Series_of_Questions_and_Answers.docx

Question 1:

Would’ve highly appreciated your assistance in regards of below mentioned:

L.4.3.3. Profit Sharing Credit The offeror shall indicate whether any insurance plan offered will be subject to participation in any profit sharing credit program, pooling agreement (including multinational agreements) or any other premium credit procedure. If this is applicable, please describe. This is for evaluation only to distinguish between otherwise equally priced, technically acceptable proposals and will not be considered in determining the lowest-priced offeror.

L.4.3.4. Employee Pool The offeror shall describe the pool that will apply to the employees under this contract. The offeror will describe the size of the pool, whether it is a mixture of commercial and government (if applicable), alternative pools that are available in the event the economic price adjustment clause becomes effective.

Answer 1: This is a business reference as to how a company structures its employee staffing. Basically it is the amount of shares of a company’s stock that get’s set aside so the shares or profits can later be issued to employees or officers of a company. How the employees manage this process is up to each individual company. All private companies have some sort of business sharing/profit plan called an “employee pool”. Please consult with your individual human resources department for specifics for your specific company..

Question 1: According to the clause C.1.1.13. “Annual Maximum Limit - The maximum annual reimbursement per patient per contract year, not including expenses covered under c.1.1.4 (for Employees Only: 100% coverage for medications to suppress opportunistic infections, such as tuberculosis and toxoplasmosis for employees who have HIV/AIDS). In view of significant increase in the number of AIDS patients please advise Annual Maximum Limit per HIV patient. Shall be limit double as it was in previous contract?

Answer 1: Yes. Separate USD 77,810 limit for expenses covered under c.1.1.4.

Question 2: Please clarify your vision of the clause “C.1.1.3. Expenses incurred for vitamins, cold remedies, and other general sales medications considered easy to take correctly and safe for most people to self-manage (for example, aspirin and skin creams) will not be reimbursed even if prescribed by a physician.”

Answer 2: Typically drugs that are sold only with doctors prescriptions in the United States are covered. Vitamins, cold remedies, skin creams and other substances that are sold over the counter and do not require doctors prescriptions in the United States are not covered. We will conduct some research for additional information and do our best to provide you with helpful links and websites.

Question 3: Will any implants and brackets be covered under the clause C.1.1.9. Dental Care. And shall them be reimbursed at any price of any licensed clinic chosen by Insured person?

Answer 3: Implants are covered. Orthodontia (brackets) are covered only if treatment begins before age 15, unless required as the result of an accident. A maximum of four years of orthodontia treatment will be covered per patient.

The contractor will have to reimburse at the clinic's official prices in any clinic (without prior notification of Insurance Company) and at any prices (i.e. without applying referent - commonly accepted overage prices).

Question 4: According to the clause below all government medical programs will not be covered by this Health Insurance Plan (like oncology, diabetes, tuberculosis etc.) “C.1.2. Health Benefits Conditions and Limitations. No coverage will be made for expenses that will be reimbursed or paid directly under a host country medical program, the U.S. workers’ compensation program, or any host government workers’ compensation program.” Is this the correct understanding of this clause or not?

Answer 4: In case these treatments are conducted in private not-governmental clinics or these treatments are not fully sponsored by Azerbaijani government reimbursements to the covered individual should be done at the same limits as all other treatments including reimbursements for drugs within set annual maximum limits.

Question 1: In the Section C “Health Insurance Services” clause “C.1.1. Employee and Dependent Health Services Benefits” there is following statement:

“Reimbursement of covered expenses is limited to the stated percentages of reasonable and customary costs.”

Please clarify if the term “reasonable and customary costs” means that in the new Solicitation we shall apply referent prices or we still have to reimburse at the clinic's official prices?

Answer 1: The contractor will have to reimburse at the clinic's official prices in any clinic (without prior notification of Insurance Company) and at any prices (i.e. without applying referent - commonly accepted overage prices).

Question 1: If it possible, please, send to us retention amounts for single employees and family plan for current insurance year.

Answer 1: The answer is: Single Employees (Self Only) USD 192.56, Family Plan $ 642.19.

Question 1: Please provide gender of Employees (not required for spouse and children) in the census (Exhibit 1, 2).

Answer 1: Please see the attached EXCEL document “Employee’s Gender”

Question 2: Please provide premium history for the current year and last 5 years - 2015 (till now), 2014, 2013 and 2012.

Answer 2:

Total $3,283,003.18

Question 3: Please provide claims history for the current 2015 (till now) and for 2014, 2013 and 2012?

Answer 3: The current insurer reports an average of 450 claims per month.

Question 4: Confirm the current benefits schedule is the same as the benefits being requested and if not advise on the differences.

Answer 4: All benefits expected are listed in the Request For Proposals.

Question 5: Who is the current insurance carrier?

Answer 5:

A-Group Insurance Company 87A R. Behbudov St., Baku AZ1022, Azerbaijan

Question 6: Are any major illnesses being treated? If Yes, indicate in Census (Exhibit 1, 2) Sheet along with diagnosis?

Answer 6: Unfortunately, the timing for the solicitation does not allow for the detailed diagnostic information to be provided on a patient-by-patient basis. If there are specific claims, medications, illnesses or conditions that are of concern, please be more precise with that question.

Question 7: Are there any large losses (in excess of USD10,000 or USD15,000) within the last year to date? If Yes, indicate in Census Sheet (Exhibit 1, 2) along with diagnosis.

Answer 7: No large losses have been reported to Embassy Baku in the past five years.

Question 8: Please provide three years of loss data by year of account including three years net premium, incurred claims and membership history. For membership history please provide the number of Employees with single coverage and with family coverage at the end of each year. Please do not include any confidential information, just the overall statistics for the group. Claims information is critical to our pricing and the relationship of claims to employee growth or shrinkage is part of the claims analysis. We feel that since your current insurance company has access to this information we would be at a disadvantage unless we had it also.

Answer 8: The numbers to anticipate for growth in the staffing covered under the proposed policy “request for proposals” are listed on pages 5, 6, and 7.

Question 9: We would like to know if you have been informed of Catastrophic cases presented last year, such as: Hemodynamics, Open Heart Surgery, Orthopedic Mayor Surgeries, Organ Transplant, Traumatic Accident, Cancer and Oncology Cases (Radio and Chemotherapy), and hospitalizations with more than 10 days.

Answer 9: Yes.

Question 10: Are you aware of any employee or dependent currently hospitalized, confined at home or a treatment facility, disabled or incapacitated?

Answer 10: Yes.

Question 11: Are any employees or dependents currently pregnant?

Answer 11: Yes.

Question 12: May we have the claims experience for each of the last 5 years preferably detailing the nature of each claim (but excluding claimants’ personal information)?

Answer 12: Unfortunately, the timing for the solicitation does not allow for the detailed information to be provided. If there are specific claims, medications, illnesses or conditions that are of concern, please be more precise with that question.

Question 13: If you are only able to provide summarized claims information by year, and if there has been any increase in benefit limits or any increase has now been requested, please detail claims where the previous maximum benefit was paid.

Answer 13: The benefit limit has doubled for this contract. The previous year had a limit of $37,000.

Question 14: When providing the claims experience detail, please confirm that this is pure claims paid and excludes any administrative retention amounts.

Answer 14: From section B.3.1.: “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 will 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. The claims paid to the health care provider or claimant do not/not include administrative retention amounts.

Question 15: For how long has the program with the current incumbent insurance carrier been in force?

Answer 15: Five and a half years

Question 16: Is it possible to have a copy of the current policy wording?

Answer 16: Please see the attached WORD document “C”.

Question 17: Has there been any change to the eligibility requirements in the last 5 years if so, what changed, when and why?

Answer 17: Section C.1.5 “Other Eligible Participants” The age of an eligible child who is a full time student increased from 22 to 25 due to the change in the SMP.

Question 18: Are there any material differences in the benefits requested and those insured for the last 5 years? If yes – what changed, when and why?

Answer 18: The Standard Medical Plan (SMP) is updated annually in Washington DC. As the SMP changes, Embassy Baku adjusts accordingly. There have been no issues at Post that have resulted in changes in benefits.

Question 19: Please advise whether are any of the persons covered required to carry firearms and if so, approximately how many, and has the number materially changed in the last 5 years?

Answer 19: Yes. In the past year, up to 183 Embassy Baku Security Staff were authorized to carry firearms.

Question 20: Are any persons to be covered not currently actively at work?

Answer 20: Yes

Question 1: Prescription medicines - does a contract imply coverage for medicines bought in any pharmacy? For instance, cost of a medicine may vary, say between 20-25 AZN in different networks of pharmacies (Dokta, Zafaran and etc) but the cost for the same medicine in German pharmacy will be around 40?

Answer 1: Yes allowed expenses at any pharmacy are covered. At present in order to avoid frauds insured are required to submit itemized receipts for expenses exceeding AZN 75.00 (USD 71.43)

Question 2: Routine annual examinations – are annual professional check-ups (for ex, drivers’ check-up to approve fitness for duties performed) included into this cathegory? If yes, does it mean that an Insured exhausts his annual check-up limit with that examination?

Answer 2: One annual checkup is covered. Professional checkups are not covered. The U.S. Embassy will pay directly to clinics for professional checkups. This will be done without the insurance company involvement.

Question 3: Would’ve highly appreciated if you advise according Financial Statement – should it be enclosed into proposal since it says “If asked by the Contracting Officer”?

Answer 3: Please include Financial Statements in your proposals.

Question 4: Are any devices for surgery covered?

Answer 4: Yes.

Question 5: What is the contract period?

Answer 5: The contract period is 1 base and 4 option years starting from October 17, 2015.

Question 6: According to the clause below all government medical programs will not be covered by this Health Insurance Plan (like oncology, diabetes, tuberculosis etc.) “C.1.2. Health Benefits Conditions and Limitations. No coverage will be made for expenses that will be reimbursed or paid directly under a host country medical program, the U.S. workers’ compensation program, or any host government workers’ compensation program.” Is this the correct understanding of this clause or not?

Answer 6: In case these treatments are conducted in private not-governmental clinics or these treatments are not fully sponsored by Azerbaijani government reimbursements to the covered individual should be done at the same limits as all other treatments including reimbursements for drugs within set annual maximum limits.

Question 7: There is a large difference in the census counts as presented in the Exhibits (1 and 2) vs Section B.2.3. Please note our observation in counts:

From Exhibit 1 and 2 Self Only: 53 Family Plan: 269

From Section B.2.3. Base Year of Contract Single Employees (Self Only): 295 Family Plan: 80 Retires: 2

Answer 7: There are mistakes in the table. The number of family plan employees should be 295. The number of single employees should be 80. A respective modification will be issued early next week.

Question 8: Additional clarification for: Please clarify your vision of the clause “C.1.1.3. Expenses incurred for vitamins, cold remedies, and other general sales medications considered easy to take correctly and safe for most people to self-manage (for example, aspirin and skin creams) will not be reimbursed even if prescribed by a physician.”

Answer 8: Typically drugs that are sold only with doctors prescriptions in the United States are covered. Vitamins, cold remedies, skin creams and other substances that are sold over the counter and do not require doctors prescriptions in the United States are not covered. Please refer to http://www.drugs.com/otc/ for more information.