply with minimum coverage in accordance with Section C.1.1.3 below:

C.1.1.13 Mental Health and Substance Abuse Care: Minimum Coverage - 50%

Inpatient and outpatient care provided to evaluate, diagnose and treat a mental health condition or substance abuse disorder. This includes behavioral health treatment, counseling, and psychotherapy. Services must be provided by a licensed psychiatrist, psychoanalyst, psychologist, or psychiatric social worker. Inpatient care for alcohol and substance abuse must be provided at a facility licensed for detoxification and rehabilitation.

36. C. 1. 1. 14. Rehabilitative and Habilitative Services and Devices:

It is coverage without any restriction. Could you be more explanatory about it? Can we include deductible or a copayment? Can we exclude some devices or treatments?

Response to this question is contained in below excerpts of Section C.

C.1.1.14 Rehabilitative and Habilitative Services and Devices: Minimum Coverage - 50%

Rehabilitative services (e.g., recovering skills, such as speech therapy after a stroke or physical therapy after an accident) and habilitative services (e.g., developing skills, such as speech therapy for children, etc.) that help develop skills needed for everyday life. Devices to help gain or recover mental or physical skills lost due to injury, disability or a chronic condition, and devices needed for habilitative reasons.

And

C.1.3 Exclusions and Limitations

There is no coverage 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.

37.- C.1.1.15 HIV/AIDS: It is covered without any restrictions. Aside from the 10.000€ LIMIT. Can we include deductible or a co-payment? Can we exclude some devices or treatments?

C.1.1.15 HIV/AIDS: 100% Reimbursement at a minimum of $10,000 per year per covered individual Medications to suppress opportunistic infections (such as tuberculosis or toxoplasmosis for covered individuals who have HIV/AIDS). Brief courses of anti-retroviral drugs during childbirth to prevent the transmission of HIV/AIDS to the child. Generally, excludes medication for the long-term suppression of HIV/AIDS through the combination of anti-retroviral drugs in locations with inadequate local healthcare infrastructures. Reimbursement under this benefit is excluded from the annual maximum limit (C.1.2).

Spain has adequate local healthcare infrastructures.

38. C.1.3 Exclusions and Limitations. Can we include any other exclusions or is it a closed list? What if those exclusions they are prevailing practice in Spain?

Proposals must comply with requirements established in Section C of the solicitation. If any of the requirements set for in the solicitation cannot be provided in Spain because of local laws, or local insurance regulations, proposals must include full explanation and evidence proving why certain services cannot be provided as stated in the solicitation.

39. Daughters and sons are included till the age of 26 years old. Only in the case they need special attention the coverage can be extended. Is there any objective way to verify those special attention (any objective criteria) and if they really need an extension of coverage?

Please see below excerpt of Section C pertaining to eligible participants.

C.1.4.1.1.2 Children: a child is defined as the LE Staff’s natural, adopted, stepchild, or foster child. The child must be unmarried and financially dependent upon the LE Staff. A child will be covered until the end of the contract year in which s/he reaches age 26. 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.

Incapability due to physical or mental condition will have to be officially recognized.

40. INDEMNIFICATION AND MEDICAL LIABILITY INSURANCE includes this clause:

“(a) It is expressly agreed and understood that this is a non-personal services contract, as defined in Federal Acquisition Regulation (FAR) 37.101, under which the professional services rendered by the Contractor are rendered in its capacity as an independent contractor. The Government may evaluate the quality of professional and administrative services provided but, retains no control over professional aspects of the services rendered, including by example, the Contractor's professional medical judgment, diagnosis, or specific medical treatments. The Contractor shall be solely liable for and expressly agrees to indemnify the Government with respect to any liability producing acts or omissions by it or by its employees or agents. The Contractor shall maintain during the term of this contract liability insurance issued by a responsible insurance carrier of not less than the following amount(s) per specialty per occurrence: 1,000,000 (one million) euros.”

“(b) An apparently successful offeror, upon request by the Contracting Officer, shall furnish prior to contract award evidence of its insurability concerning the medical liability insurance required by paragraph (a) of this clause.”

Could you please explain us if that clause means that, even having a Liability insurance, will be responsible of every medical error incurred by a doctor or a Hospital included in our medical network?

An apparently successful offeror shall furnish Evidence of medical Liability insurance upon request by the Contracting Officer prior to contract award as stated in above clause.

41. SECTION B. Can 4 year Premium be established based on casualty rate?

This will be a Firm-fixed price Contract with Economic Price Adjustment. After Contract award, economic price adjustments will be made in accordance with Section B.4. ECONOMIC PRICE ADJUSTMENT-HEALTH INSURANCE PREMIUMS

42. Shall premium be the same for the four years or can it be increased annually?

It is up to the Offeror to establish rates that they deem appropriate for each year. Offerors must submit prices for base year plus four (4) option years by filling up Section B of the solicitation.

43. Do we have to be registered in SAM.gov?

Yes, entities must be registered in SAM before contract award. It is highly recommended that all offerors start registration process while proposals are prepared. Below is a Quick guide on SAM registration process for international entities.

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SAM - Quick Guide for Internationa Entity Registration.pdf

Quick Start Guide for International Registrants Helpful Information

SAM an official free, U.S. government-operated website – it is FREE to register and maintain your entity registration record in SAM. It is FREE to get help.

What is an Entity?

In SAM, your company, business, or organization is referred to as an “Entity.”

You register your entity to do business with the U.S. government by completing the registration process in SAM.

What do I need to get started?

1. DUNS Number: You need a Data Uni-versal Numbering System (DUNS) Number to register your entity in SAM.

DUNS Numbers are unique for each physical location you want to register.

2. NATO Commercial and Government Entity (NCAGE) Code: International entities must obtain an NCAGE Code for each DUNS Number they plan to register in SAM before starting the registration process.

3. You must prepare, sign, and submit a letter designating your Entity Administrator to the Federal Service Desk within 60 days of activation.

How do I get a DUNS number?

If you do not have one, you can request a DUNS Number for free to do business with the U.S. government by visiting Dun & Bradstreet (D&B) at http://fedgov.dnb.com/webform It takes up to 5 business days to obtain an international DUNS number.

How do I get an NCAGE code?

To obtain an NCAGE Code, visit: https://eportal.nspa.nato.int/AC135 Public/scage/CageList.aspx. Make sure the legal business name and physical address you provided to get your DUNS Number and your NCAGE Code are exactly the same. It takes up to 3 business days to obtain a NCAGE code.

What about a U.S. Taxpayer Identification Number (TIN)?

You only need a TIN if your entity pays U.S. taxes. If you are an international entity that does not pay taxes in the U.S., do not enter a number in the TIN field during registration.

Steps for Registering

1. Get your DUNS Number and NCAGE Code assigned. Confirm the legal business name and physical address match in both records, then start the SAM registration process.

2. Type www.sam.gov in your Internet browser address bar.

3. Select Log In to complete authentication and create an account.

4. On the My SAM page, select Entity Registrations from the sub-navigation menu, then select Register New Entity.

5. Select your type of Entity, most likely “Business or Organization.”

6. Tell the system why you are registering in SAM. This determines what information you have to provide.

• Are you interested in bidding on Federal contracts? If so, select “I want to be able to bid on federal contracts or other procurement opportunities. I also want to be able to . . .”

• Are you just interested in becoming eligible to apply for grants or other Federal financial assistance? If so, select “I only want to apply for federal assistance opportunities like grants, loans, and other financial assistance programs.”

7. Complete your registration. Required fields are marked with a red asterisk (*). A few helpful hints:

• On the Business Information page, you will create a Marketing Partner Identification Number (MPIN). Write your MPIN down. It is used as a password in other government systems like Grants.gov.

o If you do not pay U.S. taxes, do not enter a TIN or select a TIN type. Leave those fields blank.

• On the NCAGE Code page, enter your NCAGE Code. Remember your legal business name and physical address for your DUNS Number and NCAGE Code must match.

• On the General Information page, only select Foreign Owned if your entity is owned or controlled by a foreign entity. If you are also a Manufacturer of Goods, select that first, then select Foreign Owned.

• On the Financial Information page, you do not need to provide Electronic Funds Transfer (EFT) banking information. If you do choose to provide this electronic banking information, it must be for a U.S. bank:

SAM cannot accept foreign banking information. The remittance name and address are the only mandatory sections on this page.

• In the Points of Contact section, list the names of people in your organization who know about this registration in SAM and why you want to do business with the U.S. government. These are called Points of Contact or POCs. The Government Business POC is the primary contact for your organization.

8. Select Submit after your final review. You will get a confirmation message on the screen. If you do not see this message, you did not submit your registration.

• Once approved by the IRS (if you entered a TIN), the U.S. Commercial and Government Entity (CAGE) system, and with an approved Entity Administrator letter on file, you will get an email from SAM.gov when your entity registration is active.

9. Start this process well before your contract or grant application deadline. Allow up to 12-15 business days after you submit before your registration is active in SAM, then an additional 24 hours for other systems such as Grants.gov to recognize your information.

For FREE help with your SAM entity registration, contact the Federal Service Desk (FSD) at https://www.fsd.gov/ http://fedgov.dnb.com/webform https://eportal.nspa.nato.int/AC135Public/scage/CageList.aspx https://eportal.nspa.nato.int/AC135Public/scage/CageList.aspx http://fedgov.dnb.com/webform/index.jsp https://eportal.nspa.nato.int/AC135Public/scage/CageList.aspx http://www.sam.gov/ https://www.fsd.gov/