Response_to_Inquiry_for_SAL60016P001.docx

November 12, 2015

All Prospective Offerors

DELIVERY VIA ELECTRONIC MAIL

Re: Solicitation Number SAL60016R0001 Health Insurance Contract

Dear Prospective Offerors:

Over the last two weeks, we received many questions regarding the above-referenced solicitation (“HI Solicitation”) from a prospective offerors. These questions are listed below, with responses embedded therein. We have combined some questions from perspective offerors because of their similarity. When appropriate to support our responses, we have included charts with requested data. Those charts can be found in the accompanying spreadsheets.

Question No. 1: 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.

Response No. 1: Enclosed, in a spreadsheet, are charts summarizing statistical information as requested, but limited to prevent the disclosure of the confidential and sensitive, personally identifiable information of our employees.

Question No. 2: We would like to know if you have been informed of Catastrophic cases presented last year, such as: Hemodynamics, Open Heart Surgery, Orthopedic [sic] Mayor [sic] Surgeries, Organ Transplant, Traumatic Accident, Cancer and Oncology Cases (Radio and Chemotherapy), and hospitalizations with more than 10 days.

Response No. 2: Enclosed, in a spreadsheet, are charts summarizing statistical information as requested, but limited to prevent the disclosure of the confidential and sensitive, personally identifiable information of our employees. As can be seen in the attachments, there are 9 cases with the following diagnosis:

· Pulmonary CA; Breast CA; Thyriod CA; Uterus CA, Pancreas CA and Rheumatoid Arthritis

Question No. 3: What is the name if [sic] the insurance company that currently provides coverage?

Response No. 3: The current health insurance contract is provided by SIGAL UNIQA Group AUSTRIA.

Question No. 4: Please provide employee census information for both males and females including number of employees in an age range such as Under 20, 20-29, 30-39, 40-49, 50-59, 60-64, 65 to 69.

Response No. 4: Enclosed, in a spreadsheet, are charts summarizing statistical information as requested, but limited to prevent the disclosure of the confidential and sensitive, personally identifiable information of our employees.

Question No. 5: Please provide dependent [sic] census information for both males and females including number of dependents [sic] in an age range such as 0-3, 4-9, 10-14, 15-19, 20-29, 30-39, 40-49, 50-59.

Response No. 5: Enclosed, in a spreadsheet, are charts summarizing statistical information as requested, but limited to prevent the disclosure of the confidential and sensitive, personally identifiable information of our employees.

Question No. 6: Are there any pregnant employees/spouses. If Yes, please indicate in attached census file or provide the number of instances.

Response No. 6: Enclosed, in a spreadsheet, are charts summarizing statistical information as requested, but limited to prevent the disclosure of the confidential and sensitive, personally identifiable information of our employees. In addition, there are six pregnant insured currently and 7-8 is the average per contract year.

Question No. 7: Is there a preferred list of Hospitals, Clinics or other Medical Facilities that the Embassy employees prefer? a. If yes, please provide a list of these facilities.

Response No. 7: No. Employees are entitled to seek care at all licensed medical facilities.

Response No. 7(a): N/A

Question No. 8: Section L.4.3.2.2 titled Licensing Information requires the insurance company to be locally admitted. In certain countries where we provide the employee benefits in U.S. Embassies for the local employees we issue the policies from our captive insurance company which is not admitted in those countries. In those cases the U.S. embassy has waived the requirement to be locally admitted. In other cases where we cannot get an exemption from the locally admitted requirement we partner with a company that is locally admitted. Would the U.S. Embassy in Trina [sic] consider granting us an exclusion from the requirement to be locally admitted?

Response No. 8: No, the HI Solicitation is clear in its requirement that the Contractor must possess all permits, licenses, and any other appointments required. (See HI Solicitation, Par. H.6.2; Par. I.2, incorporating FAR 652.242-73; Par. L.4.3.2.2). The U.S. Embassy in Tirana is not able to grant an exception to this requirement.

Question No. 9: Would U.S. Embassy in Tirana accept an consortium of insurance companies (local admitted insurance company and an international insurance company), that intend to submit a proposal for customized health insurance for locally engaged employees and their dependents. We are fully aware that, for consortiums, the composition of the consortium cannot be changed in the course of the solicitation procedure, unless the Contracting Authority has given its prior approval in writing.

Response No. 9: The HI Solicitation is clear in its requirements, and the U.S. Embassy in Tirana invites all prospective offerors to structure their responses to the HI Solicitation as they deem best.

Question No. 10: Please inform us if the documentation such as for e.x the balance sheet, or other certifications, have to be provided in English or in Albanian, as issued by the respective authorities

Response No. 10: The HI Solicitation is clear in its requirements, and the U.S. Embassy in Tirana invites all prospective offerors to structure their responses to the HI Solicitation as they deem best.

Question No. 11: In regards to the employees working less than 30 hours, as mentioned in the solicitation the insurance premium will be prorate, but please explain how the benefits will be provided

Response No. 11: The U.S. Embassy in Tirana fully expects and demands full benefit coverage for each of its employees, and respective dependents, who participate in this health insurance plan. The fact that certain employees may be on a flexible schedule and that the U.S. Government will prorate the portion of premiums it pays on behalf of these employees and their dependents, does not impact the coverage to be provided.

Question No. 12: While section C.1.1.16 refers to an annual limit of USD 10,000 for HIV/AIDS under section C.1.1.7 however there are no explicit limits listed under C.1.1.7. Can you please confirm that C.1.1.7 indeed carries an annual limit of USD 10,000.

Response No. 12: HIV/AIDS care coverage is separate from the annual maximum and catastrophic coverage maximum amounts. The HIV/AIDS coverage is authorized up to 10,000 USD or less based on posts’ needs. The annual maximum for medical coverage is LEK 2,522,092 per individual per contract year. Catastrophic coverage is provided if major medical conditions occur as a result of illness, accident or closely related set of major illnesses that exceed the standard maximum coverage limit (LEK 2,522,092). The maximum for catastrophic coverage is capped at LEK 12,500,000 per covered individual.

Question No. 13: Can you please confirm that there are no separate annual limits for Dental Care under C.1.1.12

Response No. 13: The annual limits for all care, Dental and otherwise, are specified in HI Solicitation Paragraphs C.1.1.16 and C.1.1.17.

Question No. 14: There is no indication regarding coverage of “pre-existing conditions” shall these conditions be covered?

Response No. 14: Yes

Question No. 15: There is no definition for “outpatient services. [sic] Can this definition be acceptable as : [sic] “ a patient who is admitted to a hospital or clinic for treatment that does not require more than 24 hours”?

Response No. 15: We will use a standard definition that is used on plans in the United States. “Outpatient: A term referring to a patient who receives care at a medical facility but who is not admitted to the facility overnight, or for 24 hours or less. The term may also refer to the healthcare services that such a patient receives.”

Question No. 16: Coverage for doctor’s, surgeon and nursing fees is detailed under outpatient medical services; Please confirm: does the same % of coverage apply even when these fees are charged while hospitalized?

Response No. 16: Please see HI Solicitation Paragraphs C.1.1.4 and C.1.1.5 which sets forth the inpatient and outpatient coverage percentages that are to be applied for fees and services while hospitalized.

Question No. 17: Under Albanian Government Public Health Insurance plan, certain inoculations for newborn care are covered. Shall these lists of “inoculation” be excluded from coverage according to provisions regarding coverage limitation of this solicitation point C.1.2?

Response No. 17: HI Solicitation Paragraph C.1.2 does not address, at all, inoculations and is intended to limit coverage only in situations where care is entirely elective and not medically necessary, resulting from egregiously reckless behavior of the patient, or covered by workers’ compensation programs.

With respect to newborn care, please see HI Solicitation Paragraph C.1.3.2, which explicitly provides that eligible dependent children are to be covered from the time of birth; Paragraph C.1.1.4 and Paragraph C.1.1.5, which explicitly state that all inpatient and outpatient care of newborn dependents, and wellness examinations, are to be covered at the specified rates; and C.1.1.6, which explicitly states that prescription drugs and medicines are to be covered at the specified rates. The clear intent of the HI Solicitation with respect to newborn care is that it is to be fully covered at the due rates.

Question No. 18: Point C.1.1.6 regarding medical equipment [sic], shall diabetes strips/ aerosol apparatus/ blood pressure apparatus, etc. be covered?

Response No. 18: HI Solicitation Paragraph C.1.1.6 clearly states that all medical equipment “for which a prescription is legally required” shall be covered at either a 100% or 90% rate, depending on whether the expense is incurred when the patient is hospitalized or not. If the items specified in question 5 cannot legally be dispensed without a prescription, they are to be covered at the appropriate rate.

Question No. 19: Point C.1.1.8 There is no definition regarding the end of postnatal period. Is it acceptable to consider post natal care given to a mother 40 days after maternity delivery.

Response No. 19: In the United States and as per the World Health Organization the standard postnatal period is 42 days and this is the time that will be used in this contract.

Question No. 20: Points C.1.1.10 – C.1.1.13 Is there a detailed “list of diagnoses” for each service, which can constitute and argument for coverage, even though [sic] that certain service is not covered. Example for orthodontic [sic] treatment, which may be a list.

Response No. 20: No. There is no universal list of all possible diagnoses which may warrant that hearing, optical, dental, and psychiatric care are medically necessary and to be covered. Such care determinations are to be made by the medical professionals attending to the patients’ care. However, the intent underlying these provisions is that coverage should be provided in situations when the course of medical treatment for a certain illness or injury of a patient extends to and includes hearing, optical, dental, and psychiatric treatment.

Question No. 21: Will medical evacuation (air ambulance) of a covered patient be covered?

Response No. 21: No. Pursuant to HI Solicitation Paragraph C.1.1.15, states that transportation for out of country treatment is not a covered expense.

Question No. 22: Will the “Benefit Guide & Claim Brochure” as well as Claim Forms be part of the Awarded contract?

Response No. 22: As set forth in HI Solicitation Paragraph C.1.7.3, the brochure is to “accurately reflect the requirements of the contract, as implemented by the Contractor’s technical proposal. In all cases, the contract shall take precedence.”

Additional Questions:

http://tirana.usembassy.gov/about-us/contract-opportunities.html

SECTION B

http://tirana.usembassy.gov/about-us/contract-opportunities.html

SECTION C

USG Response: To be determined by the medical providers as to what is necessary for preventative and wellness care.

· If this meaning is correct this kind of checkup will be compulsory to be performed by the individuals?

USG Response: This question is not clear and regrettably we cannot respond to it as it is currently posed.

· Is there a defined set of examinations?

USG Response: No.

· For the purposes of these solicitation documents, what is the meaning of the "general practitioner"?

USG Response: The common meaning of “general practitioner” is to be followed.

· For the purposes of these tender documents, what is the meaning of the "inpatient" term used at second paragraph?

USG Response: This question is not clear and regrettably we cannot respond to it as it is currently posed because “inpatient” is not included in C.1.1.5.

SECTION G

· What happens when the coverage under this contract is for a year, the premium is paid monthly, the person has been indemnified under this contract, and leave during the period of insurance? USG Response: Historically the embassy has worked with the insurance provider to settle overpayments and credits each billing cycle.

SECTION H

1-request for prior authorization, 2 -request for reimbursement Are recognized under these solicitations the two forms that we apply?

USG Response: Each prospective offeror can propose a response to the HI Solicitation, pursuant to its best judgment, operational structure, and business. All proposals will be evaluated openly and fairly by defined criteria.

SECTION I

“evidence of insurance documenting the required coverage for each health care provider who will perform under this contract” USG Response: This question is not clear and regrettably we cannot respond to it as it is currently posed.

a) every medical specialty – minimally $ 175,000.00;

b) any insurance event - minimally $ 175,000.00;

Please confirm if such understanding is correct?

· It will be responsibility of Offeror this insurance policy for professional liability to third parties or it will cover and the subcontractors - Offeror medical network and international partners, or they must have their self-insurance policy?

· There are aggregate limit in this policy?

· For how many years will be issued this insurance policy for professional liability to third parties?

· The annual limit or the whole aggregate mentioned on sub point 3.

USG Response: This series of questions is not clear and regrettably we cannot respond to them as currently posed.

USG Response: This question is not clear and regrettably we cannot respond to it as it is currently posed.

SECTION J

In regards to solicitations documents, the exhibit B is mentioned, but this act is missing? USG Response: All of sections are included in the solicitation; there is nothing missing in the HI Solicitation.

USG Response: Employee and dependent census and claims data is enclosed herein as Appendix B.

USG Response: Employee and dependent census and claims data is enclosed herein as Appendix B.

USG Response: Employee and dependent census and claims data is enclosed herein as Appendix B.

SECTION K

In section K has subparagraphs (example K 8) where is not required a concrete fulfillment but by note as marked in that subsection the offer confine accepting that being submitted economic bids. For these subsections as offer at these tender we will print, endorse and seal the tender documents format, and these forms must be attached as parts of the official bid that we will deliver? USG Response: This question is not clear and regrettably we cannot respond to it as it is currently posed. Please submit sealed offers in original and 1 (one) copy as required in SF33 to include all representations, certifications and other statements as required in Section K of the solicitation

USG Response: The small business size standard refers to small businesses in US, unless they classify as such they do not have to meet this criteria.

USG Response: This question is not clear and regrettably we cannot respond to it as it is currently posed.

USG Response: This question is not clear and regrettably we cannot respond to it as it is currently posed.

SECTION L

“For health insurance if the proposal is for Health Maintenance Organization (HMO) or clinic type describe the facilities end the medical personnel will be available.”

· The paragraph “The offeror must also describe the pool of coverage in which the covered employees will be contained … pool of coverage” means the description of all coverages under section C?

USG Response: Each prospective offeror can propose a response to the HI Solicitation, pursuant to its best judgment, operational structure, and business. All proposals will be evaluated openly and fairly by defined criteria.

· Providing periodic reporting and accounting of financial results of the plan, including reporting formats, it means only the preparation of reporting formats and attach that forms the bid?

· The overall management of the contract. What is the information we should give further on this point considering that at all points mentioned above is given all detailed necessary information?

USG Response: Each prospective offeror can propose a response to the HI Solicitation, pursuant to its best judgment, operational structure, and business. All proposals will be evaluated openly and fairly by defined criteria.

USG Response: It seeks a summary of the performance obligations of prior contracts.

· the pool that will apply to the employees under this contract.

· the size of the pool,

· a mixture of commercial and government (if applicable),

· alternative pools that are available in the event the economic price adjustment clause becomes effective.

USG Response: Each prospective offeror can propose a response to the HI Solicitation, pursuant to its best judgment, operational structure, and business. All proposals will be evaluated openly and fairly by defined criteria.

USG Response: This question is not clear and regrettably we cannot respond to it as it is currently posed.

According to the actual Albanian Insurance legislation Offeror may not cover per contract 10% of its solvency. If we shall assume that there are 1.000 employees (including their dependents) the overall insurance liability (including CAT cover and Maximum Annual Limit) shall be approximately EUR 97.000.000,00. Usually in the bidding offers we claim only the maximums cover we may give per contract. If you ask for a higher annual cover more that 10% of our solvency and lower or equal than EUR 97.000.000,00 please specify, otherwise we have to by reinsurance. USG Response: This question is not clear and regrettably we cannot respond to it as it is currently posed.

Thank you for your interest in this solicitation. Should there be additional follow up questions, we encourage all prospective offerors to contact us.

Sincerely, Jay Thompson Encl.

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