GMC QUESTIONS AND ANSWERS.docx

QUESTIONS AND ANSWERS AT THE PRE-PROPOSAL CONFERENCE

Q. Is catastrophic coverage just for evacuation and does it cover for LE staff that traveled out of post.

Ans: 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. See Section C.1.1.16 of the solicitation Q2. Are we expected to quote for Premium rates and Catastrophic rates?

Ans. Yes, each of them is a separate component and it seen as such in Section B of the solicitation.

Q3. In case of Out-Country- Treatment can the HMOs choose a hospital for an enrollee or work with enrollee’s preference.

Ans: The local hospital will make a referral and if that is not possible, the HMO can step in professionally and advise.

Q4. ORE Clarifications:

Ans: ORE and AERRA are covered as a Rider however, invoices / claims for their treatments are to be handled differently that is, direct payment by the COM, AERRA etc.

Q5 What happens when someone travels abroad and falls ill Ans: 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. See Section C.1.1.17 of the solicitation.

Q6: Are HMOs free to make referrals in case the hospitals are unable to.

Ans: Yes.

Q7. Must the vendor sign up in Sams.gov Ans. Yes, to do business with U.S. Government you must register in SAM Offerors were advised to try again in registering in SAM as the system is a lot better now than what it used to be. They were also encouraged to get back to us should they encounter challenges. The advantages of being on the system (Sams.gov) were also explained as it grants access / opportunity for vendors to bid for contract offshore.

Q8. Zadroga’s Act – if vendors will still be charged the 2% even when Government is not paying upfront.

Ans. This is new policy for any contract that is more than $250,000.00. 2% of the contract sum shall be retained by the Government.

Highlighted Points:

· The need for enrollees to be able to go for annual medical checkup (not basic vitals). This is preventive

· Inclusion of Zadroga’s Act which mandates the Embassy to deduct 2% of from any contract over $250,000.

· The need to maintain the healthy relationship that is usually initiated at the point of award and not try to change or modify the contract after the award especially at the time of implementation. This is US government contract and not any of the offerors’ company packages for health insurance so it is not based on what the company wants or what they can/cannot do.

· Hospital lists include those on vendor’s network and those provided by Government. Note that HMO cannot reject or delist hospitals after the contract has been signed.

· Quality control: not more than 5 complaints in a month. Examples of complaints are: enrollees not able to access care, HMO not paying hospitals (which in turn affect the quality of services rendered to the enrollees by the hospitals) etc.

· Any remedy / medication prescribed by a certified health care provider must be covered.

· COVID-19: Prospective offerors’ proposals could be made more robust depending on how COVID-19 tests and care will be handled.

Q9. Besides the discussions at the pre-proposal conference, can the Embassy Representatives share other points that might help prospective offerors prepare a better proposal?

Ans: Questions and answers are still ongoing. Collated questions and answers will be shared/posted on the same beta site after getting approval from A/OPE.