Q_and_A_from_pre-proposal_conference_112116.docx

PRE-PROPOSAL CONFERENCE Q & A

LOCALLY EMPLOYEED STAFF HEALTH INSURANCE

Solicitation #: SNU70017R0002

The information contained within these questions and answers 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 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.

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 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.

1. Can the covered employees make changes to their current health plan by switching from individual coverage to family coverage or family coverage to individual coverage?

Yes, employees can make changes to their coverage status one a year during a time period known as “Open Season.” During this time period, employees can change from individual coverage to family coverage or family coverage to individual coverage.

2. Can employees make changes to their plan at any other time of the year? What if an employee has a new baby, for example?

Only in special circumstances can employees make changes to their health insurance status outside of the “Open Season” time. Special circumstances include the birth of a family member, marriage, divorce, or the death of a family member. Changes can only be made when there is a change legal status or family composition.

3. How long is the contract? Can it be extended?

The total duration of this contract, including the exercise of any options shall not exceed 5 years. Please note that per clause 52.217-9, Option to Extend the Term of the Contract, allow the exercise of options to be the choice of the Government, not the contractor.

4. When is the last day that the government will make changes to the solicitation?

If any questions or inquiries will result in a change in the solicitation, an amendment will be prepared and posted on the FedBizOpps. We recommend checking FedBizOpps at least once a day to see if any amendments have been posted.

5. How are on-the-job injuries covered under this contract?

Initially, the injury should be treated as any other non-work related injury and, as such, the employee will be required to pay any co-payments and/or a percentage of medical bills incurred pursuant to the health care provider contract. In all cases, the medical services received should be covered by the health insurance contract. Once the embassy has gathered all the facts and understands the circumstances surrounding the incident, the embassy will decide if the claim should be filed as a workers’ compensation claim with the U.S. Department of Labor (DOL). If the claim is accepted by DOL, the embassy will work with DOL to reimburse the insurance provider, the medical facility, and the employee for any and all monies that are approved for payment. If a claim is not accepted by DOL, it means they have reviewed the circumstances surrounding the incident and determined that the injury does not qualify as a workers’ compensation claim. As a result, DOL will not pay for any medical bills associated with, or stemming from the injury in question and the health insurance contractor will cover the expenses as they would any other non-work related injury. The decision by DOL whether or not to accept a claim can take several weeks or months to determine and, in the meantime, the employee’s health insurance will cover any and all medical bills incurred as a result of the injury. See section C.1.2 in the Solicitation.

6. Are we going to have information on the frequency use of the services by local employee such as surgeries, medical appointment, treatment etc.?

This information will be provided as soon as it is ready and it will be posted on FedBizOpps.

7. Does the contractor have to provide services prescribed by doctor even if the contractor does not offer these services?

The contractor must provide and cover all services included in the solicitation. See section C.1.1.

8. Will exercise therapy/physiotherapy be part of this new contract? Because I saw in section C.1.2 health benefits conditions and limitations, you excluded?

Physical therapy/physiotherapy are synonymous and are covered by the solicitation in section C.1.1.6. Physical therapy/physiotherapy utilizes techniques to restore movements and abilities while exercise therapy seeks to prevent diseases or afflictions. Another way would be to say that physical therapy is used after the injury/incapacitation occurs while exercise therapy is used as a preventative measure. Exercise therapy is not covered as per section C.1.2.

9. Will milk supplements be a covered expense in this contract?

If there is a valid physician prescription outlining a medical necessity and the item is not listed under C.1.2 Health Benefits Conditions and Limitations, then it will be a covered expense.

10. Will baby formula for newborn infants be covered by this new contract?

Regular baby formula is not covered by this contract. However, if it is special formula that is only available with a prescription, then it will be covered. See section C.1.1.4.

11. Could you expand on a bit section B.3.2.1?

This section covers retention amounts. It is important to note that administrative retention amounts are fixed amounts and not percentages. Retention amounts may include, but not be limited to costs as overhead and general and administrative costs. These retention amounts are used in the calculations for determining the appropriateness of any requested economic price adjustment. Please refer to sections B.3.2.1 and B.4.

12. Can you provide a copy of the solicitation through e-mail?

The solicitation is located on the FedBizOpps website at the following link:

https://www.fbo.gov/notices/3d26b03289d622eaf2aab654e2e642f8

Copies will not be provided via e-mail.

13. Which countries are eligible to participate in this solicitation?

This is an open competition and companies/contractors from any country can participate.

14. Can you provide information about the solicitation procedures and guidelines?

Please refer to section L – Instructions, Conditions, and Notices to Offerors for detailed guidance and instructions on completing and submitting the proposal.

15. What is the estimated budget for this purchase?

We are unable to share this information.

16. Is there any extension possible for the submission deadline?

It may possible if the majority of participants request it. If an extension is offered, an amendment will be issued and posted on the FedBizOpps website. At this time, there are no plans to offer an extension to the deadline.

17. Will the pre-bid conference meeting minutes and Q & As be posted?

Yes, they will be posted on FedBizOpps under the “Other” category.

18. Please clarify the number of employees: In Section 2.3, the total number of employees is listed as 585 (=416+169) while in Exhibit J the total number of employees is 585 (=493+92) and employees covered under rider (ORE Staff) are listed separately. Employees listed under rider are not listed under Sec 2.3. Should they not be included here?

The estimated number of employees covered under this health insurance contract is 585. Section B.2.3 shows the estimated number of employees subscribed under the individual plan (self only) vs. the family plan. Section J also shows that we have an estimated number of 585 employees, this time broken down by gender (male and female) and age range. There are an estimated number of 8 ORE employees covered as riders. They are NOT included in the employee total of 585 because they are not U.S. Embassy employees. Please refer to Section C 1.3.3.

19. Please provide claims history for health Insurance for the current year and last 5 years - 2016 (till now), 2015, 2014, 2013, 2012.

The mechanism to pay for medical services in the current contract does not require insured employees to submit claims for reimbursements.

20. Please provide premium history for health Insurance for the current year and last 5 years - 2016 (till now), 2015, 2014, 2013, 2012.

We are unable to share this information.

21. Please provide average insured member counts for the last 5 years - 2016 (till now), 2015, 2014, 2013, and 2012.

Average insured member counts for the last two years are:

Individual plan: 437 Family Plan: 150

22. Advise if 2015 benefit schedule for health insurance is the same as the benefit schedule currently being requested under SNU70017R0002; and if not advise us on the differences. Alternatively, you can simply provide the previous solicitation document.

Prospective offerors are advised there are changes in the benefits and requirements set forth in this solicitation versus the Government’s requirements in the current contract. Offerors should carefully review the benefits and requirements in this solicitation and not focus on the current contract which will be irrelevant on award of a new contract resulting from this solicitation.

23. Are any major illnesses (Hemodynamics, Open Heart Surgery, Orthopedic Major 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).

The specific illness diagnosis for an employee will not be released. However, there have been 8 instances of individuals insure by the health plan diagnosed with one of the major illnesses identified above.

24. 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).

No.

25. 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).

The specific illness diagnosis for an employee will not be released. However, there has been 1 instance of an individual insured by the health plan diagnosed with HIV/AIDs. HIV/AIDs coverage is outlined under section C.1.1.14.

26. When is this plan likely to commence?

Approximately February 19, 2017.