Questions and Answers.docx

19UG5025R0004 – HEALTH INSURANCE SERVICES

Questions and Answers

Question 1 Confirm if the historical claims data provided in Section J, Exhibit B includes claims from Peace Corps and ORE staff.

Answer No. The historical claims data in Section J does not include Peace Corps and ORE staff.

Question 2 Provide average insured member counts (employees + dependent child + dependent spouse) for Health Insurance for the last 5 years – 2024, 2023, 2022, 2021 & 2020.

Answer The information provided is current and based on estimated staffing needs for the next base year and four option years. The average insured members for 2020 to 2024 will not be provided. Bidders can derive this data by using the information provided in Section J.

Question 3 When is the plan likely to commence?

Answer The anticipated start date is December 26, 2025.

Question 4 Are we covering partial premiums?

Answer Yes. The cost of insurance will be shared between the employer and the employee, with the U.S. Government covering 90% of the premium and the employee contributing 10%. This is for the offeror’s awareness but the actual split will occur on the backend and the contractor will only see one payment from the Government.

Question 5 “Self + Others” is broad—we are uncertain about the number and age of the others, so we cannot provide accurate cost estimates. Can you provide more detailed information?

Answer This information is provided in Section J of the solicitation document.

Question 6 Section C.1.2 – Health Benefits Conditions and Limitations – states that there is no reimbursement for eyeglass frames, yet Section C.1.1.8 indicates coverage for prescription frames is 80% with an applicable cap. Could you clarify this apparent discrepancy?

Answer This clause of the solicitation has been amended. Refer to amendment uploaded on sam.gov.

Question 7 Embassy staff tend to delay submitting their claims. However, Ugandan insurance law requires that claims must be submitted within 90 days of occurrence. How is this being addressed?

Answer This policy will be communicated to the employees. Additionally, the vendor must provide us with the relevant Ugandan law so that we can better address the concern.

Question 8 What is the total membership—current number of staff versus anticipated number of staff? Do we expect major changes in the coming years?

Answer We do not anticipate major changes or significant fluctuations in staff numbers. Should any major changes occur, these will be addressed through the Economic Price Adjustment (EPA). There will be close collaboration between the vendor and Human Resources to manage this.

Question 9 How are midterm additions treated in terms of premiums and benefits?

Answer The numbers stated for the base and option years represent the maximum possible membership. The Human Resources office will notify the vendor of any additional staff. Premiums for these additional staff members will be prorated for the remainder of the year.

Question 10 If premiums are not fixed, why are we contracting for five years?

The contract duration is one base year plus four option years. While prices are fixed for the five-year period, an Economic Price Adjustment (EPA) may be applied in case of regulatory changes or fluctuations in staff numbers.

Question 11 As you price, you consider the business opportunities. Are the five years guaranteed?

Answer This contract consists of one base year and four option years. However, the full five years are not guaranteed. The contract may be terminated for reasons such as lack of funding or staff reductions. Economic Price Adjustments (EPA) will address both positive and negative fluctuations during the contract period.

Question 12 Can the vendor terminate the contract before the five years end?

Answer According to the Federal Acquisition Regulation (FAR), a contractor does not have the unilateral right to terminate a contract for convenience. The contractor has the option to file a claim under the Disputes clause of the contract. Refer to Section I: Contract Clauses, for further information.

Question 13 Why is premium payment not indicated in the solicitation document? In Uganda, this payment is typically required to be 100% upfront.

Answer According to Section G.4.2, payment will be processed quarterly at the beginning of each period for which insurance coverage is provided.

Question 14 How should we handle fraud?

Answer If fraud is suspected, please deny the claim and immediately report the incident to the Embassy, providing sufficient evidence to support the allegation.

Question 15 Are premium payments made annually or quarterly? The vendor states they need to pay the regulator monthly and also pay taxes, so they require monthly payments.

Premium payments are made quarterly. The vendor is expected to have sufficient financial resources, considering their client base, to fulfill monthly obligations such as payments to the regulator and taxes. If applicable, the vendor should cite the specific Ugandan law that mandates monthly payments.