Jakarta_LES_Health_Insurance_2016_QA1_10NOV2016.pdf

SID32016R0015: Jakarta LES Health Insurance: Q&A

Page 1 of 12 November 10, 2016

Minutes of the Pre‐Proposal Conference and Question & Answers for

Solicitation Number SID32016R0015: Jakarta LES Health Insurance

October 25th, 2016 13:30‐14:30 Jakarta Time

Pre‐Proposal Minutes

Embassy Attendees:

1. Lawrence P. Lane (CO)

2. Christopher Smith (CO)

3. Rebecca Edwards (HRO)

4. Fatty Trianasari (HR Assistant)

5. Desi Iskasari (PCU)

The following is the list of vendors who attended the Pre‐proposal conference:

1. AXA Mandiri

2. Sinarmas MSIG Life

3. Sequis Financial

4. Generali Indonesia

5. Reliance

6. Willis Tower Watson

7. Abda

8. FWD Life

9. AIA

10. CAR

11. InHealth

12. MNC Life

13. ACA

14. CIU

15. AXA General Insurance

16. Askrida

17. GBG/Bess

18. Lippo Insurance

19. Wanaartha

20. Kresna Mitra

Introductions of the U.S. attendees by Larry Lane at 13:30

Reminder for English language usage for the proposal along with a review of the various sections.

Overview of the USG Procurement Process including the process of a technical review for acceptability. All approved answers, clarifications, and/or modifications to the solicitation will be posted to FedBizOpps. Prospective bidders should monitor the site for updates. All bidders will receive the same information at the same time.

Information on FAR 52.222‐50 (preventing TIPS) and SAMS information was provided.

The due date is listed as 12 Noon local Jakarta time on 22 November, 2016. International bidders should note that U.S. Daylight savings time ends on Sunday, November 6th, which may affect the time listed in FBO. However, any changes to the due date or time will be listed in a solicitation

Amendment and which will be posted on the FedBizOpps.

Questions were solicited from the audience. No answers were given and participants were advised to monitor FBO for approved written responses.

The conference ended at approximately 14:10

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Questions & Answers

The U.S. Embassy in Jakarta, Indonesia received the following questions prior to, during, or after the pre‐proposal conference on October 25th, 2016 through 17:00 on Friday, October 28th. Questions have, in some cases, been restated for grammatical purposes. The claims data provided in response to any 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. If any answer does address a change in the solicitation, it will reference an Amendment.

In addition, for any answer provided regarding claims data incurred under the existing contract, please be advised that the benefit levels are not the same as the existing 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 (USG) 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: It is common practice in the insurance industry to have the premium and claim paid history information during the last 5 years. Will you please provide us those data?

A1: Premium paid and incurred claims

Year Premium (IDR) Claims (IDR)

1 May 2011 to 30 April 2012 20,413,140,123 16,063,960,073

1 May 2012 to 30 April 2013 22,718,143,581 18,855,186,920

1 May 2013 to 30 April 2014 23,672,581,045 19,124,003,398

1 May 2014 to 30 April 2015 24,987,895,540 19,709,268,061

1 May 2015 to 30 April 2016 26,089,906,336 20,937,653,992

1 May 2016 to 30 Sep 2016 13,167,704,295 7,831,865,962

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Q2: Please provide us the member history during the past 5 years (can we say: the actual participants?)

A2: Estimated numbers of participants as of October 1, 2016 are listed in Section B.2., though there is no guarantee of participant numbers. Note that the categories included here are based on the current contract and does not match that of Section B.2. Information on the past five years is as follows:

Category 2016 2015 2014 2013 2012

Male employee/Male spouse 1,203 1,198 1,151 1,105 1,061

Female employee/spouse over 45 years of age & =<45 years of age (>=3ch)

197 194 187 180 173

Female employee/spouse over =<45 years of age <3ch

1,035 1,028 987 948 911

Children 1,847 1,801 1,729 1,660 1,594

TOTAL 4,282 4,221 4,054 3,893 3,739

Q3: 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 number (we do not need the names or identification, we just need to know the total number of people hospitalized to assess the risk).

A3: Yes there are major illnesses as listed in the parenthetical above. However, the specific illness or conditions of employees and their dependents or the specific number of cases, shall not be released but any claims would be included under the claims answer to A1.

Q4: 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).

A4: Specific illness or conditions of employees and their dependents may exist but shall not be released. but any claims would be included under the answer to A1.

Q5: Are there any large losses (in excess of $10,000) within the last year to date? 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 large losses and the amounts to assess the risk and price accordingly).

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A5: The only information which will be released is the premium and claim history, as set forth in A1.

Q6: Please provide the top ten illnesses participant from exiting insurance before information?

A6: The USG will not release this type of medical information but any claims would be included under A.1., claims.

Q7: Please provide the previous benefit schedule; is this the same benefit level as requested in this solicitation (SID32016R0015)? If not, please advise the differences of both requirements.

Alternatively, please provide us the previous solicitation documents.

A7: Please see below for current contract benefit levels:

CURRENT CONTRACT BENEFIT LEVELS: INFORMATIONAL ONLY

Description Maximum Coverage per person

Hospitalization Rp. 500,000 for room and board expenses

Outpatient Services: Rp. 10,000,000/person yearly

HIV/AIDS coverage treatment (for employees only OR employees and dependents):

Maximum coverage under this paragraph only:

Rp.88,500,000/person yearly

Obstetrical Care.

1. Normal Delivery:

2. Caesarean:

3. Miscarriage:

Rp.6,000,000/confinement

Rp.10,000000/confinement

Rp.4,500,000/confinement

Preventative Care Maximum Rp.1,100,000/year

Optical Care Rp. 1,000,000/person yearly

Dental Service Maximum Rp.3,000,000/person/year

Medical Expenses Incurred Out of Country: Reimbursement will be made at the same rate and subject to the same annual maximum limit as for expenses incurred in country

Transportation for Out of Country Medical

Treatment

80% of claim

Annual Maximum Limit – The maximum annual reimbursement per patient per contract year

Rp. 250,000,000/person yearly

Q8: Can we have the top ten usually used health provider information?

A8: The USG will not provide this information.

Q9: Since the participation is voluntarily, do you have the data of the percentage of employees who are willing to participate for the base year?

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A9: Under the current contract, the employee does not pay any portion of the premium, so all employees and eligible dependents participate. The USG has no data on expected participation for this new contract where the employee will pay a portion of the premium.

Q10: For the option year 1 to 4, will it be mandatory for the base year participants to continue their participation or it can be optional to withdraw?

A10: No. As stated in C.1.3.1.4, there will be an annual “Open Session Program” when employees may elect to join or withdraw from health services for the following year. This shall not be construed to indicate that the provider may elect to drop coverage for any employee electing to join or continue services as part of the Open Session.

Q11: Referring to C.1.3.1.4: Please define “Open Session Program”.

A11: Please see A10, above.

Q12: Does the data stated on Section J represent the actual participants?

A12: No, it is only the total of estimated participants and these numbers are reflected in Section B. The actual participants will be stated on each delivery order – see H.3. In addition, the government may periodically revise by formal modification, the Section J exhibits to include the estimated numbers specified within Section B, at no change in the firm fixed price premiums.

Q13: For rider contract per exhibit C and D, we would like to have some clarification. As we understand people under those exhibits are individual contractors. How should we deal with them? Is their benefit level equal with the non‐rider contract? Should we submit the different rate for them? It is because per section C they are not included in the list.

A13: Per sections B.1.1., G.4.4., G.4.5, and H.3.1., because their coverage is under a rider, their employer is responsible for directly interacting with the Contractor to order any coverage for their employees. When contacted by the employer, the Contractor shall advise the employer of the paperwork and payment that will be necessary to order coverage for the identified individuals. Because more than one employer may have ORE staff, the Contractor may be contacted by more than one employer (typically the Chief of Mission, Deputy Chief of Mission and Consul General Surabaya). The same firm fixed premium rate will be used for the rider and the benefit schedule will be the same but the USG is not responsible for any riders or the payment of any riders insurance.

Q14: Please clarify the number of employees. In Section 2.3, the total number of employees is listed as 4239 (=1200+227+1000+1812) while in Exhibit J the total number of employees is 4239 (=1006+314+194+913+934+878) and employees covered under rider is listed separately.

Employees listed under rider are not listed under Sec 2.3. Should they not be included here?

In Exhibit C the number of employees and dependents covered by the Rider is listed as 362 (=27+36+118+181) and in Exhibit D, the number of employees and dependents covered by the

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Rider according to age and gender is listed as 202 (=65+42+95). Please clarify why there is a mismatch.

A14: The estimated number of employees is shown on section J.

Exhibit A shows the breakdown of employees and dependents based on each agency, while Exhibit C shows the breakdown per age bracket. The list is does not include the Rider participants.

The correctable total of ORE participation (exhibit C and D) is included in Amendment 1 (SID32016R0015 A001), already posted to FBO (see “Other”).

Q15: Referring to C.1.5 the age limit for a child is 23 if he/she is a fulltime student. Please confirm regarding the data stated on Section J for one child falls under the category of age 25‐ 30, whether he/she is an eligible child who is physically or mentally handicapped so there would be no age limit for this case.

A15: Yes, this person falls under this category, since there is no age limit for an eligible child who is physically or mentally handicapped so as to be unable to live independently.

Q16: What is the minimum age eligibility?

A16: There is no minimum age eligibility for qualified dependents.

Q17: What is the language we must utilize in our proposal?

A17: Based on section L.5, provision 52.214‐34, the proposal must be in English language.

Q18: Is it any bilingual version for the RFP? (both in English – Indonesia)

A18: Please see A17. There is no bilingual version for the RFP.

Q19: Are brokers eligible to bid this solicitation?

A19: Offerors must be able to comply with the requirements of Section L, paragraph L.4.3.2.2:

Licensing information.

Q20: We still have problem in obtaining the DUNS and CAGE number for SAM registration requirements. Please advise if we must possess one to bid this solicitation.

A20: SAM registration is mandatory before the award can be made. Please see section L, provision 52.204‐7. Also, SAM registration must be maintained for base year and each option year of performance.

Q21: When is this new plan likely to commence? When is the effective date of the insurance period?

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A21: The period of performance (POP) start date will be set forth in Notice to Proceed (NTP) Letter, which will be issued after the contract award. However, for planning purposes only, we anticipate contract award will occur in second quarter of Calendar Year 2017. Please refer to section F.2. Period of Performance.

Q22: Where can we see all of this information [responses to submitted questions]? Can we have prompt web address for this information?

A22: Any changes in the solicitation requirements shall be included in an amendment and will be posted as an “Amendment” under the FedBizopps site for this solicitation SID32016R0015.

All questions and answers and the preproposal conference minutes will be posted on the FedBizOpps site but under the “Other” category, for this posted on the FedBizOps (www.fbo.gov) under the solicitation number SID32016R0015. Prospective Offerors should periodically check the FedBizopps site or they register themselves on the FedBizOpps site directly to receive notification when there are changes posted pertaining to this acquisition.

Q23: When we get the responds from this Q&A session?

A23: See A22, above

Q24: Section K, could you help us about all the statement. Its is whether made by self or requiring the legality of an institution or legal entity?

A24: Section K, Representations, certifications and other statements of offerors must be completed for the name of the offeror indicated on the SF 33, block 15A.

Q25: Please elaborate the content in section K. Would you help us what is the certain important for attachment material proposal?

A25: The completion of Section K representations and certifications is required to be included with each offeror’s proposal.

Q26: In Section L, Summary of Intruction point 3; I would ask about Technical proposal containing all tecnical factor and sub factors. Where we can see the guide and its details?

A26: The offeror’s technical proposal must address all the requirements listed under Section L paragraph L.4.3 and the subparagraphs thereunder.

Q27: How many cities covered in this contract/solicitation?

A27: The US Embassy is in Jakarta, Indonesia, with a consulate office in Medan, a consulate in Surabaya, and a consular agency in Bali. Covered employees and dependents are located within the geographical boundaries of Indonesia.

Q28: Our rate is in yearly rate, should we provide in biweekly rate for this contract?

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A28: Complete Section B, pricing, using a bi‐weekly (twice monthly) firm fixed pricing structure and no deviations to the Section B categories or contract line items shall be acceptable.

Q29: Should we prepare the confirmation letter for the offering price package?

A29: Please refer to section L for the Instructions, conditions, and notices to offerors. Section L.4 lists the required contents of a proposal.

Q30: Term of the contract: Is the contract quoted for 5 years? If yes, any other term & conditions for the renewal premium as well as on the benefit coverage e.g. any limitation of maximum increase in the premium or any possibility of changing in benefit coverage?

A30: Yes, offerors must provide firm fixed premiums for the base year AND four option years.

The benefit coverage will remain the same throughout the contract period of performance.

Also, see L.4.2.

Q31: Should the awardee provide a person for each location for pick up the document/claim?

A31: Please refer to Amendment A001, as paragraph H.4.(b)(1)., has been revised. It is the decision of each offeror how they comply with the pickup requirements of claims at the Embassy, Consulate Surabaya, Consulate Medan, and Consular Agency Bali as set forth in H.4.(b)(1).”

Q32: What does the economic price adjustment means?

A32: Please refer to section B.4.1: Premium Adjustment Based on Experience ‐ For health insurance, prices may be adjusted upward or downward based on the experience rating of the Mission(s) covered by this contract, and it specifically excludes all riders in B.1.1. No adjustment will be allowed during the first twelve months. After such time, the Contractor or the Government may request an adjustment in premiums on an annual basis. Adjustments are not retroactive to previous contract terms and any adjustment shall be in accordance with the B.4.requirements.

Q33: Currently my company can provide group health product with inpatient coverage and outpatient cover by ASO (Administrative Services Only). Is that possible for us to have the deposit from your institution?

A33: No. Payments shall be made in accordance with G.4.2. Also, reference the invoice submission requirement as stated in G.4.1.

Q34: Is there any mechanism of the cashless system required? Is this using the swiped card? Is the total number of minimum network of cashless service provider a mandatory?

A34: The Contractor shall maintain a network of Indonesian Ministry of Health licensed hospitals throughout the greater Jakarta, Surabaya, Medan, Bali for the minimum number as specified in H.9.2. This is a mandatory contract requirement. In addition, the Contractor shall

Page 9 of 12 November 10, 2016 maintain an up to date listing of cashless licensed hospitals in electronic report form, sent to the COR on a monthly basis. In terms of how the cashless system requirements are implemented, that is the decision of each prospective offeror.

Q35: Should we also provide the health talk to your employees? If yes please advise me total of city that we have to provide this session.

A35: There is no requirement for the contractor to hold the health talk for all of the employees.

Q36: When the contract is awarded, must the contractor present the socialization of the contract to all of your employees?

A36: C.1.7, the Contractor shall provide a document which sets forth a complete listing of the health insurance benefits to be provided under the contract. There is no requirement to present socialization of the contract to employees.

Q37: Based on performance threshold, there should be no more than 3 (three) customer complaints we received per month. Is this included the invalid complaint? From whom the complaint must come from?

A37: Please see section E, Inspection and Acceptance, paragraph E.2.1 through E.2.3. The COR will receive and document all complaints from personnel regarding the service provided. The COR will then present valid complaints to the Contractor.

Q38: Per section I.2. FAR 52.216‐19, Order Limitations: what are these maximum and minimum amount meaning?

A38: The maximum and the minimum amount limitations contained within USG contracts are designed to protect the USG and the Contractor. Consequently, the offeror (contractor) is not obligated to support task orders which are below the minimum order amount specified in this clause and the offeror (contractor) is not obligated to support task orders which exceed the maximum amount specified in this clause or in combination.

Q39: Section C.1.1.4 regarding Preventive Care – Immunization, please advise us whether this is only for child, for adult, or for all.

A37: The coverage is for eligible and participating employees and their dependents.

Q40: How much is the maximum benefit on the dental service benefit per employee? Would it be possible to hold limitation on scaling per year?

A40: Dental care is subject to the annual maximum limit outlined in C.1.1.10.1. Per C.1.1.6, expenses for general dental services and orthodontia treatment are covered at 80%, and there is no separate annual ceiling.

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Q41: Based on Section C.1.2 / Page 15: Health Benefit Conditions and Limitations, there is no coverage of reversal of voluntary sterilization, infertility treatment after voluntary sterilization, genetic counseling, and assisted reproductive technology. Please elaborate this sentence.

A41: The USG believes this statement is clear relative to coverage specifics.

Q42: If the patient chooses to have a higher room class on his/her own expenses during hospitalization, would it be possible to apply coverage that is based on general health insurance practice?

A42: Please refer to Amendment A001, as Section C.1, Health Insurance Services, subparagraph C.1.1.1. (A)(1) is deleted in its entirety and replaced with the paragraph below. All other subparagraphs of C.1.1.1 remain the same. Any additional charges for higher room classes are the responsibility of the covered employee or dependent.

C.1.1.1. Hospitalization:

A. Room and Board:

1. Room and Board for a Class 1 (i.e. a shared room with two beds ‐ divided by curtain ‐ and shared bathroom) or Class 2 (i.e. a shared room for between 3‐6 beds – divided by curtain ‐ and shared bathroom) type room with a daily limit of Rp 800,000. All associated hospital and medical charges are limited to those associated with a Class 1 room.

Room and board expense: 100% coverage, not to exceed Rp.800,000/day

Q43: Reinstatement is when the patient is allowed to re‐check‐in to the hospital for the same case. Do you have any requirement for this reinstatement? 14 or 30 days after their first released/check out date?

A43: No specific timeframe is identified within the requirements.

Q44: Per section C. out of country transportation, should we provide the transportation or we just provide the medical evacuation program?

A44: Yes, the offeror must provide both in accordance with paragraphs C.1.1.7 and C.1.1.8. In the context of this paragraph, “at the same rate” shall cover both percentage and limits (caps).

Q45: Should the out of country treatment be only for emergency cases, or can it be used for other medical treatment?

A45: See C.1.1.7: Medical expenses incurred out of country.

Q46: If the patient receive the out of country medical treatment without any certification in advance by his/her attending physician, can it be excluded?

A46: See paragraph C.1.1.7.

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Q46: Is there any limitation for the obstetrical care in one year?

A46: Per C.1.1.3, there is no limitation of obstetrical care based on age or total number of deliveries per employee and/or spouse but limitations exist per occurrence. In addition, obstetrical care is subject to the annual maximum limit listed in C.1.1.10.

Q47: Can we quote in USD?

A47: No. Per B.2.9, under Indonesian Law, all offers and payments must be in Indonesian Rupiah (Rp).

Q48: Can we have the information of the nature of job of the employees?

A48: All covered individuals will be employees, spouses, or dependents of the U.S. Mission to

Indonesia.

Q49: Will all the contract workers covered? And will all employees be covered under BPJS?

A49: See paragraphs C.1.3 – C.1.5: Current active employees of the United States Government, employed within the geographic boundaries of Indonesia and their eligible dependents will be eligible for coverage under the main body of this solicitation. In addition, certain individuals are eligible under a rider as outlined in C.1.3.3 and may be categorized as contractors. Non‐ personal services contract personnel and their employees (supplied by an independent contractor licensed to do business in Indonesia who provides services to other local organizations as well as to the U.S. Mission) and employees of USAID institutional contractors are not eligible.

As a Diplomatic Mission, the U.S. Embassy is not mandated to cover our employees under Indonesia’s socialized health care scheme (BPJS).

Q50: What is the maximum length of the unpaid leave? And will there be full medical coverage during the period of unpaid leave?

A50: Please refer to section C.1.6 Eligibility section C.1.6.2. Period of Ineligibility.

Q51: For US citizen which is on home leave, will the medical be covered under US national scheme or this medical scheme?

A51: Per C.1.3.1.3, U.S. Citizens which are locally hired are covered under this contract with the same benefits as any other covered employee.

Q52: Distribution of the citizenship (US citizen versus local and others, if any)

A52: See A51, above. At present, there are no locally hired U.S. citizens in the Embassy or other locations.

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Q53: Is there any minimum standard for eye refraction as there is no explanation of this benefit?

A53: See para C.1.1.5: Optical care (including refraction) is covered as stated in C.1.1.5.

Q54: Item C.1.1.1 it states that the room and board expenses is IDR 800,000, but it also stated that you required for a private room. Based on current hospital pricing, it is not possible to get a private room with budget of IDR 800,000 especially in big cities such as Jakarta, Surabaya, Bandung and Medan. Therefore most of the time, the employee will be allocated in a much higher priced room and board. If that happens, how would we handle the case 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 case of hospital is unable to provide room in conformity with the benefit entitled?

A54: See A42, above.