Questions_with_Responses__1_with_Attachment.pdf

Solicitation SYE‐700‐15‐R‐0007

Questions with Responses #1

The following questions have been received by the Embassy’s contracting officer as of May 11, 2015.

The formal written responses are given below.

Summary

1. Question regarding premium history

2. Question regarding subceilings

3. Question regarding availability of solicitation in Word‐format

4. Question regarding extension of proposal deadline

5. Other administrative questions related to the solicitation

Question 1: Would you please provide the 3 year premium history and 3 year claims history for medical insurance plan.

Answer: The following table is provided for your reference:

U/W Year Annual Premium (USD) Paid Claims

(USD)

01/10/2011‐01/10/2012 1,193,762.11 346,201.29

01/10/2012‐01/10/2013 1,287,374.00 278,101.79

01/10/2013‐01/10/2014 1,403,644.73 255,242.30

Total 3,884,780.84 879,545.38

Note: The paid claims are for a lesser coverage than that identified in the current solicitation (see

Attachment 1). The new solicitation increases the maximum amounts per person from USD$7,500 to

USD$9,000 annually.

Question 2: Can you introduce sub‐ceilings for the covers listed here under similar to the current

Contract?

C.1.1.2: Professional Services and Treatments:

Outpatient doctor's fees: $ 7.5 for a General Practitioner and $ 12.5 for a Specialist.

All out of hospital benefits: $ 1,100.

C.1.1.5: Obstetrical Care: Normal Delivery $ 500.

Caesarian Delivery $ 750.

Miscarriage or medical abortion $ 300

C.1.1.9: Dental Care: $ 150

C1.1.13: Transportation for out of country treatment: $ 5,000

Additional covers:

Cover of incubator for newborn babies: $ 850

Varicose: $ 1,000

Hereditary and Congenital diseases: $ 1,400

Answer: Please refer to Paragraph C.1.1 – Employee and Dependent Health Services Benefits, which states that “reimbursement of covered expenses is limited to the stated percentages of reasonable and customary costs.” No new sub‐ceilings will be introduced. Only those already stated in Section C are authorized for this solicitation. The maximum annual coverage is specified in Paragraph C.1.1.15.

Question 3: Is it possible to get the solicitation as a Word document since we need to fill in several parts of it in preparing our offer?

Answer: No, offerors are encouraged to type or neatly and legibly write by hand in the areas of the solicitation that require a written response.

Question 4: Will the proposal deadline be extended?

Answer: In order to allow time for all offerors to incorporate the information in this Q&A document, the proposal deadline has been extended as indicated on the cover page of the revised solicitation document that will be posted on the FedBizOpps (www.fbo.gov) website.

Question 5: Please provide a List of Items, Schedule of Requirements, Scope of Work, Terms of

Reference, Bill of Materials required.

Answer: Please refer to the solicitation document posted on FedBizOpps.

Question 6: Please provide a Soft Copy of the Tender Document through email.

Answer: A soft copy of the solicitation document has been posted on FedBizOpps.

Question 7: Please provide the names of countries that will be eligible to participate in this tender.

Answer: Please refer to Sections I through K of the solicitation for more details.

Question 8: Please provide information about the Tendering Procedure and Guidelines

Answer: Please refer to section L and M of the solicitation for more details.

Question 9: Please provide Estimated Budget for this Purchase

Answer: Please refer to Question 1 for premium history.

Question 10: Please provide any addendum or pre‐bid meeting minutes.

Answer: All addenda for this solicitation will be posted on the FedBizOpps (www.fbo.gov) website. The minutes for the pre‐proposal conference call have been posted there as well.

C u rre n t

C o n tract

D e scrip tio n

Te xt

N e w

So licitatio n

Te xt

C .1 .4

H o sp ital B en efites

C .1 .1 .1 co verage o f ro o m an d b o ard fo r a w ard ro o m o r sem i‐p rivate ro o m . 8 co verage o f ro o m an d b o ard fo r a p rivate ro o m , n o t to exceed o f th e co st o f a sem i‐p rivate ro o m

C .1 .4

P rescrip tio n D ru gs an d M ed icin es o f ro o m an d b o ard exp en ses fo r sem i‐p rivate o r w ard ro o m u p to a m axim u m o f U

SD

p er d ay w ith n o lim it o n th e n u m b er o f d ays. 7 o f ro o m an d b o ard exp en ses fo r a p rivate ro o m n o t to exceed o f th e co st o f a sem i‐p rivate ro m o f th e co st o f m ed icin es an d d ru gs fo r w h ich a p rescrip tio n is legally req u ired

C .1 .1 .3 co verage w h en h o sp italized

, an d co verage w h en n o t h o sp italized

, o f th e co st o f m ed icin es an d d ru gs fo r w h ich a p rescrip tio n is legally req u ired

C .1 .4

H

IV

/A

ID

S C o verage

[ap p lies to b o th Em p lo yee an d D ep en d en ts] C .1 .1 .4

[Fo r A ctive Em p lo yees O n ly] Th is exp an d ed co verage d o es n o t ap p ly to d ep en d en ts o r to retired em p lo yees.

C .1 .1 .5

M atern al M ed ical B en efits /

O b stetrical C are

Th is b en efit is fo r an y o n e p regn an cy an d is o n ly availab le fo r fem ale em p lo yees an d fo r in su red ep en d en t w ives o f m ale em p lo yees. Th ese ceilin gs in clu d e o u tp atien t regu lar ch eck‐u p s p lu s in

‐h o sp ital d elivery ch arges.

‐ D o cto r's visit ‐ 9 reim b u rsem en t.

‐ N o rm al D elivery ‐ 9 reim b u rsem en t u p to m axim u m o f U

SD

. Th is m axim u m in clu d es n u rsin g care fo r th e b ab y, p ro fessio n al fees, an d p re an d p o st‐n atal care.

‐ C aesarian

D elivery ‐ 9 reim b u rsem en t u p to a m axim u m o f U

SD

‐M iscarriage o r M ed ical A b o rtio n ‐ 9 reim b u rsem en t u p to a m axim u m o f U

SD

C .1 .1 .5 co verage w h en h o sp italized

, an d co verage w h en n o t h o sp italized

, o f o b stetrical m ed ical care in clu d in g p ren atal an d p o stn atal care.

C .1 .4 .3

D en tal C are reim b u rsem en t fo r ro u tin e treatm en t o n ly u p to th e m axim u m acco rd in g to th e o fficial tariff o ate o f p ro ced u

re. D en tal Services h ave th e fo llo w in g A n n u al Su b ‐C eilin g o f U

SD

fo r th e B ase

Year, First O p tio n Year U

SD

to b e in creased to

U

SD

fo r th e Seco n d O p tio n Year an b eyo n d . R o u tin e D en tal Services in clu d e:

P reven tive & Treatin g P ro ced u res, su ch as fillin g, x‐ray, scalin g an d p o lish in g, an d flu o rid e ap p licatio n ro o t can al, an d gin gival treatm en t.

C .1 .1 .9 o f exp en ses fo r d en tal services in clu d in g d en tists’ fees, x‐rays, exam in atio n an d treatm en t, clean in g, fillin gs, an d extractio n s u p to a m axim u m acco rd in g to th e o fficial tariff o n d ate o f p ro ced u re p er year fo r em p lo yee an d d ep en d en t.

C .1 .1 .4

P h ysical Th erap y reim b u rsem en t w ith n o lim it o n n u m b er o f visits p er year.

C .1 .1 .1 co verage o f exp en ses fo r p h ysical th erap

y. Treatm en t u p to m axim u m lim it fo r reaso n ab le an d cu sto m ary co sts fo r treatm en t.

C .1 .4 .5

P sych iatric Treatm en t reim b u rsem en t w ith n o lim it o n n u m b er o f visits p er year

C .1 .1 .1 co verage o f exp en ses fo r p sych iatric treatm en t u p to m axim u m lim it fo r reaso n ab le an cu sto m ary co sts fo r treatm en t.

C .1 .4 .7

O u tp atien t D o cto r V isit Fees

[N o su b ceilin g]

C .1 .4 .8

Su b ‐C eilin g fo r H ered itary an

C o n gen ital C o n d itio n s

G en eral P ractitio n er u p to a m axim u m o f U

SD

.5

(=YR

l,5 ) p er visit Sp ecialist u p to a m axim u m o f

U

SD

.5

(=YR

,5 ) p er visit

C eilin g fo r all o u tp atien t treatm en t o f U

S$ ,1 p er p erso n p er an n u m

U

SD

,4 p er p erso n p er an n u m

[N o su b ceilin g]

C .1 .4 .9

Su b C eilin g fo r In cu b ato r fo r N ew b o rn

U

SD

p er p erso n p er an n u m

[N o su b ceilin g]

C .1 .4 .1

V accin es V accin es co vered are lim ited to th o se d esign ated b y th e N atio n al P ro gram o f th e Yem en i M in istry o f

H ealth

[A d d ressed in C .1 .1 .2

C .1 .4 .1

Su b C eilin g fo r th e co verage o f

V arico se

U

SD

,0 p er p erso n p er an n u m

[N o su b ceilin g]

C .1 .5

Exp en ses In cu rred

O u t o f C o u n try

M ed ical exp en ses in cu rred o u t o f co u n try w ill b e co vered o n ly fo r an em p lo yee w h en o n o fficial travel an d w h en th e treatm en t is m ed ically n ecessary b efo re th e em p lo yee retu rn s to p o st.

R eim b u rsem en t w ill b e m ad e at th e sam e p ercen tage rate an d su b ject to th e sam e an n u al m axim u m lim it as fo r exp en ses in cu rred in co u n try. N o t to exceed ,0 p er an n u m p er p erso n as a p o rtio n o f th e p er p erso n p er an n u m

C .1 .1

M ed ical exp en ses in cu rred o u t o f co u n try w ill b e co vered fo r em p lo yees an d d ep en d en ts w h en

(a) a life th reaten in g co n d itio n o ccu rs w h en th e in d ivid u al is o u t o f th e co u n try an d treatm en t is m ed ically n ecessary b efo re th e in d ivid u al retu rn s h o m e o r (b ) th e in d ivid u al’s atten d in g p h ysician certifies in ad van ce th at su ch treatm en t is m ed ically n ecessary an d u n availab le lo cally.

R eim b u rsem en t w ill b e m ad e at th e sam e p ercen tage rate an d su b ject to th e sam e an n u al m axim u m lim it as fo r exp en ses in cu rred in Yem en

C .1 .6

Tran sp o rtatio n fo r O u t o f C o u n try

Treatm en t

A ll reim b u rsem en ts fo r tran sp o rtatio n exp en ses an d treatm en t exp en ses so u gh t [o u t o f co u n try] are su b ject to a m axim u m lim it n o t to exceed ,0 p er an n u m p er p erso n as a p o rtio n o f th e p er p erso p er an n u m

C .1 .1 .1

Tran sp o rtatio n exp en ses are su b ject to th e an n u al m axim u m lim it.

C atastro p h ic C o verage

[n o t in clu d ed in p revio u s co n tract]

C .1 .1 .1

Fo r catastro p h ic co n d itio n s, th e an n u al aggregate m axim u m sh all b e 8 p er co vered in d ivid u al fo r m ed ical exp en ses. C atastro p h ic co n d itio n s sh all b e d efin ed as m ajo r m ed ical co n d itio n s o ccu rrin g as a resu lt o f a sin gle illn ess, accid en t, o r clo sely related set o f m ajo r illn esses (o r co n d itio n s relatin g to a sin gle accid en

t) th at exceed th e stan d ard m axim u m co verage lim it.

C .1 .7

A n n u al M axim u m Lim it Th e m axim u m an n u al reim b u rsem en t p er p atien t p er co n tract year fo r all th e b en efits o u tlin ed o n p ages

, 1 an d is U

SD

,5

C .1 .1 .1

W ith th e excep tio n o f exp en ses in cu rred u n d er p aragrap h C .1 .1 .4 ab o ve, th e in su ran ce co m p an y w ill reim b u rse co vered exp en ses u p to a lim it o f U

SD

,0 p er p erso n p er co n tract year.

Th e m axim u m lim it fo r em p lo yees regu larly sch ed u led to w o rk o n a p art‐tim e b asis w o rk fo r few er th an h o u rs p er w eek w ill b e p ro rated b ased o n h o u rs in th e w o rkw eek. Fo r exam p le, th e m axim u m lim it fo r an em p lo yee regu larly sch ed u led to w o rk 2 h o u rs p er w eek is U

SD

,0 x 2

/4 , o r U

SD

,5

A ttach m en t 1

C o m p ariso n o f C o vered

B en efits W h ere a D ifferen ce fro m th e P revio u s C o tract Exists