HL_QA2_060117.docx

Health & Life Solicitation PreProposal Questions and Answers 1

QUESTIONS AND ANSWERS 2

1. Question – When is the deadline to register in www.sam.gov?

Answer – Prospective offerors are encouraged to register prior to the submittal of quotations/proposals, but are not required. Awardee vendor is required to register in www.sam.gov prior to receiving the contract award. ONLY vendors with Active SAM will be eligible for award. Therefore, if the lowest offeror is not registered, the contracting officer will award to the next otherwise successful offeror, if that offeror is registered. See attached documents to assist you in the registration.

2. Question – Please provide the loss of policy for the past two (2) years.

Answer – Please refer to question 5 from the 1st group of Q&As.

3. Question – Please provide a list of claims with their respective diagnostics for the past two (2) years.

Answer – Please refer to question 5 from the 1st group of Q&As.

4. Question – Does maternity expenses has no limits?

Answer – See section C.1.1.5 – maternity does not have maximum. Neither do have the prenatal nor postnatal care.

5. Question – Please provide the census of eligible employees with their birth dates and gender, and if they have dependents, it will be important to receive this information for their respective dependents as well.

Answer – For the census of the eligible employees, please see Exhibits A, B, C & D. See also attached report for reference.

6. Question – is the offeror expected to provide coverage for all pre-existing conditions of employees?

Answer – Yes, the US Embassy is requiring all eligible employees to be covered when the period of performance of the contract begins which is 30 days after contract award.

Each new eligible employee will be enrolled upon entering on duty with the USG.

Any employee that does not enroll within the 30 days of signing this contract or within 30 days of entering on duty with the USG can be subject to limitation of pre-existing conditions.

7. Question – Is there a close group of retirees? It is a small group of retirees.

Answer – C.1.3.3.3 list three (3) groups of retirees. The first group is closed, but there are still current employees that can be added to the 2nd or 3rd group upon reach of 67 years old. It is a small group, see attached list of current retirees and their dependents.

8. Question – Can you provide a list of the current employees’ diagnosis, employees on maternity or existing conditions?

Answer - The details of the claims are considered confidential. See attached simplified claim report as reference.

Please note that 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.

9. Question – How does the Price Adjustment clause works?

Answer – Please see Section B.4. & B.8. Premiums can be adjusted based on Experience or based on a change in Law. No adjustment will be allowed during the first twelve months. The retention amount is not subject to adjustment.

10. Question – Is the coverage local or international. It is local and international coverage just for emergency?

Answer – See Section C.1.1.12. for details of what is covered internationally.

11. Question – Is there a waiting period for new employees.

Answer – There is no waiting period for new employees. They have 30 days to enroll since the hiring date. The preexistence condition has to be accepted. (see Question 6).

12. Question – What is the age limit for a new employee to be enrolled?

Answer – New employees who have reached the age of 65 prior to entering on duty with the U.S. Government will not be eligible for life insurance coverage (C.2.4.1). In regards of medical insurance policy, unless eligible for coverage under the rider, retired employees and employees that have reached the age of 67 years are not going to be covered under the medical insurance plan (C.1.3.3.3). Upon reach of age 67 eligible employees can transfer to the retiree rider.

13. Question – Is there a minimum age for dependents?

Answer – No, dependent children are eligible since they are born.

14. Question – Is there a local in house doctor for the Embassy Employees?

Answer – No, there is no in house doctor for Embassy local staff.

15. Question – Does the Funeral benefit needs to be paid in advance?

Answer – Yes, the funeral benefit shall be paid to the beneficiary upon the death of the participant.

16. Question – Can we see the census of the retiree employees?

Answer – Please see attached census for the current retirees and their dependents.

17. Question – Section C.1.1 states that payment will be made for reasonable and customary expenses of covered benefits. In Panama each insurance company has their own table of reasonable and customary expenses. Is this okay?

Answer – The embassy will work with the awarded company to make sure this table is updated based on the local practice.

18. Question – Section C.1.1.2 calls for a $20 copay for visits to a Doctor’s office or a Specialist. Not all doctors will accept a co-payment If they are not enrolled in the insurance company network. We can only warranty that this co-payment will work with doctors enrolled in our network. What can be done for visits to doctors out of the network?

Answer – For visits to doctors out of the network, the insurer will need to pay the visit and the $20 (Not an 80%/20% co-insurance) should be deducted from the reimbursement of the claim presented.

19. Question – Section C.1.1.2 list the coverage for annual exams. Do you have a list of the annual exams?

Answer –Annual exams will include, but is not limited to: yearly physicals, bloodwork, mammograms, PSA, wellness checks, etc.

20. Question – C.1.1.1 list coverage of air transport. Is transportation for out of the country treatment covered?

Answer – Please see C.1.1.13. Transportation for out of country treatment is not a covered expense. C.1.1.1 is for local air transportation.

21. Question – Are all the employees (under Department of Justice, Department of Homeland Security, Department of Defense, etc.) administrative employees, or do any of them carries weapons?

Answer – Only the 1.20 % of employees carry weapons.

22. Question – Does the retirees covered under the rider includes only spouses as dependents?

Answer – The retirees might have spouses or children as eligible dependents (same as detailed in C.1.5).

23. Question – What is the termination age for retirees?

Answer – See section C.1.3.3.3, there are three categories for retirees, each with a different termination age.

24. Question- Section C: Health Insurance - Please describe which coverage are subject to complete a deductible:

Answer - Optical care, dental care, labs, X-Rays, physical therapy, immunizations and prescription medicines are subject to complete the deductible.

25. Question –Please confirm waiting period for maternity benefit for new employees.

Answer – There is no waiting period for maternity benefit for new employees. See Question 11.

26. Question – Please confirm waiting period for preexistent conditions for new employees.

Answer – Please refer to Question 6 & 11.

27. Question – Please confirm at what age coverage terminate for employees

Answer – New employees who have reached the age of 65 prior to entering on duty with the U.S. Government will not be eligible for life insurance coverage (C.2.4.1). If an employee is enrolled in the Life Insurance before s/he reaches the age of 65 the employee will continue with the policy as long as s/he is an employee within the US Embassy. Unless eligible for coverage under the rider, retired employees and employees that have reached the age of 67 years are not going to be covered under the medical insurance plan (C.1.3.3.3). An enrolled employee and his/her eligible and enrolled dependents may continue coverage until the end of the contract year in which the employee turns 67. Upon reach of age 67 eligible employees and his/her dependents can transfer to the retiree rider.

28. Question – In life coverage: age limit to enter in the life insurance coverage for new employees is the same age of termination of 65?

Answer – Please refer to Question 27.

29. Question – Health: age limit to enter to the health insurance coverage for new employees and termination age is the same 67 years?

Answer – Please refer to Question 27.

30. Question – Please clarify the eligibility for health insurance for LE Staff from “65 to 80”; in our meeting yesterday was confirmed at 67 as age for coverage termination.

Answer – As mentioned in the meeting this is a closed group. So the benefit was left as it was. Only the current enrolled retirees on this group can participate in this group.

31. Question – Eligibility for question #29& #30 applies the same for dependent spouse?

Answer – An enrolled employee and his/her eligible and enrolled dependents may continue health insurance coverage until the end of the contract year in which the employee turns 67. Upon reach of age 67 eligible employees and his/her dependents can transfer to the retiree rider.

32. Question – Eligibility for new born is 0 days?

Answer – Yes, see question 13.

33. Question – The funeral advance benefit will be reduced from the life benefit of the employee?

Answer – Yes, funeral advance will be deducted from life benefit.

34. Question – The insured amounts detailed in the exhibit A are the annual salaries or monthly salaries? Awards will be part of the life coverage?

Answer – The amount listed in the Exhibit A is the annual salary.

35. Question – Listed benefits without limits as the optical, room and board, preventive checkups, intensive care unit. Could we apply a limit and cover 100% up to that limit according to market reasonable costs?

Answer – Section M.5. (a): “The Government may reject, as technically, unacceptable proposals that:

36. Question – Understood the coverage is Local and will apply International only if an emergency occur. Please confirm?

Answer – Yes, please refer to Section C.1.1.12 which explains what conditions are considered emergency.

37. Question – Please confirm if outpatient visits to specialists applies with $20.00 copayment or if a co-insurance of 80%-20% must be apply?

Answer – Please refer to Question 18.

38. Question – No stop loss?

Answer – No, the solicitation does not include stop loss.

39. Question – Total disability: At what age should terminate this coverage? The standard age is 60 years old paid in 60 monthly payments. Please confirm if standard will be kept?

Answer – New employees who have reached the age of 65 prior to entering on duty with the U.S. Government will not be eligible for life insurance coverage (C.2.4.1). If an employee is enrolled in the Life Insurance before s/he reaches the age of 65 the employee will continue with the policy as long as s/he is an employee within the US Embassy.

40. Question – Exclusions for health insurance: only apply the listed in page 15?

Answer – Yes

41. Question – Exclusions for life insurance only apply the listed in page 22?

Answer – Yes

42. Question – We understand the information in B.2.3 a B.2.7 are annual projections and should be apply to current year and if this projection is under what is projected we can address to the projection clause?

Answer – Tables from B.2.3 through B.2.7 includes the estimated number of employees that can enroll in the insurance plan. This plan is not mandatory for all employees. The rates provided here are firm fixed and shall not be changed. The only price adjustment possible is B.4. Refer to question 9.

43. Question – Additionally to 3 components in B.4.1 instead of claims paid should be incurred claims which include: paid claims, variation in pending claims and variation in claims reserve?

Answer – No, this clause allows for a price adjustment based on experience, therefore a balance sheet needs to be provided showing three main components for the time period: (1) receipts (premiums received) minus the retention amount, (2) number of insurance plans and (3) claims paid.

44. Question – If we, as Insurance Company participate in the bid with a proposal with a retention that not include a broker commission, and a broker ask Insurance Company a proposal, can this company participate with two SF33, one with the direct proposal with no broker and one with the broker proposal?

Answer – An Insurance company must submit one proposal as opposed to be represented by one or various brokers, with different pricing from which we must choose.

45. Question – Please explain L.4.2 .B page 60

Answer – The volume 2 shall include the price proposal for all option years B.2.4 – B.2.7 for health and B.6.2 – B.6.6 for life, as well as the price for the Base Year.

If only part of the prices is provided, the proposal will not be considered.

46. Question - Requested benefits in this bid are actual benefits for the employees and retired?

Answer – Benefits for employees are listed in section C.1.1. and benefits for the retired employees under the rider are listed in C.1.3.3.3.

47. Question - Can you provide the diagnostic report to discard any catastrophic condition?

Answer – See question 8 & question 6.

48. Question - You can send us the census by categories (insured, insured and 1 dependent or insured and family)?

Answer – There are only two plans, single employee and Family Plan.

49. Question - What would be the required nominal sum?

Answer – The overall aggregate limit for the Health Insurance is USD 240,000 per covered individual per contract year (C.1.1.1.4)

50. Question - Who pay the Premium of the retired employees?

Answer – See section G.4.6. Retired employees payment will be made through the Credit Union (Cooperativa de Ahorro y Crédito Empleados de USAID Panama, R.L.) disbursement. In case is of a payment issue the Insurance Company needs to get in contact with the COR and then the COR will notify them about it.

51. Question - Who would be the dependents of the retired employees?

Answer – See question 22.

52. Question - Are Justice, National Security, or Defense departments only administrative or do employees use guns?

Answer – See question 21.

53. Question – Please clarify this doubt about the benefit for the retirees:

Normally, when the room has a limit of days like here, we cover 100% until day limit and then if the person stays more time, those days are covered at an 80%. This same applies to the Intensive Care unit rooms.

Please confirm what does it means the benefit described above; do we have to cover the room up to $100.00 at the 80% per day up to 35 days and what happens if they need to stay more than 35 days? They no longer have coverage? Same for the intensive care unit?

Answer – Yes, the coverage will be the room up to $100.00 at 80% per day up to 35 days, if the retiree or s/he’s dependent stays more than 35 days the cost will be assume by the retiree/dependent. Same applies for the intensive care unit.