Qs_ _As.pdf

LES Health Insurance Services – STC10014R0001

Questions & Answers:

Question: Is it possible to provide your employees’ detail?

Answer: Employee details using the attached excel format will only be provided once the contract is awarded and enrollments are requested.

Question: Can you provide your Claims Report duly stamped by the current insurer together with the Schedule of Benefits? That is, if your medical insurance scheme is presently insured.

Answer: Data on individual employees and detailed claims report will not be shared with the offerors; however, a general claims summary report will be shared once it is received from the present insurance company.

Question: What are the details of your current insurer, policy effective and expiry date?

Answer: Current Insurer: MetLife ALICO. Current policy effective date: July 1, 2009. Current Policy expiry date: December 31, 2014.

Question: Kindly confirm if the requested benefits are the same as the existing benefits with the current insurer. If not, kindly provide us their current Schedule of Benefits.

Answer: The requested benefits are changed from the existing benefits. A copy of the existing benefits is attached.

Question: Can you provide the current network list or list of major hospitals covered in the UAE?

Answer: Current network list can be obtained from insurer website.

Question: Can you provide the Opening and Closing Population/Membership count of the Policy for the year 2012-13 & 2013-2014?

Answer:

2012 - 2013

No. of Employees Abu Dhabi Male 105

Female 39

Married 131

Single 13

No. of Spouses Abu Dhabi Male 15

Female 82

No. of Children Abu Dhabi Male 73

Female 91

No. of Employees Dubai Male 52

Female 31

Married 71

Single 12

No. of Spouses Dubai Male 14

Female 40

No. of Children Dubai Male 47

Female 31

Total Insured Members 620

2013 - 2014

No. of Employees Abu Dhabi Male 116

Female 42

Married 139

Single 19

No. of Spouses Abu Dhabi Male 18

Female 84

No. of Children Abu Dhabi Male 77

Female 91

No. of Employees Dubai Male 59

Female 36

Married 80

Single 15

No. of Spouses Dubai Male 15

Female 46

No. of Children Dubai Male 55

Female 36

Total Insured Members 674

Question: Can you provide the current detailed membership list in Excel sheet with Gender, Date of birth, Designation, marital status, relationship?

Answer: An excel worksheet has already been provided that includes above requested information.

Question: Please provide details of the Territorial Coverage required.

Answer: Per Section C.1.1.12., the coverage is limited to UAE however, medical expenses incurred out of country will only be covered for employees and dependents when (a) a life threatening condition occurs when the individual is out of the country and treatment is medically necessary before the individual returns home or (b) the individual’s attending physician certifies in advance that such treatment is medically necessary and unavailable locally. Reimbursement will be made at the same percentage rate and subject to the same annual maximum limit as for expenses incurred in country.

Question: Kindly confirm Non Network coverage, whether it’s on Actual or Reasonable and Customary Charge.

Answer: For non-network coverage, the payment needs to be made for reasonable and customary expenses of covered benefits. However, discounted/contractual rate are not applicable.

Question: Annual Limit mentioned was 2.9M per Family; however we can only quote annual limit per member. Kindly confirm if the 2.9M Annual limit per member is to be applied.

Answer: The annual limit of AED 2.9M per family per contact year will apply. In case of single employee the limit remains the same.

Question: As per the RFP C.1.1.2 Deductible should be none; While as per C.1.1.3 Co-payment is AED 50 for each consultation. Please clarify what the overall deductible is?

Answer: There is no deductible however; a co-payment of AED 50 on outpatient doctor’s consultation applies.

Question: Kindly provide count of UAE nationals in the given Membership for Health Insurance 2014-15. Also clarify how many UAE nationals are under Thiqa plans (Thiqa 1, Thiqa 2, Thiqa 3 & Thiqa 4). This is required to avoid duplication of benefits and to be in line with the regulations in the Emirate of Abu Dhabi.

Answer: There are no UAE national employees and dependents in Abu Dhabi. However, there are two dependent children in Dubai who have UAE nationality.

Question: Can you please provide the solicitation documents in word format with employees’ details in excel sheet?

Answer: Attached is the solicitation document in word format. However, the offerors have to acknowledge the receipt in writing.

Question: Please advise if Group Life Insurance is a part of Health Insurance or a separate cover.

Answer: No, Group Life Insurance is not a part of health insurance plan.

Question: Who can determine “life threatening conditions”?

Answer: Insurance Companies have expertise to determine whether a case is life threatening when a claim is submitted.

Question: What is covered out of country?

Answer: Per Section C.1.1.12., medical expenses incurred out of country will be covered for employees and dependents when (a) a life threatening condition occurs when the individual is out of the country and treatment is medically necessary before the individual returns home or (b) the individual’s attending physician certifies in advance that such treatment is medically necessary and unavailable locally.

Question: How can an insurance company provide a claims report of employees as this is confidential?

Answer: The awardee does not need to provide a “comprehensive report” to include employees’ personal data/medical information.

Question: How will an insurance company comply with Dubai Health Authority for our employees who work in US Consulate Dubai pertaining to documentation as we have had few issues in the past?

Answer: As long as the employees have Emirates ID cards, that should not be a problem.

Question: Do you want to separate the employees from US Consulate Dubai and US Embassy Abu Dhabi while reporting?

Answer: Yes, the employees from US Consulate Dubai have to be shown separate while reporting.

Question: Where do the Consulate employees reside and work?

Answer: US Consulate employees reside and work in Dubai. However, the employees travel/visit Abu Dhabi for official business and may obtain healthcare facilities from Abu Dhabi.

Question: Per the solicitation document, dental is 100% covered. So, what is the annual limit as it’s mentioned in the document that maximum of 7,190.00 AED per patient per year?

Answer: Per Section C.1.1.10., 100% coverage of expenses for dental services including dentists' fees, x-rays, examination and treatment, cleaning, fillings, extractions, false teeth, crowns, and bridges. However, the orthodontic treatment is covered up to AED 7,190 per patient per year.

Question: What is Part II – Life Insurance?

Answer: US Government has contracting models in which there might be “life insurance” program is solicited as well. But, this solicitation does not cover life insurance of the USG Employees.

Question: Can the Embassy provide soft copy of the solicitation document and the exhibits?

Answer: Yes, the Embassy will disseminate the solicitation document. The offerors have to acknowledge the receipt of the same electronically.

Question: Is there currently TPA (Third Party Administrator) for claims processing and administration services?

Answer: No.

Question: Will the soft copy of the solicitation document include a separate list of employees of US Consulate Dubai?

Answer: Yes, the employee statistics will be in excel format where the prospective offerors can filter and see the employees Abu Dhabi Vs Dubai.

Question: Do we have to provide the pricing in “Bi-weekly” format?

Answer: Yes, the pricing has to be submitted per the solicitation requirement.

Question: Can you confirm where is contract to be signed?

Answer: U.S. Embassy Abu Dhabi, United Arab Emirates.

Question: What is the contract start date?

Answer: The estimated start date for this requirement will be on or around January 1, 2015.

Question: What are the reasons for going to tender?

Answer: To remain compliant on USG Federal Acquisition Regulation for full and open competition.

Question: Can you clarify the required pricing structure? As per RFP (page 3) there are 4 option years of contract with bi-weekly rates per category. Is our assumption correct that we are expected to quote for a 4 year agreement?

Answer: Offerors should quote for one base year with four option years, total for 5 years.

Question: Are we expected to provide rates on a bi-weekly rate per category? The payment frequency is bi-yearly (as per page 21) so would we actually need to include bi-weekly rates per category? Please clarify this point.

Answer: Yes, the rates have to be provided on a bi-weekly rate per category.

Question: Quote currency selected is AED but unfortunately we will not be able to submit our quote in this currency. Please confirm if we can submit our quotation in USD instead.

Answer: Per the solicitation requirement, offer currency has to be in AED.

Question: On page 57 or RFP it reads: ‘Offerors are urged to submit written questions at least 3 days before the scheduled pre-proposal conference date…’. Can you confirm when the scheduled pre-proposal conference date is?

Answer: Per the solicitation document (Section L.8.), the conference has been scheduled on September 18, 2014 at the U.S. Embassy Abu Dhabi at 10:00 am.

Question: Details of Current Insurer, Policy Effective and Expiry Date.

Answer: American Life Insurance Company, Policy Effective Date: July 1, 2009. Expiry Date: December 31, 2014.

Question: What is the name of the insurance company that currently provides coverage?

Answer: American Life Insurance Company (ALICO)

Question: Kindly clarify if the options of year of the contract mean that XXXXX has to quote premium for 5 years. It says on pg 52 of the RFP that a proposal for a base period which does not include a proposal for all option period for that same type of insurance will not be considered. Does this mean XXXXX will be disqualified if a 5 year premium is not submitted? Please confirm.

Answer: Yes, offeror has to be submit their offer for a base year with four one year option periods; totaling for 5 years. Per Section B Pricing and Section M, offers not meeting this pricing requirement will be considered technically unacceptable.

Question: On page # 3, fixed rates for four additional years must be specified. However on page # 5, reference is made to adjustable rates based on the performance of the policy. Kindly obtain a clarification from the client as this is a very important point – our practice for long-term agreements is to base rates on the performance of the policy rather than provided upfront fixed rates.

Answer: The premium rates must be provided for a base year and four option years. As indicated in the solicitation, Section B.4.1., “For health insurance, prices may be adjusted upward or downward based on the experience rating of the Mission(s) covered by this contract. No adjustment will be allowed during the first twelve months. After such time, the contractor or the Government may request an adjustment in premiums on an annual basis. Before any such adjustment is made, the contractor agrees to provide the Government a balance sheet showing two main components for the time period: (1) receipts (premiums received) minus the retention amount and (2) claims paid. The retention amount is not subject to adjustment”.

Question: Contract to be awarded for five years. What if “HAAD” decides to change policy working in between the contract?

Answer: If the Health Authority of Abu Dhabi (HAAD) makes changes to the policy, this contract will be modified to reflect such changes in accordance with the Local Laws and USG guidance.

Question: Annual limit of AED 2.9 million. Is it per member of per family? What if a member does not meet minimum HAAD requirement?

Answer: The annual maximum limit has been changed to AED 400,000 per individual per contract year.

Question: We need the official loss ratio from the current insurer.

Answer: Copy attached.

Question: We need the census list in excel sheet format.

Answer: List of insured members is attached.

Question: The current table of benefits.

Answer: Copy attached.

Question: What are the major hospitals in the current network or what is the network type?

Answer: The current network type is “Executive” and a list of health care provider network can be obtained from insurer website.

Question: What is the contract start date?

Answer: The estimated start date for this requirement will be on or around January 1, 2015.

Question: Are the members self-insured? Who are they currently insured with?

Answer: This is a “fully insured plan” funded by the Embassy and members are not allowed to self-insure. Insurance coverage is currently being provided through MetLife

ALICO.

Question: We acknowledge that the RFP details the set of benefits required, however is there any proposed Table of benefits available?

Answer: Copy attached.

Question: Do members have any optional elements in current plan design?

Answer: No.

Question: Is there any target premium?

Answer: Target Premium will not be provided.

Question: Can you clarify the required pricing structure? As per RFP (page 3) there are 4 option years of contract with bi-weekly rates per category.

Answer: The contract is for a period of 5 years (1 Base year plus 4 (1 year) option years).

Question: Is our assumption correct that we are expected to quote for a 4 year agreement?

Answer: No, the proposals are required for a total of five years (1 Base year plus 4 (1 year) option years).

Question: Are we expected to provide rates on a bi-weekly rate per category? Yes. The payment frequency is bi-yearly (as per page 21) so would we actually need to include bi-weekly rates per category? Please clarify this point.

Answer: The premium payment frequency is bi-annual however, biweekly rates need to be quoted (annual rate divided by 26 will give biweekly rate).

Question: I understand the 4 categories will have the same Table of Benefits, correct?

Answer: Yes, that is correct. The benefits plan applies across the board to all categories of employees.

Question: Quote currency selected is AED but unfortunately we will not be able to submit our quote in this currency. Please confirm if we can submit our quotation in USD instead.

Answer: The quote currency needs to be in AED (Dirhams) as payment shall be made in local currency.

Question: On Page 21 of RFP they mention that ‘the contracting officer will issue a task order as soon as possible after contract award to identity all employees to be covered…’ Can you confirm what exactly a task order is? Will this be a sort of a membership list including members’ details?

Answer: Per the solicitation document, Section G.4.2., “The Contracting Officer will issue a task order as soon as possible after contract award to identify all employees to be covered by the insurance described in this contract and the coverage selected by each employee, including eligible dependents to be covered”. The COR will make subsequent additions or deletions to this list in writing and provide the revised list to the Contractor.

If any changes have been made to the coverage listing, the Contracting Officer anticipates issuance of a new task order on quarterly basis.

Question: Can you please provide 3 years claims data + 3 years high claims data?

Answer: Detailed claims data is not available however, claims summary report with premiums, IBNR and Loss Ratio is attached.

Question: In membership list there is a ‘Post’ field. Is our understanding correct that this field shows the members’ residence countries? If not, please provide members’ residence countries.

Answer: Employees’ official work station is referred as “Post”.

Question: In membership list there is no breakdown of region of cover selected. Can you confirm region of cover selected for all the members?

Answer: The coverage is limited to UAE however, medical expenses incurred out of country will only be covered for employees and dependents when (a) a life threatening condition occurs when the individual is out of the country and treatment is medically necessary before the individual returns home or (b) the individual’s attending physician certifies in advance that such treatment is medically necessary and unavailable locally. Reimbursement will be made at the same percentage rate and subject to the same annual maximum limit as for expenses incurred in country.

Question: Please provide three year loss data by year of account including three years net premium, incurred claim 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.

Answer: Copy of claims summary report showing loss ratio and premiums paid is attached.

Question: What is the name of the insurance company that currently provides coverage?

Answer: MetLife ALICO.

Question: What are the current rates charged for each line of coverage?

Answer: The current rates charge for each line coverage is not available to the public.

Question: 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.

Answer: No Catastrophic cases of data is available.

Question: We would like to have your confirmation on certain points related to the Schedule of Benefits (SoB). The below new added benefits were not previously covered in your current policy; however, all the other benefits listed in the SoB aside from the below are covered in your current plan. Pleases confirm.

- Hearing Aids

- Dental coverage

- Medical expenses Incurred out of country Answer: Attached herewith a copy of existing table of benefits for comparison. The benefits that are currently not included in our existing plan and are being added under the new contract are:

- Hearing Aids

- Dental Care

- Optical Care (while 100% coverage for eye examinations, prescribed medicines, tests are included in our existing contract, these benefits level will be reduced to 50% in the new contract and coverage for prescription eyeglass or contact lenses up to a maximum of 832 AED a year per patient is being added).

- Co-pay of AED 50 on outpatient doctor’s consultation applies.

The benefits that are being deleted from our existing benefits plans are:

- Medical benefits incurred outside the country (UAE) – (conditions apply, please refer to new benefits schedule)

- Co-Insurance of 20% on all prescribed medicines for outpatient treatment.

- Coverage for Family Planning.

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

Answer: As noted under Section B.3, Retention is not subject to adjustment. This is for the base and options. See the following on the original contract module noting the following. (FYI).

o No adjustment will be allowed during the first twelve months. After such time, the Contractor or the Government may request an adjustment in premiums on an annual basis. Adjustments are not retroactive to previous contract terms. Before any such adjustment is made, the Contractor agrees to provide the Government a balance sheet 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. This information shall be provided per type of premium, ie per line item. The retention amount is not subject to adjustment.