Health Care Contract Q A.pdf

Solicitation S/GV100-10-R-0675

Questions and Answers

Question 1 – What are the total number of employees and dependents to be covered?

Answer – 1152 -See section J for employee and dependent statistics

Question 2 – What documents are necessary to submit?

Answer – Page 1 cover letter:

1. SF-33

2. Section B, Pricing Schedule

3.* Section B, Retention Amounts in B.3

4. Section K, Representations and Certifications;

5. Additional information as required in Section L.

* Please note that the reference to B.7 has been deleted.

Question 3 – Do the copies of the documents need to be certified?

Answer – Only what we specifically ask to be certified. Ex. L.4.3.2.2 – A notarized copy of the most current license/certificate/accreditation

Question 4 – What is the purpose of Section K?

Answer – This section seeks to determine whether the contractor is licensed and certified to provide services outlined in the contract. For clarification on individual sections, please submit questions accordingly.

Question 5 – Explain SF-33

Answer – Fill out question 12 – 18

Question 6 – What is Section L?

Answer – Contents of the Technical Proposal is section L.4.3

Question 7 – Who can extend the contract over the option years? The USG or the contractor

Answer – Aas spelled out in F.3 and Section I clauses 52.217-8 and 52.217-9 the USG has the option to extend the term of the contract. If the USG chooses to exercise an option period, it is binding upon the Contractor.

Question 8 – Can a hospital make an offer?

Answer – Yes

Question 9 – Does your plan cover traffic accidents?

Answer – Yes. See section C.1.1.2 and C.1.2

Question 10 – Are medical evacuations reimbursable?

Answer - We are still waiting for final clarification on this issue, an amendment clarifying the solicitation will be issued shortly.

Question 11 - Are other out of country medical expenses reimbursable?

Answer - See C.1.1.11 - Medical expenses incurred out of country will be covered only for an employee when on official travel and when the treatment is medically necessary before the employee returns to post. Reimbursement will be made at the same percentage rate and subject to the same annual maximum limit as for expenses incurred in country.

Employees on vacation are not covered for out of country medical expenses.

Question 12 – Please clarify the reimbursement levels for prescription drugs and medicines when patient is hospitalized and when the patient is not hospitalized.

Answer – 100% reimbursement of prescription drugs and medicines when the patient is hospitalized. 90% reimbursement of prescription drugs and medicines when the patient is not hospitalized. Section C.1.1.3 will be amended accordingly.

Question 13 – Please give a description of the plan of benefits

Answer – Refer to Sections C- J, particularly section C

Question 14 – How are complaints handled?

Answer – COR will evaluate validity of complaint. If it appears to be a legitimate complaint, the CO will contact the Contractor and try to resolve the issue. If the COR receives two or more complaints a month, the CO “will take appropriate action” see E.2.3.

Past performance is something that the USG looks at when renewing and rebidding any contract

Question 15 – What is the FAR?

Answer - The FAR is the Federal Acquisition Regulations. The Federal Acquisition

Regulations (FAR) is the primary regulation for use by all Federal Executive agencies in their acquisition of supplies and services with appropriated funds. It became effective on April 1, 1984.

Question 16 – Please clarify 52.232-19 AVAILABILITY OF FUNDS FOR THE NEXT

FISCAL YEAR (APR 1984)

Answer – Money is allocated to the Department of State by Congress. Funds are not presently available for performance under this contract beyond 30 September of each Government Fiscal

Year. The Government's obligation for performance of this contract beyond that date is contingent upon the availability of appropriated funds from which payment for contract purposes can be made. No legal liability on the part of the Government for any payment may arise for performance under this contract beyond 30 September of each Government Fiscal Year, until funds are made available to the Contracting Officer for performance and until the Contractor receives notice of availability, to be confirmed in writing by the Contracting Officer.

Question 17 - What is an ORE employee?

Answer – Official Representation Expense Employee – These are the domestic staffs of the

Ambassador and the Deputy Chief of Mission who are not employed directly by the U.S.

Mission, however they work in an official capacity for the U.S. Mission.

Question 18 – Please clarify 52.237-7 INDEMNIFICATION AND MEDICAL LIABILITY

INSURANCE (JAN 1997)

Answer - Only applies if the contractor is providing health care services. The clause does not apply to insurance companies, but it does apply to hospitals and clinics. It essentially says that providers of medical services must carry minimum liability insurance of $100,000 per occurrence.

Question 19- Please clarify 52.216-19 Order Limitations (b) Maximum Order.

Answer – As stated in section B, the current number of single Employees is 11 and Family plan employees is 236. This section states that the Contractor is not obligated to cover more than 250 single Employees or more than 250 Family Plan employees. Furthermore, the Contractor is not obligated to cover more than 260 total single and family plan employees.

Question 20 – Please clarify 652.204-70 Department of State Personal Identification Card

Issuance

Answer – This is standard contract language stating that the Department of State issues DoS

Personal ID Cards to contractor employees who work at DoS facilities on a full or part-time basis and require frequent and recurring access to DoS facilities or information systems. The DoS defines frequent and recurring access as visits that occur eight or more times per month. Non-

U.S. citizens are eligible with a written request letter from a sponsoring office.

We do not anticipate the Contractor of this Contract to visit the Embassy or DOS facilities so frequently as to require the issuance of a DOS ID card.

Question 21 – Please clarify 652.216-70 - ORDERING - INDEFINITE-DELIVERY

CONTRACT (APR 2004)

Answer - This section simply mentions which purchase order forms the Government will use to process the payments associated with this contract.

Question 22 – What is meant by retention amounts?

Answer - Retention Amounts – reference B.3 – This is the portion of the total premium that represents the contractor’s cost of doing/conducting business. This includes labor costs/rent/utilities/supplies/profit. This amount is fixed for the duration of the contract, and is not eligible for adjustment. It does not include anticipated claims to be paid out. The retention amount should also be stated as a bi-weekly rate, NOT as a percentage.

Bi-weekly Rates/Premiums – This is the total premium amount, which includes both the retention amount and the anticipated claims to be paid out. It can be adjusted based on either claims paid out or a local law.

Question 23– What is meant by bi-weekly rates? Why do we multiply this number by 26?

Answer – This is the amount of the premium per pay period, which is every two weeks.

Multiplying this number by 26 pay periods gives you the annual premium.

Question 24 - Can the premiums be adjusted? If so, when.

Answer – Please see B.4

Adjustments can be made based on an enacted law during the term of the contract

Typically requested based on claims paid out vs. anticipated claims paid out

Premium can go either up or down

Can be requested by either party - (Contractor or USG)

Question 25 - Can you give an example of how a price adjustment would work?

Example

15 Single Employees/Self Only

– offered bi-weekly premium price – 5.00

45 Family Plans

– offered bi-weekly premium price – 15.00

Single Employee/Self Only

– stated retention amount – 2.00

Family Plan

– stated retention amount - 8.00

Contractor is requesting an EPA based on claims paid out of 11,450.

1 – COR confirms the claims paid out amount is correct based on monthly reports provided to COR.

2 – COR confirms premiums paid – assuming the following estimated quantities were used:

15 single employees x 5.00 bi-weekly premium x 26 pay periods = 1,950

45 Family plans x 15.00 bi-weekly premium x 26 pay periods = 17,550

Total premiums paid = 19,500

3 – retention amount calculation:

15 single employees x 2.00 retention amount x 26 pay periods = 780

45 Family plans x 8.00 retention amount x 26 pay periods = 9,360

Total retention amount = 10,140

Amount available for claims = 9,360

(19,500 total premiums paid – 10,140 total retention amount)

Are they entitled to an adjustment? YES

How much?

11,450 claims paid out

– 9,360 amount available for claims

2,090

2,090/60 total number of insurance plans = 34.83

34.83/26 pay periods = 1.34 per pay period

New justifiable premium rates =

Single Employee/Self Only

– offered bi-weekly premium price – 5.00 + 1.34 = 6.34

Family Plan

– offered bi-weekly premium price – 15.00 + 1.34 = 16.34

Question 26 – Do you have any further comments or special instructions?

Answer - Terms and conditions of the pricing is set with exception of the possible price adjustment as outlined in section B.4. Also, the proposal must comply with Section L