RFI 19SL2025RFI0001.docx

RFI No. 19SL2025RFI0001

Request for Information (RFI)

United States Embassy Freetown, Sierra Leone.

Issued:

December 2025

INTRODUCTION

This Request for Information (RFI) is being issued to help the US Embassy Freetown better understand the availability of services offered by local insurance providers as well as industry best practices related to procuring health insurance coverage in Sierra Leone.

To gather the necessary information, specific questions have been listed in Section 3: RFI Topic Areas.

This is NOT a Request for Proposal (RFP), Request for Quotation (RFQ), or an invitation for bid, nor does its issuance obligate or restrict the Government to an eventual acquisition. All information received from this RFI will be used for market research purposes only. The Government does not intend to award a contract on the basis of responses to this RFI nor otherwise reimburse vendors for the preparation of any information submitted or Government use of such information. Acknowledgement of receipt of responses will not be made, nor will respondents be notified regarding the outcome of the information received.

BACKGROUND

United States Embassy Freetown is looking to the industry in Sierra Leone to provide input on health insurance that will:

· Meet the required minimum benefit levels as defined in Appendix: Medical Coverage and Benefits.

· Standardize provided benefits.

· Adhere to local government mandates and Department of State policies.

RFI INSTRUCTIONS

Responses should be submitted in Microsoft Word format and, excluding attachments, should not exceed ten (10) pages with Arial font equal to 12 pt.

Responses are to be submitted via e-mail to Contractfreetown@state.gov no later than 10:00 am (local time) on January 9, 2026.

INFORMATION REQUESTED FROM VENDORS

Vendors are requested to provide responses to the following questions:

· Company Profile

· Legal entity, registration, licenses to operate in Sierra Leone

· Number of years in medical insurance business

· Experience providing medical insurance to large organizations or expatriate staff

· Medical Network & Coverage

· List of in-country hospitals, clinics, and specialists in your network

· Ability to cover out-of-country treatment and transportation

· Plan Design & Benefits

· Proposed plans covering the benefits listed in Section 3

· Annual maximum limits, co-payments, deductibles, and exclusions

· Optional add-ons or off-the-shelf plans that may reduce exclusions

· Claims Management & Administration

· Claims submission and reimbursement process

· Average claims turnaround time

· Online or digital platform availability for claims and enrollment

· Pricing & Payment Options

· Estimated premiums for group and individual plans, per coverage tier (single, single +1, family)

· Payment frequency (monthly, quarterly, annually)

· Customer Service & Reporting

· Availability of account manager or dedicated support

· Reporting capabilities on utilization, claims, and coverage

· References

· List of at least 3 similar clients or organizations in Sierra Leone

3.1 EVALUATION INTREST AREAS

The Embassy is primarily interested in:

· Technical capability to provide comprehensive coverage for all mandatory benefits

· Network adequacy and access to quality medical facilities

· Timeliness and efficiency of claims processing

· Competitive pricing and flexible plan options

· Experience with expatriate or corporate clients

· Ability to support both group and individual plans

Topic 1: Desired Abilities of an Insurance Provider Please answer the following questions to help provide more clarity regarding your offerings.

Questions for Industry:

A. Benefit Services

1. Which of your commercial, off-the-shelf products would meet or exceed the minimum benefits as described in the Appendix?

2. If a particular benefit is not covered, which one(s)?

3. Could the benefits that are not included in your off-the-shelf product be added to meet our minimum requirements?

B. Local Prevailing Practice

1. Are you aware of any local laws requiring additional benefits that are not listed in the Appendix?

4.0 Appendix: Medical Coverage and Benefits

Core Health Insurance Benefits Requested: Description/Specification/Work

C.1. HEALTH INSURANCE SERVICES

The United States of America Embassy Freetown requires Health Insurance coverage for its employees as described herein.

C.1.1 Employee and Dependent Health Service Benefits

C.1.1.1 Hospitalization (Treatment in the Hospital for Inpatient Care):

Minimum Coverage - 100% 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, imaging and 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 of a semi-private room unless otherwise covered in an off the shelf plan. See Mental Health and Substance Abuse care (C.1.1.13) for details concerning inpatient psychiatric care.

See Mental Health and Substance Abuse Care (below) for details concerning inpatient psychiatric care.

See Outpatient Services (below) for details concerning professional services.

C.1.1.2 Emergency Services (Trips to Emergency Room): Minimum Coverage - 100% Services provided for conditions that could lead to serious disability or death if not immediately treated, such as accidents or sudden illness.

C1.1.3 Ambulance: Minimum Coverage - 80% Professional ground transport to move a patient from the place where s/he is injured or becomes ill to the nearest hospital able to provide treatment or to move a patient from one medical facility to another.

C.1.1.4 Outpatient Services: Minimum Coverage - 80% Services provided by a licensed healthcare provider on an ambulatory or outpatient basis (without being admitted to a hospital), including surgeon’s fees and other medical services provided at a hospital, clinic, doctor’s office, medical facility, etc. Examples include, but are not limited to:

· Annual physical examinations

· Specialist consultations and treatment, including second surgical opinion

· Minor surgical interventions

· Chemotherapy and radiation treatments

· Immunizations recommended by local authorities and/or the World Health Organization

· Diagnostic tests and diagnostic imaging

See Rehabilitative and Habilitative Services and Devices (below) for details concerning physical therapy.

See Mental Health and Substance Abuse Care (below) for details concerning psychiatric therapy.

C.1.1.5 Obstetric and Newborn Care: Minimum Coverage - Inpatient/Emergency: 100%; Outpatient: 80% Care and services that women receive during pregnancy (prenatal care), throughout labor, delivery and post-delivery, and outpatient care for newborn babies. Hospitalization during pregnancy and/or delivery will be reimbursed as inpatient care All other treatments will be considered outpatient services and will be reimbursed at that rate.

C.1.1.6 Pediatric Services: Minimum Coverage - Inpatient/Emergency: 100%, Outpatient: 80% Primary and preventive routine care services for covered dependent children, including, but not limited to: physical examinations, developmental assessments, laboratory tests, and immunizations recommended by local authorities and/or the World Health Organization.

C.1.1.7 Prescription Drugs: Minimum Coverage -Inpatient/Emergency: 100%, Outpatient: 80% Medications prescribed by a licensed health care provider that are medically required. Examples include, but are not limited to prescription antibiotics to treat an infection, medication used to treat an ongoing condition, such as high cholesterol, prophylaxis, contraceptive medication.

C.1.1.8 Preventive and Wellness Services and Chronic Disease Management:

Minimum Coverage - 80% 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.

C.1.1.9 Hearing Aids: Minimum Coverage – 80% Examinations and Treatment: 80% Minimum Coverage

Hearing Aid Apparatus: Limited to one apparatus per ear up to a maximum of SLE33,750 per covered individual per three-year period. 80% Minimum Coverage: with annual cap.

C.1.1.10 Optical Care: Minimum Coverage – 80% Examinations and Treatment: 80% Minimum Coverage

Prescription lenses and frames, or contact lenses: Covered up to a maximum of SLE6,750 per covered individual every two years. 80% Minimum Coverage; with annual cap.

C.1.1.11 Dental Care: Minimum Coverage – 80% Examinations and Treatment: Dentist’s fees, x-rays, examinations and treatment, cleanings, fillings, extractions, false teeth, crowns, and bridges up to a maximum of SLE72,000 per covered individual per contract year. 80% Minimum Coverage: with annual cap.

Orthodontia: Treatment is covered only if treatment begins before age 18, or if required as the result of an accident. A maximum of four years of orthodontia treatment will be covered per covered individual up to a maximum of SLE54,000 lifetime limit. 80% Minimum Coverage; with contract lifetime cap.

C.1.1.12 Reproductive Health: Minimum Coverage - 80% Prescribed contraceptive devices, preventive care and routine examinations, voluntary sterilization, and diagnosis and treatment of conditions which may cause infertility. Assisted reproductive technology (ART), fertility treatments, and reversal of sterilization are not covered (see Exclusions to Coverage).

C.1.1.13 Mental Health and Substance Abuse Care: Minimum Coverage - 50% Inpatient and outpatient care provided to evaluate, diagnose and treat a mental health condition or substance abuse disorder. This includes behavioral health treatment, counseling, and psychotherapy. Services must be provided by a licensed psychiatrist, psychoanalyst, psychologist, or psychiatric social worker. Inpatient care for alcohol and substance abuse must be provided at a facility licensed for detoxification and rehabilitation.

C.1.1.14 Rehabilitative and Habilitative Services and Devices:

Minimum Coverage - 50% 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.

C.1.1.15 HIV/AIDS: 100% up to SLE225,000 per contract year per covered individual Medications to suppress opportunistic infections (such as tuberculosis or toxoplasmosis for covered individuals who have HIV/AIDS). 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.

OPTIONAL BENFITS

*C.1.1.16 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.

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 or those covered under C.1.1.15, HIV/AIDS, is equivalent to SLE135,000

C.1.3 Exclusions and Limitations

There is no coverage 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 coverage 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.

C.1.4 Eligible Participants

C1.4.1.1.1 Spouse: a limit of one legal spouse as defined by local law per employee will be covered.

C.1.4.1.1.2 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.

C.1.4.2 Location of Employment: The eligible employees covered by C.1.4.1 must be employed within the geographic boundaries of Sierra Leone by:

· U.S. Department of State and Agencies

C.1.4.3 Participants Covered Under a Rider

a. All current active ORE Staff personally employed by the Chief of Mission and the Deputy Chief of Mission and assigned to their respective official Government residences and paid under an ORE account. All costs for coverage of ORE Staff are the responsibility of the Chief of Mission and the Deputy Chief of Mission, not the U.S. Government.

b. All current active employees of the Employee Association at Embassy Freetown. All costs for coverage of EAEs are the responsibility of the Employee Association, not the U.S. Government.

c. Retiree Coverage: All costs for coverage of retirees and their dependents are the responsibility of the retiree, not the U.S. Government.

C.1.5 Eligibility

C.1.5.1 Term of Eligibility and Effective Date

Each current active eligible employee and their eligible dependents are enrolled for health benefits under this contract upon award 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.

C.1.6 Brochure Requirement

C.1.6.1 The Contractor shall provide a document (brochure/pamphlet/other written document) in 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 Contractor shall furnish all copies of the brochures to the COR, who will ensure that appropriate distribution is made.

C.1.6.2 The Contractor shall provide the document described in C.1.6.1 to the COR not later than [TBD] after date of contract award. The Contractor shall provide additional brochures for new employees within ten (10) business days of the COR’s request.

C.1.6.3 The Contractor assumes full responsibility for ensuring that the document described in C.1.6.1 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.

SENSITIVE BUT UNCLASSIFIED

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