Q A_Manila_-_OPE_(Final)_11-27-15.docx

QUESTIONS RECEIVED FROM PROSPECTIVE OFFERORS PRIOR, DURING AND AFTER THE PRE-PROPOSAL CONFERENCE

RFP No. SRP380-15-R-0011, LES Group Health Insurance Services for American Embassy Manila, Philippines

The answers provided in response to the questions submitted, 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 this data may not be indicative of future claims. There are changes to the solicitation requirements and terms and conditions from 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 the basis for a request to adjust the premium rates once the contract is awarded. Rather, offerors are advised that any adjustments to contract premium rates shall be in accordance with the Price Adjustment clause B.4.

Q1: Under B.1.1, specify what type of work do the ORE staff do?

A1: ORE staff members are the household employees of the Ambassador and the Deputy Chief of Mission. They include the cooks, butler and household helpers.

Q2: Under C.1. HEALTH INSURANCE SERVICES, is the enrollment for the dependents on a voluntary or compulsory basis?

A2: Enrollment of dependents is strictly voluntary.

Q3: Under C.1.1.3. Prescription Drugs and Medicines, how much is the maximum limit for the prescribed medicine? Does the prescribed medicine coverage include dependents?

A3: 100% coverage of medications and drugs for which a prescription is legally required. Coverage for expenses incurred is included in the Maximum Benefit Limit (MBL) of ₱300,000 per illness or injury per contract year. Employees and their dependents have the same benefits.

Q4: Under C.1.1.5. Obstetrical Care, will the Obstetrical Care will be on a reimbursement basis or thru the accredited network hospitals? Is just the employee covered or is the employee’s legal spouse also included in this benefit?

A4: The Obstetrical Care will be on a reimbursement basis for non-accredited providers/hospitals and thru accredited network hospitals. Female employees and the legal spouse of employees are included in this benefit.

Prenatal and post-natal coverage is ₱300,000 with 100% coverage while an inpatient and 90% coverage as an outpatient.

Covered limits for child birth are as follows:

Q5: Under C.1.1.9. Preventive Care, what type of APE package? How much is the maximum benefit limit of the immunization for the employees? Are the dependents covered with the APE and Immunization?

A5: There is no maximum for the preventative care, but the insurance contractor can reimburse up to a limit of ₱300,000 per illness or injury per contract year. Dependents (spouse, children and parents) also have Annual Physical Exam (APE) and immunizations coverage.

Q6: Under C.1.1.10. Dental Care, how much is the maximum benefit limit of Dental Care? Are the dependents covered under this benefit? If yes, how much is the maximum benefit limit?

A6: The dental benefit is under the maximum annual coverage, ₱300,000 per patient per illness or injury per contract year. Dependents are covered and have the same limits as the employees.

Q7: Under C.1.5 Other Eligible Participants, qualified dependents (child) what is the minimum age eligibility? (2 weeks, 1 month old) A7: There is no minimum age eligibility all qualified dependent.

Q8: Under I.2 FAR 52.216-19 Order Limitations (Oct 1995), what are these minimum and maximum numbers implying? Are they derived from the expected total contract price? What constitutes an “item” in the context of this RFP?

A8: The minimum and maximum limitations are for the protection of both the US Government and the Contractor. If the US government has a requirement for less than the minimum or more than the maximum the US government is not obligated to use this contract. Likewise, if the contractor receives an order from the US government for less than the minimum or more than the maximum then the contractor is not obligated to fulfil the requirement.

Q9: Under C.3 Disability Total-Permanent, what is the definition of Total and Permanent? Are we talking about take over benefits?

A9: A physical or mental impairment which precludes the individual from performing ordinary motor or bodily functions and which requires separation from employment. Separated employees are not covered by this contract.

Q10: Request a 3-year insurance utilization report for cost analysis statistics only. (No confidential information such as employee names is required. The Utilization/Loss History for the last three (3) years is one of the factors in premium rating. And, this is one of the requirements of all the support companies we have approached.

A10: See A12 and A17.

Q11: Employee census (preferably in an excel file) that includes age, gender, etc. See attached Excel file for your use. Date of Birth is NOT required, age is sufficient.

A11: See Section J Exhibit B Q12: Premium & claims history for health Insurance for the current year and last 5 years - 2015 (till now), 2014, 2013, 2012, 2011 and 2010. It is standard practice in the insurance industry (and in other Department of State insurance solicitations) to provide this information to ensure equal/fair opportunity for all offerors in an open solicitation.

A12:

Q13: Advise if 2014 benefit schedule for health insurance is the same as the benefit schedule currently being requested under SRP38015R0011; and if not advise us on the differences. Alternatively, you can simply provide the previous solicitation document.

A13: Due to the number of changes in the solicitation requirements and terms and conditions the information included in the previous contract is not considered relevant. Rather, each offeror needs to review the solicitation requirements to determine the firm fixed price premiums to propose for the base year and each option year.

Q14: Are any major illnesses being treated?

A14: Yes, prospective offerors are advised specific illnesses or conditions of employees and their dependents are not releasable but any claims would be included under the answer to Question 12.

Q15: Are persons not actively at work?

A15: Yes, prospective offerors are advised specific illnesses or conditions of employees and their dependents are not releasable but any claims would be included under the answer to Question 12.

Q16: Are there any pregnant employees/spouses.

A16: This type of information is not releasable.

Q17: Are there any large losses (in excess of $10,000) within the last year to date.

A17: The only information which will be released will be the premiums paid out and the claims, as set forth in A12 above.

Q18: What is the start date of coverage for the plan referenced in this solicitation?

A18: The period of performance start date will be set forth in the Notice to Proceed Letter, which will be issued after contract award. However, for planning purposes only, we anticipate contract award will occur in the first quarter of Calendar Year (CY) 2016.

Q19: Item C.1.1.15 seems to be incomplete. Please let us know the separate limit for HIV/AIDS benefit described in C.1.1.4 A19: Limit for HIV/AIDS is ₱445,000. Refer to Amendment A001.

Q20: As stated in Section L 4.3.2.2 Licensing Information, “The offeror shall include a notarized copy of the most current license/certificate/accreditation…to provide health insurance coverage to persons within the host country”, does this exclusively limit responses to this RFP solely to local insurers/underwriters?

A20: As further stated in Section L 4.3.2.2, “Failure to demonstrate that the offeror is an authorized insurance company permitted to write and administer health insurance policies in the Philippines shall be grounds for rejection of the proposal”.

Q21: Would there be any local regulations barring an International TPA from providing these services in this circumstance?

A21: Refer to Section L, paragraph L.4.3.2.2 Licensing Information.

Q22: List of Items, Schedule of Requirements, Scope of Work, Terms of Reference, Bill of Materials required.

A22: The entire solicitation can be downloaded from FedBizOpps. Also, this is health insurance solicitation so there is no bill of materials. https://www.fbo.gov/ Q23: Soft Copy of the Tender Document through email.

A23: The US Government is not mailing or emailing copies of the solicitation as you can download a copy of the entire solicitation from FedBizOpps.

Q24: Names of countries that will be eligible to participate in this tender.

A24: Refer to Section L 4.3.2.2 of the RFQ.

Q25: Information about the Tendering Procedure and Guidelines

A25: Please see the Cover Letter and Section L of the solicitation for instructions for the submission of offers.

Q26: Estimated Budget for this Purchase

A26: The estimated budget is not releasable.

Q27: Any Extension of Bidding Deadline?

A27: Refer to the RFQ Amendment A003.

Q28: Any Addendum or Pre Bid meeting Minutes?

A28: Minutes of the Meeting, written Questions and Answers, and Amendment A001 are posted on the FedBizOpps.

Q29: Please post or send us the solicitation in Microsoft word format.

A29: The US Government is not mailing or emailing copies of the solicitation as you can download a copy of the entire solicitation from FedBizOpps.

Q30: We would like to know if you have been informed of Catastrophic cases presented last year, such as: Hemodynamics, Open Heart Surgery, Orthopedic Mayor Surgeries, Organ Transplant, Traumatic Accident, Cancer and Oncology Cases (Radio and Chemotherapy), and hospitalizations with more than 10 days.

A30: Yes, prospective offerors are advised specific illnesses or conditions of employees and their dependents are not releasable but any claims would be included under the answer to question 12.

Q31: Are you aware of any employee or dependent currently hospitalized, confined at home or a treatment facility, disabled or incapacitated?

A31: Prospective offerors are advised specific illnesses or conditions of employees and their dependents are not releasable but any claims would be included under the answer to question 12.

Q32: Are any employees or dependents currently pregnant?

A32: Please see the answer for question 16.

Q33. Are you able to confirm retention amounts for single employees and family plan for current insurance year?

A33. Due to the number of changes in the solicitation requirements and terms and conditions the information included in the previous contract is not considered relevant. Rather, each offeror needs to review the solicitation requirements to determine the retention amounts to propose for the base year and each option year.

Q34. Are there any material differences in the benefits being requested now and those insured for the last 5 years? If yes, what changed, when and why?

A34. There are many changes between the current and the new contract. The changes are due to the prevailing practice in the host country.

Q35. Who is the current insurance carrier?

A35. PhilCare.

Q36. For how long has the program with the current insurance carrier been in force?

A36. The current contract is for base year plus one option year.

Q37. Are any major illnesses currently being treated? If yes, please advise number of persons together with diagnosis

A37. Please see the answer for question 14.

Q38. 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. Personal information is not required, just the overall statistics for the group. This statistical information is critical to pricing and the relationship of claims to employee growth or shrinkage is part of the claims analysis. You will appreciate that since the current insurance carrier would have access to this information we would be at a disadvantage without it.

A39. Refer to Exhibit C and A12.

Q40. Have you been informed of Catastrophic cases (such as: Hemodynamics, Open Heart Surgery, Orthopedic Mayor Surgeries, Organ Transplant, Traumatic Accident, Cancer and Oncology Cases (Radio and Chemotherapy), and hospitalizations with more than 10 days.? If yes, please advise estimated cost of each case Please detail claims where the maximum benefit allowable under expiring policy was paid?

A40. Please see the answer for question 30.

Q41. Are you aware of any employee or dependent currently hospitalized, confined at home or a treatment facility, disabled or incapacitated? If yes, please provide brief details

A41. Please see the answer for question 31.

Q42. Are any employees or dependants currently pregnant? If yes, please provide estimated number of such persons.

A42. Please see the answer for question 32.

Q43. Is it possible to have a copy of the current policy wording?

A43.. Due to the number of changes in the solicitation requirements and terms and conditions the information included in the previous contract is not considered relevant.

Q44. Has there been any change to the eligibility requirements in the last 5 years if so, what changed, when and why?

A44. The new contract has an age cap of 65 for dependent parents and 22 for dependent children. Changes are based on prevailing practice in the host country.

Q45. Are any of the persons to be covered required to carry firearms? If yes, approximately how many persons carry firearms and has the number materially changed in the last 5 years?

A45. Yes. The number of personnel that carry firearms depends on the needs of the mission.

Q46. Are any of the persons to be covered currently not actively at work? If so, approximately how many? Are any persons to be insured not actively at work at present?

A46. Only current employees are covered.

Q47. Regarding prescription medicines are receipts requests for medicines up to a certain amount particularly as the cost of medicine may vary between pharmacies?

A47. No, the final cost of medications is the basis for reimbursement.

Q48. Are professional annual check-ups to be covered or are these paid for by the embassy without involvement of the insurance company?

A48. Job related medical check-ups are performed by the Embassy’s medical clinic. Any medical condition that needs additional work-ups or referrals will be covered by the insurance carrier.

Q49. Please clarify limit for expenses to be covered under C 1.1.4 - AIDS / HIV. Are such expenses included within the P300,000 or are they in addition thereto? If so, please confirm limit?

A49. Please see the answer for question 19.

Q50. Are any implants and orthodontia (braces) to be covered under the clause C.1.1.9. Dental Care? Are they to be reimbursed at any price of any licensed clinic chosen by Insured person?

A50. False teeth, crowns and bridges are covered. Dental coverage has an MBL of 300,000 per illness per year for accredited dentists. For non-accredited dentists, the limit is 800 per year per member.

Q51. Under C.1.1.10 (Dental Care) would you please clarify? In-Network Dental benefits - is it limited to P800 per patient per contract year (like the limit for Out-of-Network Dental benefits)?

A51. The in-network limit is the same as the MBL (300,000 per illness per year).

Prepared by: Approved by: