Health-14-QA.docx

(ATTACHMENT 2)

The Questions and Answers (Qs&As) for the Health solicitation No. STH200-14-R-0002 Note to Offerors:

The information contained within these questions and answers is provided for information purposes and under no circumstances shall it be construed to change any terms and conditions or requirements within the solicitation. If any answer does address a change in the solicitation, it will reference an Amendment. In addition, for any answer provided regarding the claims data incurred under the existing contract, please be advised that this data may not be indicative of future claims and could change.

Also, offerors are advised that there are changes in requirements in this solicitation which were not in 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 basis for a request to adjust the premium rates once the contract is awarded. Rather, offerors are advised any adjustments to contract premium rates shall be in accordance with the Price Adjustment clause B.4 of the contract awarded.

Question #1: Please provide Exhibit A and Exhibit B (see below) for each of the past 5 years.

Exhibit A – EMPLOYEE/DEPENDENT STATISTICS & Exhibit B - ORE EMPLOYEES RIDER, EMPLOYEE ASSOCIATION EMPLOYEE RIDER, FSN COMMUNITY RIDER AND PEACE CORPS CONTRACTOR RIDER Answer #1: The embassy has provided Exhibit A-Employee/Dependent statistics and Exhibit B-Riders on page 43 and 44, which represent the number of participates under the employees and dependents under the current contract and ORE. No further information is going to be provided.

Question #2: What are the current rates?

Answer #2: Based on the number of changes in requirements under this solicitation, the government does not believe this information is relevant.

Question #3: Who is the current insurer?

Answer #3: Bupa Health Insurance (Thailand) Public Company Limited.

Question #4: Can we have a copy of the current policy wording?

Answer #4: See Answer #2

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

Answer #5: No

Question #6: Are there any material differences in the benefits requested and those insured for the last 5 years? If yes – what changed, when and why?

Answer #6: No

Question #7: Can we have the claims experience by contract year for each of the last 5 years preferably detailing each claim (but excluding claimants personal information)?

Answer #7:

Again, Offerors need to refer to the Note to Offerors which appears before any of the questions and answers.

Question #8: A. if you can only provide summary information by year AND if there has been any increase in benefit limits or any increase has now been requested – please detail claims where the previous maximum benefit was paid.

Answer #8: The benefits levels under the current contract did not change for the claims information provided in Answer # 7. Again, Offerors need to refer to the Note to Offerors which appears before any of the questions and answers.

Question #9: B. When providing the claims experience please confirm that this is pure claims excluding any administrative retention amounts.

Answer #9: Answer # 7 is the claims experience and does not include any administrative retention amounts.

Question #10: Please advise whether are any of the persons covered required to carry firearms and if so, approximately how many, and has the number materially changed in the last 5 years?

Answer #10: None of the persons covered required to carry firearms.

Question #11: The effective date of Group Life Insurance policy.

Answer #11: This solicitation is to provide the Health Insurance services. The anticipated date for the new contract would be on November 1, 2014.

Question #12:Report claim separate by IPD / OPD / dental / HIV in past 2 years .

(November 2012 – 2013 and November 2013 – present) Answer #12: See answer #7.

Question #13: Number of claim separate by using medical card and non medical card.

(November 2012 – 2013 and November 2013 – present) The Health Insurance exclusion. See page 9-13 for not covered benefits.

Answer #13: Due to the number of changes in requirements, this information is not considered relevant.

See answer #7.

Question #14: Is the premium rate for spouse equal to the premium rate for employee? (per person) Answer #14: It is the responsibility of each offeror to determine proposed prices of employee and dependent (legal spouse and child).

Question #15: Can you provide the guideline for premium rate adjustment in the renewal year (compare with the loss ratio)?

Answer #15: No. Any adjustments to the premium rates for health insurance will be in accordance with B. 4. Economic Price Adjustment Health Insurance Premiums.

Question #16The number of single employees.

The number of family (married employees) separate by

Answer #16: The embassy has provided Exhibit A- Employee/Dependent statistics and Exhibit B- Riders on page 43 and 44, and no further information is going to be provided.

Question #17: The period of “pre existing” condition.

Answer #17: There is no pre existing condition.

Question #18: The period of “waiting period” condition.

Answer #18: There is no waiting period condition.

Question #19: Emergency room treatment (C.1.1.17) : Is this item cover only the cost of emergency room or it covers for all cost of treatment ( Ex: medicine , doctor fees ) Answer #19: it covers for all cost of emergency room treatment up to a maximum limit of 9,000 Baht per incident.

Question #20: Is the premium adjustment in each renewal year will exactly equal to the claim paid from the past year?

Answer #20: No. Prices may be adjusted upward or downward based on the experience rating of the Mission (s) covered by this contract and any request for adjustment shall be in accordance with B.4. Economic Price Adjustment-Health Insurance Premiums for more detailed information.

Question #21: Or the renewal premium can be set above the claim paid (as insurer anticipate)?

Example :

first year premium = 10 million + 2 million (fix admin cost) , first year claim = 11 million Second year premium must be 11 million + 2 million or can be higher than 11 million + 2 million Answer #21: See answer # 20

Question #22: Can the embassy provide claim experience for 3 consecutive years?

Answer #22: See answer # 7

Question #23: How the claim payment can be paid? Only by check in the name of employee or can transfer to employees’ bank account?

Answer #23: The claim payment can be paid either by check in the name of employee or transfer to employees’ bank account.

Question #24: Premium payment can be paid in Thai baht?

Answer #24: See page 7, Offers and Payments. If a contractor meets the definition of a U.S. firm, it may submit its price in US dollars for the life of the contract or it may submit its prices in local currency and be paid in local currency for the life of the contract, regardless of any currency exchange rate fluctuations.

Question #25: What is the maximum for prescription drug?

Answer #25: There is no maximum for prescription drug. However, The insurance company will cover expenses up to a limit of 2,000,000 baht per patient per contract year. Expenses incurred under section C.1.1.4.2. are subject to a separate annual maximum limit of USD 10,000 per employee.

Question #26: Does the maternity benefit cover for miscarriage?

Answer #26: Yes, it does.

Question #27: 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.

Answer #27: No loss data will be provided but offerors can refer to the claims information provided in answer # 7. The embassy has provided Exhibit A- Employee/Dependent statistics and Exhibit B- Riders on page 43 and 44, and no further information is going to be provided.

Question# 28: What is the name of the insurance company that currently provides coverage?

Answer #28: See answer # 3

Question# 29: What are the current rates charges for each line of coverage?

Answer #29: See Answer #2

Question #30: Please include the quantity of males and females in the schedule you have provided in Section J, Exhibit A.

Answer #30: The total number of males is 1,320 and the total number of females is 952. .

Question #31: 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.

Answer #31: No.

Question # 32: 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 #32: This type of medical information is not releasable.