opeHealth_and_Life_2015_Q_and_A_for_SMY30015R0004.docx

Health and Life Insurance Contract Solicitation

RFP: SMY30015R0004

Note to Offerors:

The information contained within these questions and answers and in Exhibit C is provided for information purposes and under no circumstances shall it be construed to change any terms and 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 the claims data incurred under the existing contract, please be advised that this data may not be indicative of future claims and could change.

Also, offerors are advised that there are changes in requirements in this solicitation which were not in the previous contract to include an increase in the number of participants. However, the U.S. Government is not going to describe the changes from the current contract to new contract and it is not going to identify the increase in the number of participants.

Consequently, it is each offeror’s decision on whether to use or not to use this information after carefully reviewing the requirements and terms and conditions of this solicitation and determining its proposed premiums. Under no circumstances shall the U.S. Government be liable for this data or shall it become 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 clauses B.4 and B.8 of the contract awarded.

The answers provided in this attachment shall supersede any answers provided during the Preproposal conference to include questions 35 through 41, which were the questions specifically asked during the conference.

Questions:

Question 1:

U.S. Embassy to confirm on Insurance Brokers participation as Insurance Broker/vendor/contractor for this tender exercise.

Answer:

Reference made to Section L.4.3.2.2 Licensing Information The offeror shall include a notarized copy of the most current license/certificate/-accreditation, which demonstrates that the offeror is licensed/certified/accredited or otherwise authorized by the Government of Malaysia or its agent (e.g., insurance commission, board) to provide health insurance coverage to persons (to include organizations, companies, groups) within the host country.

This section shall demonstrate that the offeror is licensed/certified/accredited through no less than the final day of the base performance period and that the offeror is eligible for renewal for the option periods. This section shall also summarize and describe any probationary, disciplinary or actions taken upon the offeror, which are in force or are about to be imposed upon the offeror by the government of Malaysia or its agents.

Question 2:

Under Section C (clause H - Professional Services and Treatment), noted that Outpatient clinic/GP/Specialist including Doctor for home visits are included under the medical coverage.

a) Is the medical program (together with Outpatient coverage mentioned above) included under the capping of Annual Limit of 95,000? If yes, is it via Cashless (using medical card) arrangement?

Answer:

Reference made to Section C – C.1.1.T Yes to both questions. With the exception of expenses incurred under paragraph C.1.1 J above, the Insurance company will reimburse covered expenses up to a limit of RM95,000 per individual per contract year.

b) Noticed 40% coverage is for home visits & physical therapy, routine annual physical examinations, and inoculations if prescribed by a physician. Does the 40% covers for every treatment episodes/per total bill subject to RM95,000 or 40% from the 95,000 Annual Limit?

Answer:

This means that insurance will cover 40% per invoice or charge for a home visit that the doctor charges.

If a physician prescribes physical therapy the insurance will cover 40% of the cost per visit. 40% of the cost of routine annual physical examinations, and inoculations which will be covered if prescribed by a physician per visit which will not exceed the total coverage limit.

c) The balance of 60% will be paid by the employees? In this case, do employees need to pay up-front or Insurer shall make full settlement to medical providers and recover from the employees (Back to Back) Answer:

Insurance will only cover the 40% and this is on a pay and claim basis. The employee pays their portion of 60 % up-front either by cash or credit card.

Question 3:

From the total Health Insurance claims for the Policy Year 2014/2015,noted the amount is RM1,631,573.79.From that amount, please clarify the amount cost under Hospitalization only (In-patient)?(The breakdown of claims between Hospitalization & Outpatient Clinic G / Specialist and others)

Answer:

Reference made to Exhibit C - Historical Claims Over Five Years, posted in FedBizOpps

Question 4:

Would you be able to provide us the Schedule of Benefit (H&S)

Answer:

See question 16 below

Question 5:

2. Would you be able to provide us the claim statistic for the past 3 years? We only need the details of illness / disease with the cost incurred. (Names not to disclose)

Answer:

Reference made to Exhibit C - Historical Claims Over Five Years, posted in FedBizOpps. Specific illnesses and/or diagnoses will not be released.

Question 6:

3. Does HIV coverage covered under current policy?

Answer:

There is no HIV coverage under the current contract. This is a new approved benefit level for the locally employed staff.

Section C.1

The Contractor shall insure that health care under this contract does not exclude HIV/AIDS care, per HR/OE/CM. Following is the approved benefit levels and terms to be included in the solicitation for the Medical Insurance Plan, the maximum limit for HIV/AIDS coverage for employees shall be a separate maximum limit of RM32,000 per HR/OE/CM.

J. HIV/AIDS coverage (for employees):

Section C.1.1.J

100% coverage of expenses for medications to suppress opportunistic infections, such as tuberculosis and toxoplasmosis for employees who have HIV/AIDS; as well as brief courses of anti-retroviral drugs during childbirth to prevent the transmission of HIV to the employee's child. This expanded coverage generally excludes medications for the long-term suppression of AIDS through the combination of anti-retroviral drugs at those posts with inadequate local healthcare infrastructures. This expanded coverage does not apply to dependents or to retired employees.

Question 7:

Page 12- I. - Prescription drugs and medicine. We do not cover expenses for prescription drugs and medicine over the counter. Does current policy cover this clause?

Answer:

No this is not included under the current contract.

Question 8:

Provide the four year premium history Claim & Premium history broken out separately into Health and Life categories which is critical to determine the insurance loss ratios. The loss ratio is based on the 'amount of claims paid' to the 'amount of premiums collected'. This ratio is instrumental in ascertaining the premiums. It is an industry standard practice to use this metric for premium computation.

Answer:

Reference made to Exhibit C - Historical Claims Over Five Years, posted in FedBizOpps

Question 9:

Provide the census containing the date of birth (or age), gender and salary of employees. This information is required to compute the life insurance premiums. The solicitation requires the death benefits to be based on a multiple of the salary. As you may already know morbidity rates (probability of death) is a function of age and gender. With the current information in the solicitation we cannot develop accurate life insurance premiums because there is no established relationship between employee age, gender, and salary.

Answer:

Reference made to Exhibit A – Employee Statistics, posted in FedBizOpps

Question 10:

Please let us know the name of the current incumbent contractor/supplier for the insurance. This information will help us in focus on certain areas (i.e. service, delivery, network etc.) in providing a better value solution for the embassy.

Answer:

AIA Berhad

Question 11:

Please provide three years of loss data by year of 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.

Answer:

Reference made to Exhibits A - Employee Statistics, B – Breakdown for ORE’s and C – Historical Claims Over Five Years posted in FedBizOpps.

Question 12:

May we have the claims experience for each of the last 5 years preferably detailing the nature of each claim (but excluding claimants’ personal information)?

Answer:

Reference made to Exhibit C - Historical Claims Over Five Years, posted in FedBizOpps. Nature of each claim cannot be released.

Question 13:

Employee census (preferably in an excel file) that includes age, gender, nationality, salary etc. See attached Excel file for your use. Date of Birth is NOT required, age is sufficient.

Answer:

Reference made to Exhibit A – Employee Statistics, posted in FedBizOpps

Question 14:

Premium history (for health & life separately) for the current year and last 3 years - 2015 (till now), 2014, 2013 and 2012

Answer:

Reference made to Exhibit C - Historical Claims Over Five Years, posted in FedBizOpps

Question 15:

Claims history (for health & life separately) for the current 2015 (till now), 2014, 2013 and 2012.

Answer:

Reference made to Exhibit C - Historical Claims Over Five Years, posted in FedBizOpps

Question 16:

Advise if 2014 benefit schedule (for health & life separately) is the same as the benefit schedule currently being requested under SMY30015R0004; and if not advise us on the differences.

Answer:

Changes:

Not in current contract: The Contractor shall insure that health care under this contract does not exclude HIV/AIDS care, per HR/OE/CM. Following is the approved benefit levels and terms to be included in the solicitation for the Medical Insurance Plan, the maximum limit for HIV/AIDS coverage for employees shall be a separate maximum limit of RM32,000 per HR/OE/CM.

(Previous contract the government paid 80% of the dependents premium.) For active employees who are regularly scheduled to work 30 or more hours per week: the USG will pay 100% of the premium cost and the employee will pay 0% of the premium cost for employee and dependent coverage.

Current limit: Annual Maximum Limit - The maximum annual reimbursement per patient per contract year, not including expenses covered under c.1.1.4, is RM 50,000 per patient per contract year.

New: Dental Care: 60% of expenses for dental services including dentists’ fees, x-rays, examination and treatment, cleaning, fillings, extractions, false teeth, crowns, and bridges. Expenses for dental care is limited to RM1800 per individual per policy year. Orthodontia treatment is covered only if treatment begins before age 15, unless required as the result of an accident. A maximum of four years of orthodontia treatment will be covered per patient up to RM1500. (See chart below for current dental coverage) Current coverage:

OUT-PATIENT

Age based preventive screening

100%

IN-PATIENT

Question 17:

Are any major illnesses being treated? If yes, indicate in Census Sheet (attached) along with diagnosis.

Answer:

Reference made to Exhibit C - Historical Claims Over Five Years, posted in FedBizOpps. Specific illnesses and/or diagnoses will not be released.

Question 18:

Are any persons not actively at work? If yes, indicate in Census Sheet attached

Answer:

Reference made to Exhibit C - Historical Claims Over Five Years, posted in FedBizOpps. Specific illnesses and/or diagnoses will not be released.

Question 19:

Are there any Disabled Lives? If yes, indicate in Census Sheet attached

Answer:

Reference made to Exhibit C - Historical Claims Over Five Years, posted in FedBizOpps. Specific illnesses and/or diagnoses will not be released.

Question 20:

Are there any pregnant employees / spouses. If yes, indicate in Census Sheet attached

Answer:

Reference made to Exhibit C - Historical Claims Over Five Years, posted in FedBizOpps. Specific illnesses and/or diagnoses will not be released.

Question 21:

Are there any large losses (in excess of $10,000) within the last year to date. If Yes, indicate in Census Sheet (attached) along with diagnosis.

Answer:

Reference made to Exhibit C - Historical Claims Over Five Years, posted in FedBizOpps. Specific illnesses and/or diagnoses will not be released.

Question 22:

Please complete the attached census with the salary information and we can use the total payroll amount from the census for an accurate payroll figure and computing our premiums.

Answer:

Reference made to Exhibit A – Employee Statistics, posted in FedBizOpps

Question 23:

In the attached Census please complete the 'occupation' column (i.e. bodyguard, office-work, field engineer etc) so that we can get an accurate employee count based on occupation and salaries to compute the premiums precisely. We can provide the best value quote upon receiving the true picture of the group (in the absence of which the underwriting department will 'increase' the premium to cover for the gross census approximations and estimates).

Answer:

Due to Personal Identifiable Information (PII) reason, we are only allowed to give the below specifics:

Security – 54 Facility staffs (which include engineers and electrician) – 14 Office workers – 112 Resident employees - 11 Drivers – 13

Question 25:

Price Table B.2.3 lists 204 single employees but Exhibit A, Column B contains only 192 single employees

Answer:

We confirmed with the Human Resources section that at this time there are 204 employees.

Question 26:

Please provide Life+TPD premiums; Exhibit C is missing this information.

Answer:

The current contracted premium for Life Insurance is RM 3.16 per 1,000 RM of salary.

Question 27:

Please provide number of Life+TPD claims (i.e number of deaths and number of Total Permanent Disability Claims) for appropriate years in Exhibit C

Answer:

Number of claims: 1 for 04/01/2014 to 06/30/2015 and 1 for 04/01/2012 To 03/31/2013

Question 28:

What is the start date of coverage for the plan referenced in this solicitation?

Answer:

Award is anticipated to be in the first quarter of Government Fiscal Year 2016

Question 29:

The item numbers on all price tables on page 8 incorrectly identified as B.6.1. Similarly the table on page 9 bears an incorrect (out of sequence) item number B.6.6. It appears like we are required to provide life prices for Fourth Option Year as well but this is not listed in the solicitation.

Answer:

Please see Amendment A002 for corrected table numbering.

Question 30:

The price tables B.6.1 incorrectly references 'Partial' whereas C.2.1.3 only requires 'Total Disability Coverage'

Answer:

Please see Amendment A002 for corrected table numbering.

Question 31:

Are there any material differences in the benefits requested and those insured for the last 5 years? If yes – what changed, when and why?

Answer:

Please see question 16.

Question 32:

Please advise whether are any of the persons covered required to carry firearms and if so, please indicate them appropriately in Exhibit C?

Answer:

At this time we do not have any employees carrying weapons. However, it is highly probably within the next calendar year, three local employees will be trained to carry firearms throughout their shifts.

Question 33:

The item numbers on all price tables on page 4 incorrectly identified as B.2.4. Similarly the table on page 5 bears an incorrect (out of sequence) item number B.6.8. It appears like we are required to provide health prices for Fourth Option Year as well but this is not listed in the solicitation.

Answer:

Please see Amendment A002 for corrected table numbering.

Question 34:

Are any deviations to the benefits stated in Section C to the solicitation allowed?

Answer:

Proposals shall contain only the benefit levels stated in Section C. Proposals offering benefit levels greater or less than those levels required in Section C may be rejected as unacceptable.

Question 35: 3 years claim experience (with breakdowns of death/hospitalizations).

Answer: Reference made to Exhibit C - Historical Claims Over Five Years, posted in FedBizOpps Question 36:

Staff listing consists of Name, Gender, New IC No. Date of Birth, Monthly Basic Salary (to generate 36 times basic salary coverage)

Answer: Reference made to Exhibit A – Employee Statistics, posted in FedBizOpps. However, certain information such as employee’s names, dependents names and date of birth are not releasable.

Question 37:

Copy of Schedule of current policy.

Answer:

The difference in terms of the benefits is addressed in the Answer to question 16.

Question 38:

We are unable to fulfill Sec L Item L2 on the technical factors and sub factors (page 57).

Answer:

If the technical proposal is incomplete then it will be considered technically unacceptable.

Question 38:

Is it Mandatory to have the SAM registered ready should company is selected? As the NCAGE process may take longer period.

Answer:

SAM registration is mandatory before award can be made (see Section L provision 52.204-7). .

Question 39:

Since US Embassy is the payor, any claims payment will be addressed to US Embassy as the receiver unless with a written instruction from the payor.

Answer:

See H.4, Contractor Responsibility in Claims and Reimbursement to Claimants.

Question 40:

For items L.4.3.2.1., under the act of PDPA (Personal Data Protection Act), insurers are prohibit to disclose clients’ name, address etc.

Answer:

Under L.4.3.2.1, offerors do not need to disclose patient’s names, claims or any other information which is protected under PDPA. Rather offerors need to provide all the requested information under this subparagraph as it pertains to the contract or subcontract for the company or corporate name customers such as the American Embassy or Hewlett Packard.

Question 41:

One contractor asked if the insurance broker can have two different companies – one for Health and one for Life?

Answer:

See paragraph L.4.3.2.2 in Amendment A002 regarding licensing.