Med_ins_Q A.docx

1. Q: Section B: Pricing. It can be difficult to project price increases several years out, since our costs are tied to CPI, regulatory changes, mandated premium increases, etc. Can we list projected prices for the years past the base year?

A: Each offer will be evaluated as a complete package covering the base and option years, and (as discussed at the pre-bid conference) must include prices for all years listed in the contract. Prices listed for years past the base year represent a commitment by the offeror. The Economic Price Adjustment (see B.4 of the solicitation) mechanism provides the contractor with a way of requesting price adjustments for contract years beyond the base year. A short description of the Economic Price Adjustment can be found at the end of this Question-and-Answer document.

1. Q: For benefit levels (Section C): Our fund lists a menu of six options—none exactly fit the USG’s listed benefit levels. Should we submit a tender, using our plan that most closely matches, or not? If not, what are our options?

A: To receive consideration as an offer, an off-the-shelf plan must exactly meet all of the listed benefit levels in the solicitation document. If an offer’s benefit levels do not exactly match those listed in the solicitation, the offer may not be considered for award.

1. Q: Namibian and South African medical plans differ somewhat from the US model. Should we include a disclaimer describing the major differences?

A: Yes, however please note that offers not complying with the solicitation’s stated terms and conditions may not be considered for award.

1. Q: Will we get feedback on our bids—whether they are receiving further consideration, or have been rejected, etc?

A: The Embassy will contact all offerors regarding their competitiveness.

1. Q: Are the employees and dependents to be covered by this Solicitation currently covered under a group health insurance plan?

A: They are currently covered under a group health insurance plan.

If so,

(a) Who is the current carrier? A. The current carrier is NMC, whose contact information is listed in Question 14, below.

(b) What is the expiration date of the current policy? A. The current policy does not have an expiration date but requires a 30-day cancellation notice.

(c) What is the anticipated Effective Date of this insurance? A. The anticipated Effective Date of the insurance being solicited will be approximately 60-90 days after the successful award has been made.

(d) What are the current premium rates? A. Current premium rates are age- and dependent-based.

1. Q: If the answer to 5. is yes, provide the total amount of claims paid during each of the last 3 years, and the total amount of premium paid during the last 3 years.

A: The Embassy cannot provide this information due to privacy concerns. NMC may be able to provide open-source data, if any is available.

1. Q: During the last 3 years, have there been any claims to exceed N100,000? If yes,

(a) The total amount paid?

(b) The diagnosis?

(c) Is this person still covered and to be covered under this insurance?

(d) The prognosis, if known.

A: The Embassy cannot provide this information due to privacy concerns.

1. Q: Are the benefits and exclusions contained in the Solicitation identical to those that are presently in effect? If no, what are the differences?

A: Currently, approximately 60% of Mission participants are enrolled under NMC’s “Sapphire” plan and 40% under NMC’s “Ruby” plan. Each of these plans, which are publicly available, have separate benefit levels and exclusions.

1. Q: Are any employees currently disabled? If yes, provide as much detail as possible.

A: The Embassy cannot provide this information due to privacy concerns. For reference purposes, all Mission employees are required to undergo a comprehensive pre-hire physical, and approximately 15% of current employees are required to undergo annual physicals, based specifically on their position responsibilities.

10. Section B 3--Administrative Retention Amounts Q: There are no retention amounts applicable on premiums paid by members, only administrative costs.

A: The retention amount is basically the company’s overhead or administrative costs and profit.

11. Section B 4--Economic Price Adjustment-Health Insurance Premium Q: Our (a bidder’s) policy is as follows: The premium increases are done in the beginning of each year, and the board of trustees of NMC approves the increase on a proposal from NMC actuaries; groups belonging to NMC do not receive any claim history prior to the adjustment of the premium and are not involved in the decision on the percentage increase. This is a Trustees decision and is in the rules of NMC Fund. There are adjustments on the premium during the year apart from the yearly increase: when a main member on his birth date falls into the next age category, his premium will then be increased. This is an NMC Fund rule and can unfortunately not be changed. Will that influence the solicitation?

A: Only the terms and conditions to include the economic price adjustment and benefit levels as stated in the solicitation will apply to the resulting contract. If an offer takes exception or adds to the terms and conditions of the solicitation, their offer may not be considered for award.

12. Section K 5--Annual Representations and Certifications Q: Methealth Namibia Administrators are a registered administrator in Namibia, their certificate is available. NMC is a registered medical aid fund in Namibia, its certificate is available. Do we (Methealth) need any additional certificates?

A: Other required representations, certifications, and statements, required of all offerors, are listed in Section K of the solicitation document.

13. Q: Who is the current vendor for these services?

A: The U.S. Mission in Windhoek currently receives health care services from Namibian Medical Care. Their contact information is as follows:

Mailing address: PO Box 6559, Windhoek, Namibia.

Tel: 264-061-287-6000 Email: info@methealth.com.na

14: Q: What were the names of the participants at the pre-bid conference, and what companies did they represent?

A: Companies and representatives were as follows:

NamMed: Sonja Malan and Karl Weyhe Namibia Health Plan: Mr. Ronnie Scholnik Namibia Medical Care: Mr. Nick Nel Tangiers Global (attended by speakerphone): Betsy Brougher

15. Q: What services does family planning include?

A: Family planning includes: reimbursement of prescribed contraceptive devices and drugs, voluntary sterilization, and diagnosis and treatment of infertility. Not covered is reversal of voluntary sterilization, infertility treatment after voluntary sterilization, genetic counseling, fertility drugs, and assisted reproductive technology.

Retention Amounts and Economic Price Adjustments

The “retention amount,” stated as a fixed monthly rate per premium in B.3, includes the contractor’s cost of doing/conducting business, for example labor costs, rent, utilities, supplies (overhead) and profit. The retention amounts proposed by the contractor are fixed for the duration of the contract, but they do not have to be constant from contract term to contract term (base year and option years). The retention amount does not include the anticipated claims to be paid out.

The monthly rates/premiums in the pricing tables include both the retention amount and the anticipated claims to be paid out and can be adjusted (either upward or downward) based on either claims paid out or a change in the local law in accordance with B.4.

WHAT IS AN ECONOMIC PRICE ADJUSTEMENT (EPA)

Per section B.4 of the solicitation either party (the contractor or the Embassy) can request an economic price adjustment. There are two types of adjustments:

1. It can be made based on an enacted law during the term of the contract;

1. Or claims paid out versus anticipated claims paid out

The result of the EPA is that the premium price can go either up or down.

EXAMPLE OF AN ECONOMIC PRICE ADJUSTEMENT (EPA) CALCULATION

Contractor is requesting an EPA based on claims paid out of S11,450. The Contractor must provide documentation supporting the claims paid out amount.

1 – The Contracting Officer will confirm the claims paid out amount is correct based on the monthly reports required by the contractor in H.5.

2 – Confirm premiums paid – using the following hypothetical quantities and premiums:

15 single employees x $10 monthly premium x 12 months = $1,800 45 Family plans x $32.50 monthly premium x 12 months = $17,550 Total premiums paid during one term of the contract = $19,350

3 – Retention amount calculation:

15 single employees x $4 monthly retention amount x 12 months = $720 45 Family plans x $17 monthly retention amount x 12 months = $9,180 Total retention amount = $9,900

Amount available for claims = $9,450 ($19,350 total premiums paid – $9,900 total retention amount)

Based on the above example the following would be the adjustment:

$11,450 claims paid out –$9,450 amount available for claims $2,000

2,000/60 total number of insurance plans (15 singles + 45 families) = 33.33

33.33/12 months = $2.78 increase per month

New justifiable premium rates = Employee/Self Only

– contract monthly premium price – $10 + $2.78 = $12.78 Family Plan

– contract monthly premium price – $32.50 + $2.78 = $35.28