Questions_ _Answers.doc

Questions & Answers FSN Health and Life Insurance Service

Solicitation # SCH50012R2003 Note to Offerors:

The information contained within these questions and answers is provided for informational purposes and under no circumstances shall it be construed to change any terms or conditions or requirements within the solicitation. If any answer does address a change in the solicitation, it will reference an Amendment A002.

In addition, for any answer provided regarding the number of personnel or claims data incurred under the existing contract, please be advised that this data may not be indicative of future claims and could change.

Therefore, it is each offeror’s decision on whether to use or not to use this information. However, under no circumstances shall the U.S. Government be liable for this data or shall it become the basis for a request to adjust the premium rates once the contract is awarded. Rather, offerors are advised any adjustments to contract premium rates shall be in accordance with the Price Adjustment clauses B.4 and B.8 of the contract.

1: Can you provide us with your requirements and procedures for claim submission and processing (for example is the insurance provider responsible for periodical on-site collection or will the embassy designate a representative to collect and submit the claims via email)?

A: Please refer to the Solicitation H4 (b) (1). All medical claims shall be submitted directly to the Contractor by employees, through a drop box in the COR's office. The claims shall be picked up from the COR each month. See solicitation amendment A002 item 6.

2: Can you provide us with a sample of the 5 highest claims during your current or latest policy year (the information can be limited to the claim amount and treatment description)?

A: The following five highest claim amounts occurred in 2011:

3: Can you provide us with the average frequency of medical treatment received per person for the current or latest policy year?

A: In 2011, each covered individual received an average of 6.94 outpatient services visits.

4: Are the participants in the policy allowed to receive treatment from hospitals and medical facilities outside the scope of medical institution under the Social Insurance policy?

A: The medical expenses occurred in the hospitals and medical facilities that are not covered by the local social insurance will not be reimbursed under this plan. Please also see answer for question 19.

5: Can you provide us with your current Life/Insurance policy benefits and corresponding level of coverage for both employees and dependents?

A: Life insurance coverage only applies to employees. It is same as the benefits listed under the solicitation.

6: Can you provide us with a list of employees and dependents (with spouses and offspring listed separately, and the proportion of males to females) participating in your current or latest policy year?

A: Ref to solicitation amendment A002 item 8.

7: Can you provide us with a claim ratio list for the current policy year and the previous 4 policy years?

A: The claim ratio for 2010 was 119.91% and 99.03% for 2011.

Note: Only two contract years were provided since there were changes in the contract benefits and requirements.

8: Can you provide us with a total claim amount list for the current policy year and the previous 4 policy years?

A: See answer to question 7.

9: Can you explain what the ‘N/A’ prescribed in C.2.1.3 resembles?

A: N/A means not applicable.

10: Can you explain what the ‘basic salary’ in C.2.1.1refers to?

A: The employee’s average monthly salary is defined as total salary (basic rates plus allowance and bonus), so basic salary does not include allowance and bonus.

11: Can you clarify the definition of ‘family plan’ and list the total amount of employees and dependents for the upcoming policy year (Exhibit A in Section J lists 1,197 dependents, which matches with the amount of family plan participants)?

A: “1,197 (now is 1,209)” listed in family plan under B.2.1., B.2.2., B.2.3, B.2.4., and B.2.5 refers to the number of dependents. The chart is revised in the solicitation amendment. Please refer to solicitation amendment A002 item 1.

12: Can you provide us with the number of female employees and dependents?

A: Please refer to amendment A002 8. Section J, Exhibit A.

13: Can you provide us with the number of employees stationed in each of the cities included in the plan?

A: Please refer to solicitation amendment A002 8. Section J, Exhibit A.

14: Can you provide us with the proportion of dependents in terms of spouses and offspring?

A: Among total 1,209 dependents, 655 are spouses and 554 are children.

15: Can you provide us with the number of employees equipped with social insurance?

A: All but 13 employees have local social insurance coverage.

16: Would you please kindly provide the information concerning the claim and compensation record for previous insured period, such as compensation ratio, etc?

A: See answer for question 7.

17: Have all the employees been covered by social medical insurance? How about the foreigners? Or different cases at different locations?

A: See answer for question 15 and 18.

18: Would you please give exact number of how many foreigners will be covered under this Contract? Does the foreigner to be covered need to get treatment in special ward or ordinary clinic can also be accepted?

A: There are 13 locally hired foreign employees are covered under this contract. They follow the same policies that the Chinese employees observe.

19: Cited from line Three C.1.1 “medical benefit supplemental to the coverage provided by the local security plan”. Does this means that all the medical benefit to be provided should be subject to relevant reimbursement requirement? Or do the medical expenses which cannot be reimbursed by social medical insurance or need to be paid by the Insured need to be reimbursed by the commercial Insurance? For example, C.1.1.4, the prescription drug can be reimbursed 100%, but according to social medical insurance rules, some medicine cannot be included in the reimbursement scope, so the Insured need to pay the expenses by themselves. So if the reimbursement scope of the commercial insurance is exactly same as that of the social medical insurance, some expenses cannot be reimbursed.

A: C.1.1 states the medical coverage purchased under this contract is a medical benefit supplemental to coverage provided by the local social security plan. Accordingly, only local social insurance covered prescription drugs can be reimbursed under C.1.1.4. Please note that there are exceptions such as 50% for prescription eyeglasses or contact lenses with a 60 USD ceiling for two lenses per patient per year; 50% for dental care for false teeth, crowns and bridges; and 90% for routine annual physical examinations, etc. Please refer to the Solicitation C.1.1.

Note: We have added routine annual physical examinations to the solicitation. Routine annual physical examinations will be reimbursed at 90%. This will be reflected in the solicitation amendment A002 item 4.

20: In case of death, the benefit for the beneficiary is 20 or 24 times of basic salary according to C2.1. What does this basic salary hereunder refer to? Bi-weekly salary or whole month salary?

A: The basic salary refer to monthly basic salary. Please see amendment A002 item 5 for the change.

21: During the price offer, does the quotation for the following 4 option year must be offered or the vendor can choose not to offer?

A: Please Refer to Solicitation L.4.2 Volume 2 – Price Proposal and fill in Section B for answer.

Definition for Option: a unilateral right in a contract by which, for a specified time, the Government may elect to purchase additional supplies or services called for by the contract, or may elect to extend the term of the contract.

22: As the premium for the dependent spouses and children are paid by the employees, we want to confirm that whether the plan participation is compulsory or optional for them. Can they opt not to participate in the program?

A: The plan is optional for both employees and eligible dependents.

23: Do you have required or preferred direct-billing hospitals?

A: No.

24: Regarding “The medical coverage purchased under this contract is a medical benefit supplemental to coverage provided by the local social security plan” on page 10. Does it mean only the treatment/medicine covered by local social security plan could be covered by this plan? Which mean only the public hospital is accepted?

A: See answers for question 4 and 19.

25: Expenses incurred Out-of-Country is not covered on page 11. Here the “Country” means host country or not? If yes, is it Mainland China only or China include HK, Macau and Taiwan?

A: The “Country” means mainland China.

26: Do you need direct billing service or just claim service (pay upfront and get reimbursement)?

A: claim service. H.4. (b).(5) is amended and reflected in the solicitation amendment A002 item 7.

27: Average salary 3363.67 is RMB 3363.67 per person/bi-week? So basic annual salary is RMB 87455.42 per person?

A: Correct. The estimated average annual salary is RMB 87,455.42 per person.

28: Can you share with us your claim history in last 5 years?

A: See answers for question 7.

29: Can you indicate your budget range for health insurance rate?

A: We do not have a specific or detailed budget for the solicitation.

30. Please provide three year loss data by year of account including three years net premium, incurred claim 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.

A: See answer to question 7.

Historical membership data is provided as follows. Please also refer to answers for question 12, 13, 14, and 15.

31. What is the name if the insurance company that currently provides coverage?

A.The current insurance provider is China Life Insurance Company.

32.

What are the current rates charges for each line of coverage?

A: We don’t understand the question.

33. 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. Please provide salary information for each category listed in the census.

A: Please refer to solicitation amendment A002 8. Section J, Exhibit A.

Regarding the salary information, we do not have the information for the average basic salary for each age category.

34.

Please provide dependant census information for both males and females including number of dependants in an age range such as 0-3, 4-9, 10-14, 15-19, 20-29, 30-39, 40-49, 50-59

A: Please refer to solicitation amendment A002 8. Section J, Exhibit A.

35.

Is there a preferred list of Hospitals, Clinics or other Medical Facilities that the Embassy employees prefer? If yes, please provide a list of these facilities.

A: We do not have preferred hospitals or clinics. Please also refer to answers for question 4 and 19.