LES_Health_Insurance_QA's_-_SDR860-16-R-003-A001.pdf

LES SUPPLEMENTAL HEALTH INSURANCE

SOLICIATATION NO.: SDR860-16-R-0003-A001

FORMAL

QUESTIONS AND ANSWERS

1- Q: Are you going to post the last 3-5 years of claims history on this group and will you provide a plan summary of the existing policy that is in effect? Who is the current provider?

A: The current medical provider is ARS Palic Salud, S.A. Claims history data in DOP$ as follows:

Claim History

Year Number of Employees Number of Dependents Amount Paid by the Embassy

2011 355 582 10,146,041.00

2012 354 573 11,743,952.00

2013 347 568 11,187,117.00

2014 399 612 10,637,768.00

2015 448 724 12,678,805.00

Jan-Jul 2016 452 674 8,266,772.00

Total 64,660,455.00

2- Q: Will you be providing a more complete census to include date of births for the population?

A: The Date of Birth (DoB) are not available for dependents. Section J, Exhibit A of the Solicitation provides the ages of the entire population as of June 30, 2016.

3- Q: The quote requests the prices to be in Dominican Pesos. Most International health insurance providers only quote in U.S. Dollars. Will you request that they convert the currency on the day quoted or will your office be able to handle the conversion numbers?

A: In accordance with Section M.10 of the Solicitation, as well as FAR 52.225-17, if the Government receives offers in more than one currency, the Government will evaluate offers by converting the foreign currency to United States currency using the exchange rate used by the Embassy in effect as follows:

Embassy of the United States of America

Santo Domingo, Dominican Republic

(a) For acquisitions conducted using sealed bidding procedures, on the date of bid opening.

(b) For acquisitions conducted using negotiation procedures:

(1) On the date specified for receipt of offers, if award is based on initial offers;

otherwise,

(2) On the date specified for receipt of proposal revisions.

4- Q: Price Table B.2.3 lists 176 single employees and 268 families, but the Exhibit A table in Section J mentions 174 single employees and 272 families. Could you please clarify?

A: As of June 30, 2016, the U.S. Embassy had 186 single employees and 266 families. This is not fixed information, as it is subject to change every month due to inclusions/exclusions of employees.

5- Q: What’s the premium history for health insurance in Dominican Pesos for the current year and last 5 years - 2016 (until now), 2015, 2014, 2013, 2012 and 2011?

A: Premium history data in DOP$ as follows:

6- Q: Did the Premium history for health insurance above include the VAT? If it did, then what percentage of VAT was included in the historical health premiums?

A: VAT (ITBIS) is not included. The U.S. Embassy has a tax exemption status with the host government.

Premium History

Year Number of Employees Number of Dependents Amount Paid by the Embassy

2011 355 582 12,091,535.00

2012 354 573 13,044,830.00

2013 347 568 13,999,641.00

2014 399 612 15,640,125.00

2015 448 724 18,586,610.00

Jan-Jul 2016 452 674 11,671,808.00

Total 85,034,549.00

7- Q: What’s the claims history for health insurance in Dominican Pesos and number of claims (counts) for the current 2016 (until now), 2015, 2014, 2013, 2012 and 2011?

A: This is a duplicate to question number 1.

8- Q: Advise if 2015 health benefit schedule is the same as the benefit schedule currently being requested under SDR860-16-R-0003; and if not, advise us on the differences?

A: Approved benefits were different in 2015. In contrast to the latter, Solicitation SDR860-16-R-0003 decreases in some areas of the coverage limits and increases or adds others. Specifically, changes are effective in the following categories: Hospital Medical Expenses; Doctor Visits; Hospital Outpatient Services; Dental Services; Orthodontia Treatments; Psychiatric Treatment; Ambulance Services; Physical Therapy; Optical Services.

9- Q: Are any major illnesses (Hemodynamics, Open Heart Surgery, Orthopedic Mayor Surgeries, Organ Transplant, Traumatic Accident, Cancer and Oncology Cases) being treated? If Yes, please provide the number of instances for each major illness (we do not need the names or identification, we just need to know the number of instances for each major illness to assess the risk).

A: Twenty five (25) affiliates have requested services for catastrophic illnesses, over the last twelve (12) months. Specifically:

Illness Instances

Arthrosis with Knee Joint Replacement 2

Atrial Fibrillation and Atrial Flutter with ICU Care 2

Chronic Renal Failure 3

Acute Respiratory Failure with ICU Care 1

Newborn Respiratory Failure with ICU Care 3

Transient Cerebral Ischemia 1

Non-Hodgkin’s Lymphoma 2

Multiple Myeloma 1

Osteoarthritis Articular Hop Replacement 1

Essential Thrombocytosis 1

Malignant Tumor of the Thyroid Gland 1

Malignant Tumor of the Breast 2

Malignant Tumor of the Colon 1

Coronary Disease with Percutaneous Transluminal Coronary Angioplasty 2

Diabetes Mellitus with Intenvise Care 2

Total 25

10- Q: Are there any persons who are currently hospitalized?

If Yes, please provide number (we do not need the names or identification, we just need to know the total number of people hospitalized to assess the risk).

A: No, as of August 2016 there are no persons hospitalized.

11- Q: Are there any pregnant employees/spouses?

If Yes, please provide number (please note we are not seeking protected private information, we do not need the names or identification, we just need to know the total number of people who are pregnant to assess the risk to price accordingly).

A: Yes, there are - Nineteen (19) individuals.

12- Q: Are there any HIV/AIDs cases?

If Yes, please provide number (please note we are not seeking protected private information, we do not need the names or identification; we just need to know the total number of people who are currently being treated for HIV/AIDs to assess the risk and price accordingly).

A: No HIV/AIDs cases are registered.

13- Q: The age limit for offspring permanency is until 25 years of age. If they are disabled, there is no age limit?

A: That is correct.

14- Q: Medications in hospitalization aren´t specified.

A: Medicines prescribed by the doctor while the patient is hospitalized must be covered at 80%. Section C, C.1.1.4 of the Solicitation document reads:

“Prescription Drugs: Coverage of expenses when hospitalized and not hospitalized, of the cost of medicines and drugs for which a prescription is legally required including those that suppress opportunistic infections, such as tuberculosis and toxoplasmosis. 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.”

15- Q: In what consists the annual routine examination?

A: An annual evaluation consists of a visit to the employee’s primary care physician.

Depending on the existing condition, the doctor will order appropriate lab tests and exams required to address health.

16- Q: There is no waiting period for maternity care or programmed surgeries?

A: No, there is no waiting period.

17- Q: Pre-existent conditions for new affiliates are covered?

A: Yes, they are.

18- Q: Do reimbursements for medical expenses abroad apply?

A: No, they do not.

19- Q: Brief course on antiretroviral drugs during pregnancy to prevent transmission of HIV to the baby. (The duration of this course will be determined by the employee´s personal doctor, following guidelines of WHO and CDC.) Will this service be offered within the limits of the HIV benefit?

A: Yes, it will.

20- Q: The amount of DOP$736,000 is the maximum per case for each family. If this limit is consumed, he/she has no right for coverage?

A: Yes, unless the patient has a catastrophic condition, in which case the limit will be in addition to the catastrophic condition limit (DOP$736,000+500,000).

If the patient has HIV/AIDs conditions, s/he will have a separate limit equivalent to

USD $10,000.00.

21- Q: a Prescription drugs apply within the family limit?

A: Yes, they do.