Q A_SGH10016R0001.docx

1. Premium history for health insurance in Ghanaian Cedi for the current year and last 5 years - 2015 (till now), 2014, 2013, 2012, 2011 and 2010 The contract cycle is August 01, to July 31. See below for the rates:

August 2011 through July 2012 charge per person was ¢26.67 August 2012 through July 2013 charge per person was ¢46.67 August 2013 through July 2014 charge per person was ¢51.32 August 2014 through July 2015 charge per person was ¢56.45 August 2015 through July 2016 charge per person was ¢114.70

2. Did the Premium history for health insurance above include the VAT? If it did then what % VAT was included in the historical health premiums?

We are exempt from VAT & NHIL.

3. You have provided the claims history for health insurance for the past 4 years, could you also please, provide Claims history in Ghanaian Cedi and number of claims (counts) for the current year 2015 (till now).

The current period covers the period August 30, 2015 through to July 2016 and the period of five months the average is 1,792.00

4. Advise if 2014 HEALTH benefit schedule is the same as the benefit schedule currently being requested under SGH10016R0001; and if not advise us on the differences.

No the 2014 Health Benefit Schedule is not the same as currently being requested under SG10016R0001. The differences are as follows:

Annual Maximum Limit:

Up to a limit of GHc11, 700.00 per covered individual per contract year.

Expenses incurred for medications to suppress opportunistic infections, such as tuberculosis and toxoplasmosis for employees who have HIV/AIDS; as well as brief courses of anti-retroviral drugs during childbirth to prevent the transmission of HIV to the employee’s child are subject to a separate annual maximum limit of USD 10,000 per employee.

Up to a limit of GHc26, 240 per individual per contract year.

100% coverage of expenses for medications to suppress opportunistic infections, such as tuberculosis and toxoplasmosis for employees who have HIV/AIDS; as well as brief courses of anti-retroviral drugs during childbirth to prevent the transmission of HIV to the employee’s child. This expanded coverage generally excludes medications for the long-term suppression of AIDS through the combination of anti-retroviral drugs at those posts with inadequate local healthcare infrastructures. This expanded coverage does not apply to dependents or to retired employees.

Dependent Coverage:

Eligible child will be covered until the end of the contract year in which he/she reaches age 18 or age 23 if a full time student.

An eligible child will be covered until the end of the calendar year in which the child turns age 19, or in the case of a child who is a full-time student, until the end of the calendar year in which the child turns age 22. There is no age limit for an eligible child who is physically or mentally handicapped so as to be unable to live independently. There is no limit on the number of children covered per employee. Parents, grandparents, siblings, and other relatives are not eligible dependents.

Obstetrical Care:

90% of obstetrical related medical expenses including pre and postnatal care.

100% coverage of expenses when hospitalized and 100% coverage of expenses when not hospitalized, of obstetrical medical care including prenatal and postnatal care.

Dental Care:

80% for dental services including dentists, fees, x-rays, examination and treatment, cleaning, fillings, extractions, false teeth, crowns, and bridges.

80% coverage of expenses for dental services including dentists’ fees, x-rays, examination and treatment, cleaning, fillings, extractions, false teeth, crowns, and bridges.

Optical Care:

90% for eye examination, treatment and prescription eyeglass or contact lenses. Maximum of GH¢195.00 per year for one set of lenses and GH¢130.00 for frames. No reimbursement for nonprescription lenses, or tinting.

95% coverage of expenses for eye examination and treatment and prescription eyeglass or contact lenses. Limited to two lenses per patient every two years. Maximum of GHc250 per year for one set of lenses and frames. No coverage of expenses for nonprescription lenses or tinting.

Psychiatric Treatment:

80% reimbursement.

No coverage of expenses for psychiatric treatment.

Professional Services & Treatment:

90% reimbursement of surgeons, fees incurred while hospitalized, at a hospital on an out-patient basis, at a clinic.

90% for medical services and expenses when not hospitalized including laboratory tests, x-rays, routine annual physical examination, and inoculations.

90% Doctors fee.

85% coverage of doctors’ and surgeons’ fees incurred while hospitalized at a hospital on an out-patient basis. 90% coverage of doctors’ and surgeons’ fees at a clinic, doctor’s office or at home. 100% coverage for medical services and expenses when not hospitalized such as laboratory tests and x-rays, prescription medicines, physical therapy, routine annual physical examinations, and inoculations.

Prescription Drugs & Medicines:

100% of the cost of medicines and drugs for which a prescription is legally required when hospitalized.

90% when not hospitalized.

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.

100% coverage of expenses when hospitalized, and 100% coverage of expenses when not hospitalized, of the cost of medicines and drugs for which a prescription is legally required. 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.

Hearing Aids:

80% reimbursement.

75% coverage of the cost of a hearing aid apparatus and related examination. Limited to one apparatus per year per patient in a three-year period.

5. 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. 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.

This information along with other medical reports is provided to the Health Insurance Contractor only by the medical service providers. The embassy does not receive these reports.

6. Are there any persons who are currently hospitalized? 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).

We are not aware of any one being currently hospitalized. We are also not aware of any one being pregnant. This information is usually provided to the contractor by the clinics or attending physicians.

7. 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).

The HR Office would not be able to provide this information.

8. 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).

No and we are not aware of any HIV/AIDs cases.

9. Are there any large claims (in excess of $10,000) within the last year to date? If yes, please provide number.

We are not aware of any. This information would normally be provided to the contractor.

10. Item C.1.1.4 seems to be incomplete. Please let us know the separate limit for HIV/AIDS benefit described in C.1.1.4 A. $10,000 – see C.1.1.14

11. Item C.1.1.14 mentions coverage of $10,000 for Section 2.J. Please clarify what Section 2.J refers to.

The mentioning of “Section 2J is erroneous. This will be replaced with C.1.1.4. An amendment will be submitted to rectify.

12. Please advise what the duties will be for the employees, and does the group currently have health insurance?

Duties include Administrative, Project Management, Finance, Secretarial, Media, Education, Nurse, Security, General Services, Chauffeur, Laborer, Custodian, Gardener, Electrician, Welder, Plumber, Mechanic, Carpenter, Technician, Mason, Painters

13. The bid requests that we be licensed, licensed with whom and for what? Since this is an Embassy would a DC license suffice?

See H.6 in the solicitation.

14. Your current member count includes 505 employees, 380 spouses and 896 children. Please provide these member counts for 2014.

Total of 1,523

15. We would like to know if you have been informed of Catastrophic cases presented last year, such as: Hemodynamics, Open Heart Surgery, Orthopedic Mayor Surgeries, Organ Transplant, Traumatic Accident, Cancer and Oncology Cases (Radio and Chemotherapy), and hospitalizations with more than 10 days.

U.S. Embassy Accra has not been informed of any such illness

16. When does the incumbent insurance company's contract expire?

The current contract expires on July 31, 2016.

17. Our experience has been that the Embassies do not release answers to prospective bidders until after the pre-proposal conference which is currently scheduled for January 6th. As the due date for submission is January 18th this leaves potentially less than 12 days for bidders to analyze the answers and prepare proposals. A suggested remedy would be for you to release answers to questions when they are drafted and not wait for after the pre proposal conference or extend the due date by 14 days. Please consider implementing one of these suggestions.

Deadline for submission was extended to February 09, 2016

18. Are we required to submit only the base year price on Feb 9, 2016?

You are required to submit pricing for base year as well as for the four (4) – one year options – see L.4.2 in the solicitation.

19. What does the first, second, third and fourth option year of contract mean? Please refer to page 6 to 8 of the bid document

The solicitation is for a base year contract and four –one year options. For example, year one is the base year. The USG may at its discretion decide to extend the contract at the end of the base year (Aug 1, 2016 to July 31, 2017) and again at the end of each option year. Please see below for an example:

Option Year One– Aug 1, 2017 to July 31, 2018 Option Year Two –August 1, 2018 to July 31, 2019 Option Year Three-Aug 1, 2019 to July 31, 2020 Option Year Four- Aug 1, 2020 to July 31, 2021

Also see 52.217-9 and 52.217-8 in the solicitation.

20. What is the percentage preference for co-payment; can this be tagged at 100% to allow administrative work to be completed for the actual reconciliation to avoid confusion?

The co-payment would be the percentage that the insurance company/contractor is not responsible for paying depending on the amounts stated in the various benefits stated in Section C of the solicitation.

Also, refer to the retention amounts stated in B.3.2.1 which are included in the premium prices stated in the pricing tables (B.2.3 through B.2.7) are the contractor’s overhead/administrative/profit to perform this service.

21. Could deduction of the employees’ percentage of an expense be done at source?

No, this is not our standard practice and the Embassy (the Embassy does not want to be seen to be interfering with its Employees accounts)

22. What percentage criteria is the current insurance vendor offering to the Embassy?

The contract prices are fixed at the time of contract award with changes only made in accordance with B.4 of the solicitation.

23. What specifically constitutes 95% of the optical care treatment coverage, would this include diseases like trachoma?

95% refers to the eye examinations, any treatments of the eyes, and prescription glasses or contact lenses. Usually, treatment of eyes include in eye diseases. Also, depending on the insurance provider, they may consider apart of medical treatment.

24. The solicitation states that you have been making monthly premium payments, but Ghanaian law, specifically the Insurance Act, 2006 (Act 724) requires insurance premium payment to be made annually in advance.

Premium payment could be made annually in advance. We would amend the solicitation to reflect this.

25. What are the number of lives (Employees, Spouses and Dependents) as stated in exhibit – D, specifically for the years (2011, 2012, 2013 and 2014) in accordance with the stated amount?

2011 - 1,696 2012 – 1,637 2013 – 1,583 2014 – 1,523

26. The referenced paragraph 2.J is missing in C.1.1.14 (needs to be inserted if needed).

The mentioning of paragraph 2J is an error. It should read C.1.1.4

27. Paragraphs C.1.1.11, C.1.2 and Paragraph 5 on page 14 are contradictory. Please clarify

This is a contradiction. Please see answer for question 28.

28. 4. Last paragraph of C.1.2 on page 15 of the solicitation states “There is no reimbursement for medical expenses incurred outside of Ghana.” Does this apply to emergencies while traveling abroad or is it just routine?

CORRECTION: Medical expenses incurred out of country will be covered for employees and dependents when (a) a life threatening condition occurs when the individual is out of the country and treatment is medically necessary before the individual returns home or (b) the individual’s attending physician certifies in advance that such treatment is medically necessary and unavailable locally. Reimbursement will be made at the same percentage rate and subject to the same annual maximum limit as for expenses incurred in country.

Transportation for out of country treatment is not a covered expense.

29. May we have a list of expenses not covered?

These are listed in paragraph C.1.2 on page 15. They are also listed below:

Expenses will not be covered for elective cosmetic surgery; spa cures; rejuvenation cures; massage; exercise therapy; long term rehabilitative therapy; eyeglass frames; non-medical hospital charges such as telephones or television; home help, family help, or similar household assistance; fees of persons who are not licensed physicians or nurses; or services or supplies which have not been prescribed or approved by a physician or nurse.

No coverage will be made for expenses that will be reimbursed or paid directly under a host country medical program, the U.S. workers' compensation program, or any Ghanaian workers' compensation type program.

No coverage will be made for expenses related to an illness or injury that is a result of an unlawful action on the part of the patient; the practice of a dangerous sport; excessive or illegal use of alcohol or drugs; a self- inflicted wound; or service in the armed forces of any country.

No coverage will be made for expenses incurred after an employee leaves the service of the U.S. Mission, except in the case of retired employees who elect to continue coverage.