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US MISSION HEALTH INSURANCE TENDER
Questions Log:
1. What is the contract year (Jan - Dec)?
See F.2, Period of Performance.
2. 2016 claims - what months have you reported?
Up until April 2016
| 3. Please clarify the number of employees: In Section B 2.3 the total number of employees is listed as 508 (79 + 429) while in Exhibit J the total number of employees is 502 (330 + 72) |
| Please see the amended Section B 2.3. |
Refer to Section J Exhibit A total number is 502
4. Do the numbers listed in Section B2.3 include employees covered under Rider (Section C.1.3.3 Participants Covered Under a Rider)
It does not include ORE Employees
5. Claims for 2016 have been provided. For how many months of 2016 is this?
Up to April 2016
| 6. Premium history for health Insurance for the current year and last 5 years - 2016 (till now), 2015, 2014, 2013, 2012. It is standard practice in the insurance industry (and in other Department of State insurance solicitations) to provide this information to ensure equal/fair opportunity for all offerors in an open solicitation. |
| Please see the amendment. Exhibit C in Section J has been modified to include total premiums paid. |
| 7. Average insured member counts for the last 5 years - 2016 (till now), 2015, 2014, 2013, and 2012. It is standard practice in the insurance industry (and in other Department of State insurance solicitations) to provide this information to ensure equal/fair opportunity for all offerors in an open solicitation. |
| Please see the attached previous contract document. Under Section B, the estimated numbers of insured employees for the family and single plans are available. |
| 8. Advise if 2015 benefit schedule for health insurance is the same as the benefit schedule currently being requested under SUG50016R0001; and if not advise us on the differences. Alternatively, you can simply provide the previous solicitation document. |
| Section C benefits were different. See attached current contract. |
9. Are any major illnesses (Hemodynamics, Open Heart Surgery, Orthopedic Mayor Surgeries, Organ Transplant, Traumatic Accident, Cancer and Oncology Cases) being treated? If Yes, please provide number (we do not need the names or identification, we just need to know the total number of people hospitalized to assess the risk).
No more than two known cases
| 10. Are there any large losses (in excess of $10,000) within the last year to date? If Yes, please provide number (please note we are not seeking protected private information, we do not need the names or identification; we just need to know the total number of large losses and the amounts to assess the risk and price accordingly). |
| There were none exceeding USD 10,000 |
| 11. Are there any HIV/AIDs cases. If Yes, please provide number (please note we are not seeking protected private information, we do not need the names or identification; we just need to know the total number of people who are currently being treated for HIV/AIDs to assess the risk and price accordingly). |
| Under 5 Known cases |
| 12. When is this plan likely to commence? |
| Estimated start date is Feb. 26, 2017 |
| 13. DUN numbers when registered with SAMs give vendors a problem and errors? What do we do? |
| See attached power point presentation guide for the SAM registration for vendors. Contact the SAM help desk |
| 14. B.2.3 Instead of Base year the table has First year, this is confusing |
| See attached amendment 001 |
| 15. Stamp duty is different from the other levies, can it included in the costing |
| Offerors should include all costs in their pricing under B.2.3-B.2.7 |
| 16. Should the prices stated include all levies beside VAT |
| Yes |
| 17. C.1.1.12 annual reimbursement maximum limit is UGX 57 M. Is this a sum of all components in Section C? |
| Section C .1.1.12 ANNUAL Maximum Limit The UGX 57 M is the maximum coverage the insurance will pay for an individual per year not including C.1.1.4 HIV/AIDS coverage. HIV/AIDS is separate (see C.1.1.4) with a separate maximum in USD that does not come under the UGX 57 M annual maximum. |
| 18. Is UGX 57m the maximum for the family plan? |
| No, it’s the total per individual in the family. C.1.1.12 “Annual Maximum Limit - THE maximum annual reimbursement per patient per contract year, is UGX 57,000,000 per covered individual per year. For outpatient services, a sublimit of UGX 4,110,000 per covered individual per year will be used per patient per contract year.” That does not include expenses covered under C.1.1.4 that has an additional maximum coverage for HIV/AIDS. |
| 19. Are there sub limits in all categories? |
| Please see section C for sub limits |
| 20. If someone went for obstetrical procedure and used their maximum limit ofUGX 8m, would they then have a balance of 49m for the policy maximum? |
| Yes. Please see C.1.1.12 |
| 21. What happens if the contractor exceeds the benefits in their proposal |
| As noted in the solicitation letter to Offerors, “Proposals that contain more benefits (even if there is no increase in cost) or fewer benefits that those stated in the solicitation may be deemed technically unacceptable. |
| 22. Can an individual exceed a sub limit, as long as it is still below UGX 57m policy maximum? |
| No, sub limits shall not be exceeded in a specified category limits. Please see the maximum limits for each covered benefit under Section C. |
| 23. Is exercise therapy covered even after a specialist has recommended it? |
| C.1.1.2 Physical therapy is covered and pre authorization is required. |
| 24. Room limit per day is not stated in the document. Will there be an amendment on this? |
| Per section C.1.1.1. “ Hospitalization: |
100% coverage of room and board expenses for either a private or a semi-private room. No limit on length of stay.”
There is no limit it is only defined by semi private or private since hospital costs differ.
| 25. We note there is no daily maximum for hospital rooms. Some hospitals for example IHK have private rooms which are also their VIP rooms. Is that also covered? |
| Per section C.1.1.1, There is no maximum daily room rate for hospitalization. The patient may decide on their room preference taking into account their annual policy maximum limit of UGX 57 million. |
| 26. If an individual is hospitalized after, for example an obstetrical procedure, is the limit UGX 8 million or would it include the hospitalization category which has a policy maximum of UGX 57 million? |
| The annual maximum limit per C.1.1.12 is UGX 57M. Therefore, in this example, the UGX 8 million will be applied and reduced from the annual maximum leaving a balance of UGX 49 M available for the annual maximum limit for the remainder of the (coverage) year. |
| 27. In section J Exhibit B – Rider for employees with more than 4 children, how do we charge provide pricing for the 5th, 6th and more children? |
| Per section C.1.3.3.2 “Dependents of covered employees who exceed the maximum limit of four dependents as specified under C.1.5 are the responsibility of the covered employee, not the U.S. Government.” |
Therefore Offerors shall provide pricing for more than 4 children with their offer as a separate submission (Rider). Riders are not part of the technical or price proposal evaluations nor will the separate submission become a part of the contract.
The coverage is the same as provided in section C.
| 28. What is the pricing for individuals under the rider |
| Please see the answer to question number 27. |
The coverage is the same as provided in section C.
| 29. Sections C.1.6.2 about period of ineligibility &G.4.2 about frequency of payments are a bit ambiguous, please clarify on these sections. |
| Under section C.1.6.2 Period of ineligibility, employees and their dependents are not entitled to health benefits during any period of employment for which premiums are not paid. |
Section G.4.2 is regarding frequency of payments. Payments are made at the conclusion of the period covered. For example, when a new employee is added, coverage will begin on the first day of employment, but his or her premium will be paid in full at the end of the quarter.
| 30. Can premium be paid at the start of the quarter as medical coverage is provided and used immediately | |
| No. Per “G.4.2. | Frequency of Payments. All funds under this contract will be obligated by issuance of task orders, as described in H.3. Each task order will fund a specific period of time and number of employees, and the task orders will be issued at the frequency described in H.3. All payments under this contract will be made at the conclusion of the period covered. Invoices may be submitted quarterly with payments being made quarterly by the Government.” |
C.1.6.1. Term of Eligibility and Effective Date
Each current active eligible employee is enrolled for health benefits under this contract upon award and thereafter during the performance period of this contract. Each new eligible employee will be enrolled upon entering on duty with the United States Government. An employee is considered active ("on the rolls") whenever such employee is on approved leave, whether paid or unpaid.
| 31. If a person left the scheme, when are the adjustments done |
| At the end of the quarter. |
Per H.3 Ordering Procedures:
If any changes have been made to the coverage listing, the Government anticipates issuance of a new task order on a [x] quarterly basis. This new task order will include all changes made since the previous task order was issued and will include any increase or decrease in necessary funding. The changes to the list of eligible individuals will supersede the initial list provided under prior task orders without prejudice to the ineligibility clause. Task orders will indicate the effective date of employment, for purposes of calculating the premium due.
| 32. If someone leaves after using the annual limit 57m, what happens since the year is covered but premiums is stopped after he/she leaves. |
| There is no penalty for early use of the annual limit of medical insurance coverage. |
| 33. In regards to the Economic Price Adjustment (EPA) process, is it required to have a full year of data to submit an EPA? Does the request for an EPA need to be completed before exercising an option year? |
| A full year of data is required to submit an EPA request. The EPA request is submitted after the exercise of an option year with the data provided from the previous 12 month contract term. |
| 34. Annual orientation: Is it one session a year or the contractor can do more. |
| As per C.1.8 it is only required once a year, but additional sessions could be approved by mutual consent. |
| 35. Section G: ORE Staff do they pay directly to the contractor |
| Yes, they will pay directly to the insurance provider. See G.4.4 |
| 36. Section G 4.5-EAE? would they also pay directly to the contractor |
| At this time there is no Embassy Association Employees. But an EAE would pay directly |
| 37. Can instructions be issued by the embassy for those payments to be done directly to the contractor for the categories in Section G |
| Yes, this can be handled administratively through an instruction from the relevant office. This will not become part of a resulting contract since appropriated funds are not used for these requirements. |
| 38. Is there possibility for alternative payment methods under medical insurance claim settlement on page 20 to be by EFT rather than cheque |
| Per H.4 (b)(4) The requirement is by check however EFT may be acceptable under mutual agreement of the individuals, HR and insurance provider |
| 39. Can claims be done online instead of by courier? | | | | |
| Per section H.4 (b) | “Medical Insurance Claims. Settlement of medical insurance shall be completed as follows: (1) | All medical claims shall be submitted directly to the Contractor by employees, through a drop box in the COR's office. The claims shall be picked up from the COR each Tuesday. | (2) | The Contractor shall date stamp and screen all claims submitted on the day of receipt. If there are any missing documents or information thereby disallowing said claim to be payable, the Contractor shall notify the employee within two days, with a copy to the COR (if notification is written). |
| (3) | The Contractor shall settle the claims no later than two weeks from the date the claim is submitted to the Contractor. | (4) | Settlement shall be by issuance of checks in the name of the employee for each claim submitted. Each check shall be accompanied by a form providing details of the amount reimbursed with an explanation of deductions, if any.” | | |
However by mutual agreement with the HR and the Insurance provider either method may be accepted.
| 40. Can claims (re-imbursements) be settled within 30 days |
| Per H.4 (a) (4) The requirement is 2 weeks. |
| 41. Table of dependent children not exceeding 4, last table states 1992 in the female column category 11-18 (page 32) |
| See attached amendment 001, correct number should be 199 |
| 42. The last two tables on page 32 i.e. Dependent Children all male -365 and dependent children not exceeding 4 male-322, are the tables related to the first table on page 33 under exhibit B for riders with figure 43 |
| The number of dependent children not to exceed 4 is 322, plus those exceeding 4 is 43 giving the total of 365 for all. |
| 43. Exhibit C – Historical claims, can the table be expressed in percentages to make the data more meaningful |
| See attached amendment 001. The claims are stated in claims paid out. |
| 44. Exhibit C – Historical claims, this data is up to what month (incomplete)2016 |
| As at April 2016 |
| 45. What happens to those services that are not covered under section C and limitations e.g. cancer |
| This is covered under hospitalization as long as they don’t exceed the annual limit of 57 |
| 46. The USD 10,000 under HIV is not part of the 57m? |
| HIV coverage is separate (see C.1.1.11) |
| 47. C.1.6.2: During a period of leave without pay, the employee pays directly to the Insurance provider? |
| Per Section C.1.6.2. Period of Ineligibility |
During a period of leave without pay or unpaid leave beyond one pay period the employee is responsible for the full cost of premiums. The USG will pay the premium directly to the contractor and will collect the full cost from the employee. Alternatively, the employee may elect to have coverage cease if he/she prefers not to pay the premium. C.1.6.3 Premium Expenses
Department of State US Embassy Kampala