Request for Quotation (RFQ) for Medical Insurance Services

Job Description

 

PEACE CORPS 

Overseas Request for Quotation (RFQ) for Medical Insurance Services

 

RFQ Number:636-25-001

 

Date: November 12th, 2024

 

Peace Corps Sierra Leone has a need for Medical Insurance Service for all its Personal Services Contractors (PSCs)

Peace Corps is soliciting fixed-price quotations from vendor community for the services detailed below.     

 

If you are interested in submitting a quotation, please do so by sending your completed and signed Attachment 1—Vendor Quotation Form by mail OR by e-mail to:

Name: Kyle Jessop

Address: 34 Old Railway Line, Signal Hill, Freetown.

E-mail: SL-DMO@peacecorps.gov

 

Quotations are due no later than 5:00PM on November 25th, 2024.  Late quotations will not be accepted.

 

Written questions about this Request for Quotation (RFQ) may be sent in the same fashion to the individual noted above in advance of the RFQ due date.  No phone calls please.

 

Peace Corps will evaluate all quotations received by the deadline based on the minimum requirements and/or evaluation factor(s) shown below.  Contingent on the availability of funds and continued need for the supplies and/or services, at the end of the evaluation process, Peace Corps intends to award a firm-fixed-price contract for the purchase of the required supplies and/or services to the selected vendor.

 

• Statement of Work/Description of Requirements  

 

HEALTH INSURANCE SERVICES 

The United States Peace Corps in Sierra Leone requires Health Insurance coverage for its locally hired Personal Service Contractors (PSCs) as described below; 

 

• Term of Eligibility and Effective Date: 

 

Each current active eligible Personal Service Contractors (PSCs) is enrolled for health benefits under this plan upon award and thereafter during the performance period of the contract.  Each new eligible Personal Service Contractors (PSCs) will be enrolled upon entering on duty with the United States Peace Corps.  A  Personal Service Contractors (PSCs)  is considered active (“on the rolls”) whenever such Personal Service Contractors (PSCs) is on approved leave, whether paid or unpaid.

 

• Periods of Ineligibility: 

 

Personal Service Contractors (PSCs) and their dependents are not entitled to health benefits during any period of employment for which premiums are not paid. Additionally, Personal Service Contractor (PSC’s) dependents are not entitled to health benefits during any period of employment during which the employee was not eligible to participate. During a period of extended Leave without Pay (LWOP) or unpaid leave beyond one pay period, the employee is responsible for the full cost of the insurance premiums for self and dependents. Peace Corps will pay the premiums directly to the Contractor and will collect the full cost from the employee on a quarterly basis. Alternatively, the employee may elect to have coverage cease if they prefer not to pay the premium. 

 

• Dependents: 

 

PSCs who are eligible to participate in the medical plan automatically confer coverage to eligible family members who meet the following criteria: 

Legal spouse: one legal spouse as defined by local law may be covered. PSC with more than one legal spouse must select only one spouse for coverage. In cases where PSCs and their legal spouse both work for Peace Corps and both are eligible to participate in the medical plan, one will be designated as the lead for purposes of the medical plan, and the other will be considered a legal spouse. 

 

Dependent children: a child is defined as the PSCs natural, adopted, stepchild, or foster child. The child must be unmarried and financially dependent upon the PSC. A child will be covered until the end of the contract year in which s/he reaches age 26. An unmarried child determined to be incapable of self-support due to a physical or mental condition will continue to be eligible to participate in the medical plan as long as the condition persists, the child remains unmarried, and the LE Staff maintains coverage.

 

2. Premium:

 

 Premiums can be based on:

 

Medical Insurance Scheme 1 

• Self Plus One (two individuals) 
• Family (three or more individuals) 

 

                           Medical Insurance Scheme 2

• Flat rate premium (Self Plus One (two individual)/Family (three or more individual)

 

3. Employee and Dependent Health Service Benefits 

 

• Hospitalization (Treatment in the Hospital for Inpatient Care): 

            Minimum Coverage – 100% 

Services and supplies provided during hospitalization including services provided by a licensed healthcare provider, bed and board (semi-private accommodations), operating room, recovery room, intensive care, imaging and diagnostic testing, and general hospital nursing care, physical therapy, as well as drugs and medicines administered while in-patient. When private accommodations are provided, coverage will be limited to the cost of a semi-private room unless otherwise covered in an off the shelf plan. 

 

See Mental Health and Substance Abuse Care (below) for details concerning inpatient psychiatric care. 

 

See Outpatient Services (below) for details concerning professional services. 

 

• Emergency Services (Trips to Emergency Room): Minimum Coverage – 100% 

 

Services provided for conditions that could lead to serious disability or death if not immediately treated, such as accidents or sudden illness. 

 

• Ambulance: Minimum Coverage – 80% 

 

Professional ground transport to move a patient from the place where s/he is injured or becomes ill to the nearest hospital able to provide treatment or to move a patient from one medical facility to another. 

 

• Outpatient Services: Minimum Coverage – 80%

 

Services provided by a licensed healthcare provider on an ambulatory or outpatient basis (without being admitted to a hospital), including surgeon’s fees and other medical services provided at a hospital, clinic, doctor’s office, medical facility, etc. Examples include, but are not limited to: 

• Annual physical examinations 
• Specialist consultations and treatment, including second surgical opinion 
• Minor surgical interventions 
• Chemotherapy and radiation treatments 
• Immunizations recommended by local authorities and/or the World Health Organization 
• Diagnostic tests and diagnostic imaging 

 

See Rehabilitative and Habilitative Services and Devices (below) for details concerning physical therapy. 

 

See Mental Health and Substance Abuse Care (below) for details concerning psychiatric therapy 

 

•  Obstetric and newborn care: minimum coverage – inpatient/emergency: 100%; outpatient: 80% 

 

Care and services that women receive during pregnancy (prenatal care), throughout labor, delivery and post-delivery, and outpatient care for newborn babies. hospitalization during pregnancy and/or delivery will be reimbursed as Hospitalization (treatment in the hospital for impatient care). All other treatments will be considered outpatient services and will be reimbursed at that rate.

 

•  Pediatric services: minimum coverage – inpatient/emergency: 100%, outpatient: 80% 

 

Primary and preventive routine care services for covered dependent children, including, but not limited to: physical examinations, developmental assessments, laboratory tests, and immunizations recommended by local authorities and/or the world health organization. 

 

•  Prescription drugs: minimum coverage -inpatient/emergency: 100%, outpatient: 80% 

 

Medications prescribed by a licensed health care provider that are medically required. examples include but are not limited to prescription antibiotics to treat an infection, medication used to treat an ongoing condition, such as high cholesterol, prophylaxis, contraceptive medication. 

 

•  Preventive and Wellness Services and Chronic Disease Management: 

                          Minimum Coverage – 80% 

 

Counseling or preventive care designed to prevent or detect medical conditions and care for chronic conditions such as asthma and diabetes. Examples include, but are not limited to: physicals, immunizations, and cancer screenings. 

 

• Hearing aids: minimum coverage – 80% examinations and treatment: 80% minimum coverage

 

Hearing aid apparatus: limited to one apparatus per ear up to a maximum of le 15,000.00 SLE per covered individual per three-year period. 80% minimum coverage: with annual cap. 

 

•  Optical care: minimum coverage – 80% examinations and treatment: 80% minimum coverage 

 

Prescription lenses and frames or contact lenses: covered up to a maximum of SLE 3,000.00 SLE per covered individual every two years. 80% minimum coverage; with annual cap. 

 

•  DENTAL CARE: MINIMUM COVERAGE – 80% 

 

Examinations and treatment: dentist’s fees, x-rays, examinations and treatment, cleanings, fillings, extractions, false teeth, crowns, and bridges up to a maximum of SLE 32,000.00 per covered individual per contract year. 80% minimum coverage: with annual cap. 

 

Orthodontia: treatment is covered only if treatment begins before age 18, or if required as the result of an accident. a maximum of four years of orthodontia treatment will be covered per covered individual up to a maximum of SLE 24,000.00-lifetime limit. 80% minimum coverage; with contract lifetime cap. 

 

•  REPRODUCTIVE HEALTH: MINIMUM COVERAGE – 80%

 

Prescribed contraceptive devices, preventive care and routine examinations, voluntary sterilization, and diagnosis and treatment of conditions which may cause infertility. assisted reproductive technology (ART), fertility treatments, and reversal of sterilization are not covered (see exclusions to coverage).

 

•   MENTAL HEALTH AND SUBSTANCE ABUSE CARE: MINIMUM COVERAGE – 50%

Inpatient and outpatient care provided to evaluate, diagnose and treat a mental health condition or substance abuse disorder. This includes behavioral health treatment, counseling, and psychotherapy. Services must be provided by a licensed psychiatrist, psychoanalyst, psychologist, or psychiatric social worker. Inpatient care for alcohol and substance abuse must be provided at a facility licensed for detoxification and rehabilitation.

 

•  REHABILITATIVE AND HABILITATIVE SERVICES AND DEVICES:

                MINIMUM COVERAGE – 50%

 

Rehabilitative services (e.g., recovering skills, such as speech therapy after a stroke or physical therapy after an accident) and habilitative services (e.g., developing skills, such as speech therapy for children, etc.) that help develop skills needed for everyday life. Devices to help gain or recover mental or physical skills lost due to injury, disability or a chronic condition, and devices needed for habilitative reasons.

 

• HIV/AIDS: 100% REIMBURSEMENT AT A MINIMUM OF SLE 100,000.00 PER YEAR PER COVERED INDIVIDUAL

 

Medications to suppress opportunistic infections (such as tuberculosis or toxoplasmosis for covered individuals who have HIV/aids). Brief courses of anti-retroviral drugs during childbirth to prevent the transmission of HIV/aids to the child. Generally, excludes medication for the long-term suppression of HIV/aids through the combination of anti-retroviral drugs in locations with inadequate local healthcare infrastructures. 

Reimbursement under this benefit is excluded from the annual maximum limit (section 4).

 

•  180 DAY COVERAGE FOR DEPENDENTS AFTER EMPLOYEE’S DEATH

 

At the time of a covered employee’s death, his/her eligible dependents covered under post’s medical plan are eligible to continue receiving the same level of medical coverage for up to 180 days. This optional benefit is subject to availability of funds at post and no extensions are permitted.

 

• ANNUAL MAXIMUM LIMIT 

 

The maximum annual reimbursement per covered individual per contract year, not including expenses defined under exclusions and limitations (see section 5) and those covered under section 3; o, and HIV/aids is equivalent to SLE 60,000.00

 

• Exclusions and Limitations

 

There is no coverage for elective cosmetic surgery; spa cures; rejuvenation cures; massage; exercise therapy; long-term rehabilitative therapy; non-medical hospital charges (e.g., telephone, television, etc.); home help, family help, or similar household assistance; fees of persons who are not certified health care providers; advanced reproductive technology (e.g., in-vitro fertilization, intra-cellular sperm injection, artificial insemination, microsurgical epididymal sperm aspiration, testicular sperm extraction, cryopreservation, etc.); or services or supplies which have not been prescribed or approved by a certified health care provider. Exclusions to coverage may be amended if provided in an off the shelf plan and is the lowest-cost and technically acceptable. Removal of any exclusions require prior authorization.

 

There is no coverage for expenses that will be reimbursed or paid directly under a host country medical program or workers’ compensation program, the U.S. workers’ compensation program, or post’s locally hired PSC Staff workers’ compensation program.

 

• Medical Expenses Incurred Out of Country: Medical expenses incurred out of country will be covered only for an employee when on official travel and when the treatment is medically necessary before the employee returns to post.

Reimbursement will be made at the same percentage rate and subject to the same annual maximum limit as for expenses incurred in country. 

 

• Transportation for Out of Country Treatment: Transportation for out-of-country treatment is not a covered expense.

 

6. Eligible participants 

 

 Identification of eligible employees and dependents: Peace Corps will provide a list of all eligible employees and dependents with relationship to employee (self/spouse/child) and DOB for each. Updates will be provided to add or remove individuals on a bi-weekly/monthly basis. 

 

• Definition of dependents 

•  Spouse:

 

A limit of one legal spouse as defined by local law per employee will be covered. 

 

•  Children: 

 

A child is defined as the le staff’s natural, adopted, stepchild, or foster child. The child must be unmarried and financially dependent upon the PSC staff. A child will be covered until the end of the contract year in which s/he reaches age 26. An unmarried child determined to be incapable of self-support due to a physical or mental condition will continue to be eligible to participate in the medical plan as long as the condition persists, the child remains unmarried, and the PSC Staff maintains coverage. 

 

• Location of Employment: 

 

The eligible employees covered by C.1.4.1 must be employed within the geographic boundaries of Sierra Leone. 

 

• Eligibility

 

• Term of Eligibility and Effective Date 

 

Each current active eligible employee and their eligible dependents are enrolled for health benefits under this contract upon award and thereafter during the performance period of this contract. Each new eligible employee and eligible dependents 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. 

 

Self-Only: 1 covered individual 

— Self Plus One (two individuals)

— Family (three or more individuals)

 

• Option A

 

Medical Insurance for the period covering December 18th, 2024, through July 31st, 2025

 

Medical Insurance Scheme 1 – Premium in two different categories as described in chart below

Item	Description	Qty (Number of Personal Service Contractor)
001	Self Plus One (two individuals)	4
002	Family (three or more individuals)	37

 

OR

 

Medical Insurance Scheme 2 – Flat premium rate for all Personal Service Contractor

 

Item	Description	Qty
001	Self plus One /Family	41

 

• Option B

 

Medical Insurance for the period covering December 18th, 2024, through December 17th, 2025

 

Medical Insurance Scheme 1 – Premium in two different categories as described in chart below

Item	Description	Qty (Number of Personal Service Contractor)
001	Self Plus One (two individuals)	4
002	Family (three or more individuals)	37

 

OR

 

Medical Insurance Scheme 2 – Flat premium rate for all Personal Service Contractor

 

Item	Description	Qty
001	Self plus One /Family	41

 

Please note: 

• Peace corps will only be implementing either Option A or Option B.

• Peace Corps will only implement Medical Insurance Scheme under any of the option chosen. 

 

 

 

Place of Performance: All services required will be provided to United States Peace Corps Personal Service Contractors contracted in Sierra Leone 

Contract Terms and Conditions

 

As an Agency of the United States Government, Peace Corps has an approved contract template that it intends to use for the award.  Peace Corps reserves the right to deny making a contract award to a vendor should they refuse to sign the Peace Corps approved contract template. 

Minimum Criteria:

 

A quotation will not be considered further if it does not meet the following minimum criteria:

• All services detailed in section A above (Statement of Work/Description of Requirements) will be provided based on details in the response to this RFQ.
• All legal registration documents are attached (Business registration certificate/certificate of incorporation, tax clearance, NASSIT registration, etc.). 
• Submit completed Attachment 1 – vendor quotation form 

Evaluation Factors:

Quotations that meet the minimum criteria listed above may be further evaluated based on the following factors:

• • Past Performance
  • Price

• Other:

• • Coverage of service providers including the provinces 
  • No. of service providers of key services
  • Turnaround time for reimbursing PSCs
  • Turnaround time to respond to queries 

 

Award may be made with or without negotiations between the Peace Corps and the selected vendor.  Award may be made to a vendor that provided the lowest priced technically acceptable quotation, or to a vendor other than the one that provided the lowest priced quotation, should that vendor be determined to have provided the best value quotation to the Peace Corps taking technical and cost factors into account.

All vendors that submit quotations in response to this RFQ will be notified of the results.

 

[End of RFQ]

 

ATTACHMENT 1 – VENDOR QUOTATION FORM

 

RFQ Number: 636-25-001

 

Vendor:

 

Authorized Representative:

 

Name:

 

Position/Title:

 

Phone Number:

 

E-mail Address:

 

Quoted Prices (Inclusive of Administrative and/or Overhead Costs):

 

Option A

 

Medical Insurance for the period covering December 18th, 2024, through July 31st, 2025

 

Category 1 – Premium in two different categories as described in the chart below

 

Item	Description	Qty	Unit Price	Total
001	Self Plus One (two individuals)	4
002	Family (three or more individuals)	37
Total

 

Category 2 – Flat premium rate for all Personal Service Contractor

 

Item	Description	Qty	Unit Price	Total
001	Self plus One /Family	41
Total

 

Option B

 

Medical Insurance for the period covering December 18th, 2024, through December 17th, 2025

 

Category 1 – Premium in two different categories as described in the chart below

 

Item	Description	Qty	Unit Price	Total
001	Self Plus One (two individuals)	4
002	Family (three or more individuals)	37
Total

 

Category 2 – Flat premium rate for all Personal Service Contractor

 

Item	Description	Qty	Unit Price	Total
001	Self plus One /Family	41
Total

 

Items/Services Included in Total Quoted Price Above but Not Indicated in Chart:

 

Quoted Work or Delivery Schedule (If Any):

 

Quoted Payment Terms:

 

Quoted Warranty Terms (If Any):

 

Quoted Additional Terms and/or Conditions:

 

Please submit the following in addition to the documents required in Section D – Minimum Criteria

• List of service providers country wide by category.
• Name and contact details (address and mobile number) of at least three referees to whom similar services have been provided.

 

SUPPLIER AUTHORIZED REPSENTATIVE  

 

Signature:  _______________________________

     

Date: _______________________________