QA_19TH2025R0002 GMC Health Insurance FINAL.pdf

Embassy of the United States of America

Bangkok, Thailand

Solicitation No. 19TH2025R0002 – GMC Health Insurance Questions and Answers

Q 1: “We would like to have further information for considering insurance premium as in yellow highlight;”

A: Answers are provided in the table below.

Insured Name Embassy of the United States of America

Existing Insurer name ALLIANZ AYUDHYA GENERAL INSURANCE PCL

1-3 years loss history Not included. Loss information belongs to the current contract holder.

Type of Policy Group Health insurance

Insurance Period This solicitation is for base year starting from April 26, 2025-April 25, 2026 with 4 one-year and 1 six-month options.

Type of Business Embassy of the United States of America

Number of Employees Total number of employees = 1292 Male = 527, Female = 765 and proportion amount of male and female Number of Eligible dependents

Total number of eligible dependents = 1193 Male = 550, Female = 643 and proportion amount of male and female

Age range of Employees and Eligible dependents

Age Range Employee Dependents 0-10 - 192 10-20 - 298 20-30 53 174 30-40 329 109 40-50 520 234 50-60 381 165 60-70 9 19 >70 - 2

TOTAL 1292 1193

Q 2: “In Section J- Exhibit F, Claims Table, please provide the start and end months of each year listed

A: The period starts in April and ends in April of the following year. The current contract period ends on April 25, 2025.

Q 3 “Can you confirm if the claims data in Section J, Exhibit F includes claims from ORE employees?”

A: The claims data does not include ORE employees.

Q 4: “Please provide average insured member counts (employees + dependent child + dependent spouse) for Health Insurance for the last 5 years – 2023, 2022, 2021, 2020 & 2019.

It is standard practice in the insurance industry (and in other Department of State insurance solicitations) to provide this information to ensure equal/fair opportunity for all offerors in an open solicitation.”

A:

Year Average insured member counts

2019 2179 2020 2395 2021 2471 2022 2494 2023 2497

Q 5: “Provide a detailed member census containing age and gender of each member?”

A:

Employees Gender Age Range Male Female Grand Total 20-30 22 31 53 30-40 128 201 329 40-50 203 317 520 50-60 176 205 381 60-70 1 8 9 Grand Total 530 762 1292 Dependents Gender Age Range Male Female Grand Total 0-10 100 92 192 10-20 132 166 298 20-30 78 96 174 30-40 37 72 109 40-50 102 132 234 50-60 82 83 165 60-70 17 2 19 >70 2 2 Grand Total 550 643 1193

Q 6: “What is considered major medical illness under Catastrophic Coverage under section C.1.1.16?”

A: 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 7: “When is this plan likely to commence?”

A: This solicitation is for base year starting from April 26, 2025-April 25, 2026 with 4 one-year and 1 six-month options.

Q 8: “Invoices have to be submitted via email to US Embassy Bangkok, Director of Financial Management Center (Section G.4.1, page 23). => please clarify which government agency is the policy holder”

A: US MISSION THAILAND (US EMBASSY BANGKOK)

Q 9: “Taxpayer Identification. Section 52.204-3 (Section K.4., page 55) => to what extent, this requirement applies to the contractor as a foreign entity and income originates in Thailand, not in the US.

Please confirm is this following sentence applies to the contractor: Offeror is a nonresident alien, foreign corporation, or foreign partnership that does not have income effectively connected with the conduct of a trade or business in the U.S. and do K.4 (d) Please confirm: Corporate Entity (not tax exempt); K.4 (e)”

A: Section 52.204-3 (Section K.4) applies to contractors to determine their taxpayer identification requirements. For a foreign entity with income originating in Thailand and not effectively connected with a trade or business in the U.S., the sentence “Offeror is a nonresident alien, foreign corporation, or foreign partnership that does not have income effectively connected with the conduct of a trade or business in the U.S.” does apply. Therefore, the contractor should complete K.4 (d). Additionally, if the contractor is a corporate entity (not tax exempt), they should also complete K.4 (e).

Q 10: “Ownership or Control of Offeror Section 52.204-17 (page 59) => please clarify information to provide as to immediate owner and highest-level owner”

A: Section 52.204-17 requires the offeror to provide information about both the immediate owner and the highest-level owner.

• Immediate Owner: This refers to the entity that directly owns or controls the offeror. The offeror should provide the name, address, and unique entity identifier (if applicable) of the immediate owner.

• Highest-Level Owner: This refers to the entity that ultimately owns or controls the offeror, which may be several levels up the ownership chain. The offeror should provide the name, address, and unique entity identifier (if applicable) of the highest-level owner.

The offeror must ensure that the information provided is accurate and up-to-date to comply with the requirements of Section 52.204-17.

https://www.acquisition.gov/far/part-52#FAR_52_204_17

Q 11: “Affirmative Action Compliance Section 52.222-25 (page 58) => please clarify, is the contractor subject to this requirement”

A: This provision applies to the solicitation. Yes, the contractor will be subject to this requirement if awarded.

Q 12: “Privacy Act (Compliance Department) => Does this requirement in (b) apply to this insurance contract? “When the contract is for the operation of a system of records on individuals to accomplish an agency function”

A: The requirement in (b) of clause 52.224-2 Privacy Act applies to the insurance contract if the contract involves the design, development, or operation of a system of records on individuals to accomplish an agency function. If the insurance contract includes maintaining records that contain personal information about individuals, such as health records, and these records are used to accomplish an agency function, then the requirement would apply.

Q 13: “Indemnification and Medical Liability Insurance => Does this requirement apply to this insurance contract?”

A: Yes, it does.

Q 14: “Limitation of Liability-Services => Does this requirement apply to this insurance contract?”

A: Yes, it does.

Q 15: “Reporting Nonconforming Items => Does this requirement apply to this insurance contract?”

A: Yes, it does.

Q 16: “Termination for Convenience of the Government (Fixed-Price) => Does this requirement apply to this insurance contract?”

A: Yes, it does.

Q 17: “Limitation on Payments to Influence Certain Federal Transactions => Please clarify about “Cooperative agreement”. What does it mean exactly?”

A: Cooperative Agreement is a legal instrument of financial assistance between a Federal awarding agency or pass-through entity and a non-Federal entity that, consistent with 31 U.S.C.

6302-6305. Cooperative Agreement’s terminology can be found in Grants.gov website.

Q 18: “52.209-10 Prohibition on Contracting with Inverted Domestic Corporations => would the contractor be deemed an inverted domestic subsidiary?”

https://uscode.house.gov/view.xhtml;jsessionid=E6AB27503FE16825A6A171F967DF4B24?req=granuleid%3AUSC-prelim-title31-subtitle5&saved=L3ByZWxpbUB0aXRsZTMxL3N1YnRpdGxlNS9jaGFwdGVyNjM%3D%7CZ3JhbnVsZWlkOlVTQy1wcmVsaW0tdGl0bGUzMS1jaGFwdGVyNjM%3D%7C%7C%7C0%7Cfalse%7Cprelim&edition=prelim https://uscode.house.gov/view.xhtml;jsessionid=E6AB27503FE16825A6A171F967DF4B24?req=granuleid%3AUSC-prelim-title31-subtitle5&saved=L3ByZWxpbUB0aXRsZTMxL3N1YnRpdGxlNS9jaGFwdGVyNjM%3D%7CZ3JhbnVsZWlkOlVTQy1wcmVsaW0tdGl0bGUzMS1jaGFwdGVyNjM%3D%7C%7C%7C0%7Cfalse%7Cprelim&edition=prelim https://grants.gov/learn-grants/grant-terminology#c

A: An inverted domestic corporation is defined as a foreign incorporated entity that meets the criteria outlined in 6 U.S.C. 395(b), applied in accordance with the rules and definitions of 6 U.S.C.

395(c). This typically involves a U.S. company that has restructured itself so that the parent company is a foreign corporation, often to take advantage of lower tax rates.

Q 19: “Options to Extend Service => please confirm that this clause should not apply to the contract as specific period already been fixes.

The Government may require continued performance of any services within the limits and at the rates specified in the contract. These rates may be adjusted only as a result of revisions to prevailing labor rates provided by the Secretary of Labor. 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 _____”

A: The six-month optional extension is in addition to the 5 years (base year plus four option years). FAR clause 52.217-8 is inserted to the solicitation as per FAR 37.111 and FAR 17.208(f) and this clause shall apply to the contract. The six-month option to exercise FAR 52.217-8 pricing table is included in Section B.

Q 20: “52.228-3 Workers’ Compensation Insurance. Please confirm that this section should not apply to the contractor as a Thai entity.”

A: According to FAR 28.305 and FAR 28.309, this contract will be a public-work contract performed outside the United States, so FAR clause 52.228-3, Workers’ Compensation Insurance (Defense Base Act), applies to the contractor who performs under this contract.

Q 21: “52.229-6 Taxes-Foreign Fixed-Price Contracts => Is this section applicable to the contractor?”

A: FAR clause 52.229-6 applies to this contract.

Q 22: “SAM registration => how do we know we are already registered in the system? Can we create new email address different from the one used when you submitted a proposal 5 years ago? If no, can you provide old email address or ID related to our proposal in 2019? Otherwise, can we create new entity to register in SAM system with a new email address?”

A: To check whether your company has a SAM account, please contact BangkokGSOProcurement@state.gov. If you create new email, SAM.gov system will not recognize your email and will not allow you access. The Embassy cannot provide your old email address or ID. You cannot create new entity to register SAM as the record will be duplicated. To add a new email address in SAM system, you need to have the previous email during the sign in.

For questions, search the answers from the Knowledge Base or submit an incident in www.fsd.gov.

You are encouraged to start the SAM registration process as soon as possible if not already completed.

https://www.acquisition.gov/far/37.111#FAR_37_111 https://www.acquisition.gov/far/17.208#FAR_17_208 https://www.acquisition.gov/far/28.305#FAR_28_305 https://www.acquisition.gov/far/28.309#FAR_28_309 mailto:BangkokGSOProcurement@state.gov http://www.fsd.gov/

Q 23: “Section F: Clause F.2 Period of Performance and F3 Options:

• What would be the decision criteria of USG in exercising the option (of not to extend)?

• When would this decision (of extending the option) be made known to insurer?”

A: According to FAR clause 52.217-9(a) in Section I, the Government may extend the term of the contract by written notice to the Contractor with the performance of the contract or within 30 days after funds for the option year become available, whichever is later. The determination criteria to exercise the option is specified in FAR 17.207. However, evaluation of options will not obligate the Government to exercise the option(s) as per FAR clause 52.217-5 in Section M.

Q 24: “From the description “…Any failure to reach agreement under this clause shall be subject to the procedures in the Disputes clause.:

i. in the event of failure to reach agreement, how would we be proceeding on the option years?

ii. pause the contract (i.e. no cover) until we resolve the dispute?

iii. If not paused, is the insurer obliged to continue providing cover according to the initially stated premium for the option years?”

A: All disputes shall be resolved in accordance with clause 52.333-1 Disputes. The contractor will be required to continue to perform within the agreed upon terms of the contract pending final resolution of the dispute. Clause 52.233-1(i) states “The Contractor shall proceed diligently with performance of this contract, pending final resolution of any request for relief, claim, appeal, or action arising under the contract, and comply with any decision of the Contracting Officer”

Q 25: “Please determine the logic of premium rate to be written in the submission table format (method 1 or 2), if else, please explain.”

Example Scenario:

A: The pricing of the base and options are based on your proposed pricing. The Government cannot state what the price of each period should be.

Q 26: “Are we correct to understand that we have to choose between two choices of premium offering.

https://www.acquisition.gov/far/17.207 https://www.acquisition.gov/far/52.233-1?searchTerms=52.233-1

1. Fixed rate as in table 3.2 à this will require no retention amount, but we cannot adjust premium annually.

2. Adjustable premium rate à this require fixed retention amount to be set in premium, but we are allowed to adjust premium rate (excluded retention amount) based on insured performance. Adjustment will be the result of mutual agreement in an annual meeting.”

A: The offeror is required to provide the premium rates in paragraph B.2 and retention amount in paragraph B.3.2. According to paragraph no. B.3.1 in Section B, the retention amount is a fixed amount that is a part of the premium rates that the offeror provides in paragraph B.2. The retention amount may include, but not limited to, such costs as overhead and general and administrative costs and profit. The retention does not include the actual portion of the premium intended to fund claims paid to the health care provider/claimant. The Contractor or the Government may request an adjustment in premiums as per paragraph B.4 in Section B but the retention amount which is the part of the premium rate is not subject to the adjustment.

Q 27: “Regarding the adjustable premium, can we set the special agreement as the following sample:

• Set the criteria if LR > X%, the contractor require an increase on premium for next year. the contractor can determine the formula for LR.

• Set the premium adjustment table, example as following.”

A: This is requirements type contract with fixed priced units with economic price adjustment under which will be issued fixed-priced orders. The government cannot agree to a special agreement for rate adjustment as proposed. An adjustment to premiums (up or down) may be requested on an annual basis after the first 12 months of performance per the process outlined in section B.4.1 of the solicitation. Adjustments are not retroactive to previous contract terms.

Requests for adjustments must include (1) receipts (premiums received) minus the retention amount, (2) number of insurance plans and (3) claims paid.

Q 28: “Regarding claims data provide, is it annualized or just raw amount, if raw amount, please determine the days of exposure. (as of date is fine)”

A: It’s annualized.

Q 29: “Please provide claims data from 2024UY (current year).”

A: See following table.

Annualized

Claims

IPD

96,178,990

OPD + Physical Check-up

48,265,472

Maternity

1,408,097

Dental

10,958,789

OTHER

8,960,294

Total 165,771,643

Q 30: “Claims report in excel with the details as for example but not limited to ICD10 + claim type (IPD/OPD/Dental/Others) + Claimant type (Employee / Dependent). In case cannot provide excel claims report, please provide claims counts and claims amount separated by claims type.”

A:

Annualized

Claims

IPD

96,178,990

OPD + Physical Check-up

48,265,472

Maternity

1,408,097

Dental

10,958,789

OTHER

8,960,294

Total 165,771,643

Q 31: “When is the effective date of current period?”

A: The effective date of fourth option year of the current contract was April 26, 2024 and this contract will expire on April 25, 2025.

Q 32: “When is the policy be effective for next renewal year?”

A: This solicitation is for base year starting from April 26, 2025-April 25, 2026 with 4 one-year and 1 six-month options.

Q 33: “Please confirm if current coverage (2024UY) is the same as in section C.1.1 / C.1.2 / C1.1.3 and cover up to minimum percentage stated in this section? If else, please provide their current coverage.”

A: The Statement of Work (SOW) lists the minimum benefit level. There are no substantive changes to the listed sections from the previous solicitation from 2019/2020.

Q 34: “Please clarity if the following benefits are covered under current benefit or not?

i. Prosthesis Benefit (heart valve, skull, hip joint and knee joints)

ii. Organ Transplant Benefit. Please also confirm if excluding or include costs of organ acquisition and all costs incurred by the donor.

iii. Alternative treatment including Acupuncture, Chiropody, Homeopathy, Thai traditional medicine, Chinese traditional medicine”

A: All medically necessary treatments are covered, except those listed under Section C.1.3 Exclusions to Coverage.

Q 35: “Please confirm if all employees have same coverage, if not, please provide the coverage for each member and criteria to allocate the plan.”

A: All employees and their eligible dependents have the same coverage.

Q 36: “Please confirm if and the dependents have same coverage as employee, if not, please provide the coverage of dependent.”

A: All employees and their eligible dependents have the same coverage.

Q 37: “Please provide past year(s) coverage, or confirm if there is any different comparing to existing coverage (2024UY).”

A: The Statement of Work (SOW) lists the minimum benefit level. There are no substantive changes to the listed sections from the previous solicitation from 2019/2020.

Q 38: “What is the criteria to be considered as catastrophic coverage (Section C.1.1.16), please provide explanation or example case which condition can be cover / cannot be covered under catastrophic coverage.”

A: 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. Examples of such conditions might include but are not limited to injuries resulting from a vehicle accident or heart attack.

Q 39: “About QASP, please address the benchmark COR use for validation of complaints.

(Section E - PDF P.19)

i. We would like to know if there will be solid agreement for services, we need to comply on, for example, reimbursed within X days, required claims submission system etc.

ii. Apart from notify us to correct the defect, will there be any other consequences.”

A: Please refer to Section H.4: Contractor Responsibility in Claims and Reimbursement to Claimants. As all claims must be submitted directly to the Contractor by employees, the Contractor should establish an appropriate claims system or procedure.

Q 40: “Please provide past year census / group size.”

A:

Age Range Employee Dependents 0-10 - 192 10-20 - 298 20-30 53 174 30-40 329 109 40-50 520 234 50-60 381 165 60-70 9 19 >70 - 2

TOTAL 1292 1193

Q 41: “What would be an acceptable threshold of claims incurred to trigger a premium adjustment?”

A: The government cannot state at this time what an acceptable threshold might be to trigger a premium adjustment. A reasonable adjustment to premium may be requested on an annual basis after the first 12 months of performance in accordance with the procedures outline in section B.4.1 of the solicitation. 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.

Q 42: “From the description “…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.”: Who would be responsible for the cost of the independent third party review service?”

A: The Government will be responsible for the independent third-party review service’s cost.

Q 43: “From the description “…Any failure to reach agreement under this clause shall be subject to the procedures in the Disputes clause.”: in the event of failure to reach agreement, how would we be proceeding on the option years? Do we pause the contract (i.e. no cover) until we resolve the dispute? If not paused, is the insurer obliged to continue providing cover according to the initially stated premium for the option years?”

A: All disputes shall be resolved in accordance with clause 52.333-1 Disputes. The contractor will be required to continue to perform within the agreed upon terms of the contract pending final resolution of the dispute. Clause 52.233-1(i) states “The Contractor shall proceed diligently with performance of this contract, pending final resolution of any request for relief, claim, https://www.acquisition.gov/far/52.233-1 appeal, or action arising under the contract, and comply with any decision of the Contracting Officer”.

Q 44: “What would be the decision criteria of USG in exercising the option (of not to extend)?”

A: The determination criteria to exercise the option is specified in FAR 17.207. However, evaluation of options will not obligate the Government to exercise the option(s) as per FAR clause 52.217-5 in Section M.

Q 45: “When would this decision (of extending the option) be made known to insurer?”

A: According to FAR clause 52.217-9(a) in Section I, the Government may extend the term of the contract by written notice to the Contractor with the performance of the contract or within 30 days after funds for the option year become available, whichever is later.

Q 46: “To proceed with the expat proposal, we will need a census that includes the following information for those requiring coverage:

• Name

• Date of Birth

• Gender

• Employee Tier

• Home Country

• Host Country

If Life/LTD coverage is part of the RFP request, please also provide salary and occupation details—otherwise, no further information is needed.”

A: All employees are local staff, no expat included.

Q 47: “B.4. EPA : from the wording, please kindly explain or provide the example in detail of EPA calculation for each case and How is the EPA amount effected or adjusted for each policy year? And When or during each period for get the payment or refund the payment?

In case of

1. total Premium received – Retention is higher than total claim paid?

2. if total Premium received – Retention is less than total claim paid?

3. Etc.”

A: Any adjustments to premiums shall be in accordance with the process outlined in section B.4.1 of the solicitation. An adjustment (up or down) may be requested annually after the first 12 months of performance.

According to paragraph no. B.3.1 in Section B, the retention amount is a fixed amount that is a part of the premium rates that the offeror provides in paragraph B.2. The retention amount may include, but not limited to, such costs as overhead and general and administrative costs and profit. The retention does not include the actual portion of the premium intended to fund claims paid to the health care provider/claimant. The following EXAMPLE demonstrates how premium rates that shall be provided by the offeror in paragraph B.2 in Section B and a subsequent price https://www.acquisition.gov/far/17.207 adjustment can be calculated. The numbers provided are only used to provide an EXAMPLE and should NOT be used to guide potential bids.

Bi-weekly Premium Rates = Retention Amount + Premium intended to fund claims paid to the health care provider/claimant e.g.

100 THB Retention Amount for Employee + 900 THB Premium for claim paid = 1,000 THB Bi-weekly Premium Rates

120 THB Retention Amount for Eligible Dependents + 980 THB Premium for claim paid = 1,100 THB Bi-weekly Premium Rates

The Contractor or the Government may request an adjustment in premiums as per paragraph B.4.1 of the solicitation but the retention amount (which is the part of the premium rate) is not subject to the adjustment.

The amount available for claims and the total amount of claims that were paid out shall be used for premium adjustment calculation. The amount available for claims is the total premium paid by the government deducted by the total retention amount.

Total premium paid by the government = Number of premiums x bi-weekly premium rates x 26 e.g.

1,400 employees x 1,000 THB bi-weekly premium rates x 26 = 36,400,000 THB 1,400 eligible dependents x 1,100 THB bi-weekly premium rates x 26 = 40,040,000 THB Total premiums paid by the Government = 36,400,000 + 40,040,000 = 76,440,000 THB

Total retention amount paid by the government = Number of retention x retention amount x 26 e.g.

1,400 employees x 100 THB bi-weekly retention amount x 26 = 3,640,000 THB 1,400 eligible dependents x 120 THB bi-weekly retention amount x 26 = 4,368,000 THB Total retention amount paid by the Government = 3,640,000 + 4,368,000 = 8,008,000 THB

Amount available for claims = Total premium paid by the Government – Total retention amount paid by the Government e.g.

Amount available for claims = 76,440,000 – 8,008,000 = 68,432,000 THB

Before any such adjustment is made, the Contractor agrees to provide the Government a balance sheet showing three main components for the time period: (1) receipts (premiums received) minus the retention amount, (2) number of insurance plans and (3) claims paid.

According to paragraph B.4.1 in Section B, mutually agreed to adjustments shall be effective thirty days after complete information is received by the government. Adjustments are not retroactive to previous contract. The premium adjustment is not to refund losses that might have occurred in the past.

Q 48: “C.1.1.11 Dental Care: as U.S. Embassy Request for Proposals number 19TH2025R0002 for GMC Health Insurance mention that condition in the TOR is minimum coverage, please provide detail or condition to cover under Dental benefit? And you will give more than minimum treatment & coverage, please give more detail and be more specific?”

A: Minimum coverage for dental care is outlined in section C.1.1.11 of the solicitation. There are no substantive changes to the listed sections from the previous solicitation from 2019/2020.

Q 49: “Can we propose different condition or change any condition from TOR”

A: The Statement of Work (SOW) specifies the minimum benefit level; however, you may propose benefits that exceed this minimum.

Q 50: “Emergency services (trips to emergency room) – min coverage 100% , This is the existing requirement from current TOR. However, I just want to be clear how different this is between Ambulance and Emergency services ? It would be good to understand what this is.”

A: Please refer to C.1.1.2 and C.1.1.3. An emergency service is any health care service provided for conditions that could lead to serious disability or death if not immediately treated, such as accidents or sudden illness. Ambulance service is the professional ground transport to move a patient from the place where s/he is injured or becomes ill to the nearest hospital able to provide treatment or to move a patient from one medical facility to another.

Q 51: “Annual physical examinations. It is paid under OPD where there’s no limit of OPD itself, it is paid under limit per year of 2M baht per person? What if the member had the checkup claim and it was 100K-200K ,do you will pay?”

A: Yes, the insured person is covered as long as the amount is within the annual limit of section C.1.2 in the solicitation.

Q 52: “Hearing Aids. For TOR that Limited to 1 apparatus per ear per 3 years. this is like optical benefit If the contract period is 5 years, should we be clear on how we’re going to pay on year 4 and year 5? Please specific”

A: Please see Section C.1.1.9. Once the maximum hearing aid benefit is used, the covered individual will need to wait for three years (year of purchase plus additional two years), to use coverage from insurance. If after the three years, the contract is still in force, the employee can purchase another hearing aid through insurance if needed up to the maximum coverage listed in the contract. The cap is per covered individual for a given three-year period.

Q 53: “Optical Care. From Max coverage is 10,359 baht per person every 2 years.80% minimum coverage, with applicable cap. Please explain and give example? If the contract period is 5 years, how much we’re going to pay.? What about the new employee/family members joining on year 5, how will we pay?”

A: Please see Section C.1.1.10. Coverage will reset after two contract years as long as the contract is still in effect. For example, once an employee meets the optical care coverage maximum, they can only receive additional coverage after a two year wait (year of purchase plus additional one year). The cap is per covered individual, so adding a new eligible participant will start a new two-year period.

Q 54: “Point C.1.1.17 Out of country medical treatment , C.1.1.18 Out of country medical travel, C.1.1.20 Employee Assistance Program C.1.1.21 Excess Coverage

These appear in TOR as “RESERVED” Any meaning for that? By “RESERVED”, can you clarify if we will we have to provide anything upon their request?”

A: Sections that were marked “RESERVED” do not apply to the contract.

Q 55: “Does CPAP will be covered or not? And please specific amount of coverage and condition? Does it’s covered once a lifetime or not?”

A: If the medical treatment for CPAP is medically required, then it will be covered.

Q 56: “Does Precocious Puberty is covered or not?”

A: Precocious puberty is covered as long as it is considered a medical condition.