Version_2_Q As_solicitation_SSP50015R0001.docx

QUESTIONS AND ANSWERS

SOLICITATION S-SP500-15-R-0001 – Health Insurance Services.

1. Do we have to submit the proposal in a pen-drive or any other digital format?

Proposals must be submitted as stated in Section L of the solicitation.

2. What will be the Frequency of payments? Monthly, bi-annually, annually?

See Section G.4.2. of the solicitation.

3. Does the Embassy want health insurance coverage for casual workers?

Eligible participants are listed in Section C.1.3. of the solicitation

4. Does the proposal to explicitly meet the requirements set forth in the solicitation?

Yes. Proposals must meet all requirements set forth in the solicitation.

5. Is insurance to be provided in-country?

Health Insurance services are to be provided in accordance with Section C of the solicitation.

6. What data do you consider important to select your health Insurance company?

Award will be made as stated in Section M.3 of the solicitation.

7. Why would you not accept the proposal of the insurance company?

Proposals that do not meet selection criteria set forth in Section M will be rejected.

8. Do we have to show the premium that will be apply year by year (base year of contract, Option year 1 of contract), or specifying the premium for year 1 and a renewal clause matrix will work?

As stated in Section L.4.2. (b). Proposals must include prices for base year and for all four option periods for health Insurance program. This change is included in Amendment 1.

9. Will the policy be paid by the US Embassy for both the employee and dependents? Is the US embassy going to fund the 100% of the cost for both employees and dependents? Could you provide how many dependents would be included in the policy: spouse, spouse + son /s, etc.?

As stated in section G.4.3. The U.S. Embassy shall make payments to the contractor for all employees, whether or not the employee is contributing to the premium amount.The employee’s share of the premium will be collected in form of payroll deductions.

Eligible Dependents are included in Section C 1.5. Other Eligible Participants.

10. Could you specify a little bit more about the product (plan) would you like us to quote for the RFP? Reimbursement to an annual limit of € 150,000 and a 100% reimbursement per insured or family unit?

The proposal should include a Network plan with free choice from list of participating health care professionals, the policy holder will receive services and care at no additional cost per service other than the monthly premium payments established in the contract with Reimbursement up to €150,000.00 per year per family as stated in Section C.1.1.10.

11. We understand that the data given in the table in Appendix A (Section J) are all Embassy employees and their dependents who have the insurance is it right? On the other hand, what the table in Annex B ("ORE employees rider") means?

All employees and family members presently receiving supplemental Health Insurance services are included in Appendix A (Section J). Since this will be an indefinite delivery indefinite quantity type contract, Quantities provided are estimates only and may vary.

ORE stands for Official Residence Expenses. ORE employees work at Ambassador and Deputy Chief of Mission residences. These employees will be covered under a rider. This definition is included in Amendment 1. (Section C.3.0.)

12. Where are all Embassy employees and their dependents geographically located? Is everyone in Madrid?

U.S. Mission Spain has employees in Madrid, Barcelona, Sevilla, Palma de Mallorca, Las Palmas de Gran Canaria, Fuengirola (Málaga), and Valencia.

13. Regarding the Dental coverage, could you specify the product expected to be quoted? Do you need a network product with some deductibles and discounts for the rest of treatments or a reimbursement product with a % of reimbursement at any specialist?

The Embassy is looking for a network product including services listed under Section C.1.1.6.

14. It is noted in the RFP that the invoices have to be send in physical format, by regular mail. Is this the only option? Might be sent by e-mail, BMS, etc.?

Invoices can be submitted by e-mail. This change has been included in amendment 1.

15. It is noted in the RFP that refunds to policyholders must be made by nominative check. Is this point mandatory? Could the refunds be made directly to the account provided by the customer when a claim occurs and therefore a refund applies?

Refunds via electronic funds transfer to the claimant are acceptable. This change has been included in Amendment 1.

16. Do we have to inform you of all contracts we have achieved over the past three years, or just those related to Embassies, Government Institutions, State Associations, etc.? Is it absolutely necessary to present all the information indicated in the RFP, regarding these contracts?

As stated in Section L.4.3.2.1. Offerors need to list contracts and subcontracts over the past three years for the same or similar works. It is necessary to include all the information indicated in the RFP.

17. 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.

Total value of existing contract at time of award (Base period plus four option years) was 1,239,558.84 euros.

18. 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.

The existing contractor has been informed of the following claims last year:

· VERTEBRAL FUSIONS IN CIRCUNFERENCE WAY

· HIP ARTHROPLASTIA WITH PROTHESIS

· VERTEBRAL COMPRESSION TREATMENT: CIFOPLASTIA

· VITRECTOMY

· APENDICECTOMY

· SYNOVECTOMY (HIP, KNEE, SHOULDER)

· RETROAURICULAR TYMPANIC SURGERY

· INGUINAL HERNIA AND/OR FEMORAL, BILATERAL

19. What is the name of the insurance company that currently provides coverage?

The name of current contractor is Sanitas, S.A. Seguros.

20. Please provide employee census information for both males and females including number of employees in an age range such as Under 20, 20-29, 30-39, 40-49, 50-59, 60-64, 65 to 69.

Statistics are provided in Annex 1 - Section J

21. Please provide dependent census information for both males and females including number of dependents in an age range such as 0-3, 4-9, 10-14, 15-19, 20-29, 30-39, 40-49, 50-59.

Statistics are provided in Annex 1 - Section J

22. Is there a preferred list of Hospitals, Clinics or other Medical Facilities that the Embassy employees prefer?

a. If yes, please provide a list of these facilities

As stated in Section L.4.3.1. offerors shall demonstrate that medical facilities and medical personnel will provide insurance and services required in the solicitation.

23. Section L.4.3.2.2 titled Licensing Information requires the insurance company to be locally admitted. In certain countries where we provide the employee benefits in U.S. Embassies for the local employees we issue the policies from our captive insurance company which is not admitted in those countries. In those cases the U.S. embassy has waived the requirement to be locally admitted. In other cases where we cannot get an exemption from the locally admitted requirement we partner with a company that is locally admitted. Would the U.S. Embassy in Madrid consider granting us an exclusion from the requirement to be locally admitted?

Licensing Information shall be the one provided under Section L.4.3.2.2. The Government will not consider waiving this requirement.

24. Confirm that the contract is regulated under Spanish jurisdiction.

Contract is regulated by U.S. jurisdiction. Contractors shall meet Licensing requirements in Spain stated in Section L.4.3.2.2.

25. Are the insured entitled to Social Security in Spain?

All local employees are entitled to Spanish Social Security.

26. How customary and reasonable expenses shall be defined?

Definition for this is found in Section C.3.0 – Definitions.

27. Is pharmacy under coverage?

This is stated in C.1.2.

28. Confirm that they only have travel assistance for emergencies.

Medical expenses Incurred out of country are described in Section C.1.1.8.

29. It is indicated that expenses abroad will be provided in cases where a physician certifies in advance that the treatment is medically necessary and not available "locally". Does that mean that an insurer can travel to receive a treatment that doesn’t exist in Spain?

See Section C.1.1.8. Expenses incurred Out of Country.

30. Origin of the insured. Are they Spanish?

Embassy local employees are from different nationalities.

31. In the case of pensioners, how do we know that they are going to live in Spain once they retire?

The Embassy has no control on where employees will be living after retirement, however, as stated in Section C.1 services are to be provided in Spain.

32. It is explained that Psychiatric treatment is covered to 50 days - Are calendar days or sessions?

Section C.1.1.7 states: “100% coverage of expenses for psychiatric treatment for up to 50 days”.

33. Is there a grace period to provide all services.

There will be no grace period for receipt of any services for holders of this group policy. This has been included in Amendment 1.

34. Do we have to provide a list of network facilities as part of our technical proposal?

Offerors shall submit a list of its network physicians/nurses and medical facilities as part of their technical proposal. This has been included in Amendment 1.