Attachment A (QA).pdf

SBU - CONTRACTING AND ACQUISITIONS

Attachment A

Q1. An active census of covered employees and dependents, including date of birth, gender, and relationship status.

A1. Please refer to page 54-55 of the solicitation. Mission cannot provide date of birth for each single employee due to the sensitivity and protection of Personally Indemnifiable Information (PII)

Q2. Historical utilization and claims data for at least the most recent nine (9) months, including claim frequency, paid claims, and overall utilization experience.

A2. Available data is attached.

Q3. Opening and closing headcount information for the most recent contract period, including employee and dependent enrollment changes.

A3. Opening 1068 Employees, and 2,821 Dependents. Closing 1,048 Employees and 2,798 Dependents.

Q4. A detailed Schedule of Benefits or Benefits Matrix, if available in a separate format, to supplement the minimum coverage requirements described in the solicitation.

A4. The solicitation establishes the required minimum benefits and coverage to be proposed. Offerors shall base their proposals on the requirements set forth in the solicitation.

Q5. Any additional actuarial, enrollment, or claims experience information that may assist offerors in preparing accurate and competitive pricing.

A5. Available data is attached.

Q6. Active list for members/ Families (Dates of Birth).

A6. See answer to question 1.

Q7. Detailed utilization for at least 9 months for the current contract (2025-2026).

A7. Available data is attached.

Q8. Detailed utilization for past two years contracts.

A8. Available data is attached.

Q9. Opening population for current contract (2025-2026).

A9. See answer to question 3.

Q10. Current Table of Benefits (TOB) if different than the requested one.

A10. See answer to question 4.

Q11. Current active members highlighting (ID number – Date of Birth – Salary – Gender – Occupation)

A11. See answer to question 1.

Q12. Insurance compensation (Fixed Amount or multiple of Salary)

A12. All details are provided in the solicitations. The summary is 24 months of the last reported salary in the case of natural death and 48 months of the last reported salary in the case of accidental death or permeant disability.

Q13. In case of choosing the multiple of salaries option provide the number of salary multiples for to be applied as insurance cover.

A13. See answer to question 12.

Q14. Detailed claims history 3-5 years (claim date – amount type)

A14. Available data is attached.

Q15. Required covers i.e. (Death, Total Permanent Disability - Total Partial Disability – Accidental Death).

A15. All details are provided under section C.

Q16. Current insurer Carrier

A16. Information cannot be shared to maintain fair competitiveness.

Q17. Renewal or inception date.

A17. By November 1, 2026.

Q18. Current Free Cover Limit or the Automatic acceptance limit (the limit that the insurer automatically accepts the insured amount without doing medicals)

A18. All employees are accepted after going through pre-hiring medical examinations.

Q19. Current coverage.

A19. Please refer to the current solicitation. Current contract cannot be shared for fair competition.

Q20. Please provide claims data for Health Insurance and life Insurance separately for the last 5 years – 2025, 2024, 2023, 2022 & 2021. 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.

A20. Available data is attached.

Q21. Please provide the member count for Health Insurance & Life Insurance separately for the last 5 years – 2025, 2024, 2023, 2022 & 2021. 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.

A21. Available data is attached.

Q22. Please provide a detailed breakup of employees’ salaries and ages.

A22. See answer to question 1.

Q23. Please provide a detailed breakup of Member census with Date of Birth, Gender, Nationality and Marital Status.

A23. See answer to question 1.

Q24. When is the plan likely to commence?

A24. See answer to question 17.

Q25. The current Table of Benefits for both health and life insurance.

A25. See answer to question 4.

Q26. The updated member list, including categories and demographics (if available)

A26. See answer to question 1.

Q27. The existing policy claims experience, preferably for the last 2–3 policy years.

A27. Available data is attached.

Q28. Kindly asking your kind support regarding below requirements/inquiries needed for pricing: Medical claims file detailed for the past 3 years. Current table of benefits. Life claims as per below table for the past 5 years.

A28. Available data is attached.

Q29. Kindly clarify what’s needed in SF-33.

A29. The offeror will need to fill blocks 15 through 18 of the SF-33.

Q30. What’s meant by fixed price for the 5 years.

A30. Meaning, that the offeror must propose prices that remain unchanged throughout the entire five-year contract period (base year plus all option years). No price increases or adjustments will be allowed during the contract term except through the Economic Price Adjustment clause.

Q31. In case of premium adjustment in any optional year, what is the procedure and what happens in case the adjustment is not approved from the Embassy’s side.

A31. Per Sections B.5.1 and B.5.2 (health) and B.9.1 and B.9.2 (life), the Contractor or the Government may request a premium adjustment on an annual basis after the first twelve months of the contract, supported by the required balance sheet and claims data. Any adjustment is subject to mutual agreement of the parties and is implemented through a written contract modification. If the parties cannot reach agreement, the matter is resolved under the Disputes clause (FAR 52.233-1).

Q32. Are Riders enrolled from start of the policy, and what is the criteria of addition during the policy.

A32. ORE riders are enrolled from day one. AECWA riders may be added later, with the enrollment date to be determined at that time, if applicable. AECWA riders are not currently enrolled.

Q33. Kindly clarify Admin Cost &TPA cost excluding claim fund.

A33. Per Sections B.4 and B.8, administrative and TPA costs are captured in the retention amount, a fixed bi-weekly amount included within the premium for each category of coverage and period of performance. The retention amount covers overhead, general and administrative costs, and profit, and excludes only the portion of the premium intended to fund claims.

It must be proposed as a fixed amount, not as a percentage of premium, and is not subject to adjustment.

Q34. Please confirm an annual policy will be issued each year, not one policy with 5 years duration.

A34. The policy will be issued annually. The Embassy retains the option each year to renew or discontinue coverage for four additional optional years in addition to the base year (Total of five years).

Q35. Please clarify the current setup for the Mental Health inpatient coverage, is it on direct basis or RI.

A35. This is a new benefit.

Q36. Does 80% minimum coverage means we can add 100% coverage or to stick to the 80% and please clarify what’s the current setup for these benefits.

A36. 80% is the minimum. Coverage of up to 100% may be offered.

Q37. Newborn coverage for the 100K is for the maternity coverage, while newborns are added from day 1 with annual limit, kindly confirm.

A37. Reference C.1.1.5 and C.12, the EGP 100,000 limit applies to both pre-natal and post-natal coverage. The newborn is covered up to 800K cap from day one.

Q38. Kindly clarify preventive and wellness service is it checkup or with doctor request, and please clarify what’s the current checkup for this point.

A38. C.1.1.8 coverage applies to checkups, immunizations, and screenings, and may be used with a doctor's referral. It also covers early detection for diabetes and other genetic diseases.

Q39. Out of the country coverage, please clarify is it up to the local R&C prices (locally), and what’s the current setup for this point.

A39. Reference C.1.1.17 medical expenses incurred out-of-country will be covered, but coverage will be the same and subject to the same total maximum annual limit as for medical expenses incurred in-country (locally).

Q40. Are all members under the same policy or will we have separate entities.

A40. Reference C.1 and C.2 all members are under the same policy in terms of medical insurance. As for Life Insurance, only employees are covered.

Q41. Kindly define excess coverage and how it will be paid, and to whom it is applied from the members.

A41. Reference C.1.4.4 and C.1.1.16 excess coverage (Catastrophic Coverage) applies to all members and provides an additional EGP 800,000 limit once the primary EGP 800,000 limit is reached. It is paid as part of the overall claims process. The total coverage amount can be up to EGP 1,600,000.

Q42. We have to follow FRA regulations, and Egyptian laws, so kindly specify what laws to be followed in the contract.

A42. We adhere to the terms of the authorized solicitation. Where FRA regulations conflict with the solicitation, we will address such instances on a case-by-case basis. The Embassy may invoke diplomatic immunity or rely on specific bilateral agreements with the host country for particular legal matters.

Q43. Regarding the profit share, can we share our own formula.

A43. No. The profit-sharing (Experience Rating Refund) formula set out in Section B.10 of the solicitation, including the prescribed retention percentages, is fixed and must be used as written. Offerors may not substitute an alternative formula.

Q44. Kindly clarify the process of additions/deletions applied currently.

A44. Enrollments are submitted as they occur. Deletions are compiled into a single report shared with the vendor every six months. The Embassy collects insurance cards from departing employees upon their departure.

Q45. Can you please provide 5 years loss ratio table including annual premium for medical and for life and disability.

A45. Available data is attached.

Q46. Can you please provide 5 years membership breakdown by employees with single coverage and employees with family coverage for medical.

A46. Available data is attached.

Q47. Please provide details by treatment country for the current and historical years, including the currency used.

A47. Nearly all treatments were handled within the network in Egypt. One exception involved an employee who received treatment abroad, as the required treatment was unavailable in Egypt; that employee's claims reached the coverage cap.

Q48. Please confirm if there is any maximum increase or any cap to be applied in the price adjustment clause.

A48. There is no specific percentage cap for the adjustment.

However, adjustments are based on the experience rating of the Mission as detailed in Sections B.5 and B.9 and are subject to mutual agreement.

Adjustments to the fixed retention amount are prohibited.

Q49. Are parents currently covered under the scheme, if yes what’s the criteria of inclusion.

A49. No

Q50. Are we allowed to add our own exclusions for medical, life and disability.

A50. No. Please adhere to the terms and conditions of the solicitation.

Q51. Is there an exit clause after 1 year of cover for Health and Life.

A51. The contract is issued annually. The Embassy has the option to renew or not to renew at the end of each performance period as per F.2 and F.3. The contract may also be terminated in accordance with the FAR clauses at 52.249-2 (Termination for Convenience) and 52.249-8 (Default).

Q52. If there is no exit clause, can the insurer add an exit clause in the proposal.

A52. No. Deviations from the terms and conditions, are not permitted.

Q53. Please confirm if the Insurer has the right to not exercise an option year.

Could you please confirm the process in case of disagreement between the insurer and US Embassy regarding the annual adjustment clause.

A53. The right to exercise an option year rests with the Government, as per FAR 52.217-9. In case of disagreement over a price adjustment, the matter is subject to the Disputes clause (52.233-1).

Q54. Are we allowed to deviate from the terms and conditions?

A54. No.

Q55. G.5 Refunds to the government: (page 34) > in case claims are lower than paid premiums we shall refund the overpayment to the government; do we get this correctly.

A55. Yes. Clause G.5 applies specifically when the Government finds it has been overpaid because covered headcount (employees and/or dependents) decreased; in that case the Contractor must credit or refund the overpayment within ten calendar days of the Contracting Officer's request.

Q56. Section B.2.2 : The estimated annual count is expected to remain nearly the same over the next five years. Could this estimate be adjusted, given that the same figures have been projected for all five years?

A56. The estimates provided may fluctuate based on turnover dynamics; however, we do not anticipate significant changes. We expect the headcount changes to be around 100 employees, plus or minus the estimates provided.

Q57. Section B.2.2 need clarification for the below: MINIMUM AND MAXIMUM AMOUNTS. During the Base Year of the contract, and during the option year that might be exercised, the United States Government (USG) shall place orders totalling a minimum of EGP 100,000.00. This reflects the contract minimum guarantee for each period of performance. The amount of all orders, for base and all option years shall not exceed EGP 2,000,000,000.00. This reflects the contract maximum. MINIMUM AND

MAXIMUM AMOUNTS.

A57. This clause establishes that the Government guarantees to order a minimum of EGP 100,000 worth of services during each period of performance (base year and each option year). The total cumulative value of all orders placed over the entire contract period (base plus all options) shall not exceed EGP 2,000,000,000. These are the financial limits of the contract.

Q58. What is the definition of CLINs in this context?

A58. In this context, CLINs (Contract Line Item Numbers) refer to the different pricing elements and categories within Section B. This includes the pricing for Single Employees vs. Family Plans for Health Insurance, and Basic Life, Accidental Death & Dismemberment, and Partial & Total Disability for Life Insurance. They are used to structure and evaluate the proposal.

Q59. need more clarification regarding: (section B.5.2.1) Employee Pool – This clause is only in effect if the Contractor included details in its offer regarding a pooling arrangement, of which this contract is a part.

A59. This clause is only applicable if an offeror proposes to include this contract's experience in a larger pooling arrangement (e.g., a global or regional pool of insurance business). If such a pool is proposed, the offeror must provide details of how the pool impacts any request for a price adjustment under Section B.5. This is for evaluation and contract administration purposes, as detailed in L.4.3.4.

Q60. (page 18 section: C.1.1.4 section) Immunizations recommended by local authorities and/or the World Health Organization, This could be covered as Vaccinations coverage with capped amount.

A60. There is no sub- cap. The immunization is covered up to the overall cap.

Q61. What is the requested maximum amount and FSA?

A61. Medical Insurance: EGP 800,000 in addition to catastrophic limit of additional EGP 800,000.

Life Insurance: 24 months of the employee’s last reported salary in case of natural death. 48 months of employee’s last reported salary in case of accidental death or total permanent disability. Please see all details in the solicitation.

Q62. Regarding C.2.1.3 Partial and Total Disability Coverage, we have a clause for waiting period of 6 months and elimination period which should be stated in the contract. Please advise.

A62. Please adhere to the terms and conditions of the solicitation. No lower terms will be accepted.

Q63. a) Regarding Profit sharing: the percentage of insurer retention could be changed to 30% instead of 20% as stated in the solicitation. b) IBNR factor should be mentioned in percentage of 14% for life and 18% for medical as the formula in the solicitation does not clarify the percentage.

A63. The percentages are fixed as stated in Section B.10 (25% for Health, 20% for Life). The IBNR factor is part of the "Change in reserves" described in B.10.1.2 and B.10.2.2 and should be calculated according to the Contractor's standard and prudent actuarial practices. Deviations from the formula are not permitted.

Q64. Naics Code: in Section K.

A64. The NAICS code for this solicitation is 524114 – Direct Health and Medical Insurance Carriers.

Q65. Does the current insurance company must fill all section K and Section L fully, if not, what particularly to be filled as a current provider.

A65. All offerors must complete all required sections of the proposal as per Section L. Instructions. This includes completing Section K (Representations and Certifications) and providing a compliant technical and price proposal as outlined in Section L.4. There is no exception for the current provider.