Revised_Questions_and_Answers.pdf

April 3, 2013 RE: Solicitation Number: SEG‐300‐13‐R‐0001 LES Health and Life Insurance for Cairo, Egypt Revised Questions and Answers

1. In section C.1.1.12 about medical expenses incurred out of Egypt. Who will judge whether that treatment is unavailable locally?

The decision will be taken based on the treating physician report, which will be reviewed by the Embassy Regional Medical Officer and the insurance company representative. Amendment number A003 will be issued on FedBizOps changing the Solicitation paragraph C.1.1.12, Medical Expenses incurred out of country.

2. In section C.1.1.13 please provide definition of catastrophic conditions?

The definition of the catastrophic cases include but are not limited to renal failure, cancer and hepatitis C. A mechanism to include other cases would be subject to management approval.

Amendment number A003 will be issued on FedBizOps changing the Solicitation paragraph C.1.1.13, Medical Expenses incurred out of country.

3. In section C.1.5 other eligible participants. Concerning the special needs children. Could I get some information about the number of current special needs?

No data is available since previous contracts did not provide services for special needs without limitation on age

4. In section C.1.1.7, Is there any ceiling for hearing aids care like the ceiling for optical care?

It falls within the annual maximum limit

5. I would like to ask about the general procedures of the referral of employees, whether employees will go directly to consultants or will they be referred by the physician at the Embassy. Also, who will be running the clinic at the embassy?

Under the current contact, The Contractor is operating two on‐site LES health units at the Embassy and USAID office facilities respectively. Each LES Health Unit is staffed by one physician licensed to practice medicine in Egypt and one full‐time female administrator. Offeror is free to make proposals on the items that are responsive to the requirements of the solicitation.

6. What do you mean by optical & dental reimbursement?

By reimbursement of covered expenses, the Mission intends that covered employees and dependents would be made financially whole for their outlays consistent with benefits outlined in the solicitation. With regard to payment to the service provider, there is no requirement that payment be made by the employee or dependents. The coverage provider may make direct payment to the service provider, but the coverage provider should be prepared to reimburse an employee who pays the service provider directly.

7. Do we have specific list of uncovered services?

It is found in page 13 of Solicitation under paragraph C.1.2 Health Benefits Conditions and Limitations

8. It was mentioned that the claims were 5,185,121.11 is that per year or 6 months?

6 month

9. Can we know the claims for the whole year?

Multiply the 5,185,121.11 of the 6months twice with will be average.

10. With reference to our meeting today concerning Solicitation Number SEG‐300‐13‐R‐0001, I would like to add one more question about the bellow clause:

B.4.2.1 Employee Pool – This clause is only in effect if the contractor included details in its offer regarding a pooling arrangement, of which this contract is a part. Our question is:

What is the meaning of the above mentioned clause “pooling arrangement, of which this contract is a part” kindly specify in details.

Employee pooling is not subdivision of covered employees and dependents under our contract, but rather the insurance company pooling other employers employees with that of our mission

11. Are the eligible employees and dependents currently covered under a group health insurance plan? If yes, Yes, all employees and their dependents (limited to one spouse and two children) are covered under the current health insurance plan.

12. Are the benefits described in Section C of the Solicitation identical to the benefits currently in effect? If no, The itemized benefits are the same. However, the ceiling is different; the maximum annual reimbursement is 400,000.00, in accordance with C.1.1.13, Annual Maximum Limit.

13. What are the differences between the benefit plans currently in effect and the benefits described in the Solicitation? Can we please have a copy of the current plan?

We have broadened the coverage areas within the specified items: added more children, optical services, and obstetrical care have been modified etc.

Current plan is available under the Freedom of Information Act.

14. Have there been any significant changes to the health benefits during the last three (3) years? If yes, please date of change and describe change.

No changes. However, the maximum reimbursement per patient per contract year, not including expenses covered under C.1.1.4, is 200,000.00 EGP and up to 400,000.00 for catastrophic treatment.

15. Who is the current insurer or provider of benefits? Has there been any change of insurer or provider of benefits during the last three (3) years.

The current insurer provider for the last 3 years has been ALICO.

16. What are the current rates? What have the rates been during the last three (3) years?

Current Rates are available under FOIA as part of current Contract

17. What was the average number of covered employees and dependents during 2010, 2011 and 2012?

Average number of coverage is as follows:

Year Employees Dependents 2010 1196 2242 2011 1106 2232 2012 1107 2250

18. Identify all claims that have exceeded USD 5,000 during the last 3 years. Without identifying the name of the individual, indicate the diagnosis, current prognosis, and current course of treatment.

Data is maintained by the insurance company.

19. How many eligible employees are at age 70 and older?

None, as on‐board employees may not be extended beyond the age of 65.

20. Do the claims amounts contained in Exhibit D include both Health and Life claims? If yes, can these be separated?

No, the amounts are for health claims.

21. Does the claim amount contained in Exhibit D for year 2012 represent the whole year?

No, the amount represent only six months.

22. During each year indicated in Exhibit D, how much was incurred in Egypt and how much was incurred outside Egypt?

Two cases incurred outside Egypt during the last five years.

23. Is it necessary to respond to both Part I and Part II in order to be considered for either?

According to Section L in the Solicitation, offerors may submit proposals on only one insurance plan: Part I‐Health Insurance or Part II‐Group Life Insurance.

24. With regard to Total Permanent Disability Coverage, is it the intent that loss due to work‐related bodily injury not be covered?

The Total Permanent Disability is for work or non‐ work related coverage.

25. With regard to Total Permanent Disability Coverage, is there a waiting period prior to payment of benefits?

Six months.

26. What is the maximum basic monthly salary?

The average basic monthly salary = 4,941.12 EGP. The maximum basic monthly Salary is a restricted figure.

27. Total claims paid during each of last 3 years by type ie death, accidental death, dismemberment, disablement. Also, cause would be helpful.

Total claims paid during the last 3 years inclusive of 3 natural death cases and 1 accidental death case broken down as follows:

2010 = 270,738 EGP

2011 = 169,440 EGP

2012 = 247,662 EGP

28. Salary by age band.

The average basic monthly salary = 4,941.12 EGP and average age = 42 years.