QUESTIONS_AND_ANSWERS_-_SOLICITATION_N_SPA10016R0001_Final.pdf

PRE-PROPOSAL CONFERENCE

FORMAL

QUESTIONS AND ANSWERS

SOLICITATION Nº SPA10016R0001

HEALTH INSURANCE FOR LOCALLY EMPLOYED STAFF

The U.S. Embassy Asuncion convened a pre-proposal conference on Tuesday, February 16, 2016 at at 10:00 a.m. for the above referenced solicitation for Local Employed Staff health insurance benefits, for local employees of the Embassy, for official residence employees (ORE), and for retirees, if they elect, as a rider to this health insurance benefit program. Five firms participated in this pre-proposal conference:

Coomecipar, ASISMED, Migone, MEDILife, and Santa Clara. The questions and answers below are responsive to the inquiries received at this meeting. Prospective bidders have an additional opportunity to submit questions to the Embassy regarding this solicitation. The deadline for submission of formal questions is March 11, 2016. The questions must be submitted to U.S. Embassy Asuncion, Mariscal Lopez 1776, Asuncion Paraugay. Questions may be hand delivered or sent via e-mail:

AsuncionContracting@state.gov.

QUESTION 1

SECTION - C.1.1.1 Hospitalization:

a. What services are included?

All services provided while the individual is hospitalized. No exceptions.

b. What does “medical expenses” mean?

All costs that would normally be billed to the individual while hospitalized. Instead, these expenses should be covered by insurance.

c. What is the definition for prescription medicines?

Any medicine or drug that has a doctor’s prescription (receta medica).

d. What does intensive care mean?

Special medical treatment of a dangerously ill patient, with constant monitoring. The Spanish term for intensive care is “terapia intensiva”.

e. Is there a limit on the number of hospitalization days or intensive care?

No limit on number of days. See section C.1.2 Health Benefits Conditions and Limitations for the dollar limit.

QUESTION 2

SECTION C.1.1.4 Professional Services and Treatment:

What is the level of coverage for prescription medicines? 100% as stated in C.1.1.1? Or, 90% as stated in C.1.1.4? Or, 0% when not hospitalized as stated in C.1.1.6?

This is an error in the original language. The solicitation has been amended and is available on the solicitation page of the FedBizOpps website. The amended version removes all references to prescription medications in C.1.1.1 and C.1.1.4. The language in C.1.1.6 remains unchanged, so the coverage for medication now reads:

mailto:AsuncionContracting@state.gov https://www.fbo.gov/index?s=opportunity&mode=form&id=7977261f5285071ea979dfcee1309523&tab=core&_cview=1

Prescription Drugs and Medicines:

• 100% coverage of the cost of medicines and drugs for which a prescription is legally required when hospitalized, admitted to an emergency room, or by emergency response teams.

• 90% coverage of the cost of medicines and drugs for which a prescription is legally required when administered at a hospital on an out-patient basis, clinic, doctor’s office, or lab.

• No coverage for prescription medications filled by the participant or administered outside of the above mentioned places.

• No coverage for expenses incurred for medicines, vitamins, cold remedies, etc., that are available over the counter without a prescription will not be covered even if prescribed by a physician.

QUESTION 3

SECTION C - C.1.1.5 annual physical examinations and inoculations.

a. What are the specific annual physical examinations that are 100% covered?

It is a routine physical examination done yearly in order to assess if the patient has any readily visible signs of medical issues that need to be addressed. Typically this includes a review of past medical history, and interview with the patient by a physician, a physical examination of the patient’s body, and if required by the physician any tests such as blood/urine and other routine laboratory tests, chest x-rays, pulmonary function testing, audiograms, full body CAT scanning, EKGs, heart stress tests, vascular age tests, urinalysis, and mammograms or prostate exams. The local Spanish term is “chequeo annual.”

b. It is understood that fees for inoculations have 100% coverage but what about the vaccines?

Are they covered?

Inoculation and vaccine are synonymous words – they are the same thing.

QUESTION 4

SECTION C.1.1.7 Obstetrical Care:

a. What kind of medical expenses are covered under the normal or caesarean delivery? What is covered under miscarriage?

Whatever the doctor determines is needed to ensure the health and safety of the mother and child.

b. What are the pre-natal and post-natal duration periods?

The pre-natal period begins immediately upon discovery of the pregnancy and ends at birth or termination of the pregnancy. The post-natal period, consistent with Paraguayan law 5508, is 18 uninterrupted weeks after birth. The post-natal period may be extended if required by the attending physician or Instituto de Prevision Social (IPS) due to complications or extenuating circumstances.

QUESTION 5

SECTION C - C.1.1.10 Psychiatric Treatment:

a. What is the definition of a “session”?

An appointment with a psychiatrist during which the patient receives treatment.

b. If a patient changes psychiatrists or sees more than one psychiatrist in a year, do they get 9 sessions per psychiatrist?

No, the individual gets 9 total sessions in a year, and this may be divided between different psychiatrists.

QUESTION 6

SECTION C.1.1.11 Optical Care:

What is the definition for prescription lenses?

The glass lens in glasses. It does not include the frame or contact lenses.

QUESTION 7

SECTION C.1.1.12 Dental Care:

a. What dental procedures are considered preventive?

An annual visit which includes an oral evaluation, routine cleaning, x-rays and fluoride treatment.

b. What dental procedures are considered minor restorative?

Scaling, fillings, extractions, periodontics (gum disease) and endodontics (root canal).

c. What dental procedures are considered major restorative?

Crowns, inlays, bridges and dentures.

d. What procedures are included for orthodontia treatment?

Braces or similar interventions used to align irregular teeth.

QUESTION 8

SECTION C.1.1.14 For employees and dependents:

Is it correct to mention C.1.1.13 (Hearing Aids: no coverage) or this is an error?

There is an error in the original language. Amendment number 2 has rectified this error, changing the reference to C.1.1.14. Likewise, in section C.1.2 the references to C.1.1.13 have been changed to C.1.1.14.

QUESTION 9

SECTION C.1.5 Other Eligible Participants:

What is the definition for “Full Time Student”? Is there any certification that should to be provided?

A full-time student is a student that is taking at least 12 credit hours (i.e. classroom hours or accredited online hours) per week when school is in session. For the purposes of the contract, no certification required. However, the insurance may request proof of enrollment and may deny coverage if the individual is unable to provide this proof.

QUESTION 10

SECTION L.4.3.1 Management Approach:

Section C does not establish limits for each subject. How can we know if our offer is greater or less than the level of benefits required?

You must comply with the minimum as stated. If a benefit is not explicitly excluded, then you must assume that it is included.

QUESTION 11

SECTION L.4.3.2.1. Experience and Past Performance:

How does this requirement apply to Pre-Paid Medicine Companies?

This requirement applies to any company tendering an offer for insurance services under this solicitation. All offerors are required to provide references as requested under this section.

QUESTION 12

SECTION L.9 FINANCIAL STATEMENT:

Will a balance sheet covering the last 5 years and an income tax return be sufficient to meet the requirements of this section?

If requested by the contracting officer, the offeror must be prepared to provide all documentation listed in L.9.

QUESTION 13

SECTION I – 52.237-7 INDEMNIFICATION AND MEDICAL LIABILITY INSURANCE (JAN 1997):

a. How does this requirement apply to Pre-Paid Medicine Companies? Pre-paid companies are not responsible for the service provided by the professionals who are independent handlers and take full responsibility for medical-legal aspects of their practice.

If the contractor is solely an insurer, then the malpractice insurance is not required as part of the offer. However, if the contractor provides medical services either through direct-hired personnel or through subcontractors, the contractor must provide proof of medical mal-practice insurance. The cost of obtaining this insurance should be factored into the price.

b. Must all medical professionals that work for our company obtain this insurance? For example, if we employ 200 doctors and nurses, must each doctor and nurse obtain this malpractice insurance.

No. Only one policy is required. The insurance company must obtain an umbrella insurance for medical malpractice that covers malpractice of the company, the company’s employees, the company’s subcontractors, and/or agents. For the purposes of this contract, the coverage policy only needs to cover participants within the contract. For example, if the insurance policy is limited and does not extend the malpractice insurance to other customers of the insurance company, that is not an issue as long as all participants under this contract are covered.

QUESTION 14

Please provide regulation and/or narrative of the rules for the contract, legal documents required, interest for late payments, modification on prices, currency of the bid, etc.

Please see the solicitation package.

QUESTION 15

Please provide following information…

a. Estimated number of local employees Please see table B.2.3, section J and Exhibit A (Exhibit A was added to the amended solicitation available on the solicitation page of the FedBizOpps website)

b. Composition of Family group See C.1.5.

c. Average age of possible beneficiaries See Exhibit A

d. Geographic distribution of beneficiaries, (location where beneficiaries live).

The vast majority of beneficiaries reside in the greater Asuncion area.

QUESTION 16

What is the meaning of the acronym “USG” United States Government.

QUESTION 17

In regard to payment, please explain…

a. The payment process and pay period (15 or 30 days?)

30 days from receipt of a proper invoice. The funds will be paid via an electronic funds transfer.

b. Explain how the 4 option periods work.

The Embassy may unilaterally exercise the first option year at the end of the base year. The Embassy may then exercise the second option year at the end of the first, etc. The Embassy will review factors such as current need, performance of the contractor, and costs. The Embassy at this time intends to exercise all option periods under the contract. Please keep in mind that we calculate pricing for option periods when determining the best-priced offer.

c. Will the VAT be included in the 20% of the total amount that the employee shall pay?

No.

QUESTION 18

In regard to insurance coverage, please clarify…

a. What does the term “event” mean?

All the expenses incurred by an individual, due to the same covered disease or injury.

b. Is there a limit to the number of events considered for each Beneficiary?

No. The contractor should estimate the probability of covered individuals having multiple events in one year and price the offer accordingly.

c. Will the events originated/ delivered by chronic, congenic and oncologic pathologies be considered?

Yes. Please note, however, that all expenses under one disease would be considered one event.

d. Is the $120,000 of coverage per individual the limit per event or the entire year?

Per event. For example, if a person has 3 events in one year, theoretically the individual could incur claims up to 3 x $120,000.

https://www.fbo.gov/index?s=opportunity&mode=form&id=7977261f5285071ea979dfcee1309523&tab=core&_cview=1

QUESTION 19

Can insurance brokers bid on this contract?

This solicitation is for insurance companies only. If a broker firm were to bid, the offer would be rejected as technically unacceptable. If a broker assists an insurance firm in bidding on the contract, then that is a separate business arrangement between the insurer and the broker.

QUESTION 20

Please provide…

a. Employee and dependent census that includes age, gender. Exhibit A was not attached to the Solicitation.

Exhibit A in amendment number 1 and includes demographic information.

b. Premium history for health insurance in Paraguayan Guaranies for the current year and last 5 years - 2015, 2014, 2013, 2012 and 2011.

The prior premium rate was divided 15% by the employee and 85% by the Embassy. This contract will divide the premium 20% and 80%, which is clearly stated in the solicitation.

Specific data on dollar amounts is not available. Regardless, coverage and premium rates are significantly different under this contract that the previous one.

c. Did the Premium history for health insurance above include the VAT? If it did then what % VAT was included in the historical health premiums?

VAT is not included under the old contract and will not be included under this contract.

d. Claims history for health insurance in a) Paraguayan Guaranies and b) number of claims (counts) for the current 2015, 2014, 2013, 2012 and 2011. Please confirm these figures include claims by Retirees & OREs.

This data is unavailable.

e. Advise if 2015 HEALTH benefit schedule is the same as the benefit schedule currently being requested under S-PA100-16-R-0001; and if not advise us on the differences.

The benefit levels and coverage is not/not the same. There are significant changes. We recommend you carefully read the current solicitation to understand the requirements.

f. 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 the number of instances for each major illness.

This data is unavailable.

g. Are there any pregnant employees/spouses. If Yes, please provide number.

This data is unavailable.

h. Are there any large claims (in excess of $10,000) within the last year to date. If Yes, please provide number.

This data is unavailable.

*****NOTHING FOLLOWS*****