Q A_HI.docx

QUESTIONS AND ANSWERS

HEALTH INSURANCE SERVICES

REQUEST FOR PROPOSALS (RFP) NUMBER S-AM100-13-R-0015

Below are answers to the questions received from offerrors for the subject solicitation by August 5, 2013.

1. Question – Is there a health insurance plan currently in place, which this plan will replace?

Answer – Yes.

2. Question – Can we obtain a copy of the current plan or policy or other booklet describing the benefits currently provided?

Answer – The current benefit plan is very similar to the one provided in the current solicitation package under Section C.

3. Question – Are the current benefits identical to the benefits requested in the solicitation?

Answer – Please see the attachment below with the detailed changes to benefit levels. The current benefits are provided first in black and the benefits requested in the solicitation are directly below the original language in red.

4. Question – Have any benefits been changed during the last 3 years?

Answer – No.

5. Question – How long has the current insurance provider been under contract?

Answer – 3 years.

6. Question – What are the current rates?

Answer – This information cannot be disclosed

7. Question – Please provide the total amount for the claims paid for each of the last 3 years.

Answer – First year: AMD (Armenian Dram) 71,974,000; second year: AMD 71,505,000; third year: AMD 102,043,000.

8. Question – Please provide the total amount for the premium paid for each of the last 3 years.

Answer – This information cannot be disclosed.

9. Question – Please provide average number of insured employees/dependents for each of the last 3 years.

Answer – First year: 309/656; second year: 295/621; third year: 294/657.

10. Question – Please provide details of any claim which exceeded USD 20,000 for each of the last 3 years.

Answer – There were no claims exceeding USD 20,000 for past 3 years.

11. Question – Please confirm the following scheme is requested by you:

· 90% reimbursement for doctors consultations whether in-patient or out-patient;

· 100% reimbursement for inpatient laboratory and instrumental exams, drugs, etc., except for the doctors consultations for which 90% reimbursement applies;

· 80% reimbursement for outpatient laboratory and instrumental exams, drugs, expect for the doctors consultations for which 80% reimbursement applies.

Answer – Confirmed. This is the scheme requested.

12. Question – Under paragraph C.1.1.8., what do you mean by “two lenses”: two pair (4 pieces) or two pieces?

Answer – “Two lenses” means one pair of glasses or contact lenses.

13. Question – Under paragraph C.1.1.9 are implants considered to be “false teeth” and should be reimbursed?

Answer – Yes. Implants are considered to be false teeth and should be reimbursed.

14. Question – Under paragraph C.1.1.13, please specify if AMD 3,000,000 is the maximum reimbursement amount per insured person per contract year. In which cases AMD 4,100,000 will apply? If we understand correctly, Section F of the plan is not shown in the Solicitation.

Answer – AMD 3,000,000 is the maximum reimbursement amount per insured person per contract year. The amendment 003 to the solicitation is issued to replace words “Section F” with “C.1.1.13”

15. Question – What is the scope of routine annual physical examination under paragraph C.1.1.2?

Answer – Routine annual physical examination includes gynecological/urological exam, mammogram and inoculations.

16. Question – Under paragraph C.1.2 costs for massage and exercise therapy are not covered. In addition to massage and exercise therapy there are also other methods of alternative medicine, such as reflexotherapy, acupuncture, bioresonance diagnostics and treatment, ozonotherapy, hydrocolonotherapy, iridodiagnostics, phytotherapy, homeopathy, hypnosis and others which does not fall into the category of scientific medicine. The Solicitation does not specify if these methods are covered or not, while massage and exercise therapy are clearly excluded from the coverage. Please clarify if these expenses are covered or not.

Answer – Neither massage and exercise therapy nor the above listed methods (alternative medicine) are covered.

17. Question – Please advise whether laser surgery for defective eyesight correction is covered under this plan.

Answer – Not covered.

ATTACHMENT

CHANGES TO BENEFIT LEVELS

*NOTE: PREVIOUS CONTRACT BENEFITS LEVEL IS IN BLACK AND THE NEW BENEFIT LEVEL IS IN RED

C.1.1.1. Hospitalization: 100% reimbursement of hospital room and board for a ward room or semi-private room. The cost of a private room will be reimbursed up to 100% of the cost of a semi-private room. 100% reimbursement of hospital medical expenses including nursing care, operating room costs, intensive care, recovery room costs, and prescription medicines and drugs administered while hospitalized. 100% reimbursement of surgeon’s fees, doctor’s fees, X-rays, and laboratory tests when hospitalized. 80% reimbursement of ambulance service.

C.1.1.1. Hospitalization: 100% reimbursement of hospital room and board expenses for a ward room or semi-private room. 70% reimbursement for the cost of a private room. 100% reimbursement of hospital medicine expenses including laboratory tests and x-rays, nursing care, operating room costs, intensive care, prescription medicines, and physical therapy. 80% reimbursement of ambulance service.

C1.1.2 Outpatient Care: 80% reimbursement of doctor’s and surgeon’s fees at a hospital on an outpatient basis, at a clinic or doctor’s office, or at home. 80% reimbursement for medical services and expenses when not hospitalized such as laboratory tests and x-rays, prescription medicines, routine annual physical examination (including gynecological/urological exam and mammogram), and inoculations.

C.1.1.2. Professional Services and Treatment: 90% reimbursement of doctors' and surgeons' fees incurred while hospitalized, at a hospital on an out-patient basis, at a clinic or doctor’s office, or at home. 80% reimbursement for medical services and expenses when not hospitalized such as laboratory tests and x-rays, prescription medicines, physical therapy, routine annual physical examination, and inoculations.

C.1.1.3 Obstetrical care: 100% reimbursement when hospitalized, and 80% reimbursement when not hospitalized, of obstetrical medical care including prenatal and postnatal care.

C.1.1.4 Obstetrical Care: 80% reimbursement for obstetrical related medical expenses including normal delivery, pre and post natal care. 90% reimbursement for obstetrical related medical expenses for caesarean delivery.

C.1.1.4 Prescription drugs and medicines: 100% reimbursement when hospitalized, and 80% reimbursement when not hospitalized, of the cost of medicines and drugs for which a prescription is legally required. Expenses incurred for medicines, vitamins, cold remedies, etc., that are available over the counter without a prescription will not be reimbursed even if prescribed by a physician.

C.1.1.3. Prescription Drugs and Medicines: 100% reimbursement of the cost of medicines and drugs for which a prescription is legally required when hospitalized and 80% reimbursement when not hospitalized. Expenses incurred for medicines, vitamins, cold remedies, etc., that are available over the counter without a prescription will not be reimbursed even if prescribed by a physician.

C.1.1.5 Optical care: 80% reimbursement for eye examination and treatment and prescription eyeglass or contact lenses. Limited to one set of lenses per patient every 18 months. The maximum reimbursement for one set of lenses is limited to a total of AMD 37,000. No reimbursement for eyeglass frames, nonprescription lenses, or tinting.

C.1.1.8 Optical Care: 80% reimbursement for eye examination and treatment. Prescription eyeglasses or contact lenses, limited to two lenses per patient every two years with a maximum of AMD 37,000. No reimbursement for nonprescription or prescription lenses, frames, or tinting.

C.1.1.6 Dental care: 80% of expenses for dental services including dentists’ fees, x-rays, examination and treatment, cleaning, fillings, extractions, false teeth, crowns, and bridges. Orthodontia treatment is 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 maximum reimbursement for dental care is limited to a total of AMD 395,000 per covered individual per contract year.

C.1.1.9 Dental Care: 80% reimbursement of expenses for dental services including dentists fees, x-rays, examination and treatment, cleaning, fillings, extractions, false teeth, crowns, and bridges. 85% reimbursement of expenses for orthodontics. Orthodontia treatment is 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 maximum reimbursement for dental care is limited to a total of AMD 600,000 per covered individual per contract year.

C.1.1.8 Psychiatric treatment: 80% reimbursement. The maximum reimbursement for psychiatric treatment is limited to a total of AMD 217,000 per covered individual per contract year.

C.1.1.7 Psychiatric Treatment: 60% reimbursement

C.1.1.10 Medical expenses incurred out of country

Medical expenses incurred out of country will be covered for employees and dependents when (a) a life threatening condition occurs when the individual is out of the country and treatment is medically necessary before the individual returns home or (b) the individual’s attending physician certifies in advance that such treatment is medically necessary and unavailable locally. Reimbursement will be made at the same percentage rate and subject to the same annual maximum limit as for expenses incurred in country.

C.1.1.11 Medical expenses incurred out of country

a. Medical expenses incurred out of country will be covered for employees and dependents when (a) a life threatening condition occurs when the individual is out of the country and treatment is medically necessary before the individual returns home or (b) the individual's attending physician certifies in advance that such treatment is medically necessary and unavailable locally. Reimbursement will be made at the same percentage rate and subject to the same annual maximum limit as for expenses incurred in country.

b. Transportation for out of country treatment Transportation for out of country treatment will be a covered expense for employees and dependents. The patient's attending physician must certify in advance that the treatment is medically necessary and unavailable locally. 80% of the patient's transportation expenses by the least expensive, appropriate means of transportation to the nearest city with adequate medical facilities will be reimbursed. 80% of the transportation expenses of an attendant will be reimbursed if the patient's attending physician 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 unconscious. All reimbursements for transportation expenses are subject to the annual maximum limit.

C.1.1.11 Maximum Annual Reimbursement The insurance company will reimburse covered expenses up to a limit of AMD 2,575,000 per covered individual per contract year.

C.1.1.13 Maximum Annual Reimbursement The USG will reimburse covered expenses up to a limit of 3,000,000 in local currency per patient per contract year. Expenses incurred under C.1.1.12 of the plan are subject to a separate annual maximum limit of AMD 4,100,000 per employee.

ADDITIONS:

C.1.1.6 Family Planning: 80% reimbursement of prescribed contraceptive devices and drugs and voluntary sterilization. Not covered is reversal of voluntary sterilization, infertility treatment after voluntary sterilization, genetic counseling, and assisted reproductive technology.

C.1.1.10 Hearing Aids: 80% of reimbursement every 3 years.