SBF50015R0003_-_(3)Questions.docx

The Embassy of the United States of America, Nassau

Questions and Answers

SBF500-15-R-0003

FSN HEALTH & LIFE INSURANCE

Per 15 STATE 42468: LE Staff: Bahamas: Authorization of Medical and Life Insurance Benefit Levels for Solicitation

1. Is there a plan maximum for ambulance services? (C.1.1.1) 80% coverage of land ambulance service and 100% coverage of national air carrier ambulance service. No plan maximum

2. In C.1.1.2, Professional services, it states 80% for doctors and surgeons fees while hospitalized, at a hospital on an out-patient basis, at a clinic or doctor’s office and Home Visits are not covered. As there are no local hospices, what occurs if persons are bed ridden and require care?

Persons requiring care at home as they are bed-ridden should be considered as covered under out-patient basis, otherwise home visits (care) are not covered.

3. What is the plan maximum for dental care – is it inclusive of orthodontia care or are they separate plan maximums?

Dental Care: 45% coverage of preventative care and minor restorative expenses. 35% coverage for major restorative expenses and 30% coverage of orthodontia expenses. No plan maximum

4. In C.1.1.11, Overseas care, it states that treatments that are medically necessary or emergency or referred by a physician stating services cannot be treated locally. What occurs if member is adamant on care abroad (maternity) or seeking 2nd opinion?

Medical expenses incurred out of country employees and dependents when (1) a life threatening condition occurs when the individual is out of the country and treatment is medically necessary before the individual returns home or (2) the individual's attending physician certifies in advance that such treatment is medically necessary and unavailable locally. Coverage will be made at 80%.

If only the life of the mother is threatened or the service is not available locally

5. Is there a listing of conditions that are considered catastrophic?

No pre-determined list

6. The annual out of pocket maximum is stated as $3000 and $7800, please confirm the deductible amounts if any, and whether deductible has to be met prior to services rendered?

The insurance company will cover medical expenses incurred, subject to the stated limits. Payment will be made for reasonable and customary expenses of covered benefits. The medical treatment must be prescribed or provided by a physician or nurse licensed in the Bahamas, the United States, or in the country in which the treatment or prescription is received. Coverage of expenses will be made in Bahamian Dollar ($), unless otherwise stated.

Deductible:

For employees only: $400.

For employees + family: $800 The amount of the deductible should be included towards the out of pocket maximum for the year.

7. Please provide the definition of spouse.

For the purposes of this plan, a spouse is defined as the employee's legal spouse (limit one)

8. For benefits not defined, should the contractor use the 80% coverage?

No, any benefits not specifically addressed in the solicitation are not covered

9. Please provide calculation of the Life & ADD&D volumes. Was the calculation compared to industry practice? The chart below reflects the current actual benefit versus what we are being asked to charge on:

Premiums are calculated as illustrated in the below table. Estimated bi -weekly payroll dollars are shown in the pricing tables in the solicitation. Offerors must propose bi-weekly premiums per 1,000 of salary for each premium category. The sum of the bi weekly premiums for the 3 premium categories are then multiplied by 26 pay periods to calculate the yearly estimated insurance premiums. Offerors should propose all-inclusive premiums for the benefits described in Section C.2. Do not multiply the proposed premiums by the monthly salary benefit multiples described in Section C.2.

image1.png