QAs_Health_Insurance.pdf

LES Health Care Solicitation U.S. Embassy Suva August 2013

Solicitation Questions and Answers

1. Claims history for the last three years until to date.

2010 2011 2012 2013 (a/o May

17)

Premiums $141,118 $139,037 $193,622 $43,184

Claims $64,861 $76,828 $368,537 $71,587

The data provided in response to this question is provided for informational purposes and under no circumstances shall it be construed to change any terms or conditions or requirements within the solicitation. In addition, for any answer provided regarding claims data incurred under the existing contract, please be advised that the benefits levels are not the same nor may this data be indicative of future claims. 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 Economic Price Adjustment, Section B.4.

2. List of staff and dependents.

This information will be released after the contract award and only to the contractor who is awarded the contract.

3. Have any staff or dependent that may have legally changed his/her name?

Please see response to Question 2, above.

4. Have any staff or dependent that may have suffering from any major illness such as cancer, heart problem, tumor, diabetes, organ failure or transplant etc?

This type of individual employee medical information will not be released, however, the medical claim amounts for all employees have been provided in answer to Question 1, above.

5. Have any staff who may have on-going or re-occurring illness and on medication?

Please see response to Question 4.

6. Any major claim or treatment rejected by your current insurer? If yes, state illness and reason why the claim was rejected?

7. Any pending local or overseas treatment in process or approved for treatment?

8. Detailed Medical Claims Experience for the last 5 years (Local hospitalisation, overseas evacuation, outpatient, optical, dental) from the current medical provider.

Please see Question 1. The information set forth in Question 1 represents the extent of the claims information we will be providing. The data provided in response to Question 1 is provided for informational purposes and under no circumstances shall it be construed to change any terms or conditions or requirements within the solicitation. In addition, for any answer provided regarding claims data incurred under the existing contract, please be advised that the benefits levels are not the same nor may this data be indicative of future claims. 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 Economic Price Adjustment, Section B.4.

9. Copy of existing Medical Policy to do a Gap Analysis.

Please be advised this solicitation differs from our current medical policy. Any offers that deviate from the solicitation requirements shall be considered unacceptable.

10. Will US Embassy agree to annual premium payment upfront and fortnightly claim deduction?

Please see Section G.4 for information on payment. Any offers that deviate from the solicitation requirements shall be considered unacceptable.

11. Would US Embassy accept local insurer standard policy and its coverage e.g.; QBE

Insurance (Fiji) Ltd which differs from the benefits stated in the RFP?

Any offers that deviate from the solicitation requirements shall be considered unacceptable.

12. Please explain Profit Sharing Credit Plan (L.4.3.3 and M.3.2).

We cannot provide more information on this subject than what is provided in the solicitation.

13. Please explain Fixed Pricing for 2 years.

As stated in B.2, this is a firm fixed price contract subject to an economic price adjustment after the base year period and in accordance with the requirements and conditions stated in B.4

14. Will an offshore medical provider be considered provided it is the lowest priced?

Please see Section B.2: “Foreign Firms.” To be acceptable and eligible for evaluation, proposals must be prepared in accordance with Section L -

INSTRUCTIONS, CONDITIONS AND NOTICES TO OFFERORS, and must meet all the requirements set forth in the other sections of this solicitation. Acceptable proposals will be evaluated pursuant to Section M of the solicitation and award shall be made as set forth in M.3.

15. Would in-house outpatient plan be considered under the solicitation package for premium saving option?

16. Under Section G Contract Administration Data G.6 “The contractor shall show Value

Added Tax (VAT) as a separate item on invoices submitted for payment”. VAT at current (2013 year) legislated @15% applies on general insurance premium with the exception of Medical and Term Life policies, thus VAT will not apply.

Since it is not clear what question is being asked, no answer will be provided.

17. Do all other requirements need to be met apart from lowest price bid?

18. Do U.S. vendors typically offer a profit sharing plan as part of their offer?

We cannot comment on the offers of other vendors.

19. The RFP is very complicated and suggests coverage for a much larger group of people; is this RFP the same as one that would be used in the States for a group of many hundreds or thousands?

The RFP in question is based off of a standardized USG contracting format.

20. Why is the method of claims in the RFP so different than the current method of claims; why is the USG asking that claims be reimbursed rather than paid directly to prior-approved service providers?

Reimbursement is covered under subparagraphs C.1.1.4 and H.4(b)(5) of the solicitation. Again, the benefits and terms and conditions stated in the solicitation represent the Government’s requirements, which prospective offerors must comply with in their entirety.

21. If all the tenders received do not comply with your specifications and therefore are deemed to be “technically incorrect” what will US embassy do about covering staff?

The Contracting Officer will make a decision whether to cancel the solicitation since no proposals conformed to the solicitation requirement and get approval for an USG direct reimbursement system or to enter into written negotiations with those offerors the CO determines are within the competitive range after price and technical evaluations.

However, under no circumstances will the Government award a contract which deviates from the benefits levels and requirements stated in the current solicitation.

22. The cover requested is quite different to current coverage; this may result in new underwriting (medical assessment) of existing members, especially if a different insurer from BSPL is appointed. Is US embassy prepared to undergo new medical assessment for all staff? There is a risk that some staff may not be covered under the new policy going forward if they have existing medical conditions.

This solicitation contains the approved benefits for eligible employees and their dependents and there will no exceptions or conditions in providing these benefits to eligible employees and their dependents. Furthermore, there is no pre-qualification or exclusion due to preexisting conditions for eligible employees and their dependents.

23. Has staff been consulted regarding the proposed new product? We note that reimbursement was a major source for complaints from staff in the past.

Reimbursement is covered under subparagraphs C.1.1.4 and H.4 (b) (5) of the solicitation. Again, the benefits and terms and conditions stated in the solicitation represent the Government’s requirements, which prospective offerors must comply with in their entirety.