Second_Set_Questions_and_Answers_Health_Insurance_FedBizOpps.pdf

U.S. Consulate General Hong Kong

Second Set of Questions

Solicitation Number SHK30015R0001- Group Health Insurance Services

The Consulate received the followings questions during the conference or prior to the conference.

The claims 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 Price Adjustment clause B.4.

Q1: Please provide three years of loss data by your account including three years net premium, incurred claims and membership history. For membership history please provide the number of Employees with single coverage and with family coverage at the end of each year. Please do not include any confidential information, just the overall statistics for the group. Claims information is critical to our pricing and the relationship of claims to employee growth or shrinkage is part of the claims analysis. We feel that since your current insurance company has access to this information we would be at a disadvantage unless we had it also.

A1: Premium Paid and Incurred Claims

Year Premium Paid Incurred Claims

4-1-12 to 3-31-13 HK$ 1,733,882.54 HK$2,677,965.46

4-1-13 to 3-31-14 HK$ 1,914,210.69 HK$1,269,571

4-1-14 to 3-31-15 HK$ 1,492,806.85 HK$1,560,074.22

(up to Feb 28, 2015)

Membership History

Year No. of Employee with single coverage

No. of Employee with family coverage

4-1-12 to 3-31-13 107 60

4-1-13 to 3-31-14 123 48

4-1-14 to 3-31-15 117 43

Q2: 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.

A2: Our Human Resources Office has not been informed of catastrophic cases.

Q3: In order to facilitate the pricing and claim estimation, please provide the below supplementary information for our underwriting purpose:

1. Existing benefit schedule under Blue Cross.

A3.1: The existing benefit schedule under Blue Cross is not relevant to this solicitation. Please focus on the requirements in the current solicitation.

2. The recent 9-10 months claim experience report by Blue Cross with claim amount breakdown for

Hospitalization, Supplementary Major Medical, Clinical & Dental Amount.

A3.2: Please refer to the first set of Q&A posted in FedBizOpps.

3. Please specific the exclusions (if any) related to HIV/AID care

A3.3: Please refer to C.1.1.4 HIV/AIDS coverage in the solicitation document.

4. Monthly/Quarterly/Semi-annual/Yearly premium rate are available subject to underwriter approval in the solicitation with or without credit facility. Please advise if it is acceptable by the Consulate

A3.4: Please provide the premium rate according to requested types and formats stated in the pricing tables in Section B from page 3 to 5 in the solicitation document. The Consulate will issue quarterly task order (please see paragraph G.4.2 and H.3 in the solicitation document) based on bi-weekly premium rate x the total numbers of bi-weekly pay period in that quarter. The Consulate has 26 bi-weekly pay periods per year. The Contractor will be required to submit their invoices according to the instruction stated in paragraph G.4 Submission of Invoices and Payment.

Q4: How to define Catastrophic Coverage or Major Illness in Paragraph C.1.1.15? Does it cover inpatient and outpatient?

A4: “Catastrophic Coverage” will supplement the basic medical policy (it is similar to the term

“Supplementary Major Medical Benefits”) in providing additional coverage for expenses incurred both in and out of the hospital.

Q5: Please define “dangerous sport” of second paragraph in C.1.2, page of the solicitation document.

Dangerous sports would be considered extreme sports and involve certain activities perceived as having a high level of inherent danger.

Q6: What is the payment mode for the insurance premium?

A6: Please refer to paragraph G.4 Submission of Invoices and Payment and FAR Clause 52.232-33, PAYMENT BY ELECTRONIC FUNDS TRANSFER - SYSTEM FOR AWARD MANAGEMENT in the solicitation document.

Q7: Has any employee or dependent suffered from an injury, illness or other medical/health condition that resulted in total claims of $2,500 or more during the last three years?

A7: Yes. There are claims above HK$2,500. These are all included in the totals provided under Answer A1 above.

Q8: Are any employees or dependents currently hospitalized, confined at home or a treatment facility, disabled or incapacitated?

Prospective offerors are advised specific illnesses or conditions of employees and their dependents are not releasable but any claims would be included under the answer to Q.1.

Q9. Are any employees or dependents currently pregnant?

A9: Obstetrical care is not a covered expense for employees or dependents.

Q10: Are any employees or dependents not actively at work performing his/her normal duties due to illness, injury or other medical/health condition?

A10: All employees are actively at work. Any claims regarding employees or dependents are included in the answer to Q.1, and again, prospective offerors are advised specific illnesses or conditions of employees and their dependents are not releasable but any claims would be included under the answer to Q.1.

Q11: Are you aware of any circumstances, chronic or continuing medical, mental or nervous conditions which can be expected to produce ongoing claims for any employees or dependents?

A11: No.

Q12: Are any employees/dependents currently residing in the U.S. or Canada? If Yes, please provide details in census section.

A12: All employees reside in H.K. However, please be advised dependents may reside outside

H.K. In addition, offerors are advised that employees are not required to report the place of residence of their dependents, so the USG does not have access to this type of data. Notwithstanding, offerors are advised, an enrolled employee’s dependents must meet the eligibility requirements stated in

Section C., paragraph C.1.6.

Q13: If local nationals are applying for coverage, will the employees be traveling outside of their home country? If Yes, how often? For how long?

A13: Employees may travel outside H.K. on temporary duty or personal travel. There are no restrictions on number of trips or length of trip. The new solicitation does not require travel coverage.

Q14: Can you provide me the state and zip code in China

A14: Hong Kong does not have a state or zip code.