Continution_to_Block_14.pdf

Continuation to Block 14

U.S. Embassy, Manama

LE Staff Health Insurance for U.S. Embassy, Manama Solicitation Number STC10016R0010

Amendment No. A002

The solicitation dated 9 September 2016 includes all revisions. Only sections clearly labeled as amended have been changed. Specific changes are noted below;

SECTIONS CHANGES

Section B. 2.3 Through B.2.7 Estimated Number of Employees changed

Section J, Appendix A: Employee Statics Updated list is included (Page No. 35) and Page numbers 36 and 37 are removed

Section B.5 Through B.8 These sections are added to maintain consistency with other USG contracts. These sections are reserved as not applicable to this contract

Section C.1.1.11 Medical Expenses Incurred Out of the Country

This section is modified to clarify “out of the Country” refers to “outside the geographical boundaries of the Kingdom of Bahrain”

STC10016R0010 MANAMA LE STAFF HEALTH INSURANCE

APPENDIX A – QUESTIONS AND ANSWERS

Questions/Comments Response

1 Please confirm the maximum annual reimbursement per patient per contract year, not including expenses covered under c.1.1.4, is BD fourteen thousand per patient.

Annual per patient maximum per contact year is BD. 3,770 for expenses covered under section C.1.1.4 plus BD. 14,000 for all other expenses.

2 Please provide census information for the employees and the head count of dependents and their age or date of birth.

Please find attached Section J, Exhibit A (page number 35) For privacy reasons, no names, nationality, national IDs, or dates of birth will be provided.

3 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 find the attached sheets, Table ‐1, Table ‐2 and Table ‐3. Single/Family coverage ratios for last 3 years are not available, but we do not anticipate that these will vary significantly from current numbers (see Exhibit A, page 35)

4 Please confirm if you have been informed of Catastrophic cases presented last year, such as: Hemodynamics, Open Heart Surgery, Orthopedic Major Surgeries, Organ Transplant, Traumatic Accident, Cancer and Oncology Cases (Radio and Chemotherapy), and hospitalizations with more than 10 days.

Table‐2 is representative of the types of services requested under the current plan.

While we are unable to provide specific information about catastrophic claims, the total amount paid out over the past 3 years do not suggest that catastrophic cases have been common.

5 Please Clarify on the number of Employees.

Please see attached, section B.2.3 (page 3), B.2.4, B.2.5 (page 4 and 5) B.2.6, B.2.7 (page 5)

6 Premium history for health insurance in BHD for the current year and last 5 years - 2016 (till now), 2015, 2014, 2013, 2012 and 2011.

Please see attached sheet, Table ‐1

7 Did the Premium history for health insurance above include the VAT? If it did then what % VAT was included in the historical health premiums?

VAT is not applicable in Bahrain

8 Advise if 2015 HEALTH benefit schedule is the same as the benefit schedule currently being requested under STC10016R0010; and if not advise us on the differences

The proposed policy does not add to or subtract from the conditions or treatments covered by our existing policy.

While coverages under the current policy are set at 90% across the board, coverage for certain treatment categories has increased from 90% to 100%.

9 Are there any persons who are currently hospitalized? If Yes, please provide number

No running list is available

10 Are there any pregnant employees/spouses.

If Yes, please provide number?

No running list is available

11 Are there any HIV/AIDs cases. If Yes, please provide number

No HIV cases reported

12 Please Provide claims history of the group as much as much as possible for 3 yrs.

Please see the attached sheets, Table‐1, Table‐2, Table‐3

13 What is the termination date of the existing policy? What is the inception date of the new/proposed policy?

The current policy is scheduled to terminate at the end of the day, October 31, 2016. The inception date of the new policy will be November 1, 2016.

14 Is the territorial limit of the policy for Kingdom of Bahrain only but worldwide on emergency cases?

Yes. Please see Sections C.1.1.11 and C.1.1.12 as amended.

15 Which page is B.7(Retention Amounts) of the attachment?

B.7 is not applicable to this solicitation, hence it is reserved. Please see page 7.

16 The claims records for each category(Claims incurred or Paid) for the past 3 years including the current year and indicate up to which treatment month the claims are settled & The Applicable Network under each category?

Please see attached list ‐ Table‐1, Table‐2 and Table‐3.

17 Claim Ratio : See attached sheets, Table‐1, 2, and 3

18 What is US Embassy’s Budget/Target Premium?

Premium history is provided in attached table ‐ 1

19 Provide Opening & Closing Population? See attached information sheet, Table ‐ 3

20 Provide the current provider list under each category.

This is the proprietary information of the current contractor, hence we are unable to share

21 Reimbursement co-payment? Unclear what is being asked.

USG will need more information to ensure the question is answer appropriately

22 Is it a compulsory or voluntary cover of the 10% for the staff as stated

Unclear what is being asked.

USG will need more information to ensure the question is answer appropriately

23 Reason for Tendering - you want to shift insurer or looking for a better service / lower premium

New solicitation after the expiry of the current contract

STC10016R0010 ‐ Manama LE Staff Health Insurance

Table ‐ 1

Policy Year Suboffice Code Paid Claims‐USD

Policy Year 2010‐11 001 $132,495

002 $2,291

Policy Year 2010‐11 Total $134,786

Policy Year 2011‐12 001 $125,666

002 $2,761

Policy Year 2011‐12 Total $128,426

Policy Year 2012‐13 001 $162,025

002 $3,822

Policy Year 2012‐13 Total $165,847

Policy Year 2013‐14 001 $176,654

002 $4,169

Policy Year 2013‐14 Total $180,823

Policy Year 2014‐15 001 $182,335

002 $4,902

Policy Year 2014‐15 Total $187,237

Policy Year 2015‐16 ‐ Nov 15 to Apr 16 001 $116,896

002 $883

Policy Year 2015‐16 ‐ Nov 15 to Apr 16 Total $117,778

Table ‐ 2

Period 1st Nov 2014 to 31st Oct 2015

Claimant No Diagnosis Description Paid Amount

USD

1 RHEUMATOID ARTHRITIS $8,936

GASTROESOPHAGAL REFLUX DISEASE (GERD/GORD) $546

DENTAL $298

POLYMYALGIA RHEUMATICA $282

HYPOCALCEMIA $279

ARTHROPATHY UNSPECIFIED SITE UNSPECIFIED $136

SORE THROAT / PHARYNGITIS ACUTE $92

FEVER $88

SPONDYLOSIS CERVICAL $73

POLYARTHRITIS $48

VAGINITIS / VULVO‐VAGINITIS / VULVITIS $47

GASTRITIS $43

NECK PAIN / CERVICALGIA $25

Total $10,894

2 RENAL CALCULUS UNSPECIFIC $4,892

KIDNEY CALCULUS $2,841

DENTAL $220

Total $7,953

3 BRONCHIECTASIS $4,736

DENTAL $531

ALLERGIC RHINITIS / RHINORRHEA / HAY FEVER $193

SINUSITIS ACUTE $132

HYPERTENSION $24

BRONCHITIS ACUTE $24

LUMBAGO / LOW BACK PAIN $12

Total $5,651

4 UTERINE LEIOMYOMA / FIBROID UTERUS $4,984

ABDOMINAL PAIN OTHER SPECIFIED SITE $79

UNSPECIFIED FOLLOW‐UP EXAMINATION $36

Total $5,098

5 CHOLELITHIASIS / GALLBLADDER STONE $2,454

BRONCHITIS ACUTE $697

DYSPEPSIA / HYPERACIDITY $468

CHOLECYSTITIS $461

GASTRIC ULCER $277

FEVER $187

UNSPECIFIED RESPIRATORY ABNORMALITY $162

VAGINITIS / VULVO‐VAGINITIS / VULVITIS $69

Total $4,775

6 CERVICAL POLYP $3,071

HEADACHE / HEAD PAIN $177

LEUKORRHEA / PER VAGINAL DISCHARGE (PVD) $145

POSTCOITAL BLEEDING $80

Total $3,472

7 C/S DELIVERY ADMISSION (MEDICALLY NECESSARY) (MATERNITY) $2,772

ANTENATAL CARE / PREGNANCY (MATERNITY) $326

OPTICAL $265

CERVICITIS / ENDOCERVICITIS $56

BRONCHIAL ASTHMA $49

Total $3,469

8 HYPERTENSION $1,283

JOINT PAIN $385

HYPERLIPIDEMIA/DISPLIPIDEMIA $365

PAIN IN LIMBS / HAND PAIN / LEG PAIN $208

PSORIASIS $199

BRONCHITIS ACUTE $198

DIABETES MELLITUS WITHOUT MENTION OF COMPLICATION TYPE II

OR UNSPECIFIED TYPE NOT STATED AS UNCONTROLLED $184

VARICOSE VEINS LEG $178

DERMATITIS (& CONTACT) / ECZEMA $108

ATOPIC DERMATITIS / ECZEMA / BESNIER'S PRURIGO /

NEURODERMATITIS $93

UNSPECIFIED TEAR FILM INSUFFICIENCY $36

DIABETES MELLITUS (DM) $36

VARICOCELE $22

VITAMIN D DEFICIENCY UNSPECIFIED / (RICKETS) $14

UNSPECIFIED INFECTION OF BONE $11

GASTROESOPHAGAL REFLUX DISEASE (GERD/GORD) $7

Total $3,327

9 RENAL COLIC $1,700

ABDOMINAL PAIN $660

UPPER RESPIRATORY INFECTION (URTI / URI) $183

GASTROENTERITIS / ENTERITIS OR COLITIS $181

URETER CALCULUS $160

CYSTITIS $149

CONSTIPATION $86

URINARY TRACT INFECTION (UTI) $64

SUPERVISION OF OTHER NORMAL PREGNANCY $40

LOWER RESPIRATORY TRACT INFECTION (LRTI) $24

OTHER SPECIFIED DISORDER OF BLADDER $8

Total $3,255

10 OVARIAN CYST $2,192

RENAL COLIC $334

HYPOTHYROIDISM ‐ ACQUIRED $256

EXCESSIVE MENSTRUATION / MENORRHAGIA $178

UTERINE INFLAMMATORY DISEASE / ENDOMETRITIS $79

PAIN IN LIMBS / HAND PAIN / LEG PAIN $41

HEADACHE / HEAD PAIN $36

ABDOMINAL PAIN $36

MASTODYNIA / MASTALGIA / BREAST PAIN $36

CONJUNCTIVITIS ACUTE $17

DENTAL $13

TEMPOROMANDIBULAR JOINT DISPLACEMENT (TMJ) $6

Total $3,223

Table ‐ 3

Policy Year Average No of Insured

Premium Paid Claims Benefit Ratio Members Dependents Total

Policy Year 2012‐13 80 147 227 $233,680 $165,847 71%

Policy Year 2013‐14 81 151 232 $262,111 $180,823 69%

Policy Year 2014‐15 91 171 262 $322,865 $187,237 58%