Questions and Answers Health Insurance Solicitation.pdf

SENSITIVE BUT UNCLASSIFIED

FORMAL

QUESTIONS AND ANSWERS

SOLICITATION Nº 19PA1024R0001

HEALTH INSURANCE FOR LOCALLY EMPLOYED STAFF

On April 18, 2024, U.S. Embassy Asuncion published a solicitation notice for the procurement of health insurance services for locally employed staff of the Embassy. The questions and answers below are responsive to the inquiries received from potential bidders via email at AsuncionContracting@state.gov or during the pre-proposal conference for this solicitation that took place on April 30, 2024.

mailto:AsuncionContracting@state.gov

NO QUESTION RESPONSE

1 Please provide average insured member counts for the last 6 years – 2023, 2022, 2021, 2020, 2019 & 2018. 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.

The average insured member counts for the last six years are as follows:

120-150 employees with 80-90 dependents

13-17 retirees with 25-32 dependents

2 Please provide the claims data for the year December 2022 to December 2023.

Please see Amendment No. 0002 of the solicitation.

3 Please confirm if the claims data provided under Section J- Exhibit F includes the retiree claims as well.

Yes, retiree claims are included in the data provided in Section J – Exhibit F.

4 The claims data from December 2021 to December 2022 appears to be notably lower compared to other years. Could you please verify if these figures are accurate? Additionally, could you confirm whether this data covers a full 12-month period?

Please see Amendment No. 0002 of the solicitation.

5 It seems that the Employee Statistics in Section J-Exhibit A only covers the 145 employees and their dependents eligible for Plan 1. Could you please provide a similar set of statistics for the 35 employees (as indicated in the price tables in Section B) who would be eligible solely for Plan 2?

Employee Statistics for PLAN 2 are not available, this plan was not included in previous contract.

6 Ref. SECTION B: PRICES FOR PLAN 1 – PRICES FOR PLAN 2

Through pages 2 to 7 in the Prices Charts, "Self" and "Self Plus One", means "Employee" and "Employee Plus one Legal Spouse". Is our interpretation correct?

Self Plus One is a premium category that will cover the Employee plus any eligible dependent as described in Section C. Prospective offerors should be aware that the U.S. government recognizes same-sex spouses/domestic partners’ eligibility for benefits, and Embassy Asuncion will recognize and authorize extension of insurance coverage to same-sex spouses/domestic partners.

7 Ref. SECTION G.4.2. Frequency of Payments

Considering that the rates per premium are biweekly, how would the provisions established in point G.4.2 apply?

Invoices may be submitted bi-weekly, at the conclusion of the period covered. Payments will be made monthly by the Government.

8 Ref. SECTION C.1 & C.2

The only difference between Plan 1 and Plan 2 is that for PLAN 1 cover expenses of USD 120,000 are per individual, per event, per contract year and PLAN 2 cover expenses of USD 120,000 are per individual, per contract year? Therefore Plan 1 has more coverage than Plan 2. Is our interpretation correct?

PLAN 1

Annual Maximum Limit is $120,000 per individual, per event, per contract year. This plan incorporates the benefit levels of post’s current insurance contract and will be offered to current employees only.

PLAN 2

$120,000 per individual, per contract year. This plan conforms with the Department’s requirements and local practices and offers expanded services and benefits with a lower annual maximum reimbursement limit and therefore a possible lower employee premium payment. This plan will be offered to current employees who opt for this plan and will be the only option for new employees.

See Sections C.1 and C.2 of the solicitation.

9 Ref. SECTION C.1.1.2. Hospitalization

Please define clearly "utilitarian materials".

Utilitarian materials as stated in the solicitation refer to any ancillary items deemed useful for the patient’s treatment plan.

10 Ref. SECTION C.1.1.2. Hospitalization

Please define clearly "disposable/expendable medical supplies" of both plans.

Disposable/expendable medical supplies as stated in the solicitation refer to any items necessary for the patient’s treatment plan that are for one use.

11 Ref. SECTION C:

PLAN 1, C.1.1.8. Family Planning: Not covered.

PLAN 2, C.2.1.12 Reproductive Health: No Coverage

Family Planning and Reproductive Health are not covered in neither Plan 1 nor Plan 2. Is our interpretation correct?

Yes, your interpretation is correct.

12 Ref. SECTION C.2 HEALTH INSURANCE SERVICES - PLAN 2

What is the purpose of PLAN 2? Both are available for current employees.

Please see the response to #8.

13 Ref. SECTION C.2.1.7 Prescription Drugs

Considering that contraceptives are outpatient prescription drugs and common habitual medication, we understand that contraceptive medication will not be covered for inpatients or outpatients. Is our interpretation correct?

Under PLAN 1, per C.1.1.6, contraceptive medications are covered while the insured is hospitalized. Under PLAN 2, per C.2.1.7, contraceptive medications are 100% covered if prescribed in an in-patient setting.

14 Ref. SECTION C.2.1.15 HIV/AIDS

Considering that HIV/AIDS coverage is not part of the medical coverage plans commercialized in Paraguay, we understand that antiretroviral medications are not part of the USD 10,000 coverage for neither Plan 1 nor Plan 2. Is our interpretation correct?

Incorrect. Responsive offers should include HIV/AIDS coverage as described in Section C.

15 Ref. SECTION C.2.3: Exclusions to Coverage

Our coverage exclusions or limitations can be added to both PLAN 1 and PLAN 2 proposals, is our interpretation correct?

Exclusions or limitations to coverage may be amended in both PLANS 1 and 2 based on what’s provided in an off the shelf plan and is the lowest-cost and technically acceptable. Removal or addition of any exclusions require U.S. Government review and prior authorization.

Note: The USG does not require the contractor to cover the services listed at C.2.3, e.g. spa cures, nonetheless, if the contractor provides these as part of their off the shelf plan (and has quoted the lowest price), then the service could be provided under the contemplated contract.

16 Ref. SECTION I: CONTRACT CLAUSES, 652.215-70 EXAMINATION OF RECORDS

We understand that the scope of this clause refers to access to uses of coverage which are records our company that we can share if asked, and solely of employees of this Contract. Other information of the company or subcontractors are confidential, and an authorization of each patient must be previously given to the Department State Office in order to access them. Is our interpretation correct?

This clause states that the Department of State Office of the Inspector General can request complete, prompt, and free access to all Contractor or Subcontractor files, documents, records, data, office space and employees, except as limited by law. This applies to all such files, documents, records, etc. related to this proposed contract, or any subcontract to this contract.

17 Ref. SECTION L.2 SUMMARY OF INSTRUCTIONS

The presentation of the proposal has to be done electronically according to invitation letter, but in SECTION L, physical copies are required. Are both forms of presentation required, or we can choose to submit the proposal either electronically to address indicated at block 9 or in physical samples at the address given in Block 7?

Please send your offer only electronically via email to AsuncionContracting@state.gov as instructed in the cover letter of the solicitation. Your offer must be in English.

18 Ref. SECTION L.4.3 Volume 3. Technical Proposal Instructions to Offerors PART 2: 4. Describe the pool(s) of coverage the offeror uses to administer its insurance, which pool of coverage the employees under this requirement will be contained, and what percentage of that pool they would represent.

Please clarify this point.

Offeror shall describe the scope of the service being offered, number of subcontracts, partnerships, structure and type of businesses, places where services can be provided, estimated number of resources (equipment, professionals, medical specialties) available for this contract, etc.

19 Ref. SECTION L.4.3, Volume 3, Technical Proposal Instructions to Offerors PART 2: 7. Describe how, and at what monetary level, the offeror will maintain an adequate reserve level to pay claims.

Is the balance sheet presented sufficient to comply to this requirement? If not, please clarify which financial document we have to include in our proposal.

The last three countable annual balances will serve as sufficient financial documentation.

20 Ref. SECTION L.4.3, Volume 3, Technical Proposal Instructions to Offerors PART 3: 4. Brief description of and comparability to the work required under this solicitation.

Please clarify this point.

The offeror must list all contracts and subcontracts it has held over the past three years for the same or similar work, provide brief description of each contract and compare those contracts with the work required under this solicitation.

See Section L.4.3, Volume 3, Technical Proposal Instructions to Offerors, Part 3 of the solicitation in its entirety.

mailto:AsuncionContracting@state.gov

21 Ref. SECTION L.4.3.4: Employee Pool

Please explain what is required from this clause

Please see the response to #18.

22 Ref. SECTION L: Instructions, Conditions and Notices to Offerors

Due to the medical scope coverage of the contact, we understand that a DBA insurance does not apply for this contract and therefore it is not required to be acquired by the offeror. Is our interpretation correct?

Your interpretation is incorrect. This requirement does apply. The Offeror shall include in their offer Defense Base Act (DBA) insurance premium costs covering contractor’s employees that will work on this contract, to include American citizens, Individuals hired in the United States or its possessions, regardless of citizenship, Host Country Nationals (HCNs) and Third Country Nationals (TCNs) working overseas. The offeror shall obtain DBA insurance directly from any Department of Labor approved providers at the DOL website at http://www.dol.gov/owcp/dlhwc/lscarrier.htm

23 Kindly also be aware that the solicitation stablish the Plus One only can the legal spouse… therefore is clear that the Plus One can be the spouse, legally married with the individual covered.

Please see the response to #6.

24 Please clarify the DBA requirement.

Please see the response to #22.

25 English: Should the Retention table include the values that can be increased to the base year amount?

Spanish: En el cuadro de retención deben ir los importes que pueden ser incrementados al importe del año base?

The retention amount is part of the premium and may include, but not be limited to, such costs as overhead and general and administrative costs. It shall also include any profit. Essentially, it includes all costs except the actual portion of the premium intended to fund claims paid to the health care provider/claimant. Please note that the retention amount is a fixed amount and will not be adjusted for any reason.

See B.3.1 of the solicitation.

http://www.dol.gov/owcp/dlhwc/lscarrier.htm

26 English: What does the employee pool refer to? How would it be applied?

Spanish: A que refiere el fondo común de empleados? Cómo se aplicaría?

Please see the response to #18.

27 English: Should the company attach the exclusions to the contract?

Spanish: La empresa debe anexar las exclusiones del contrato?

The solicitation includes the U.S. Government’s minimum requirements. Allowable exclusions are listed at C.1.1.24 and C.2.3.

Any exclusions proposed by the bidder must be included in their offer.

28 Ref. Section C.2.1.15 HIV/AIDS

English: Please clarify point C.2.1.15

Spanish: Favor aclarar el punto C.2.1.15

Please see the response to #14.

29 English: Where should be the laws that the company accepts be placed?

Spanish: Dónde se debe colocar las leyes que acepta la empresa?

The contractor must comply with the laws and regulations of the republic of Paraguay and also with all contract clauses included in the solicitation.

30 English: Please clarify ‘paid claims.’

Spanish: Favor aclarar las reclamaciones pagadas

A 'paid claim’ is a payment made by the insurer on behalf of the insured party pursuant to a judgment, or by way of repair or settlement of a claim.

31 Ref. SECTION L.4.3, Volume 3, Technical Proposal Instructions to Offerors PART 2: #4

English: Please clarify what this means: Describe the pool(s) of coverage the offeror uses to administer its insurance, which pool of coverage the employees under this requirement will be contained, and what percentage of that pool they would represent.

Spanish: Favor aclarar a qué refiere lo siguiente: Describir el grupo de cobertura que el oferente utiliza para administrar su seguro, que grupo estarán incluidos los empleados bajo este requisito y que porcentaje de ese grupo representarán.

Please see the response to #18.

32 English: Differences in coverage between plans 1 and 2.

Spanish: Diferencias de cobertura entre los planes 1 y 2.

Please see the response to #8.

33 English: Do you have dependent payments? Who pays for that fee, or it is all between the employee (15%) and the embassy (85%)? Are prices allowed by age range? (e.g. parents, in-laws >65 years, etc.)

Spanish: ¿Tienen adherentes pagos? Quién abona esa cuota, o todo es entre el empleado (15%) la embajada (85%)? ¿Se admite precios por rango etario? (ej, padres, suegros >65 años, etc)

The data at C.1 is for informational purposes. The U.S. government is responsible for paying all premiums invoiced (with the exception of riders (C.2.4.3) and certain dependents (defined in C.1.5.2)) consistent with the terms and conditions of the contemplated contract.

See G.4.3. of the solicitation.

34 Ref. B.2.3 - B.2.7, Pricing Tables

English: What does the period of "26 * total price for the base year" refer to? (pg. 5)

Spanish: ¿A qué se refiere el periodo de "26 * precio total para el año base"? (pág. 5)

This is a firm fixed price contract. The offeror is requested to provide bi-weekly rates per premium. That bi-weekly amount shall be multiplied by 26 paid periods in a year. The result will be the total price for the base year period. Offerors will need to do the same calculation for option periods.

35 Ref. B.2.3 - B.2.7, Pricing Tables

English: What do you mean by “excess coverage”? (p. 5, below price chart) How is this computed or measured, and what is done with the surplus?

Spanish: ¿A qué se refiere con "exceso de cobertura"? (pág. 5, debajo del cuadro de precios) ¿Cómo se computa o mide esto, y qué se hace con los excedentes?

Excess coverage for Extended Family (C.2.4.1.1.4) is included under this contract only as rider benefits; the Contractor shall bill the individual covered at the rates specified below. See Section G for billing procedures. Note that USG is not responsible, nor liable, for any riders.

The contractor will need to provide monthly prices for Retirees (Riders) Retirees covered under this clause shall have all rights and benefits conceded to USG employees including coverage for spouses and the options stipulated at same prices set for employees/beneficiary coverage. The retirees will make payment directly to the Contractor for the entire premium amount.

36 English: What are the costs of the international insurance mentioned during the meeting? Or should it be contracted separately?

Spanish: ¿Costos del seguro internacional mencionado en la reunión? ¿O se debe de contratar aparte?

Please see the response to #22. The offeror shall contact companies listed on the DOL website to get the estimated total cost of the insurance required.

37 English: Is the health insurance only applicable to the national territory of Paraguay or is it also at the international level?

Spanish: ¿El seguro médico es solo a nivel nacional en territorio paraguayo o también es a nivel internacional?

Health insurance services (PLAN 1 and PLAN 2) are required under this contract for the national territory the republic of Paraguay only.

See C.1.1.10 and C.1.2 of the solicitation.

38 English: Please explain how to fill out the retention table Spanish: Favor explicar cómo llenar el cuadro de retención

Please see the response to #25.

39 Ref. B.3: ADMINISTRATIVE RETENTION AMOUNTS English: Please clarify point B.3, specifically in relation to the term “Retention,” considering the exemption from Value Added Tax (VAT) for the United States government.

Spanish: Aclarar punto B.3, específicamente en relación con el término "Retención", considerando la exención del Impuesto al Valor Agregado (IVA) para el Gobierno de los Estados Unidos.

Please see the response to #25. The amount paid by the US Government shall not include VAT.

40 Ref. B.4.2. Premium Adjustment Based on Laws

English: In the pre-proposal conference, it was mentioned that the rates must be established by calculating all the costs that may be incurred during the base period and the option years (5 years) and that they cannot be modified during that period, however, point B. 4 mentions: “No adjustment will be allowed during the first twelve months. After that period, the Contractor or the Government may request an adjustment in the premiums annually.”

Spanish: En la reunión informativa, se mencionó que las tarifas se deben establecer calculando todos los costos que puedan incurrir durante el periodo base y los años de opción (5 años) y que no podrán ser modificadas durante ese periodo, sin embargo, el punto B.4 menciona: “No se permitirá ningún ajuste durante los primeros doce meses. Después de ese plazo, el Contratista o el Gobierno podrán solicitar un ajuste en las primas anualmente”.

The rates may be adjusted during the performance period of the contract as a result of laws enacted by the host Government, if such change in the laws has a direct impact on the cost to the Contractor to perform this contract at the contracted rate. The Contractor must provide all documentation necessary to support any requested adjustment.

See B.4.2 of the solicitation in its entirety.

41 English: Does the government seek to receive care exclusively in a single medical center or does it also consider other medical centers with which it may have agreements?

Spanish: ¿El gobierno busca recibir atención exclusivamente en un único sanatorio o también considera otros centros médicos con los que pueda tener convenios?

The U.S. Government will consider offers that include additional medical centers distributed around the country where beneficiaries will be able to receive the service contracted at same terms and conditions.

42 Ref. G.5 REFUNDS TO THE GOVERNMENT

English: Considering the data provided by the US Embassy, the rates are established taking into consideration a minimum number of employees, approximately 120 people. During the meeting, it was mentioned that there will be few inclusions or exclusions. In this context, what is the situation that applies to what is mentioned in point G.5?

Spanish: Considerando los datos proporcionados por la Embajada Americana, se establecen las tarifas tomando en consideración una cantidad mínima de funcionarios, aproximadamente 120 personas. Durante la reunión, se hizo referencia a que habrá pocas inclusiones o exclusiones. En este contexto, ¿cuál es la situación que se aplica a lo mencionado en el punto G.5?

120 employees is not the minimum quantity. This number is an estimated quantity.

Clause G.5 will apply if at any time during performance of the contract the Government finds that the Contractor has been overpaid because the number of employees and/or dependents covered has decreased.

43 SECTION L: INSTRUCTIONS, CONDITIONS AND NOTICES TO

OFFERORS The Offeror shall include Defense Base Act (DBA) insurance premium costs covering their employees working on the contract to include American citizens, Individuals hired in the United States or its possessions, regardless of citizenship, Host Country Nationals (HCNs) and Third Country Nationals (TCNs) working overseas. The offeror shall obtain DBA insurance directly from any Department of Labor approved providers at the DOL website at http://www.dol.gov/owcp/dlhwc/lscarrier.htm

Due to the medical scope coverage of the contact, we understand that a DBA insurance does not apply for this contract and therefore it is not required to be acquired by the offeror. Is our interpretation correct?

Please see the response to #22.

https://gcc02.safelinks.protection.outlook.com/?url=http%3A%2F%2Fwww.dol.gov%2Fowcp%2Fdlhwc%2Flscarrier.htm&data=05%7C02%7CBartzAG%40state.gov%7C64e24de9f9904a6a028b08dc6e155e42%7C66cf50745afe48d1a691a12b2121f44b%7C0%7C0%7C638506285251032731%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C0%7C%7C%7C&sdata=6Bq2hinPAm52EsBy7zfpp42jFvBj87PE4R%2B4Ha8SACI%3D&reserved=0

44 Under Section J-Exhibit A-Employee Statistics, there is a category titled “Special Agreements”. Could you please confirm what the numbers under this category represent?

According to C.1.5.2., special agreements between the Contractor and covered employee may be established to cover the dependents based on an additional premium which will be paid in each case by the employee without charge to the U.S. Government.

45 Please provide a current census of members covered under the policy, including age, gender, and any other demographic information that may affect policy terms or premiums.

A comprehensive outline of the current policy terms, including coverage limits, exclusions, and any special conditions.

This information is included in Section J – Exhibit A – Employee Statistics.

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