Qs_ _As_additional.pdf

LES Health Insurance Services – STC10014R0001

Questions & Answers:

Question: What types of information can you provide that might help us measure or anticipate the dollar amount of claims in the new year that will relate to ongoing illnesses or sickness where claims were paid in the most recent period? I've attached a sample of a regular report we provide to our clients that categorizes claims paid - can you provide something like this for the most recent period?

Answer: Claims report will be disseminated as we receive it from the current insurer.

Question: The claims report provided does not mention claims report date. Please provide claims report Generation date and claims cut-off date.

Answer: Claims report will be disseminated as we receive it from the current insurer.

Question: B.3 – Administrative Retention Amounts: Clause imposes an obligation for retention amount on XXXXX, not only when price adjustment under B.4 is requested.

You must get clarification from US Embassy.

Answer: Clarifications was issued in the SF30 address; noting the following no Economic Price address will be issued on retention; see B.4 on USG request.

Question: B.4 – Economic Price Adjustment: Once premium is fixed, the increase or decrease is based on the addition or deletion of members. It shall be the same throughout the period of the policy and only at the renewal stage, change of premium amount may be negotiated. The clause allows premium decrease that can be initiated by US Embassy and if not mutually agreed, the determination of the matter will go to the dispute resolution forum and the applicable premium will be decided by the court. If the forum decides decrease, it will come into existence. As such, the clause B.4 shall not be allowed.

Answer: USG is requesting to allow the premium flexibility to insure all employees are covered base off the U.S. Embassy current employee status during base and 4-(one) year options.

Question: Clause 1.1.18.3: Clause states that this contract of US Embassy shall take precedence. To refer to this sentence and please state that it is not acceptable. The US Embassy contract includes payment terms and conditions, other procedural formalities etc. We should state in our letter that our policy documents would prevail in the event of any conflict between the provisions of this US Embassy contract and XXXXX’s policy documents such LOA, Policy wording, SOB and Quotation. Various contradictory provisions are existing. E.g. please see C.1.8.2. which requires all medical claims shall be submitted by the employees through a drop box in the embassy’s contracting officer’s office and the claims shall be picked up by XXXXX from there each Tuesday.

Answer: This is not a clause but a need and requirement that is non-negotiable, requested by USG for vendor to propose against.

Question: Section E incorporates clauses by reference. Insurer’s performance quality assurance steps and other processes are detailed herein. To exclude the section as the processes are stated in our policy documents and the quality assurance, insurer’s capacity to practice the activity are all assured by the relevant laws of UAE especially by Insurance Authority and HAAD. Remedies for the breach of these obligations by the insurer are specified in the relevant laws. The governing law of the policy shall be that of UAE’s and the dispute resolution forum UAE courts (governing law and dispute resolution forum is already stated in our policy wording). As such, Section E is not acceptable.

Answer: This is a requirement that is being requested by the USG, on Inspection and Acceptance and not opens to negotiations.

Question: Section F- Includes provisions about period of policy, extension etc. These are covered by policy document and there should not be a contradiction with the policy.

Section is not acceptable.

Answer: Section F, is the Deliveries or performance. This request is not conditional for our requirement for services.

Question: Section G – Appointment of point of contact, internal duties of COR, submission of invoice and payment etc. Please see payment terms are different for each unit. XXXXX’s tender documents can state the payment procedures for each unit (if acceptable to XXXXX) and the section is not necessary. Contradiction with our procedures will come if the section is allowed.

Answer: This request is not conditional for our requirement, and shall not be negotiated.

Question: Section H – Contradictory clauses with our procedures and additional procedures imposed by US Embassy, which are not acceptable shall be excluded.

Answer: This request is not conditional for our requirement, and shall not be negotiated.

Question: Section I – To exclude completely. Some of the clauses are not for health insurance and others are covered by the policy documents and the relevant laws of UAE.

Further, some clauses are not acceptable to us e.g. period of availability of funds from embassy, medical liability insurance stating amounts per specialty per occurrence $96,000 etc.

Answer: This request is not conditional for our requirement and shall not be negotiated

Question: Section K – Agreeing to K .1. is acceptable. However, the rest of the part of Section K contains clauses not applicable in UAE, submission to certain US laws and penalty rate on misrepresentation etc. By agreeing to K.1., rest of Section K will become active. K4 imposes restrictions on business operations in Sudan.

Answer: This request is not conditional for our requirement and shall not be negotiated.

Question: The solicitation document mentions this is a five years contract. Please note that we will be able to quote for the base year and prepare a sensitivity analysis for the following four years where it will be illustrated as a percentage and not in figures. Please advise on this point as well.

Answer: Price proposal for the option years of both insurance programs or for any one program; however, a price proposal for an option year with no proposal for the base year will not be considered, nor will a proposal for a base period which does not include a proposal for all option periods for that same type of insurance. See Section L.

Question: Kindly provide us the Date of Birth of the members in the “list of active members: in order to prepare our quotation.

Answer: Date of Birth will not be provided.