Amendment 0004 signed update health ins solicitation OPE apvd 01292020.pdf

SBU - CONTRACTING AND ACQUISITIONS

Amendment No. 0004 to Solicitation No. 19TH20-20-R-0001

Health Insurance Services

1. Section B Part I - Prices, paragraphs B.2.3 to B.2.7 are hereby deleted in their entirety and replaced with the updated number of 1,300 persons as showed at the below tables to be related to the updated total number of employees and dependents = 2,500 persons (Payroll + Non Payroll) in Section J - List of Exhibits/Attachments.

B.2.3. BASE YEAR OF CONTRACT :

Bi-Weekly Rates Per Premium in Thai Baht (THB):

No. Category Estimated Number of Persons

Bi-Weekly Premium Rate per each person

Extended Bi-Weekly Total Baht

1 Employees

1,300

2 Eligible Dependents

1,200

SUB TOTAL

TOTAL Price for BASE YEAR (Subtotal x 26): __________________

B.2.4. FIRST OPTION YEAR OF CONTRACT:

of Persons

Bi-Weekly Premium Rate per each person

Extended Bi-Weekly

TOTAL Price for FIRST OPTION YEAR (Subtotal x 26 ): _________________

Solicitation No. 19TH20-20-R-0001

Health Insurance Services

B.2.5. SECOND OPTION YEAR OF CONTRACT:

of Persons

Bi-Weekly Premium Rate per each person

Extended Bi-Weekly

TOTAL Price for SECOND OPTION YEAR (Subtotal x 26): ______________

B.2.6. THIRD OPTION YEAR OF CONTRACT:

of Persons

Bi-Weekly Premium Rate per each person

Extended Bi-Weekly

TOTAL Price for THIRD OPTION YEAR (Subtotal x 26): __________________

Solicitation No. 19TH20-20-R-0001

Health Insurance Services

B.2.7. FOURTH OPTION YEAR OF CONTRACT:

of Persons

Bi-Weekly Premium Rate per each person

Extended Bi-Weekly

TOTAL Price for FOURTH OPTION YEAR (Subtotal x 26): __________________

2. Section J, Exhibit E, is deleted in its entirety and replaced with the following Exhibit E:

Exhibit E – CLAIMS PAID OUT FOR THE PAST 5 YEARS.

Year Total Thai Baht total USD

11/01/2014 - 10/31/2015 54,038,157 $ 1,743,167 11/01/2015 – 10/31/2016 67,197,826 $ 2,100,000 11/01/2016 – 10/31/2017 64,113,678 $ 2,035,400 11/01/2017 – 10/31/2018 66,921,665 $ 2,160,000 11/01/2018 - 10/31/2019 65,339,176 $ 2,114,537

3. Section C, paragraph C.1 is hereby deleted in entirety and replaced with the following revised paragraph:

C.1. HEALTH INSURANCE SERVICES

The Government of the United States of America requires Health Insurance coverage for its employees as further described in C.1.2 in Thailand. The Government has determined that the prevailing practice by employers in Thailand is to provide for their employees health insurance protection.

Health insurance protection will be representative of locally prevailing compensation practice as further described in C.1.2. The specific health benefit coverage under this contract is set forth in Section C and the Exhibits in Section J.

The Contractor shall insure that health care under this contract does not exclude HIV/AIDS care.

Solicitation No. 19TH20-20-R-0001 Health Insurance Services

4. Section C, paragraph C.1.1.15 is hereby deleted in entirety and replace with the following revised paragraph:

C.1.1.15 HIV/AIDS: 100% Reimbursement at a minimum of $10,000 per year 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. Reimbursement under this benefit is excluded from the annual maximum limit (C.1.2).

5. Section C, paragraph C.1.1.16 is hereby deleted in its entirety and replaced with the following revised paragraph:

C.1.1.16 180 Day Extended Dependent Coverage after Employee’s Death: At the time of a covered employee’s death, his/her eligible dependents covered under post’s medical plan are eligible to continue receiving the same level of medical coverage for up to 180 days. The extension of coverage is available for up to 180 days, even if this time period moves into a new policy year, however the coverage will end upon contract termination.

6. Section C, paragraphs C.1.1.18 Medical Expenses Incurred Out-of-Country and C.1.1.19 Transportation for Out-of-Country Treatment: 80% Reimbursement are hereby deleted in their entireties.

7. Section C, paragraph C.1.1.20 is hereby deleted in its entirety and replaced with the following

C.1.1.20 Excess Coverage:

Excess Coverage is additional coverage equal to 2,000,000 Baht to be applied to any covered individual to any covered benefit. LE Staff must pay 100% of the premium if they elect Excess Coverage. This can be used for any coverage individual for any covered expense that exceed annual maximum. Employees must select this coverage prior to the start of the policy year.

Employees who select this coverage will pay through payroll deduction and the Contractor will be paid directly by the Embassy. Underwriting is not allowed. A minimum participation rate of 10% is allowed, though not required.

8. Section G, paragraph G.6 GOODS SERVICE TAX is hereby deleted in its entirety.

Health Insurance Services

9. Section H, paragraph H.5 is hereby deleted in its entirety and replaced with the following revised

H.5. REPORT REQUIREMENTS. The Contractor shall provide the following monthly reports.

All Employee Claims Reports shall be received by the COR no later than the 10th day of each month. All Explanation of Benefits Reports shall be received by the Employee no later than the 10th day of the month. Both reports shall be either in an electronic or paper format, however, both reports shall be submitted in the same format. The report shall report on the previous month's activities.

(a) Employee Claims Report. The report shall list all claims paid by the Contractor to a claimant, including the name of the claimant, date claim is received by the Contractor, and the amount claimed. This report shall also include all outstanding claims and a brief description of why claim has not been paid. The report shall not include any claims information for riders.

(b) Employee Explanation of Benefits Report. The report shall list all of the claims paid by the Contractor for the individual employee including date claim is received by the Contractor and the amount claimed.

10. Section C, Paragraph C.1.1.1 is hereby deleted in its entirety and replaced with the following revised paragraph:

C.1.1.1 Hospitalization (treatment in the hospital for Inpatient care):

Minimum Reimbursement Rate - 100%

Services and supplies provided during hospitalization, including services provided by a licensed healthcare provider, bed & board (semi-private accommodations), operating room, recovery room, intensive care, imaging and diagnostic testing, general hospital nursing care, physical therapy, as well as drugs and medicines administered while in-patient. When private accommodations are provided, coverage will be limited to the cost of a semi-private room unless otherwise covered in an off the shelf plan or when no semi-private rooms are available.

11. Delete “PEACE CORPS” and other wordings related to “PEACE CORPS Contractors” out of the following paragraphs: B.1.1, C.1.4.2, C.1.7.1, G.4.4.c, H.3.1 because PEACE CORPS is not one of the Riders included in this solicitation.

Health Insurance Services

12. Section M, paragraph M.5 is hereby deleted in its entirety and replaced with the following revised paragraph:

M.5. TECHNICAL EVALUATION

Offers will be evaluated on:

(i) Meeting each of the individual mandatory requirements/minimums for health insurance coverage specified in Section C through H and submitting an acceptable management approach (Part 2 under L.4.3) indicating how vendor will administer the plan and demonstrate an understanding, knowledge and familiarity of the requirements. The Government may reject, as technically, unacceptable proposals that:

(a) Fail to provide at least the minimum reimbursement levels for each benefit required by the solicitation; or

(b) Fail to demonstrate how solicitation requirements will be met.

(ii) The demonstration that the offeror is licensed/certified/accredited or otherwise authorized by the Government of Thailand or its agent (e.g., Office of Insurance Commission (OIC) of Thailand, board) to provide health insurance coverage to persons (to include organizations, companies, groups) within the host country. If the offeror is not licensed/certified/accredited or otherwise authorized by the Government of Thailand, it must demonstrate that it is licensed/certified/accredited by a government other than that of the host country to provide health insurance for persons in Thailand and must demonstrate its capacity to provide health benefits in Thailand to meet the minimum requirements and other conditions set forth in this solicitation;

and,

(iii) Acceptable relevant Experience and Past Performance; and

(iv) Meet all other terms and conditions set forth in this solicitation.

13. Section H, paragraph H.4 (b)(1) is hereby deleted in its entirety and replaced with the following revised paragraph:

H.4 (b)(1) All medical claims shall be submitted directly to the Contractor by employees, through a drop box in the COR’s office. The claims shall be picked up from the COR each Tuesday.

Alternatively, if the Contractor offers a cashless service option such as a medical card, the employee may use the medical card for immediate claim submission to the Contractor.

14. Section C, paragraph C.1.4.1.2.1 is hereby deleted in its entirety and replaced with the following revised paragraph:

C.1.4.1.2.1 Spouse: a limit of one legal spouse per employee will be covered. For same-sex marriages, if the employee can provide proof of legal marriage from the country in which they were married, the same-sex spouse shall be covered.