Questions and Answers for Health Benefits and Life Insurance Solicitation 7.09.doc

Questions and Answers for Health Benefits and Life Insurance Solicitation

#S-CA525-09-R-1037

1. Can I allow the Insurance Company who I choose to use as a provider to administer the plan because I do not have the staff to do so? Yes.

2. Can the claims be directly sent to the Insurance Company and by pass me?

Yes.

3. When dealing with subsequent years (2-4), the Insurance Companies usually give a quote on the package for the first year. On years 2-4 the rates are subject to change by the Insurance Company. How does this get handled by your department? The contractor is only authorized to increase premiums based on claim reports in accordance with Section B.4 – Economic Price Adjustment – Health Insurance Premiums; Section B.8- Economic Price Adjustment – Dental Insurance Premiums; Section B.12 - Economic Price Adjustment – Life Insurance Premiums; Section B.16- Economic Price Adjustment – Group Long Term Disability (LTD) Premiums.

4. Does Current coverage exist? Yes.

5. If so, are their claims reports for at least three years? Yes. Claims reports for the past three and half years are attached (attachment #1).

6. Can you provide a plan design of the current coverage? Attached is a copy of the booklet describing the current coverage (attachment #3).

7. Is the Canadian “Direct Drug Program” to be provided in the bid? If what you are referring to is the “pay direct drug card program” referenced in Section C.1.2.2.1, yes, it is to be included in the bid.

8. If so, would you consider a bid without one attached? If what you are referring to is the “pay direct drug card program” referenced in Section C.1.2.2.1, a bid without it will not be accepted.

9. Can you advise current carriers and any claims information? Yes, Great West Life Assurance Company. Claims reports are attached (Attachment #1).

10. Can you advise current and renewal rates? The contract is in the final option year so there are no renewal rates available. The current rates are attached (Attachment #2).

11. Can you advise if one carrier for all lines of coverage is preferred or if more than one carrier can be used? We would prefer one carrier but would consider more than one carrier if the costs are beneficial to the U.S. Government.

12. Are their alternatives to covering the retirees and not under this plan? Retirees must be covered in accordance with Section B of the solicitation.

13. The retention guarantee could only be one year, will this cause an automatic exclusion? Yes.

14. Can the contract be negotiated in US Dollars? No.

15. Explain process of pricing adjustment? The price adjustment process is explained at the end of each benefits division of Section B of the solicitation, see sections B.4, B.8, B.12, and B.16 as indicated in Question #3.

16. How long are the existing premiums valid for? Until termination of the present contract - December 31, 2009.

17. Are there rate structures and methods to change benefits? Yes.

18. Can you deviate from the benefit package provide in the RFQ or claims format? Only if you highlight where there is a deviation and agree to modify your product (deliverable) to comply with what is requested in the solicitation if awarded the contract.

19. Does the U.S. Government in fact require the report listed in H.5? Reports are not requested on a regular basis but the offeror is obligated to make them available if requested.

20. Does the U.S. Government require Provincial Party Replacement Insurance for third country nationals or resident U.S. Citizens employed by the U.S. Embassy? We require all covered employees to be eligible for provincial insurance. No replacement insurance is required.

21. Are there Service Agreements in place? There is no service agreement in place at this time but there are alternate methods for assessing service.

22. What is the effective date of the coverage? January 1st, 2010

23. Number of carriers the group has had in the last 5 years? One

24. Detailed plan designs of current benefits? See Attachment #3 for the current detailed benefits plan.

25. Details of the proposed plan designs? There are no proposed changes to the plan. The solicitation provides the proposed benefits plan.

26. Electronic census in Excel with all eligible employees, not just participating employees. The electronic census that you submit should contain all of the information you provided on the paper copy as well as home zip codes. All eligible employees participate in the current plan’s coverage and are identified in the request for proposals. There are no zip codes in Canada; there are postal codes. Identifying employees by postal codes may violate Canada’s privacy laws.

27. Benefit changes that the group has had in the past 2 years.

Effective July 1, 2007:

Drugs:

A.

Employees pay the 100% of the dispensing fee. (This is in addition to the $2.00 deductible.)

B.

The health insurance plan will only reimburse for generic drugs. If non-generic drugs are desired/required, the employee pays the difference. Information on generic drugs from Health Canada is available in a separate document.

Major Medical:

There is an annual deductible of C$25 for a single employee and C$50 per family. (This change was applied initially in July, 2007, and pro-rated for the remainder of the calendar year.)

Vision:

The maximum reimbursement is increased from C$105 to C$250 per 24 months for each individual. Employees may now use this benefit for frames, lenses, corrective eye surgery, and eye exams. Reimbursement is capped at 80 percent of actual costs up to the maximum of C$250 every 24 months.

Dental:

A.

There is an annual deductible of $25 per single employee and $50 per family. (This change was applied initially in July, 2007, and pro-rated for the remainder of the calendar year.)

B.

Cleanings are now authorized only once per year rather than twice.

C.

Non-Major work (Dental 1 and 2) is now also capped at C$1,500 per year.

28. Current out of network reimbursement for both the medical and the dental. There is no “out of network” reimbursement. Please see the benefit coverages and plan provisions.

29. Month by month claims with enrollment information for the most recent 12 months for both medical and dental (please note if claims are incurred or paid for both medical and dental). Claims information for last 3 and a half years is contained in Attachment 1. There have been no claims for death benefits (life insurance) in the last 12 months.

30. Large claims information with diagnosis, dollar amount and current status for most recent 12 months. There is one individual reoccurring large claim for each experience period provided. For the period from February 1, 2008 to January 31, 2009 there was an amount of $32,393 paid in excess of the pooling level. For the period from February 1, 2009 to June 30, 2009, the excess amount is $5,731. Please note that these amounts are not included in the experience reports provided to the market. Diagnosis cannot be provided due to Canada’s privacy laws.

31. Is there a current pooling level and if so do the aggregate claims include or exclude amounts over the pooling level? The pooling level is $10,000 per individual plus first dollar out-of-country. All claims paid over the pooling level are not included in the experience report.