Q A Final.pdf

Question (Q) and Answer (A) for Health Insurance Provider pre-proposal meeting

1. Can we have the claim experience of US Embassy for the past 3 years? The personal information can be masked as we only need the claim information.

CLAIM EXPERIENCE in Rupiah

Nov 2007-Oct 2008 Nov 2008-Oct 2009 Nov 2009-May 2010

CLAIM PAID CLAIM PAID CLAIM PAID

11,950,257,771 12,526,070,026 3,493,817,562

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 clause B.4.

2. What is the procedure of excess settlement claim by the Embassy?

Please see Section H.4.b.

3. Would you be open for benefit plan and price change in the subsequent periods or when the adequacy declines due to medical inflation? (Such as increase in local hospital room rates)

The premium rates for the base year and each option year option must be firm fixed priced rates. Any adjustment to an option year premium rate(s) would be in accordance with the requirements set forth in Economic Price Adjustment clause, B.4.

4. Could you tell us the judging criteria for deciding the winner of the tender? Will it be purely based on cost or is there any other consideration?

A: Please refer to Section M: Evaluation factors for award.

5. Will you be open to suggestion to change insurer in the subsequent renewal period? In case other insurer have better offer or able to provide better package.

A: No.

6. Would you prefer the invoicing process for member alternation to be on ad-hoc basis or a more regular basis let’s say twice a year?

A: Please see Section G.4.2, Frequency of Payment

7. May I know your target cost throughout 4 years of appointment?

A: This information is not releasable.

8. We are not an insurance company. We provide healthcare management services to corporate or NGO clients using a network of credentialed service providers within Indonesia only and state of the art case processing system and a dedicated team comprising medical and supporting staff. In order to be qualified for bidding to the above tender, please advice if our healthcare management services proposal within Indonesia based on a self insured plan can be acceptable later. Further details of the program will be presented subject to the above confirmation

A: See Q&A list # 47

9. Coverage of benefit and others of:

Inpatient benefit:

Pre & Post Hospitalization

One day surgery (one day care)

Emergency Outpatient treatment including dental caused of accident

Anesthetic doctor’s fee

Limit per confinement –

Annual maximum limit for inpatient

Term of conditions of:

In the event of hospital room is fully occupied

If during hospitalization, the Participant desires to have treatment room which is higher than the benefit entitled

In the event of hospital is unable to provide room in conformity with the benefit entitled

A: Hospital benefits are set forth in Section C. The participant is required to pay the difference if during hospitalization the participant desires to have a room which is higher than the stated benefits in the solicitation/contract.

If the hospital is full and a room cannot be provided consistent with the hospital benefits stated in Section C , the participant shall first be given an opportunity to transfer to another comparable hospital that can provide a room consistent with the stated benefits.

If the participant elects not to be transferred to another hospital facility, the participant will be responsible for any increases in costs beyond the designated hospital benefits level , until a room within the benefits level is available or provided.

10. Outpatient benefit:

Immunization benefit (what kind of immunization)

Family planning (KB)

TORCH

Acupuncturist & chiropractor

A: See section C.1.1.2. and should be based on local practice

11. Glasses: Is there any minimum standard for eye refraction

12. Others:

Soft copy TOR in Microsoft word

Further explanation about C.1.1.8 (transportation for out of country medical treatment)

A: The solicitation to include amendments issues as well as the Qs&As are available and may be downloaded at www.FBO.gov .

There was an administrative error by including two subparagraphs C.1.1.8. and the revision is provided in A004.

13. Section B.2-1:

a. What is Base Year and Option Year 1-4? - on Page 2

b. Can we do it directly on annual basis? – on Page 2-4 _

c. Will the number of person change significantly within these 2 months (more or lesser)? - on Page 2-4

d. What is ‘monthly rates’? - on page 3

e. Can we use incurred claim rather than paid claim? - on page 6

f. How is the method of premium payment? I’m not sure I understand this question?

a. See Sections F.2. for the base year and F.3. for the option years.

b. No.

c. No.

http://www.fbo.gov/

d. The monthly rate is the firm fixed price premium rate in local currency, proposed by each offeror, for the health insurance services as specified in Section C and Exhibit A for each of the categories listed.

e. No.

f. See G.3 and G.4. regarding payments.

14. Section B.4-1:

Dispute Clause: Your statement is not clear to us. We are using BMAI (Local Insurance

Mediation). Is this what you mean? - on page 6

A: As stated in paragraph B.4.1., the Government reserves the right to have an independent third party review the balance sheet and make recommendations regarding the appropriateness of a requested economic price adjustment. This independent review would only occur in the instance when the contractor requested a price adjustment in accordance with B.4., and the

Government Contracting Officer believed it would be beneficial to have this type of review after it reviewed the documents provided by the contractor.

15. Section C.1.1.2

Does physical exam apply for the whole employees? - on Page 7

A: Every employee and dependents will get the same benefit level of physical exam

16. Section C.1.1.3

Can we change to IDR currency as long as the limit is USD 10,000? Since it is Rupiah’s policy – on page 8

A: Section C, C.1.1.3. as amended in A004 total annual limit is revised to Rp 88,500,000.

17. Section C.1.3.1

C.1.3.1.1 – are these citizens of Indonesian or include US citizens? Please breakdown no of lives – on page 11

C.1.3.1.2 – Is this local Indonesians? Please breakdown no of lives – on page 11

C.1.3.1.3 – How many lives (Male, Female, Child)? - on page 11

This service is for Indonesia citizens who work for the US Embassy and its consulates. The number of participants (lives) are available in the tables in section B.2 and section J, Exhibit A.

18. Section C.1.1.8

What is the max. time spent for local employees local/American citizens having overseas Indonesia duties? - on page 9

A: No maximum time, and this service is only for locally employed staff.

19. Section F.1

52.242-15 Clause for ‘Stop Work Order’ can we have the definitions? – on page 19

52.242-17 Clause for ‘Government Delay of Work’ can we have the definitions? – on

A: The full text of clauses may be accessed electronically at this address:

http://acquisition.gov/far/index.html or http://farsite.hill.af.mil/search.htm or http://www.statebuy.state.gov or search engine network.

20. Section G

G.4.2. What does it mean ‘Contractor may submit invoices every six month for payment to be made at the beginning of the month for which insurance coverage is provided in accordance with FAR 32.404? – on page 21

G.5. What about correlation with G.4.2? - on Page 21

A: Each task order will fund a specific period of time and number of employees and the task orders will be issued at the frequency described in H.3 (e.g. every six months). The contractor may submit invoices every six months for the specific period of time covered in each task order.

Refunds as defined in G.5, pertain to the payments addressed in G.4.2.

21. Section H

H.4.a.4 What about if document is not completed yet? – on page 23

H.4.a.5 Is it necessary? (related to H.4.b.2 and H.4.b3) – on page 23

H.4.b.4 If its only by transfer, is it OK? - on page 24

H.5.a and b It depends on when the hospital is submitting the relevant document or billing to insurance company – on page 24

A: - H.4.a.4: see H.4. (b)(2)

- H.4.a.5: Yes

- H.4 (b) (4): Yes - the insurance company should notify the employee in two days that they should revise/complete the claim. If they failed to advise the employee, the start date will be started when the insurance company pick the claim up.

See also Section H.4.(b) as amended in A004to incorporate an administrative change to remove a word which should have been omitted/removed .

- H. 5.a. and b: When the claims received

22. Section I

(a)52.232-19 Availability of the funds next fiscal year. Please explain what it means?

- on page 30 http://acquisition.gov/far/index.html http://farsite.hill.af.mil/search.htm http://www.statebuy.state.gov/

(b) 52.237-7-a Professional Liability – we are not in position to ask our sub-contractor to buy PI Insurance – on page 31

(a) See FAR 32.7 on Government contract funding which may be accessed using one of the search engines highlighted in the answer provided to question 19.

(b) Any deviations to the solicitation requirements shall be considered unacceptable.

Consequently, the Contractor shall insert the substance of this clause, including this paragraph

(f), in all subcontracts under this contract for health care services and shall require such subcontractors to provide evidence of and maintain insurance in accordance with paragraph (a) of this clause. At least 5 days before the commencement of work by any subcontractor, the

Contractor shall furnish to the Contracting Officer evidence of such insurance.

23. Section K

K5 52-204-8 (a). (2) ‘The small business size standard is 7 million’. What does it mean?

- on page 42

A: It refers to the size standard of small business is the volume of business would not exceed 7 million, and this applies to U.S. businesses.

24. Is the Room and Board for Hospitalization Flat IDR 500,000 for all employees including spouse and children? The annual limit IDR 250,000,000 is for hospitalization only, or the annual limit of IDR 250,000,000 is already included benefits (inpatient, outpatient, dental, and maternity)?

Annual maximum limit for all benefits is Rp.250,000,000 excluding the expenses covered under

C.1.1.3 is applied for employees including dependents.

Rp500,000 is for room and board per day for a ward room. The Rp.250,000,000 is the total amount each person will be reimbursed per year including all benefits (optical, dental, maternity, in and out patient etc.

25. Is hospitalization program as charged (100% cover as per receipt) both inside network or outside network? Or only 100% for inside network but limited inner limit for outside network?

A: It is as charged for inside network and outside network providers.

26. Do all benefits (inpatient, outpatient, dental, and maternity) use swipe card?

A: Yes. The employee can use the swipe card for those benefits in the provider. If they do not want to use it, they can reimburse their claim.

27. What is your regulation about excess claim? Do your employees have to pay on the spot at hospital or insurance company will pay first in advance for them, then insurance company will charge the excess claim later after 1 month?

A: See section H.4.(b) and the subparagraphs thereunder. –

28. What is the age of minimum coverage of a baby born/child? Is it 15 days or 0 day of baby’s age?

A: Provider should cover 0 days age of baby.

29. Does the outpatient allow the employees to get Direct to all specialists?

A: Yes

30. Do you cover Hemodialisis for your employees including spouse and children? If yes what is the amount per year for every member?

A: Yes. Since hemodialysis is a continuing treatment, the insurance should allow the employee/dependents to use their aggregate maximum limit per year.

31. What is your existing insurance health? Can you provide us claim experience? The more better/lower your claim experience is the more better the premium is.

A: Citra International Underwriters .

Claim experience: see Q&A list #1.

32. Is claim reimbursement delivered to insurance company or picked up by insurance company?

A: Refer to H.4(a)(4) and H.4(b)(2) and In addition, the pick up point of reimbursement claim is the Human Resources Office.

33. Is socialization program of health benefits will be held in Jakarta only?

A: The Government of the United States of America requires Health Insurance coverage for its employees as described in C.1.2 in Indonesia, which includes Jakarta, Surabaya, Medan and Bali.

34. What terms of payment do you choose? We have 3 options for you: quarterly, semi annually and annually (we do not have monthly payment).

A: See section G.4.2. Frequency of payment.

35. When will the fix data will be given to us? Because we want to calculate the fix premium by factual data member.

A: See Q&A #1. Again, please be advised the data provided 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.

36. In the last paragraph of your above letter it is stated that “to award a contract to the responsible company submitting an acceptable offer at the lowest price” whilst in Section

C.1.1. regarding employee and dependent health service benefits it is stated that reimbursement of covered expenses is limited to stated percentage of reasonable and customary costs. We would appreciate it very much if you could elaborate on what is meant by reasonable and customary costs as far as providing health benefits is concerned, e.g. the standard (rating) of hospitals or clinics, to enable us to provide a list of providers of same category at the lowest price

A: 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.

37. C.1.1.6 Optical care: Please confirm that with regard the above benefit this will be based on

Reimbursement of covered expenses subject to the annual limit provided

A: Optical may be based on the reimbursement of covered expenses subject to the annual limit stated in the solicitation.

38. C.1.1.7 Dental service: Please confirm that this service will be based on Reimbursement as well

A: Dental service may be based on the reimbursement covered expenses subject to the annual limit stated in the solicitation.

39. Refunds to the Government: Please refer to page 21 section G.5 regarding Refund of overpayment due to decrease of number of employees. Please confirm refund of insurance premium is only applicable to employees who has left the service of the Government and has not made a claim under the Health Insurance Scheme at any time during the contract

A: If at any time during performance of the contract, if the contractor has been overpaid because the number of employees and/or dependents covered has decreased, the Contracting

Officer may either allow that overpayment to be credited to the Government’s account or require that the contractor refund the overpayment.

40. Re Excess Claims: Please refer to page 23 section (b) (2) regarding excess claims whereby the

Contractor shall notify the employee within two days of such costs with a copy to contractor.

Please confirm that should Contractor not receive reimbursement from the employee within

10 working days Contractor shall remind in writing to employee with copy to COR of such outstanding costs and if settlement is not received within another 5 working days Health

Benefit insurance scheme for such employee is suspended

A: Section H.4.(b).2 refers only to submitted claim.

41. Re Section H: special contract requirements section H.3. ordering procedures. We wish to propose a clause regarding payment of a ‘deposit insurance premium’ which is a payment of a percentage (say 80%) of the estimated premium for a particular period. As you are aware

Contractor should pay Reimbursement claims within 10 working days which mean the first reimbursement claim to be settled is ‘due date/effective date of the contract’ plus 10 days whilst payment of first premium installment is approximately effective date of contract plus

60 days this is following Section G.4.2 in page 21 regarding frequency of payments whereby

HRO has to reconcile number of employees.

Should our proposed clause is not acceptable we wish to propose a credit term of insurance premium payment of 30 calendar days as part of clause G.4.2. which would be appreciated

A: Any deviations to the solicitation requirements shall be considered unacceptable.

42. Will you give us the information of average age for male, female, and children

43. Do US Embassy will be using premium based on data (section B) or using premium based on specific data (data that insurance get after US Embassy choose the Health Insurance Provider

A:The premiums used by US Embassy will be the firm fixed prices offered by the contractor in section B. The total estimated number of participants is based on Exhibit A, but when the delivery order is issued it will be based on actual/current information.

44. Is there any current HIV/AIDS case or that type of infections?

A: So far, there is no HIV/AIDS case

45. This plan will be applied for all employees and dependents for the embassy and its consulates.

Is there any protocol, which will be applied if someone should use above than this plan? If this will be assuming as excess, how will be treated?

A: See Q&A list # 2. No employee can go above the benefit levels and the maximum aggregate amount.

46. We are an insurance company, should we provide the proposal via a broker or directly to

Government?

A: You should provide the proposal directly to Government

47. Is an insurance broker can participate in this solicitation process?

A: 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.

48. For complication of pregnancy, if one pregnant woman got problem and should be hospitalized, will this covered under the inpatient or outpatient?

A: If the employee/spouse has a problem during prenatal (9 months) such as hyper emesis and needs to be hospitalized, it should be covered under inpatient. If there is no need to be hospitalized, it would be covered under outpatient.

49. Complication only will be case by case, normally for miscarriage. Sometimes complication is not only miscarriage, will it be covered under inpatient or outpatient

A: See Q&A list #48 and 94

50. Will food supplement be covered?

See Q&A list #111

51. C.1.1.9: Transportation cost be under other coverage.

A: 80% of transportation cost is required under C.1.1.9. The transportation cost is included under C.1.19

52. Transportation cost: we don’t have that kind of facility and experience, so we will subcontract this.

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

53. Before you choose the insurance provider, can you give us the data of the employee?

54. Do we have to declare the commission level?

A: No. Please see L.4 in terms of what information is required within each offeror’s proposal.

55. Are you concerned to know the unit cost?

A: No. Please see L.4 in terms of what information is required within each offeror’s proposal which includes the pricing proposal.

56. Baby 0 days age will be covered. What are the maximum age of child and employee/spouse will be covered?

A: See section C.1.5

57. Section J: Total of participants in section J is that exhibit A + B?

A: Please refer to paragraph B.1 and B.1.1., Exhibit B, are ORE staff and Peace Corps PSCs and they are riders under this contract.

58. For emergency case, life is number one, US Embassy will not research the insurance provider to do the emergency assistant, and will immediately do the action, then reimburse to the provider. Is there any days for the insurance company to investigate your reimbursement claim?

A: See section H.4.(b)(2)

59. Is this premium cost will be based on section B or after you give us the specification data.

A: See Q&A list # 43

60. To do all of the service, we have 3rd party agency to handle the claim. Should we subcontract this or could we use our own 3rd party agency?

A: It is each offeror’s decision as to how it will meet the requirements set forth in the solicitation.

61. Are you open for the format of the pricing?

A: Any deviations to the solicitation requirements will be considered unacceptable.

62. Page 30-31. FAR 52.237-7 (a) (b): Do we liable to do this? Do we need to buy this? Is this allowed for us to buy

A: All offerors shall comply with FAR Clause 52.237-7 as set forth in the solicitation.

63. Insurance company is not a medical company, we don’t have the doctor or hospital. Is this

FAR 52.237-7 applicable to us?

A: See the answer provided above.

64. B.4.2.1: what is the employee pool?

A: See Section L.4.3.4. and each offeror is required to address this in their proposal

65. Is the premium included the ORE?

A: No. See B.1.1.

66. Our firm is interested in providing a proposal for your local employees medical coverage. Can you assist us with information on the current carrier, rates and claims prior claims information?

A: See Q&A list #1

67. I wanted to touch base with you in regards to this bid opportunity to become broker on the

Health Insurance for the US Embassy in Jakarta. Is there any way we can submit a proposal electronically? Have you had any other bidders interested? We would really like to work with you on this case.

A: Electronic proposals are not allowed under this solicitation. Please see Sections L.3. and L.4., the subparagraphs thereunder, regarding the submission and requirements of proposals. Since this solicitation was posted on the FedBizOps, the Embassy does not have a prospective offerors or bidders list.

68. Are the US Company invited to bid?

A: Yes.

69. How to claim experience for the last 3 years? Please provide us the detail claim report.

A: See Q&A list # 1

70. Please provide us the detail for the existing benefit (not the premium but only the room and board and detail for the limits)

A: Since there have been changes in the benefit levels, the existing benefits are not considered relevant information to this solicitation. Consequently, the benefits required by the

Government are stated within Section C of the solicitation, which offerors must comply with.

71. Q: Regarding the Liability Policy is still needed?

A: See Q&A list #22

72. Q: Please explain in detail section B.4.2.1. – Employee Pool

A: See Q&A list #64

73. Please clarify section C.1.1.9. – Annual Maximum Limit, i.e. Rp. 250,000,000, whether it is applied for all benefits (as an aggregate) including In Patient or is there any specified annual maximum limit for In Patient in particular?

A: See Q&A #24

74. Q: Is there any reference to be used for currency exchange rate applied under section C1.1.3 or we can use Kurs Tengah Bank Indonesia instead?

A: See Q&A list #16, the total limit was revised in Indonesian Rupiah as amended in A002.

75. Please reconfirm that food supplement is covered only under section C.1.1.4. Obstetrical Care and not on other benefits.

A: See Q&A list #111

76. Under section C.1.5, what kind of document (proof of evidence) will be used to determine a child is physically or mentally handicapped?

A: A declaration of condition of employee or family member from a medical doctor and/or psychiatrist, licensed in Jakarta

77. Under section C.1.6.1 (2), will USG responsible to collect premium from employee for his / her dependent coverage or should insurer collect directly from employee himself/herself?

A: Employee is responsible for dependents coverage and should settle directly with the insurance company.

78. Under section L.4.1., please clarify what is Standard Form 33?

A: SF33 is the first page of this solicitation package and at the bottom on the right side of the page will be the Standard Form reference.

79. Under section G.5 – Refunds to the Government, will it be subject to no claim condition?

A: See section G.5 and Q&A list #39

80. Can we have the claim experience of US Embassy for the past 3 years? The personal information can be masked as we only need the claim information.

Can we have the data with the following format:

Claim Experience:

2007/2008 2008/2009 2009/2010 Benefit Type (Product) Claim Incurred Claim Paid Claim Incurred Claim Paid Claim Incurred Claim Paid Inpatient xxx,xxx xxx,xxx xxx,xxx xxx,xxx xxx,xxx xxx,xxx Outpatient xxx,xxx xxx,xxx xxx,xxx xxx,xxx xxx,xxx xxx,xxx HIV Related xxx,xxx xxx,xxx xxx,xxx xxx,xxx xxx,xxx xxx,xxx Maternity xxx,xxx xxx,xxx xxx,xxx xxx,xxx xxx,xxx xxx,xxx Medical Check Up xxx,xxx xxx,xxx xxx,xxx xxx,xxx xxx,xxx xxx,xxx Optical Care (Vision) xxx,xxx xxx,xxx xxx,xxx xxx,xxx xxx,xxx xxx,xxx Dental xxx,xxx xxx,xxx xxx,xxx xxx,xxx xxx,xxx xxx,xxx

Member Data:

No of Employees Age Band Male Female <20 xx xx 20-30 xx xx 30-40 xx xx 40-45 xx xx 45-50 xx xx >50 xx xx

If possible, could you provide us with a more detailed claim experience with the following format:

Benefit (Product) Status

Payment Amount

Approved Charge BenefitPaid Excess

Sex M/F

Outpatient Employee 9,230,500 7,230,500 7,230,500 2,000,000 Male

Inpatient Spouse 12,188,597 12,188,597 12,188,597 0 Female

Maternity Spouse 15,272,500 15,272,500 15,272,500 0 Female

A: See Q&A #1. This is the only information the Government will provide recognizing there have been changes in the benefits.

81. Can we have the demography data for US Embassy employees? Ie: How many employees in Jakarta, Medan and Surabaya?

A: Demography data of US Embassy employees is as below. Please be advised these numbers do not include dependents or ORE employees which are riders under the contract.

BALI 8

JAKARTA 925

MEDAN 27

SURABAYA 84

USAID/JKT 104

TOTAL 1148

82. In your document item C1.1.1 it is stated that Room and Board Expenses is Rp 500,000 but it also stated that you require for a private room. Based on current hospital pricing, it is not possible to get a private room with budget of Rp 500,000 especially in big cities such as Jakarta, Surabaya and Medan. Therefore most of the time, the employee will be allocated in a much higher priced room and board. If that happens, insurance program will only cover based on the following methods.

a. Pro-rate Basis :

Eg. If the employee is admitted to R&B of Rp 750,000 and the total bill adds up to Rp 15,000,000. The insurer will only reimburse 500,000/750,000 x Rp 15,000,000 = Rp 10,000,000.

b. Apply Inner Limit:

For every chargeable item will impose a limit. Eg. Doctor visit, X-Ray, Lab charges, ICU, Medicine etc.

Please be informed that in Indonesia, the room charge for the same category (eg. VIP / Class

1) vary greatly between hospitals. Thus in Indonesia, Insurance will use the fixed Room & Board limit (Rp. 500,000) rather than the room category (private room) to calculate cost, premium and coverage.

Based on the information above, please tell us your current practice and could you elaborate more on your requirement. Will you prefer Pro-rate basis

A: See Q & A list no: 9.

83. Would you prefer the invoicing process for member alteration to be on ad-hoc basis or a more regular basis let say twice a year?

A: See section G.4.2

84. May I know what is your target cost throughout 5 years of appointment?

A: See Q&A #7

85. We just want to verify that this contract is not binding for 5 years but there will be an annual review to assess the contract?

A: Prospective Offerors must provide firm fixed premium prices for the base year and each option as a part of its proposal, which shall be binding. The Government may extend the term of the contract pursuant to the authority of Section I clause 52.217-9, and at the option year firm fixed premium prices proposed.

86. Will the claim excess be guaranteed before hand?

A: Employee and insurance company should agree before hand.

87. Is there any additional condition for out of country medical treatment?

A: Please see section C.1.1.8

88. What is the meaning of long term rehabilitative therapy in the exclusions? Could you be a bit more specific? Any examples?

A:An example of long term rehabilitative therapy would be care in a nursing home or facility.

89. What is the rule with regards to claim disputes?

A: See FAR 52.233-1, which may be accessed using one of the FAR search engines previously highlighted in these questions and answers.

90. Could we negotiate regarding section H.4.(a).(5) ? It stated that the Contractor shall provide notification to the employee within ten working days whether said claims have been settled and in what amount. We could not fulfill this requirement because the data from the provider will only reach the insurer after 10 working days.

A: Any proposed deviation(s) to the solicitation benefits, requirements and clauses shall be considered unacceptable.

91. Do you have any other limitations regarding the claims eligibility?

Such as Congenital Anomalies, pre-existing conditions for new members, waiting period for maternity, psychiatric treatment, Medical Care and treatment for Growth Disturbance including but not limited to Failure To Thrive (FTT), eating disorder, speech disorder, hyperactivity, autism, dyslexia, mentally retarded, delay in walking, except caused by Disease proved by Doctor's Certificate, All medical cares and treatments in connection with stress, depression, neurosis, manifestation of psychosomatic, geriatric condition, psycho-geriatric, or other peculiarities and mental disorder. Cost of circumcision not related to a Disease or infection. Injury or Disease directly or indirectly arising from staging and/or participating in demonstration, strike, riot, disorder, rebellion, power take-over and acts violating the law.

Treatment or medical care resulting from an airplane Accident taking place when the Participant becomes a passenger or a crew, except in scheduled commercial flight. Injury or Disease directly or indirectly resulting from all actions relating to the use of alcohol, narcotics, drugs, prohibited substance, poison, gas, nuclear radiation and the like purposefully used, except resulting from the work of the Participant. Treatment or medical care resulting from carrying out dangerous activities, such as parachute jumping, diving, hang-gliding, car race, motor boat race, motor race and the like, bungee jumping, rafting, physical contact sports, cliff climbing, cave exploring, and other high risk sports. Experimental, traditional and or alternative medical care and or treatment outside the Western medical science, which is not limited to acupuncture (except performed by a Doctor), Chinese medicine man (sinshe), bone traditional medicine man, paranormal, chiropractor, naturopath, holistic and the like.

Conditions related to Sexually transmitted Diseases/venereal diseases and their squeal.

Treatment or medical care resulting from an airplane Accident taking place when the Participant becomes a passenger or a crew, except in scheduled commercial flight.

A: Please see the conditions and limitation as stated in Section C.1.2. in the solicitation.

92. Would you be open for benefit plan and price change in the subsequent periods or when the adequacy declines due to medical inflation? (Such as increase in local hospital room rates)?

93. Does US Embassy local employee insurance include in US Embassy Pooling Program, if it is exist and could you please name your Pooling Provider?

A: This information is not releasable.

94. We just want to clarify that complication of pregnancy is covered under Outpatient.

Scenario:

An expectant mother into 6 months of pregnancy developed bleeding due to complication.

She is admitted into the hospital and warded for few days. After treatment, both the mother and baby are in good condition. The mother returned home afterwards.

If this particular scenario occurs will it be covered under Outpatient or Inpatient?

A: During hospitalization shall be covered under Inpatient

95. We just want to clarify that all benefit (Inpatient, Outpatient, Maternity, Medical Check Up, Optical / Vision and Dental) is applicable for all members including dependents for the exception of HIV related benefit only applies for Employee. Please confirm with regards to this.

A: The benefit level is applicable for employee and dependent, except C.1.1.3, which is only applicable for the employee. See section B.

96. What is the procedure of excess settlement claims by the Embassy?

A: See Q&A list #2.

97. We are an Insurance Broker, do we have to provide the information stated in L.4.3.2.1 , L.4.3.2.2 and others (financial statement etc.) as well ? Or do you just require the information from our Insurance partner?

A: Prospective offeror proposal must comply with the proposal requirements stated in Section

L.3. And L.4, and the subparagraphs thereunder.

98. According to the pre-proposal conference on August 18th 2010 regarding the solicitation of

Health Insurance Service Provider, we need your guidance how to get Contractor

Identification Number and Data Universal Numbering System (DUNS) Number and CCR number.

A: See full text of FAR provision 52.204-6 in section L.

99. Please confirm the annual limit for hospitalization

A: See section C.1.1.9.

100. If the employee is HIV positive, please confirm whether it would reduce the annual limit of

250 million, or directly using the limit of USD 10,000HIV.

A: See section C.1.1.3 and C.1.1.9

101. Please confirm whether it is allowed that if in a family already has 3 children and a wife age

<45, where the age is still productive to have a son, to anticipate the birth of the fourth child, the member eliminates their first child because there is already signs of pregnancy to the fourth child.

A: The first child may be eliminated, but the maternity expenses should be covered. There is no limitation on the maternity benefits. One of the children will be drop when the child is born.

102. Re C.1.5. stated that there is no age limit for an eligible child who is physically or mentally handicapped whereas for a normal child hood until 23 years age limit. Please confirm as it is stated that physically or mentally handicapped is covered in C.1.5. but the treatment is excluded in C.1.2.

A: See Q&A list #103

103. Confirming the above question, Re C.1.5 stated that an eligible child who is physically or mentally handicapped is covered, however in Re. C.1.2 stated that long term rehabilitative therapy is excluded. Please confirm on the exclusion since physically or mentally handicapped child requires long treatment therapy.

A: See Q&A list #88

104. Please confirm on the coverage of colored contact lens with prescription

A: See Section C.1.1.6 and C.1.2. Tinted lens are not covered.

105. Please confirm for any diagnose related with hormonal and menstruation, is it included in the treatment for infertility or not

A: If these are claimed as infertility treatment, it would not be covered.

106. Please confirm on the coverage of non medical treatment such as soap, gargle medicine, balsam, powder, shampoo (purchased in a regular store).

A: Not covered.

107. Please confirm on the coverage of ritually treatment such as circumcision and ear stud.

A: Not covered.

108. Please confirm the coverage of Pre-post menopause

A: Not covered.

109. Please confirm on the range of age for phymosis treatment

A: No range of age for phymosis

110. Please confirm on the coverage for sexual dysfunction, early ejaculation, impotence, sex change.

A: Not covered. See C.1.2.

111. Please confirm on the coverage for food supplement and vitamin that related to diagnose

A: If food is part of the hospital, it would not be covered. If vitamin is over the counter, it also would not be covered.

112. Please confirm on the reimbursement for double covered claim from other insurance

A: The Government cannot confirm this type of information. However, even if there were confirmation, this would not change or impact the requirements or benefits stated in the solicitation.