Third_Set_Questions_and_Answers_Health_Insurance_FedBizOpps.pdf

U.S. Consulate General Hong Kong

Third Set of Questions and Answers

Solicitation Number SHK30015R0001- Group Health Insurance Services

The Consulate received the followings questions on March 30, 2015.

Q1: For Hospitalization Benefit under Section C.1.1.1.

1. For item (1) & (10), the Maximum days per stay is 100 days. What is the meaning of “per stay”? Is it equal to “per confinement”, “per disability”, “per illness”, “per year”, per accident” or anything else or may be there is no special meaning?

A1.1: “Per stay” means per illness.

2. For item (2), what is the meaning of “not to exceed 100% of the costs of a semi-private room”? Basically, the costs of daily semi-private room charges in all private hospitals of

HKSAR should be more than HK$1,000. Is there any special meaning?

A1.2: The maximum daily reimbursement for a private room is limited to 100% of the cost of a semi-private or up to HK$1,000, whichever is lower.

3. For item (3), is the benefit of hospital medical expenses also subject to other limitation? Such as “per stay”, “per confinement”, “per disability”, “per illness”, “per confinement”, etc.

A1.3: Expenses for item (3) are limited to HK$2,000 per day, up to maximum of 100 days per illness.

4. For item (4) to (9), what is the exact meaning of “per illness”? All medical expenses due to accidental injuries will not be covered? Basically, “per illness” is totally different from “per disability” and we cannot find the Definition under the Tender Specification.

A1.4: “Illness” includes “disability” and also any accidental injuries.

5. For item (4), is the benefit of laboratory tests and X-rays also covered the advance imaging like MRI, PET Scan and CT Scan? If the medical expenses have exceeded the maximum limit per illness, will it be reimbursed under miscellaneous hospital charge?

A1.5: Yes. Expenses for MRI, PET Scan and CT Scan are covered under laboratory tests and X-rays. Medical expenses exceeding the maximum limit for laboratory tests and X-rays per illness will be reimbursed under miscellaneous hospital charge.

6. For item (7), if the patient has diagnosed with “2 illnesses” for 1 confinement in HA ward level, can he/she claim for double benefit (i.e. HK$500 x 2)?

A1.6: No. The patient can only claim the cash benefit for confinement in a government ward once per day.

Q2: For HIV/AIDS coverage under Section C.1.1.4

1. What is the meaning of “for active employees only” and what is the intention for ACG to mention this benefit does not apply to retired employees? In fact, retired employee is not eligible to be covered under the whole medical scheme.

A2.1: That is correct. Retirees will not be covered in any case.

2. Please elaborate more about excluding medications for the long-term suppression of AIDS via the combination of anti-retroviral drugs at those posts with inadequate local healthcare infrastructures.

A2.2: Hong Kong is not considered a post with inadequate local healthcare infrastructures.

Q3: For Catastrophic Coverage under Section C.1.1.14

What is the meaning of “major medical conditions” as well as the definition of “per illness”?

A3: Just as the supplementary major medical benefits, catastrophic coverage will supplement the basic medical policy to provide additional coverage for expenses incurred both in and out of the hospital. When medical expenses exceed the basic policy’s limits, the catastrophic coverage begins to pay. Thus “major medical conditions” are those whose expenses exceed the basic policy coverage. For a definition of “illness,” see Q.1, part 4.

Q4: For Medical Expenses Incurred Out of Country under Section C.1.1.15

Is it implied all medical expenses incurred out of country and without the attending physician certification can be excluded for reimbursement.

A4: The certification requirement applies for cases where the patient travels out of country for the purpose of receiving medical treatment.

Q5: For Definition of “Contributory Insurance” under Section C.2.0.

Is it only applied to those active EE who are regularly scheduled to work less than 30 hours per week together with his/her dependent? No other types of EE will pay the premium on voluntary basis?

A5: That is correct.