GMC solicitation Q & A OPE_HROE apvd 01292020.pdf

Bangkok Post Questions and Answers for Health Insurance Service

19TH20-20-R-0001

January 30, 2020

Q. 1. Total number of employees and dependents mentioned in the price tables (Section B) do not match with the total number of employees and dependents mentioned under Section J of the solicitation. As per the prices tables in Section B, the total number of members (employees + dependents) is 2,520 while the total member count is 2,485 in Section J (page 36). Please update the correct Member Census counts in Section B and Section J.

A.1. The most up-to-date total number is 2,500 (Payroll + Non Payroll Employee & Dependents). Refer to Amendment 0004, Item 1.

Q.2. Section J (page 37 and page 38) has paras titled ‘A-Payroll’ and ‘B-Non-Payroll’, what do these titles represent? Does ‘B-Non-Payroll’ refer to ORE, EAE and other RIDERs?

A.2. Yes, Non-Payroll refers to ORE, EAE and other Riders.

Q.3. The total count for members on page 36 is 2,485 whereas sum total of members in A- Payroll and B-Payroll (page 37 and 38) is 2,499. Please reconcile these member counts. Refer to the attached Excel file for easy reconciliation.

A.3. Refer to answer A.1.

Q.4. Solicitation has claims history for health Insurance for the years 2015-2016, 2016-2017 and 2017-2018. Please provide the claims history for 2014-2015 and the current year 2018-2019 (we understand the full year data may not be available yet, so please provide the claims data available and clearly mention the associated period/months).

A.4. Refer to Amendment 0004, Item 2.

Q.5. Please provide Member counts in the claims table provided in Section J.

A.5. Refer to answer A.4 for claims history.

Q.6. Does the Claim table in Section J include claim amounts from ORE, EAE and other Rider Members?

A.6. Refer to answer A.4. These figures do not include riders.

Q. 7. Are there any HIV/AIDs cases. If Yes, please provide number (please note we are not seeking protected private information, we do not need the names or identification; we just need to know the total number of people who are currently being treated for HIV/AIDs to assess the risk and price accordingly).

A.7. No

Q.8. When is this plan likely to commence?

A.8. April 2020.

Q.9. Do you mean Minimum Reimbursement rate from actual claim amount and not excess Annual Maximum Limit 2,000,000 Baht?

A.9. Correct, the Minimum Reimbursement Rate applies per claim up to the annual maximum limit. Refer to Section C, paragraph C.1.1.20 for information regarding optional, excess coverage.

Q.10. Point C.1.1.5 Obstetric and Newborn Care. About outpatient care for newborn babies what is the limit covered age of newborn babies?

A.10. Newborn Care coverage ends once an infant is discharged from the hospital and registered as an individual member of the plan.

Q.11. Point C.1.1.6 Pediatric Services. Covered dependent children what is the limit covered age of dependent children?

A.11. Refer to Section C, paragraph C.1.4.1.2.2 for the age requirements of dependent children.

Q.12. Point C.1.1.7 Prescription Drugs. Can buy from drug stores& government hospitals only same as existing policy? Or can buy from private hospital as well?

A.12. Refer to Section C, Section C.1.1.7. Private hospitals are not excluded as a point of purchase for legally prescribed medications.

Q. 13. Point C.1.1.11 Dental care. A maximum of 4 years of orthodontia treatment shall be covered per covered per patient up to a maximum of USD2,400 lifetime limit. So if there’s any deletion/addition before 4 years this patient will get this benefit as prorate or not?

A. 13. It is not prorated. For example, if someone has receipts up to $2,400 and has only been insured for 2 years, that bill should be paid up to 80%, per the definition of the benefit. The benefit levels are per person. The addition of a child would start the clock at the time the child is added to the insurance policy. Once a child is “deleted” from an insurance policy, all benefits would end.

Q.14. Point C.1.1.17 Catastrophic Coverage. What do we mean by Catastrophic Coverage? And how the coverage will be calculated?

A. 14. Catastrophic Coverage is coverage where the annual maximum limit has been met and this coverage provides an additional benefit for that 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.

Q.15. Point C.1.1.19 Transportation for Out of Country Treatment: 80% Reimbursement. Our evacuation or SOS package with AGA we have USD 1 million or about THB 30 million. Which we covered including Evacuation, Repatriation, and Repatriation of mortal remains (Must be more than 150 km. from residence. So can we offer this or do we have to tailor as 80% of 2,000,000THB for reimbursement?

A.15. Section C, paragraph C.1.1.19 has been deleted. Refer to Amendment 0004, Item 6.

Q.16. Point C.1.1.20 Excess coverage. What does it mean by “Employee responsible for paying 100% of premium for Excess Coverage”? Do we mean the employee has to pay 100% of claim for Excess Coverage or pay 100% of buying insurance premium for Excess Coverage.

A.16. We are referring to optional coverage for benefits in excess of the standard annual maximum limit. Therefore, the Employee would be responsible for 100% of the premium via payroll deduction, if they elect the coverage. The Contractor will be paid directly by the Embassy. Refer to Amendment 0004, Item 7.

Q.17. Do Dental & medical checkup will be covered both employee and dependent? Or covered only employee?

A. 17. Refer to Section C, paragraph C.1.1.11. Dental and medical check-up benefits will be covered for all members.

Q. 18. 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 appreciate you have provided the dollar amount of paid claims for the past 3 years ending October 31, 2018. Please provide additional information crucial to the development of our rates. Please note the current contractor has access to this information and we and others would be at a significant disadvantage if we didn’t also have it. The additional information we are requesting is as follows:

• Please provide claims information for the period of November 1, 2018 to the latest period in 2019 you have the information and please specify that date.

• Please provide the number of claims incurred in all periods

• Please provide the premium billed in all periods

• Please provide average number members during all periods. This is the average number of employees + spouses + dependents.

A.18. Refer to answer A.4.

Q.19. The Timing of the Embassy’s answers to Questions from Prospective Vendors – We note that the pre-solicitation conference is December 11, 2019 and that proposal are due eight days later December 19, 2019. We believe it is general practice for the embassy to wait until after the pre-proposal conference to issue answers to the questions they receive from prospective contractors such as the questions herein. Will the embassy publish answers to questions from prospective vendors as they are available and not wait until the conclusion of the pre-proposal conference? If the embassy intends to wait until after the pre-proposal conference to answer our and other prospective contractors’ questions, we respectfully request the embassy issue a three-week extension of the proposal due date now. The information we are requesting herein is critically important to the development of our proposals and without the three-week extension we would be at significant disadvantage to the current contractor who already has access to the information.

A.19. See Amendment 0003. The updated due date for proposals is February 14th, 2020.

Q.20. Excess Coverage - We note employees can purchase excess coverage of 2,000,000 Baht and have two questions:

a) How should we provide our quotations for this excess coverage?

b) How will the contractor receive the employee’s payments for the excess coverage they purchase? Will the embassy collect these funds and remit them to the contractor on behalf of the employee?

A.20. The Contractor should include a separate line item for Excess Coverage on premium invoices. The Embassy will collect the funds via payroll deduction and pay the Contractor directly. Refer to Amendment 0004, Item 7.

Q. 21. Does this solicitation number 19TH2020-R-0001 contain the same requirements as the current contract? If not, please provide section C from the current contract.

A. 21. No, this solicitation is completely different from the current contract as the benefit levels in this solicitation are based on global medical coverage and not coverage unique to Thailand.

Q. 22. 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.

A. 22. Services are only covered when rendered in Thailand. Section C, paragraph C.1.1.18 has been deleted. Refer to Amendment 0004, Item 6.

Q. 23. We note there are 72 non payroll employees and they have 39 dependents. Please explain why these employees are listed separately? What makes them, different from the other employees listed?

A. 23. Please refer to answer A.2.

Q. 24. We note in section C.1 The cost of such insurance protection is borne by both the employee and the employer using a scaled premium split based on employee grade. Please provide those details.

A. 24. Refer to Amendment 0004, Item 3, for updated language in Section C, paragraph C.1.

Q.25. B.1.1 Invoice will separate by each rider, right?

A.25. Separate invoices should be sent to each Rider organization or individual as determined between the Rider and the Contractor. Refer to Section G, paragraph G.4.4.

Q.26. B.2.1. The contract says US Government is exempt from VAT but then later says to add GST as a separate line item. Is GST referring to stamp duty?

A.26. Section G, paragraph G.6 has been removed from the solicitation. Refer to Amendment 0004, Item 8.

Q.27. B.2.3: Base Year (and Option Year) Tables have two columns, one is the “Bi-Weekly Premium Rate per each person”, and the other is “Extended Bi-Weekly Total Baht”. Is the Extended Bi-Weekly Total Baht related to C.1.1.16 for Extended 180 day coverage for dependent? Or can you clarify more on the Extended Bi-Weekly Total Baht.

A.27. The Extended column is simply the ‘Estimated Number of Persons’ figures multiplied by the ‘Bi-Weekly Premium Rate per each person’, giving a total premium.

Q.28. B.3.2 Retention amount. In the circumstances that the US Embassy requests for material/significant change in the operating flow / customer service support in Option Years, does the insurance company allow to change the retention amount in Option Years?

A.28. The retention amount does not change during the life of the contract. Refer to Section B, paragraph B.3.1

Q.29. B.4.1. Price for Basic (US Embassy) and Rider (associations) must be the same? If increase price for Basic, does price also increase for Rider?

A.29. Prices are not required to be the same for employees and riders.

Q.30. On the other hand, as experience of Rider is not counted under Basic, what if Rider has worse claims than Basic, are we allowed to increase price more for Rider?

A.30. Refer to answer A.29.

Q.31. Historical experience can be taken into account for premium adjustment. How about considerations of other factors (e.g. change in future medical trend for renewal years due to increase in healthcare provider charges) which impact renewal year price?

A.31. No, the only adjustments to the premiums allowed are in Section B, paragraph B.4.

Q.32. When considering historical experience for price adjustment, will contractor be allowed to present on incurred basis? If on incurred basis, there will be a projection of reserves of outstanding claims to be considered for the historical experience.

A.32. Refer to answer A.31.

Q.33. B.4.2.1. With regards to the employee pool, is this refer to stop loss arrangement? Is there an existing arrangement that we can refer to?

A.33. If the contractor is using employee pools and intends to add our employees to an existing pool, then the contractor must disclose those details in its offer. Please refer to Section B, paragraph B.4.2.1 and Section L, paragraph L.4.3.4.

Q.34. C.1 stated premium split between employer and employee based on employee grade.

How should contractor collect premium? Or as per C.1.7 “During a period of Leave Without Pay (LWP) or unpaid leave that is one pay period or less, coverage under the insurance contract will continue. The USG will pay the total premium cost to the Contractor. The employee’s share of the premium will be collected through payroll deduction in that or the subsequent pay period.”

That employer will collect employee’s share and then pay the total premiums to contractor directly?

A.34. Yes, that is correct, as stated in Section C, paragraph C.1.

Q.35. Request for existing table of benefit.

A.35. Refer to A.21.

Q.36. C.1.1.1 Confirm no itemized benefit limits (except Hearing Aids/Vision/Dental/HIV&AIDS) on the inpatient and outpatient coverage, for example, no sub-limits on room & board, surgeon’s fee, etc and inpatient claims will be reimbursed at 100% up to the THB 2m limit, without taking catastrophic and excess coverage into account. Per actual cost

A.36. Refer to Section C, paragraph C.1.1.1. The benefit levels do not include sub-limits. We would be interested, however, to see bidders’ off the shelf plan offerings, as long as the plans meet or exceed the minimum benefit levels of this solicitation, as per Section L, paragraph L.4.3, Part 1.

Q.37. C.1.1.1 What is the definition of I.C.U cover as charged?

A.37. The actual cost. Refer to answer A.36.

Q.38. C.1.1.1 What is off the shelf plan?

A.38. This refers to any standard insurance package that the Contractor may offer.

Q.39. C.1.1.2 What does ‘trips to emergency room’ mean?

A.39. Section C, paragraph C.1.1.2 refers to services provided in the Emergency Room of a hospital.

Q.40. C.1.1.2 Does this benefit, Emergency Services (trips to emergency room), mean Emergency OPD Treatment can be claimed in IPD benefit?

A.40. Section C, paragraph C.1.1.1 and C.1.1.2 refer to when the patient is admitted to the hospital and the IPD benefit can be claimed.

Q.41. C.1.1.4 Does the benefit plan has sum Insured limit for IPD and OPD?

A.41. See Section C, paragraph C.1.2 for the Annual Maximum Limit.

Q.42. C.1.1.4 What is the Annual Limit Amount? 2 million baht/year

A.42. Refer to answer A.41.

Q.43. C.1.1.5 Does newborn baby must apply for the insurance? If yes, how many days newborn must apply for insurance and does the benefit separate from ...?

A.43. Refer to answer A.10.

Q.44. C.1.1.5 What is the age of newborn baby?

A.44. Refer to answer A.10.

Q.45. C1.1.5 for Outpatient (ANC), allow to use cashless services or not?

A.45. Yes. For Outpatient, we allow to use cashless service (medical card). Refer to Amendment 0004, Item 13.

Q.46. C.1.1.6 What is the covered age range for Pediatric?

A.46. Refer to answers A.10 and A.11.

Q.47. C.1.1.6 Does Pediatric sum insured separate from IPD/OPD?

A.47. Refer to answer A.36.

Q.48. C.1.1.6 Does kids must buy IPD/OPD?

A.48. Refer to answer A.36 and Section C, paragraph C.1.4

Q.49. C 1.1.6 can you clarify more in the definition that said “Including, but not limited to” what is the cover benefit?

A.49. A member may visit the doctor or hospital for any number of reasons. We cannot provide an exhaustive list.

Q.50. C.1.1.7: Prophylaxis is referring to preventive measures/treatment/drugs? If so, should it be more like immunization and be included under C.1.1.8 and all subject to 80% reimbursement rate regardless it is inpatient or outpatient claims?

A.50. No, Prophylaxis is correctly included Section C, paragraph C.1.1.7.

Q.51. C.1.1.8 Request for list of immunizations, cancer screening, etc. which is covered under this benefit.

A.51. We cannot provide an exhaustive list of all treatments used for all disease management and prevention.

Q.52. C.1.1.8 Request for the definition of Chronic disease.

A.52. Per the U.S. Centers for Disease Control and Prevention, chronic diseases are defined broadly as conditions that last 1 year or more and require ongoing medical attention or limit activities of daily living or both.

Q.53. C.1.1.8 Does the wellness mean Health Check up?

A.53. Section C, paragraph C.1.1.8 includes physical exams for preventive and wellness.

Q.54. C.1.1.9 Does the sum insured of hearing aids separate from OPD? Since it mentioned per three year period.C.1.1.9 How can we track the claim history back in 3 year period?

A.54. Refer to Section C, paragraph C.1.1.9 for limits related to hearing aids. This benefit does count toward the Annual Maximum Limit noted in Section C, paragraph C.1.2.

Q.55. C.1.1.10 do you have limit of the lenses?

A.55. Section C, paragraph C.1.1.10, has no limits on the number of lenses, only the dollar amount per year.

Q.56. C.1.1.11 do you have limitation for Orthodontia? For treatment only?

A.56. Section C, paragraph C.1.1.11 states the limit for orthodontia treatment.

Q.57. C.1.1.12 Does the family planning cover both IPD & OPD? And if it is included sum insured both IPD and OPD?

A.57. Yes, please refer to answer A.41.

Q.58. C.1.1.13 Does the Mental Health and Substance Abuse Care sum insured is included in

IPD/OPD?

A.58. Yes, please refer to answer A.41.

Q.59. C.1.1.14 Does Rehabilitative and Habilitative Services and Devices cover both IPD & OPD?

A.59. Yes, please refer to answer A.41.

Q.60. C.1.1.14 Does the coverage include sum insured in IPD/OPD?

A.60. Yes, please refer to answer A.41.

Q.61. C.1.1.15 “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”. Does this mean anti-retroviral drugs will be covered if the members are in locations with adequate local healthcare infrastructures? How to define “inadequate local healthcare infrastructures”?

A.61. Refer to Amendment 0004, Item 4, for updated language in Section C, paragraph C.1.1.15.

Q.62. C.1.1.15 Minimum benefit limit of $10,000 per year. Please confirm the currency of this limit is in USD.

A.62. Correct, the currency is in USD, as written.

Q.63. C.1.1.15 Does the coverage will be for both IPD & OPD?

A.63. Yes, please refer to answer A.41.

Q.64. C.1.1.16 Please elaborate “This optional benefit is subject to availability of funds at post” and what’s the definition of funds at post?

A.64. Refer to Amendment 0004, Item 5.

Q.65. C.1.1.16 If the fund is sufficient for only certain number of dependent and not all dependents of the deceased employees, how will we execute?

A.65. Refer to answer A.64.

Q.66. C.1.1.16 Does 180 day extended dependent coverage after employee’s death cover until end of the policy year?

A.66. Section C.1.1.16 refers to Dependent Coverage for up to 180 days after the death of the employee, even if into a new policy year. Refer to Amendment 0004, Item 5.

Q.67. C.1.1.17 Catastrophic coverage. What’s the definition of “major medical conditions occurring as a result of a single/illness/accident or closely related set of major illnesses”?

And do they apply any co-payment?

A.67. Refer to answer A.14. No co-payments are applied.

Q.68. C.1.1.19 How frequent does this happen and if any historical claims data can be provided with details about which country and the cost of treatment? In particular, any claims incurred and treated in the US before? What if the scenario that member has the business trip to other country and have the health condition which needs to go back to BKK? Does this cover?

A.68. Refer to answer A.15.

Q.69. C.1.1.20 Optional top-up cover (Excess Coverage) of THB 2m to be purchased by members: is this a new feature or could it be in existing experience? If it is an existing feature, were there any changes in the design in the past years and the new contract year in 2020?

A.69. This is a new benefit.

Q.70. C.1.1.20 What’s the take up rates or number of existing members currently purchased this excess coverage? Do we assume no underwriting is allowed when we take over members currently purchased this excess coverage?

A.70. This is a new benefit for all members. Refer to Amendment 0004, Item 7.

Q.71. C.1.1.20 Is insurer allowed to underwrite members who newly choose this option? If underwriting is not allowed, can we require a minimum participation rate on the excess coverage?

A.71. Refer to A.70. A minimum participation rate of 10% is allowed, though not required.

Please see Amendment 0004, Item 7.

Q.72. C.1.1.20 Excess means another IPD & OPD? What is the sum insured for each benefit?

A.72. Section C, paragraph C.1.1.20 is additional coverage of 2 million BAHT for any covered individual for any covered benefit

Q.73. C.1.1.20 Excess means additional major medical? Therefore, total major medical is 4MB?

A.73. Refer to answers A.16 and A.72.

Q.74. C.1.1.20 Does this allows for members to choose this benefit during the policy year, not the beginning of the policy year?

A.74. The Excess Coverage benefit must be elected prior to the start of the policy year. Please see Amendment 0004, Item 7.

Q.75. C.1.1.20 What is the premium payment method for to collect from the responsible Employee?

A.75. Refer to answers A.16 and A.71.

Q.76. C.1.3 Please clarify more on the Exercise Therapy?

A.76. Exercise Therapy is a regimen or plan of physical activities designed and prescribed for specific therapeutic goals by a licensed physician.

Q.77. C.1.3 Please clarify for Long-term rehabilitative therapy?

A.77. Long-term rehabilitative therapy programs are programs that take 120 to 180 days or longer to help treat chronic alcohol or drug addiction.

Q.78. C.1.7.1 “During a period of Leave Without Pay (LWP) or unpaid leave that is one pay period or less, coverage under the insurance contract will continue. The USG will pay the total premium cost to the Contractor. The employee’s share of the premium will be collected through payroll deduction in that or the subsequent pay period.”

Is the definition of one pay period equivalent to premium frequency which is bi-weekly? Or pay period refer to the payroll pay period and if so, what is the duration of payroll pay period?

A.78. Payroll and premium payment frequency are both bi-weekly.

Q.79. C.1.4.1.2.2 An unmarried child determined to be incapable of self-support due to a physical or mental condition meaning child age over 26?

A.79. Refer to answer A.11. There is no age limit for physically or mentally handicapped children incapable of self-support.

Q.80. C.1.7.2 “During a period of extended (beyond one pay period) of Leave Without Pay (LWP) or unpaid leave, the employee is responsible for the full cost of the insurance premiums for self and dependents. The Mission will pay the premiums directly to the Contractor, and will collect the full cost from the employee on a quarterly basis. Alternatively, the employee may elect to have coverage cease if that employee prefers not to pay the premium“ How often did this happen (LWP beyond one pay period), e.g. number of employees applied LWP beyond one pay period?

A.80. Historically, this has happened less than 10 times per year.

Q.81. How does the Table of Benefits (TOB) underlying the experience compare with what is requested? Have there been major changes in coverage / plan design during 2016-2019? If yes, can provide the plan design for each policy year?

A.81. Refer to answer A.21.

Q.82. Table of benefits (TOB)- same benefits for all employees? If not, please provide the TOB for each member group.

A.82. All benefits are available to all members.

Q.83. Do we need to provide group life coverage?

A.83. Life insurance is not part of this solicitation.

Q.84. Foreign exchange (FX) – there are some benefits showing in USD, e.g. hearing aid, optical care, dental care, HIV. What FX should be used for benefits? Should FX be fixed?

A.84. The foreign exchange rate will be the prevailing rate on the date the claim is paid by the Contractor. The rate cannot be fixed.

Q.85. Underwriting- should this be Medical History Disregard (MHD) for existing members?

How about new members, should it be with health declaration or MHD?

A.85. All members are covered without regard to pre-existing conditions.

Q.86. Can we have the current benefit table?

A.86. Refer to answer A.21.

Q.87. E.2. Any financial penalty if exceed 3 complaints each month?

A.87. Refer to Section E, paragraph E.2.3 for Procedures related to handling complaints.

Q.88. G.4. Invoice- should invoice be split by employment type?

A.88. Yes, refer to answer A.25.

Q.89. Do we need to provide details of the amount reimbursed with explanation every time?

A.89. Refer to Amendment 0004, Item 9.

Q.90. Which channel that we will use to send this explanation, Email or Hard Copy?

A.90. Refer to Amendment 0004, Item 9.

Q.91. 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.”

o As contractor receives bi-weekly premiums but there could be no funds available after 30 Sep of each Government Fiscal Year, confirm the contractor should continue to pay and settle claims, and allow members to continue using any cashless arrangement?

A.91. Each contract period is financed by annual appropriations and there is no guarantee that funds will be available for the next contract period, meaning the option year. If funds are available, the government will award the next option year. If funds are not available, then the government will exercise the option year but not issue a task order and the contractor will not perform these services until such time as funds are available.

Q.92. Section J, Exhibits A-D o What period is the membership in the various exhibits for?

o What is the number of employees in the previous policy year 2016/2017/2018/2019. Have these numbers been significantly changed in the past? If yes, can the monthly membership be provided?

o Average age for policy year 2016/2017/2018/2019 o Gender ratio for policy year 2016/2017/2018/2019

A.92. Refer to answer A.4.

Q.93. Section J, Exhibits A-D What are the geographic locations of members in Thailand? Are they mostly in Bangkok?

A.93. Yes, approximately 90% of the members reside in the Bangkok area and the other 10% in Chiang-Mai, Udornthani, and Ayuthaya.

Q.94. Spouse definition- same sex marriage is not covered?

A.94. Refer to Amendment 0004, Item 14.

Q.95. Section J- in B) Non-Payroll, what is meant by non-payroll?

A.95. Refer to answer A.2.

Q.96. Section J, Exhibit E Claims data (Exhibit E)

SQ.1. Are the claims showing in Exhibit E including all claims paid for those have excess options?

SA.1. No, the Excess Coverage option is a new benefit. Refer to answer A.4.

SQ.2. Is claims paid on incurred period in Exhibit E? If it is on incurred basis, when was the claims data being extracted after each policy period?

SA.2. Within 3 months at each policy ending.

SQ.3. Can we have claim details which provide the type of claims, providers, claim amount, diagnosis?

SA.3. Refer to answer A.4.

SQ.4. Any large and ongoing claim

SA.4. We cannot provide this information.

SQ.5. The proportion of cashless and reimbursement

SA.5. Post does not understand this question.

SQ.6 % Claim outside Thailand/ % Claim in USA

SA.6. 99% of claims are inside Thailand

SQ. 7. The proportion of US and non-US nationality

SA.7. 99% local staff is Thai nationality

SQ.8. Exhibit E Claims paid for the past 3 years. Please confirm the claims paid amount are either in Thai Baht or USD, and we do not need to add up the THB and USD to get the total claims paid. For example, in 11/1/2017-10/31/2018, the total claims paid was Thai Baht 66,921,665 in the middle column, and USD 2,160,000 was just the USD equivalent amount of 66,921,665.

SA.8. Correct, the USD column simply reflects a currency conversion. Claims were paid in Thai Baht.

SQ.9. Can we have confirmation that the same contractor was used for 2016-2018 policy periods?

SA.9. Yes

SQ. 10. Can we ask who is the existing TPA?

SA. 10 AETNA Health Insurance

A.96. Refer to answers in red above.

Q.97. Section L The profit sharing agreement, what is the current agreement? When should this be measured?

A.97. Refer to Section L, paragraph 4.3.3 which requires the offeror to include information in their offer of any profit sharing agreements associated with this contract.

Q.98. Section L Winning contract is the one with the lowest price. What about considerations of value-added services including size of hospital network, wellness programs, etc? Will the evaluation take these into account or not considered at all?

A.98. Refer to Section M, paragraph M.3.1 and Amendment 0004, Item 13 for revised Section M.5.

Q.99. Section L Will there be any presentation sessions / meetings for potential contractors to present and discuss our offer prior to award? If so, when will be the target date of such meeting?

A.99. No, there will be no presentations or meetings to present and discuss offers.

Q.100. Section L.4.3 Part 2- item 4: please clarify more:

Describe the pool(s) of coverage the offeror uses to administer its insurance; which pool of coverage the employees under this requirement will be contained, and what percentage of that pool they would represent

A.100. Refer to answer A.33.

Q.101. L4.3.3 Will the profit sharing include the voluntary plan (individual excess coverages)?

A.101. The offeror has the option to include the voluntary plan or not but must notify the Embassy either way in the offer.

Q.102. Section M: What expected award date?

A.102. Refer to answer A.8.

Q.103. Section M: What is the inception date?

A.103. Refer to answer A.8.

Q.104. Section M.5(i)(b): Other additional benefits not required by the solicitation. Does this include the additional service such as mobile application?

A.104. Refer to Amendment 0004, Item 13.

Q.105. What is the insurance premium payment term currently? Is it possible that the insurance premium will be paid annually or semi-annually?

A.105. No, the solicitation in Section B, paragraphs B.2.3 through B.2.7 and Section G, paragraph G.4.2 requires premiums to be paid bi-weekly.

Q.106. Is it possible that the insurance premium charge depends on the number of claim transaction occurred?

A.106. Refer to Section B, paragraph B.4 which allows for EPA adjustments to the premiums.

Q.107. What is the effective date of the insurance scheme under TOR?

A.107. Refer to answer A.8.

Q.108. For the 5 yrs. Contract determined in TOR, is the contract can be cancelled by both US Embassy and/ or the Insurer at the end of each year?

A.108. No, if you refer to Section F, paragraph F.3 and Section I, 52.217-9 OPTION TO EXTEND THE TERM OF THE CONTRACT (MAR 2000) the government reserves the right to unilaterally exercise the option years for the contract.

Q.109. Can insurer provide separate maximum benefit of 2 million baht for each employee and each of his family?

A.109. Refer to Section C, paragraph C.1.1.20 for Additional coverage equal to 2,000,000 Baht to be applied to any covered individual who signs up for the additional coverage.

Q.110. Is there any limit number of eligible insured spouse and child?

A.110. Refer to Section C, paragraph C.1.4.1.2. Eligible dependents include one legal spouse and unlimited children.

Q.111. In case that spouse and child of eligible employee do not live in Thailand, are these spouse and child eligible under TOR?

A.111. Refer to answer A.22. Coverage applies only for services rendered in Thailand.

Q.112. Regarding to Exhibit E – Claim Paid Out for the past 3 years, please provide us with the following data:

-policy plan for employee, spouse and child for year 2016-2019 -claim detail classified by IPD, OPD and Health Check Up for *employees

* spouse and child -number of employee, spouse and child as of 1 November 2015/2016/2017 /2018/2019

- Loss Ratio for:

*period 11/1/2015-10/31/2016 *period 11/1/2016-10/31/2017

* period 11/1/2017-10/31/2018

* period 11/1/2017-10/31/2019

A.112. Refer to answer A.4.

Q.113. Since we are an insurance broker (not an actual insurance company); we would like to know if there is a maximum on the number of insurance companies a single broker can work with?

A.113. This solicitation is for one vendor who can provide all required services as listed in the solicitation.

Q.114. Would a bid from a broker be accepted for review or would it have to be directly from the insurer?

A.114. Yes, an insurance broker can submit a bid for review, if the broker does so in accordance with Thai law. Refer to Section H, paragraph H.6 and Section L, paragraph L.4.3, Part 4.

Q.115. Renewal date: section F2 30 days following contract award. When?

A.115. Refer to answers A.102 and A.8.

Q.116. H5 (a): monthly claims report from Contractor, stating claimant’s name?

A.116. Yes, as stated in Section H, paragraph H.5 (a). Refer to Amendment 0004, Item 9 for updated paragraph H.5.

Q.117. We need the current contract Full Benefits Schedule.

A.117. Refer to answer A.21.

Q.118. Regarding Section J, Exhibit E, we request the complete claims reports for the past 3 years.

A.118. Refer to answer A.4.

Q.119. Is the claims data stated in the tender for a similar headcount existing today (2,500 members) or was it for a different headcount. If so, please provide headcount for previous years.

A.119. Refer to answer A.4.

Q.120. In the list of benefits what does the % of reimbursement mean? This is fairly dependant on which claims will be submitted by members (like if they comply with exclusions etc….)

A.120. Refer to answer A.36.

Q.121. Is there other insurance in place that may limit the usage of the current plan in place?

A.121. No.

Q.122. How does the mechanism of excess coverage C.1.1.20 work? Does it mean that there will be a voluntary plan with an extended limit at 4MTHB? How does it relate to the C.1.1.17 (catastrophic coverage) , is it on top? The excess coverage cost is expected to be borne by the employee: shall we invoice the employer directly and they deduct from salary?

A.122. Refer to answers A.14 and A.16.

Q.123. Is it a 4 years contract with a structured renewal formula based on loss ratio? Is there any exit clause for any of the parties?

A.123. Refer to answers A.106 and A.108.

Q.124. Is it an annual payment terms: upfront payment for initial census and additions/deletions at end of year, to which effect is the biweekly premium needed in clause B2: shall we just divide the yearly premium by 26? What is the extended bi-weekly?

A.124. Premiums will be paid bi-weekly. Refer to answer A.27.

Q.125. Are they willing to accept compulsory submission through easy claim app? (we will still collect the papers on top of it)

A.125. Refer to Section H, paragraph H.4 (b) for acceptable claim submission and settlement process.

Q.126. As a local company, do we have to comply with K.12? Is this compulsory upon submission or upon appointment if relevant to us? The link does not work.

A.126. Yes, DBA insurance is required.

Q.127. The services will be provided jointly by a TPA (April Thailand) and an insurer (Liberty in Thailand). Do both parties have to submit the Appendix K? Does each party need to submit its financials? What if part of the services are performed by a sister company of April in Thailand.

Do they need to fill up the compliance part (K) as well?

A.127. Please see Section I, DOSAR 652.242-73 for the requirement to ensure that any subcontracting or joint venture arrangement that both parties can legally work in the host country. Also, both companies will have to be registered in SAM’s which will require both companies to complete Section K and include their financials.

Q.128. What if certain information cannot be provided for the 19th? Is everything compulsory?

A.128. Refer to answer A.19.

Q.129. L4.3 part 2/Question 4: the account will be the only one in the pool, experience rated as a single account: OK? (same for L.3.4.3)

A.129. Refer to answer A.33.

Q.130. L4.3 part 3: we usually do not provide such information that is highly confidential.

Alternatively, we can try to get consent from one of our large customer to act a referee

A.130. Section L, paragraph L.4.3, part 3 requires the offer to submit past performance information as part of their offer. Please see Section M, paragraph M.1 states that for an offer to be acceptable and eligible for evaluation, proposals shall be prepared in accordance with Section L.

Q.131. What is the maximum age of Overage member (included dependent) need to provide coverage to?

A.131. The only age limit is noted in Section C, paragraph C.1.4.1.2.2.

Q.132. HC break down by job and type of insured and theirs spouse and child?

A.132. More than 90% of our employees are office workers.

Q.133. Are there any members working in Thailand for less than 1 year? If yes, please provide headcount by each period below.

A.133. The government does not track this data nor do we require the current contractor to track this data.

Q.134. Details and estimate cost of medical of any member working in Thailand less than 1 year?

A.134. The government does not track this data nor do we require the current contractor to track this data.

Q.135. What is the task of each grade according to Grade 1-13 members? Is there any difference in grade?

A.135. Refer to answer A.132.

Q.136. Refer to Rider group according to item no. B1.1, Do premium calculation, adjustment of premium and premium payment method of this group difference from the Embassy’s genuine employee group or not?

A.136. Refer to answer A.29.

Q.137. When will bi-weekly payment start? And will the payment made on 1st and 15th of each month or not? If not, please let us know how to count the determined bi-weekly period.

A.137. Refer to Section G, paragraph G.4.2

Q.138. In normal case, we cannot provide the medical coverage for those military group (Department of Defense, Department of Homeland Security as it is common exclusion of the policy. Do Embassy has any employee who work like this or not and do we need to provide full coverage to them the whole time or not?

A.138. Refer to Section C. paragraph C.1.4.2.

Q.139. For 180 days extension to dependent of any employee who dead during policy period, will embassy pay premium during the extension period for dependent or not?

A.139. Refer to Section G, paragraph G.4.3.

Q.140. Do we need to cover excess dependent who extend according to item no. C1.1.20 in the same claim pool of main policy? Do we need to include them while we calculate the adjustment premium or treat them as individual policy?

A.140. Refer to Amendment 0004, Item 7.

Q.141. Refer to item no. C.1.7.2, in case of leaving without pay for any employee, will employee pay bi-weekly premium by themselves or embassy will pay and collect them of employee later?

A.141. Refer to answer A.139.

Q.142. Is benefit required only 1 plan?

A.142. Refer to answer A.36.

Q.143. What is the different scope of Emergency service (C1.1.2) and Ambulance (C1.1.3)?

A.143. Refer to answer A.39 and Section C, paragraph C.1.1.3 for reference to ambulance services.

Q.144. C.1.1.1 How many days of the covered for ‘Room & Board’? How many days of the covered for ‘I.C.U.’? And please note that the number of days for ‘I.C.U.’ when combined with ‘Room & Board’ will not exceed the number of days specified for ‘Room & Board’.

A.144. Room and Board are covered for as long as the attending physician determines is necessary, or until the annual maximum benefit is reached, whichever comes first.

Q.145. C.1.1.1 ‘Room & Board’ is set to be semi-private room, what if the hospital does not have semi-private room?

A.145. Refer to Amendment 0004, Item 10.

Q.146. C.1.1.2 Does ‘Emergency Services (trips to emergency room)’ mean the employee can claim emergency treatment which is a result of an injury within 72 hours after an accident or sudden sickness which lead to serious disability or death if does not receive immediately treatment? If yes, ‘Emergency Services (trips to emergency room)’ includes follow up treatment? If include follow up treatment, how many days for follow up treatment from the first date of Emergency Services treatment? Is this benefit covered under ‘In-patient Medical Treatment’? Does the member need to be hospitalized in hospital? Is there any sub-limit for ‘Emergency Services (trips to emergency room)’? If yes, please provide the sub-limit amount.

A.146. Refer to answers A.39, A.40, and A.36.

Q.147. C.1.1.3 Is there any sub-limit for ‘Ambulance’? If yes, please provide the sub-limit amount.

A.147. Refer to answer A.36.

Q.148. C.1.1.4 Please provide details of ‘Annual Physical Examination’ or examination list and sub-limit for this benefit.

A.148. Refer to answer A.36. There is no sub-limit for annual physical exam. The physician should determine what services are required for each patient.

Q.149. C.1.1.4 Is there any sub-limit for ‘Immunizations’ benefit?

A.149. Refer to answer A.36.

Q.150. C.1.1.5 Is ‘Out-patient Newborn Care’ automatically covered for newborn under mother’s policy, right after childbirth until the newborn age over 14 days?

A.150. Refer to answer A.10.

Q.151. C.1.1.6 What is the covered age for ‘Pediatric Care’? Is the physical examination, development assessment and laboratory test for ‘Pediatric Care’ following to the medical guideline e.g. newborn, at the age of 2 months, 4months, 6 months, 9 months, 12 months, 18 months, 2 years, 3 years, 4 years, 5 years and 6 years? Is there any sun-limit for this benefit?

A.151. Refer to answers A.11 and A.36.

Q.152. C.1.1.7 Does ‘Prescription Drugs’ mean insured got prescription drugs from hospital to buy drugs in pharmacy outside hospital? Does ‘Prescription Drugs’ cover for the medication up to 90 days both in-patient and out-patient? The prescription must be issued not over 180 days and can be used 2 times per each prescription?

A.152. Refer to answers A.12 and A.36.

Q.153. C.1.1.13 Does the ‘Mental Health and Substance Abuse Care’ including cigarette addiction? Is there any sub-limit for ‘Mental Health and Substance Abuse Care’? If yes, please provide the sub-limit amount.

A.153. Refer to Section C, paragraph C.1.3 for Exclusions and Limitations.

Q.154. C.1.2 Is there any sub-limit for bone marrow transplant, organ transplant and kidney dialysis? If yes, please provide the sub-limit amount.

A.154. Refer to answer A.36.

Q.155. C.1.3 Below are the general exclusions of the insurance policy, please confirm.

o Aesthetic treatment or cosmetic surgery, i.e. acne, melasma, freckle, dandruff, weight loss or control or selective surgery, except in cases of necessary surgery as a consequence of an Accident under the cover to reconstruct or restore the function of an organ.

o Any treatment related to pregnancy, miscarriage, abortion, childbirth, complications from pregnancy, Assisted Reproductive Technology (ART), fertility treatments, and reversal of sterilization.

o Treatment or prevention, using drugs/chemical substances for anti-aging or hormone replacement in mature women who are close to menopause and/or who already are, deterioration of sexual activity (loss of libido) in both men and women, and any condition relating to sex and gender reassignment surgery (sex change operation).

o Request to be hospitalized in a Hospital or a Medical Facility, request for an operation, recuperation, rehabilitation, or treatment by resting, examination which is not directly related to treatment received in a Hospital or a Medical Facility or a Clinic. Or diagnosis, treatment or examination to determine a cause which are not Medical Necessity or are not meet the Medical Practice Standard.

o Long-term rehabilitative therapy o Eyesight examination or treatment, lasik treatment (eye laser surgery), expenses for equipment to support or correct eyesight.

o Treatment or operation relating to teeth and gums, dentures, dental crowns, root canal treatment, tooth filling, orthodontics/braces, dental scaling, extraction, dental implant, excluding treatment required as a result from an Accident but not including expenses for dentures, dental crowns, root canal treatment, and dental implant.

o Treatment or therapy for cigarettes.

o Any medical expenses that the Covered Person who is a Physician organizes for him/herself, including treatment given by a Physician who is the parents, spouse or child of the Covered Person.

o Suicide, attempting to commit suicide, self-inflicted Injuries or attempt whether by own self or allow others to perform either while insane or not, including any Accident occurred to the Covered Person by, consumes or injects narcotic drugs or toxic or overdosing of prescribed medicine.

o Injury sustaining while the Covered Person is committing a felony or while being arrested, under arrest or escaping arrest of authorities.

o Injury that arises while the Covered Person is taking part in racing of all kinds, including car, boat, horse, ski, jet-ski, skate, boxing, parachute jumping (except for the purpose of life saving), boarding, leaving, or traveling in a hot air balloon or a glider, bungee jumping, diving using oxygen tank and breathing apparatus.

A.155. Refer to Section C, paragraph C.1.3 for Exclusions and Limitations.

Q.156. C.1.3 Please confirm that the benefit of ‘In-patient Medical Treatment’ will not cover as follow:

o General health checkup o Inoculations and vaccinations excluding vaccination for rabies after an attacked by an animal and vaccination for tetanus after an Injury.

o Infertility (includes infertility investigation and treatment), vasectomy.

o Medication, any treatments or diagnosis which is not related to the diagnosis, symptoms, or abnormalities stated in the Physician’s report.

o Private nursing service.

A.156. Refer to Section C, paragraph C.1.3 for Exclusions and Limitations.

Q.157. C.1.3 Does this insurance plan cover for defibrillator, pacemaker, prosthetic or artificial equipment/organ, medical devices, durable supplies and supported devices?

A.157. Refer to Section C, paragraph C.1.3 for Exclusions and Limitations.

Q.158. In case the employee in unable to work on a full time basis due to injury or sickness on his/her coverage effective date, the contractor shall provide coverage to that employee on the first day he/she returns to work on a full time basis, please confirm. In case the spouse or children of the employee has been admitted for a treatment in hospital on or before his/her effective date, the contractor shall provide coverage to that dependent after he/she is fully recovered and discharged from hospital, please confirm.

A.158. As long as the premium is paid, the employee should be provided coverage for services that occur on or after the effective date.

Q.159. Please provide top 20 frequency hospitals, top 20 claim amount diseases, top 20 claim frequency diseases, claim frequency and severity for the last 3 years.

A.159. The government does not track this information.

Q.160. In the last 3 years, do you have any major claim bigger than 500,000 THB? If yes, please specify diseases, claim amount and year.

A.160. The government does not track this information.