REQUEST FOR INFORMATION 19KZ1026N0369_Final.docx

REQUEST FOR INFORMATION 19KZ1026N0369

SECTION 1

Description

1.1 The U.S Department of State Mission in Kazakhstan is seeking information on how any interested contractor could provide medical insurance services to US Mission Kazakhstan.

1.2 THIS IS A REQUEST FOR INFORMATION (RFI) ONLY. This RFI is issued solely for information and planning purposes – it does not constitute a Request for Proposal (RFP) or a promise to issue an RFP in the future. This request for information does not commit the Government to contract for any supply or service whatsoever. Further, the US Mission in Kazakhstan is not at this time seeking proposals and will not accept unsolicited proposals. Respondees are advised that the U.S. Government will not pay for any information or administrative costs incurred in response to this RFI; all costs associated with responding to this RFI will be solely at the interested party’s expense. Not responding to this RFI does not preclude participation in any future RFP, if any is issued. If a solicitation is released, it will be synopsized on the Home | SAM.gov website. It is the responsibility of the potential offerors to monitor this site for additional information pertaining to this requirement.

SECTION 2

Background

Comprehensive health insurance coverage and administrative services for eligible US Mission Kazakhstan employees and dependents as defined in Attachment A to this RFI.

2.1 Planned Execution/Award: TBD

2.2 Delivery Period: Base 1 year, with 4 option years.

2.3 Limitations or unique requirements: See article 5 of the attached SOW.

2.4 Security Requirements: Not Applicable

SECTION 3

Requested Information:

Interested contractors shall provide the following information to assist the U.S. Mission Kazakhstan in conducting market research:

· Company Profile and Experience

· Number of years in business providing medical insurance services

· Physical address and contact information

· Status of business license or similar regulatory authorization in Kazakhstan or similar

· Size and scope of medical insurance contracts over the past 3-5 years

· Current client base (number and types of organizations served)

· Experience serving diplomatic missions, international organizations, U.S. Government entities, or similar clients

3.1 Past Performance Reference:

· Provide at least three (3) references from similar contracts, including:

· Client name and point of contact

· Brief description of services provided

· Client contact information (email and phone)

3.2 Provider Network and Coverage Capabilities

· Comprehensive listing of medical provider networks, including:

· Hospitals (names and locations in Kazakhstan)

· Clinics and outpatient facilities

· Physicians and specialists (by specialty)

· Pharmacies

· Dental providers

· Optical/vision care providers

· Mental health providers (psychiatrists, psychologists, psychiatric social workers)

· Orthodontic providers

· Rehabilitation facilities

· Geographic coverage within Kazakhstan (cities/regions served)

· Number of providers in network by category

· Quality assurance measures for network providers

· Direct billing arrangements with in-network providers

SECTION 4

Responses

4.1 Interested parties are requested to respond to this RFI with a white paper.

4.2 White papers in Microsoft Word are due no later than Monday, June 15th 2026, 15:00 local time. Responses shall be limited to 20 pages for Section 2 (see above) and submitted via e-mail only to AstanaGSOPRocurement@state.gov. Proprietary information, if any, should be minimized and MUST BE CLEARLY MARKED. To aid the Government, please segregate proprietary information. Please be advised that all submissions become Government property and will not be returned

4.3. Section 1 of the white paper shall provide administrative information, and shall include the following as a minimum:

4.3.1. Name, mailing address, phone number and e-mail of designated point of contact.

4.3.2. Contracting strategy to provide medical insurance services to US Mission Kazakhstan.

The number of pages in Section 1 of the white paper shall not be included in the 20-page limitation, i.e., the 20-page limitation applies only to Section 2 (see above) of the white paper.

4.4 Section 2 of the white paper shall answer the issues addressed in Section 3 (see above) of this RFI and shall be limited to 20 pages.

SECTION 5

Industry Discussions

Embassy representatives may or may not choose to meet with potential offerors. Such discussions would only be intended to get further clarification of potential capability to meet the requirements.

SECTION 6

Questions

Questions regarding this announcement shall be submitted in writing by e-mail to AstanaGSOProcurement@state.gov . Verbal questions will NOT be accepted. Questions will be answered by posting answers to the SAM.gov website; accordingly, questions shall NOT contain proprietary or classified information. The Government does not guarantee that questions received after June 8th, 2026, 15:00 local time will be answered.

SECTION 7

Summary

THIS IS A REQUEST FOR INFORMATION (RFI) ONLY to identify sources that can provide comprehensive health insurance coverage and administrative services for eligible US Mission Kazakhstan employees and dependents. The information provided in the RFI is subject to change and is not binding on the Government. The Department of State Mission in Kazakhstan has not made a commitment to procure any of the items discussed, and release of this RFI should not be construed as such a commitment or as authorization to incur cost for which reimbursement would be required or sought. All submissions become Government property and will not be returned.

Attachments:

Attachment A: Statement of Work (SOW)

ATTACHMENT A

Statement of Work (SOW)

Medical Insurance Services Agreement

1. Project Overview This Statement of Work (“SOW”) defines the scope, responsibilities, deliverables, and terms under which Provider will deliver medical insurance services to US Mission Kazakhstan.

The purpose of this agreement is to provide comprehensive health insurance coverage and administrative services for eligible employees and dependents.

2. Definitions:

For the purposes of this SOW, the following terms shall apply:

“Mission”: The U.S. Mission Kazakhstan (US Embassy Astana and Consulate General Almaty).

“Contractor” or “Provider”: The entity providing insurance coverage and administrative services.

“Employee”: An eligible Mission staff member enrolled in the plan.

“Dependent”: An eligible individual related to an Employee, as defined below.

“Covered Individual”: Any enrolled Employee or Dependent.

“Healthcare Provider”: Any licensed medical provider or facility.

“In-Network Provider”: A provider contracted with the Contractor.

“Out-of-Network Provider”: A provider not contracted with the Contractor.

“Covered Services”: Services eligible for payment under this SOW.

“Medically Necessary”: Services consistent with accepted medical standards.

“Claim”: A request for payment or reimbursement.

“Reimbursement”: Payment made to a Covered Individual.

“Direct Billing”: Payment made directly to a provider.

“Premium”: Payment made by the Mission for coverage.

“Contract Year”: A 12-month coverage period.

“Pre-Authorization”: Prior approval required for certain services.

Dependents:

Spouse: a limit of one legal spouse as defined by local law per employee will be covered. LE Staff with more than one legal spouse must select only one spouse for coverage. In cases where LE Staff and their legal spouse both work for the mission and both are eligible to participate in the medical plan, one will be designated as the lead for purposes of the medical plan, and the other will be considered a legal spouse.

Children: a child is defined as the LE Staff’s natural, adopted, stepchild, or foster child. The child must be unmarried and financially dependent upon the LE Staff. A child will be covered until the end of the contract year in which s/he reaches age 26. An unmarried child determined to be incapable of self-support due to a physical or mental condition will continue to be eligible to participate in the medical plan as long as the condition persists, the child remains unmarried, and the LE Staff maintains coverage.

3. Scope of Services The benefit levels are a standard package that must be provided to U.S. Mission Kazakhstan:

Health Insurance Coverage

Hospitalization (Treatment in the Hospital for Inpatient Care):

Services and supplies provided during hospitalization including services provided by a licensed healthcare provider, bed and board (semi-private accommodations), operating room, recovery room, intensive care, imagingand diagnostic testing, and general hospital nursing care, physical therapy, as well as drugs and medicines administered while in-patient. When private accommodations are provided, coverage will be limited to the cost ofa semi-private room unless otherwise covered in an off the shelf plan.

Emergency Services (Trips to Emergency Room):

Services provided for conditions that could lead to serious disability or death if not immediately treated, such as accidents or sudden illness.

hospital able to provide treatment or to move a patient from one medical facility to another.

Outpatient: 80% Inpatient: 100% Outpatient: 80%

examinations, developmental assessments, laboratory tests, and immunizations recommended by local authoritiesand/or the World Health Organization.

Inpatient: 100% Outpatient: 80% Inpatient: 100% Outpatient: 80%

prescribed by a licensed health care provider that are medically necessary. Examples include, but are not l imited to: prescription antibiotics to treat an infection; medication used to treat an ongoing condition, such as highcholesterol; prophylaxis; or contraceptive medication.

Inpatient: 100% Outpatient: 80% Provider Clinic Pharmacy — 100% Inpatient: 100% Outpatient: 80%

Preventive and Wellness and Chronic Disease Management:

Counseling or preventive care designed to prevent or detect medical conditions and care for chronic conditions such as asthma and diabetes. Examples include, but are not limited to: physicals, immunizations, and cancer screenings.

Coverage - 80% Provider Clinics — 100% Coverage - 80%

Hearing AIDS:

Examinations and Treatment:

Hearing Aid Apparatus:

Limited to one apparatus per ear up to a maximum of USD 1,500 per covered individual per three-year period. 80% Coverage: with annual cap.

Limited to one apparatus per ear up to a maximum of USD 1,500 per covered individual per three-year period. 80% Coverage: with annual cap.

Optical Examinations and Treatment:

Prescription lenses and frames or contact lenses:

Covered up to a maximum of USD 300 per covered individual every two years. 80% Minimum Coverage; with annual cap.

Covered up to a maximum of USD 300 per covered individual every two years. 80% Minimum Coverage; with annual cap.

Rehabilitative and Habilitative Services and Devices:

Rehabilitative services (e.g., recovering skills, such as speech therapy after a stroke or physical therapy after an accident) and habilitative services (e.g., developing skills, such as speech therapy for children, etc.) that help develop skills needed for everyday life.

Devices to help gain or recover mental or physical skills lost due to injury, disability or a chronic condition, and devices needed for habilitative reasons.

Brief courses of anti-retroviral drugs during childbirth to prevent the transmission of HIV/AIDS to the child. Generally excludes medication for the long-term suppression of HIV/AIDS through the combination of anti-retroviral drugs in locations with inadequate local healthcare infrastructures.

Reimbursement up to $10,000 per contract year per covered individual

Reimbursement up to $10,000 per contract year per covered individual

Dental Examinations and Treatment:

Dentist’s fees, x-rays, examinations and treatment, cleanings, fillings, extractions, false teeth, crowns, and bridges up to a maximum of USD 3,200 per covered individual per contract year. 80% Minimum Coverage: with annual cap.

Catastrophic Coverage

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.

Out-of-Country Medical Treatment:

Medical expenses incurred out-of-country will be covered at the same benefit levels and subject to the same total maximum annual limit as for medical expenses incurred in-country.

family members. To be considered a covered expense, the attending certified health care provider must certify in advance that the treatment is medically necessary and unavailable locally. 80% of covered individual’s transportation expenses by the least expensive, appropriate means of transportation to the nearest city with adequate medical facilities will be covered. 80% of the transportation expenses of an attendant will also be covered, but only if the covered individual's attending certified health care provider certifies that an attendant for the patient is necessary, (e.g., a parent in the case of a patient who is a minor, or a family member to make medical decisions in the case of a patient who is unwell or unconscious). All coverage for transportation for out-of-country medical treatment is subject to the total maximum annual limit. Transportation to a neighboring country without the attending certified health care provider certifying that the treatment is medically necessary and unavailable locally will not be covered.

4. Annual Maximum Limit - The maximum annual reimbursement per covered individual per contract year, not including expenses defined under Exclusions and Limitations and those covered under HIV/AIDS to be equivalent to 27,000 USD 5.Exclusions and Limitations There is no reimbursement for elective cosmetic surgery; spa cures; rejuvenation cures; massage; exercise therapy; long-term rehabilitative therapy; non-medical hospital charges (e.g., telephone, television, etc.); home help, family help, or similar household assistance; fees of persons who are not certified health care providers; advanced reproductive technology (e.g., in-vitro fertilization, intra-cellular sperm injection, artificial insemination, microsurgical epididymal sperm aspiration, testicular sperm extraction, cryopreservation, etc.); or services or supplies which have not been prescribed or approved by a certified health care provider.

Exclusions to coverage may be amended if provided in an off the shelf plan and is the lowest-cost and technically acceptable.

Removal of any exclusions require prior authorization.

There is no reimbursement for expenses that will be reimbursed or paid directly under a host country medical program or workers' compensation program, the U.S. workers’ compensation program, or post’s LE Staff workers’ compensation program.

6.Plan Administration Coverage Tiers and Premium Basis Premiums will be determined based on the number of individuals covered under the selected enrollment category:

· Self-Only: Coverage for one (1) individual (employee only)

· Self Plus One: Coverage for two (2) individuals (employee plus one eligible dependent ( spouse, unmarried, financially dependent children under 26)

· Family: Coverage for three (3) or more individuals (employee and eligible dependents) Eligible Participants Identification of Eligible Employees and Dependents: U.S. Missions in Kazakhstan, will provide a list of all eligible employees and dependents with relationship to employee (self/spouse/child) and DOB for each. Updates will be provided to add or remove individuals on a bi-weekly/monthly basis.

Enrollment Each current active eligible employee and their eligible dependents to be enrolled and thereafter during the performance period of this contract. Each new eligible employee and eligible dependents will be enrolled upon entering on duty with the United States Government. An employee is considered active ("on the rolls") whenever such employee is on approved leave, whether paid or unpaid.

Periods of Ineligibility:

Employees and their dependents are not entitled to health benefits during any period of employment for which premiums are not paid.

Additionally, employee's dependents are not entitled to health benefits during any period of employment during which the employee was not eligible to participate.

During a period of extended Leave Without Pay (LWOP) or unpaid leave beyond one pay period, employee and his family members will be ineligible for the coverage unless the employee is responsible for the full cost of the insurance premiums for self and dependents. The Mission will pay the premiums directly to the Contractor, and will collect the full cost from the employee on a quarterly basis. Alternatively, the employee may elect to have coverage cease if they prefer not to pay the premium.

Deliverables The Provider (contractor) will deliver:

Active insurance coverage for enrolled members. The Contractor shall be responsible for all planning, estimating, programming, project management, scheduling, dispatching, supervision, and inspection of work. The Contractor shall maintain his own reference library of technical reference works and local laws and regulations, including current tariffs and registries. The Contractor shall treat the information provided by the Embassy concerning employee' personal data, medical information, and salaries as highly sensitive and not divulge any employee information to unauthorized persons. The Contractor shall establish procedures for handling medical insurance claims as follows:

Medical Claims:

· All medical claims shall be submitted directly to the Contractor by employees.

· The Contractor shall settle the claims no later than two weeks from the date the claim is submitted to the Contractor.

· (4) Settlement shall be by issuance of checks in the name of the employee for each claim submitted. Each check shall be accompanied by a form providing details of the amount reimbursed with an explanation of deductions, if any.

· The Provider shall accept the Employee’s or dependent’s choice of hospital for surgery and choice of healthcare provider for examinations and treatment. The Contractor shall pay the related expenses directly to the selected hospital or provider or reimburse expenses to the employees.

Brochure Requirements:

· The Contractor shall provide a document (brochure/pamphlet/other written document) in Russian, Kazakh, English that sets forth a complete listing of the health insurance benefits to be provided under this contract.

· This brochure shall be provided in sufficient quantities so that each covered employee receives a copy. The Provider shall furnish all copies of the brochures to the COR, who will ensure that appropriate distribution is made.

· The Contractor shall provide the document described in C.1.6.1 to the COR not later than 30 days after date of contract award. The Provider shall provide additional brochures for new employees within ten (10) business days of the COR’s request.

· The Provider assumes full responsibility for ensuring that the document described accurately reflects the requirements, coverage, and contract terms of the contract, as implemented by the Contractor’s technical proposal. In all cases, the contract shall take precedence. Should the COR discover that the document contains inaccuracies, the Contractor will be notified in writing; however, failure on the part of the U.S. Government to notice any inaccuracies shall in no way limit, revise or otherwise affect the requirement under this contract for the Contractor to fully comply with all contract terms.

Customer Support

1. 24/7 member support hotline

2. Online portal access for members

3. Provider network assistance Timeline

· Contract Start Date: TBD

· Implementation Period: 2026-2027

· Coverage Effective Date: TBD

· Contract Term: Base 1 year, with 4 option years.