HEALTH_INSURANCE_Q&A1.docx

U.S. MISSIONS in TURKEY

HEALTH INSURANCE SOLICITATION

ANSWERS TO QUESTIONS NO. 1 19TU15-18-R-3007

Oct. 11th, 2018 Below is the list of questions received and their respective replies:

Please provide the following statistics:

1. Age/DOB: A detailed list of enrollees with DOB will be provided after award and cannot be provided at this time, since it will be PII. At this time, the average statistics for the age groups can be found under question 24 below.

2. Sex- Female or Male: While a detailed list of enrollees will be provided after award, the statistics for the female and male enrollees can be found under question 24 below.

3. Dependent status i.e., Coverage for:

a. Employee (E)

b. Employee & Spouse (E/S)

c. Employee & Children (E/C)

d. Employee, Spouse & Children (E/S/C) The requested statistics can be found under Exhibit A of the RFP.

4. Claims History: 2013, 2014, 2015, 2016, and 2017 – and YTD The statistics for the claim history can be found under question 20 below.

5. Catastrophic Cases: Please refer to replies under question 11.

6. Date contract is expected to start: The new contract is planned to start on Feb. 28th, 2019, however this date is not firm but is an estimate.

7. Advise if previous benefit schedule for life/health/disability insurance is the same as the benefit schedule currently being requested. If so, please provide a description of benefits. No, the benefits covered under the current contract are quite different than the ones under this RFP. The benefits under the current contract can be obtained from FedBizOpps by searching for solicitation no. 19TU15-18-R-3000.

8. Are there any persons who are currently hospitalized? If yes, please provide number.

No, currently there are no enrollees who are hospitalized.

9. Are any major illnesses (i.e. hemodynamics, open heart surgery, orthopedic major surgeries, organ transplants, traumatic accident, cancer and oncology cases) being treated? If yes, please provide number.

The information on major illnesses is as follows:

Total

10. Are there any pregnant employees/spouses? If yes, please provide number.

Currently, there are 14 enrollees who are pregnant.

11. Are there any catastrophic cases (in excess of $10,000) within the last year to date?

a. If yes, please provide numbers.

b. Status of claim – paid/incurred.

Among our enrollees, there are only three (3) enrollees with serious illnesses which incurred more than $10,000.

12. Are there any HIV/AIDS cases? If yes, please provide total number.

There are no enrollees with HIV/Aids.

13. Are any employees currently disabled? If yes please provide total number We do not have a record of any enrollees with disabilities.

14. Current vendor information:

a. Name: Acibadem Saglik ve Hayat Sigorta A.S.

b. Contract number: 19TU15-18-D-3000

c. Value: 7,975,564.-TL for one year

d. Effective Date: February, 28, 2018

e. Date of expiration. February, 28, 2019

15. What currency should offerors use in submitting bids? As stipulated under Section B.2 Pricing, prices for premium rates are to be submitted in Turkish Liras (TL).

16. Number of enrollees for the last 3 years by Single, Married and Family Status.

The requested statistics can be found under Exhibit A of the RFP.

17. Percentage of local nationals. 97% of our enrollees are local nationals.

18. 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.

The number of dependent children above 18 years old studying abroad are as follows: 1 child in the States, 1 child in Denmark and 2 children in the UK. Since we do not require the student record of children under 18 years old, we do not have the statistics of how may dependent children under 18 who study abroad.

19. Location(s) of insured employees.

The locations of the employees are Ankara, Istanbul, Adana, Izmir, and Gaziantep cities. We cannot know the location of the dependents for certain.

20. Claims history with loss ratio for health insurance for the current year and each of the last 5-6 years, including claims from ORE employees:

21. Premium history for health insurance for the current year and each of the last 5 years.

Please refer to reply to question 20 above.

22. Did the premium history for insurance include the VAT? If so, what percentage of VAT was included in the historical premiums?

No, the US Mission in Turkey is exempt from VAT.

23) Did the premium history for insurance include Insurance Premium Tax (IPT) .If so, what percentage of IPT was included in the historical premiums?

In Turkey, there is no insurance tax (IPT nor BSMV) for health insurance.

24) Current gender statistics within age range for employees, dependent children and spouses:

DEPENDENT CHILDREN BY GENDER WITHIN AGE RANGE

EMPLOYEE SPOUSES BY GENDER WITHIN AGE RANGE

EMPLOYEES BY GENDER WITHIN AGE RANGE

25. Provide the three + years total number members on June 30. This is the total number of employees + spouses + dependents on December 31 of each year.

The total number of enrollees on an annual basis is provided under question no. 20 and is for the contractual period from August until August of each year.

26. Please provide the number of retirees who are currently enrolled in the plan?

Currently there are 67 retirees and their dependents enrolled.

27. Please provide the number of male and female retirees by age brackets.

NUMBER OF RETIREES

Age (in years)

28. Please indicate how many retirees are single retiree, how many are retiree plus one and how many are retiree plus family.

Since the previous and current contracts did not differentiate retiree, retiree plus one and retiree plus family, these statistics are not available.

29. We note the total number of employees in section B is 756 however, in Exhibit A the total number is listed as 748. Is there a discrepancy?

Section B Pricing contains an estimated number of enrollees while Exhibit A has the current number. The offerors are to provide their proposal according to the estimated numbers provided under Section B. The exact number of enrollees will be known after the open season prior to each performance period.

30. We note in Section C.1.1.16 that transportation for out-of-country medical treatment will be a covered expense for covered employees and eligible family members. To be considered a covered expense, the attending certified health care provider must certify in advance that the treatment is medically necessary and unavailable locally. We also note in section C.1.1.15 that limit as for medical expenses incurred in-country and there is no requirement for a certification from an attending certified health care provider in advance that the treatment is medically necessary and unavailable locally. Doesn’t the member or dependent need to obtain a certification from an attending certified health care provider in advance that the treatment is medically necessary and unavailable locally for that expense to be covered?

The following sentence is valid for C.1.1.15 Out of Country Medical Treatment as well as C.1.1.16: To be considered a covered expense, the attending certified health care provider must certify in advance that the treatment is medically necessary and unavailable locally.

31. How many out of country cases have there been in the last 5 years?

There are no out of country cases in the last 5 years.

32. Questions about B.3 Rider CLINS in section B Pricing: what does the number 70 under ‘Retired Employees & their Dependents’ represent? Is that the actual number of retirees? Of the 70 how many are retirees only, retirees plus one and retirees plus family?

Under each of the years, the ‘Retired Employees & their Dependents’ means the foreseen number of retired employees and their dependents, i.e. there are no separation of retirees plus one and plus family.

33. Questions about B.3 Rider CLINS in section B Pricing: Is the space to the right of the 70 for our proposed annual premium?

To the column to the right of the numbers, the annual premiums are to be placed and to the far right column the ‘Total for All Persons’ are to be placed.

34. Questions about B.3 Rider CLINS in section B Pricing: Questions about Catastrophic Coverage up to 29,000 TL – What does the number 20 represent – we assume that is an estimate of how many employees will sign up for this option?

Yes, each of the numbers under the CLINs denotes an estimated number of enrollees for that particular option.

35. Provide large claims details including amount paid, diagnosis, if the treatment is ongoing and if the member is a primary insured, dependent child or spouse.

Please refer to reply to question no. 11.

36. Claims dump to include date of service, amount paid, diagnosis, location of treatment, provider information.

The reply to this request contains detailed PII information which is deemed to be confidential, and so cannot be provided and publicized. Claims history on an annual basis is provided under question no. 20.

37. Can we limit HIV/AIDS care?

No limitation on HIV/AIDS care can be imposed.

38. Can we have waiting periods on pre-existing conditions, maternity, and mental and nervous coverages?

No waiting periods can be imposed.

39. Is it possible to submit an alternative proposal (i.e. one that does not necessarily fit all requirements as listed in the SOW)? All proposals shall conform to the requirements as stated in the RFP, otherwise, your proposal will be considered as non-responsive and will not be considered for award.

40. Why are the 3 benefits covering hearing aids, optical care and dental care limits in USD while the other prices are in TL currency?

These benefits were stipulated to be in USD but will be converted to TL at the time of award.

HR/OE: M Bedi (Clear) image1.tmp