Questions and Answers - Life and Medical Insurance Coverage - U.S. Mission Saudi Arabia.pdf

Life and Medical Insurance Coverage for Locally Employed Staff of U.S. Mission Saudi Arabia

Solicitation Number 19SA7021R0004

Questions and Answers

Q1: Solicitation reference C.1.2 Annual Maximum limit, the maximum annual reimbursement per covered individual per contract year, not including expenses defined under Exclusions and Limitations (C.1.3) and C.1.1.16, Catastrophic Coverage, or those covered under C.1.1.15, HIV/AIDS, and C.1.1.21 Excess Coverage is equivalent to SAR 500,000.

Please explain difference between item No. C.1.1.16 and C.1.1.21?

Can insurance company quote new premium for each section (if it will exercise) based on nature of case?

A1: Please refer to the complete definitions per the solicitation for C.1.1.16 Catastrophic Coverage and C.1.1.21 Excess Coverage. C.1.1.16 Catastrophic Coverage is a benefit provided to all eligible participants and the additional coverage level is made available due to a catastrophic event, C.1.1.21 Excess Coverage is an optional benefit where eligible participants must select Excess Coverage individually and pay 100% of premium for Excess Coverage. Excess Coverage is a rider to the contract, the employee enrolls directly with the vendor and pays the premium directly to the vendor.

The USG will not be responsible for collecting these premium payments.

Please submit premiums in proposal based on requirements in Solicitation to ensure technical acceptability of the offer.

Q2: Solicitation reference C.1.3 Exclusions and Limitations. Do standard exclusions apply under each health benefit covered?

Please specify specific exclusions related to each benefit covered.

A2: Please see Solicitation section C.1.3 Exclusions and Limitations. Items described in C.1.3 are not covered. Exclusions may be amended if provided in an off-the-shelf plan and is the lowest-cost and technically acceptable.

Q3: Solicitation reference C.1.1.11 Dental Care: Minimum Coverage. Please clarify if the orthodontia limit of SAR 9,000 is a sub-limit of overall dental limit.

A3: Dental and Orthodontia have separate caps (or limits). Orthodontia coverage is a separate limit than general dental coverage. It is not a sub-limit within the overall dental limit (SR 12,000). These are two separate benefits and two separate maximum caps.

Q4: For the group life insurance, can we obtain a copy of the list of individuals including date of birth, employee number, and occupation for each employee for all options?

A4: In accordance with Privacy laws, we are prohibited from providing this information for the group life or medical insurance.

Q5: Could you please provide claims records for the last 5 years?

A5: **PENDING – The Embassy will issue a response next week.**

Q6: What are the benefits per level of coverage or classes?

A6: The offeror must propose as per scope of work. The solicitation sets minimum benefit levels and proposals that meet or exceed the minimum coverage levels are technically acceptable and may make a proposal more competitive. One of the goals of setting minimum coverage levels is to enable vendors to bid with existing off the shelf plans.

Q7: Group Life, can we obtain details of any work-related travel to hostile / unsafe locations, i.e., Iraq, Yemen, Syria, etc.?

A7: Insurance companies should present what their standard language is for areas of conflict.

Q8: Health Insurance, can you provide current network of medical providers?

A8: The offeror must propose as per scope of work.

Q9: Health Insurance, will coverage be extended outside the Kingdom of Saudi

Arabia (KSA)? If yes, will it be on a reimbursement basis or direct billing?

A9: Please see solicitation reference C.1.1.17 Out-of-Country Medical Treatment and C.1.1.18 Out-of-Country Medical Travel in Section C. Please include details regarding direct billing or reimbursement for coverage extended outside Saudi Arabia.

Q10: Medical Insurance, Existing Table of Benefits?

A10: Please submit as per the Scope of Work.

Q11: Medical Insurance, what is the inception date of the contract?

A11: The inception date is July 1, 2021 per Solicitation, Section F.2.

Q12: Kindly provide the 700 unified number (if applicable)?

A12: U.S. Embassy number is 7001068233.

Q13: Life Insurance, please provide us employees list in excel format with their desired sum insured for each employee?

A13: Please see solicitation reference (Part II Group Life Insurance sub-section

C.2.1) in Section C, scope of work.

Q14: Will there be a checklist for both covers to make sure all requirements are met? If yes, could you share it with us?

A14: Please refer to Section C, Scope of Work for both Life and Health insurance.

Q15: Are the required documents and declaration available in a separate document individually, or do we have to extract them from the solicitation?

A15: The offerors must provide the required documents as per the Solicitation requirements.

Q16: Solicitation reference C.2.1.3 Partial and Total Disability coverage.

No waiting period is defined for Partial disability due to sickness. Generally waiting period varies from 6 months to 12 months period.

Please specify your requirement on waiting period.

A16: **PENDING – The Embassy will issue a response next week.**

Q17: Solicitation reference C.2.1.3 Partial and Total Disability coverage.

There is no compensation scale for Partial and Total Disability cover under KSA law. We use standard Continental Scale for such benefits, which is Internationally accepted.

Please confirm that standard Continental Scale is acceptable or provide your compensation scale of benefit to use for this coverage.

A17: **PENDING – The Embassy will issue a response next week.**

Q18: Solicitation reference C.2.4.1. Entry age for New employees is restricted to age 60.

Please advise termination date for employee under Life insurance coverage.

A18: The termination date for employee under Life Insurance coverage is upon separation of the employee from service.

Q19: Solicitation reference C.2.2- Life Insurance Benefits Conditions and Limitations. Standard exclusion always applies to Life insurance coverage.

Please advise your applicable exclusions under each type of life insurance coverage.

A19: No benefits shall be payable if an employee's death or other insurance event was caused directly or indirectly by war. War shall be defined as declared or non-declared war or any martial operations or invasion, hostile acts of foreign powers, rebellion, riot, civil war, uprising, mutiny, operations by military or usurpatory authorities, martial law or state of siege or any other similar event or reason for declaring martial law or war. A terrorist attack shall not be considered war.

No benefit shall be payable under this contract if the employee's bodily injuries have been caused directly or indirectly and totally or partially by:

1. Violating the law or in resisting detention or arrest,

2. Participation in competitions involving the use of wheeled vehicles, horses, boats or water skis,

3. An accident resulting from the employee being under the influence of alcohol, drugs or other toxic substance unless administered by a physician.

Death because of a disease or physical or mental infirmities and medical or surgical treatment thereof (except pyogenic infection due to an accidental cut or wound) shall be considered a natural and not an accidental death.

Suicide will not be covered.

Q20: Solicitation reference C.2.1 Group Life Insurance Coverage: Passive war and Terrorism coverage is not requested under this life insurance solicitation.

Please advise if you need coverage for Passive War and Terrorism

A20: Please kindly refer to the Scope of Work. Technical acceptability will be determined based on the requirements put forth in the Solicitation.