PROVISION OF IN-PATIENT AND OUT-PATIENT MEDICAL INSURANCE FOR WORLD VISION SOMALIA

TENDER NO. WVS/OT/001/FY20

TENDER DESCRIPTION: PROVISION OF IN-PATIENT AND OUT-PATIENT MEDICAL INSURANCE FOR WORLD VISION SOMALIA

LOCATION: SOMALIA; SOMALILAND, PUNTLAND AND SOUTH WEST STATE

Background

World Vision (WV) is relief, development and advocacy organization dedicated to working with children, families and communities to overcome poverty and injustice. WV Somalia has worked with the children of Somalia, their families and communities since 1992 through a variety of emergency and rehabilitative programming to address the emergency needs of the communities while addressing some of the underlying causes of vulnerability in those same communities. Over the last 25 years, the programme has grown to over 20 districts spread over three main operational locations Puntland, Somaliland and South-Central and Jubaland with headquarters in Mogadishu, Somalia.

The strategic aim of WV Somalia is to develop and implement high quality projects that address emergency, rehabilitation and developmental needs in a demand driven and responsive manner. The overall goal of all WV Somalia is enhancing the resilient well-being of two million children and their communities by 2020.

Provision of In-patient and Out-patient Medical Insurance Cover

World Vision Somalia invites tenders from approved, experienced and registered medical insurance underwriters operating in Somalia (South West State, Puntland and Somaliland) to provide In-Patient and Out-Patient medical insurance to World Vision Somalia staff in Somalia.

1. MANDATORY REQUIREMENTS

The Underwriter must provide and ensure the following conditions are met:

1. Bid Security of USD 10,000.00 in form of a Bank Guarantee. Only a Bank Guarantee from Dahabishil Bank will be accepted
2. Submit certificate of registration as an insurance underwriter and proof of authorization to underwrite medical insurance in Somalia. Must attach a copy.
3. Submit audited accounts for the last three (3) years 2016, 2017 and 2018.(Certified by auditor)
4. Attach last six months bank statements-Signed by the issuing Bank
5. List and locations of your current health providers (e.g. hospitals, clinics, specialist’s pharmacies etc.)
6. A list and contacts of your current corporate/INGOs clients receiving similar services (Medical Insurance) from your company. (Attach at least three reference letters)
7. Attach evidence of at least one current clients with minimum annual premium value of USD 450,000. (Attach LPOs/Award Letter/contracts)
8. Submit a certified copy of certificate of Incorporation/Registration.(Attach a current copy from your Regional Government/Authority)
9. Submit a copy of current tax compliance certificate from the respective Regional/Government Tax Agency/Department. Attach current copy
10. Must Fill the Price Schedule in the format provided.
11. Properly bound, paginated document.(Document should be arranged in the order of No. 1-11(above) **

2. TECHNICAL REQUIREMENTS

The Technical Proposal shall provide the following information as a minimum but not limited to the below, bidders are allowed to give more information of their products:

Bidders must meet all the mandatory requirements (above) to qualify technically

TECHNICAL EVALUATION CRITERIA

1. A brief description of your company with an outline of your experience in providing similar services(MUST attach Registration certificate with the relevant Insurance Regulator for the last five years(2014-2019)
2. Submit recommendation letters from at least three (3) current INGOs and/or corporate clients served in a similar assignment (Medical Insurance). Attach evidence of at least one current client with minimum annual premium value of USD 450,000. (Attach LPOs/Award Letter/contracts)
3. Provide Signed Audited Accounts for three years 2016, 2017, and 2018 with Gross Premiums in the year 2018 of not less than USD. 1,000,000. Provide the last six months bank statements-Signed by the issuing Bank
4. Demonstrate capacity to provide administrative services across all regions within Somalia and Somaliland (branch network) Clearly indicate your area of operations and location of offices
5. List of Health Providers and their geographical distribution in Somalia and Somaliland. Give a schedule of approved hospitals, Doctors and pharmacies per region and physical location of each facilities.
6. Proposed supervisory team engaged with this assignment – CVs, profiles and role of each member and expected communication protocols
7. Comply with World Vision Somalia minimum requirements for inpatient, outpatient, maternity, dental and optical cover (As detailed below in the Benefits Limits)
8. Proposed methodology or process flow of claim settlement. (Describe the process of settling a claim with expected time lines at each stage of the process)
9. Describe Deductibles/Excess in your technical proposal (if any).
10. Please give details of any Riders in your technical proposal. Each Rider must be described in detail. Each rider MUST clearly show if it will be offered for free or it will be charged (if chargeable, the cost should be indicated against the rider)
11. Please describe additional Benefit Limit (if any) giving clear description of each benefit and its application.

3. BENEFITS LIMITS

STAFF MEDICAL SCHEME – INPATIENT AND OUT PATIENT

SCHEME POPULATION: 360A. OUTPATIENT COVER (INSURED)**

Overall Scheme Cover Limit: -USD 800.00 per family per annum general OP cases

-USD 250.00 (Dental Stand Alone) per family per annum

-USD 250.00 (Optical Stand Alone) per family per annum

-USD 600.00 (Maternity Stand Alone) principal/Spouse per annum

OUT PATIENT BENEFITS

OUT PATIENT BENEFITS

Consultation with a General Practitioner: Covered within Outpatient Limit up to USD 30 for GP

Consultation with a Specialist upon referral by a General Practitioner up to the specialist’s charge: Covered Limit up to USD 50 for Specialist

Prescription Drugs and Dressings up to a maximum of 30 days Dosage: Covered

Gynaecological illness and Treatment: Covered

Pre-existing, chronic, cancer, Psychiatric, congenital conditions and HIV/AIDS and related treatment: Covered

Examination, Diagnostic and Treatment services by authorized General Practitioners, Specialists and Consultants: Covered

Laboratory test services carried out in the authorized facility assigned to treat the insured person: Covered

Radiology diagnostic services carried out in the authorized facility assigned to treat the insured person: Covered

MRl, CR scans and Endoscopies in case of medical non-emergency (require pre authorization): Covered

Medical expenses arising from Terrorism: Covered

Vaccines (required pre authorization): Covered

OPTICAL LIMITS

OPTICAL BENEFITS (Stand Alone-Out-patient)

Outpatient Ophthalmologists Expenses: Covered

Prescribed Frames and Lenses: Covered

Frames and lenses are limited to one pair every one year unless otherwise Medically Necessary: Covered

Medication: Covered

Contact Lenses: Covered

Visions tests for errors of refraction: Covered

Laser Correction of Eyesight: Covered

Prescribed Plano (flat)/Non degree lenses for Photophobia/Photosensitivity diseases: Covered

Dental Benefits

DENTAL BENEFITS (Stand Alone-Out-Patient)

Consultation: Covered

Medication: Covered

Tooth Extractions (Simple & Surgical): Covered

Tooth Fillings (Amalgam, Resin Plastic & Composite): Covered

Prescribed Scaling: Covered

X-rays: Covered

Root Canal Treatment (R.C.T): Covered

Crown (lf Followed by R.C.T): Covered

Dentures ( lf in the Event of An Accident): Covered

Maternity Benefits

MATERNITY BENEFITS — Principal/spouse only (stand Alone)

Out-patient Ante-natal services: Covered

ln-patient Maternity services:

a) Covered for Normal Delivery and pregnancy related

complications and for medically necessary elective and

subsequent C-section, complications and medically

necessary termination within Maternity Limits

b) All claims from pre-existing pregnancies will be payable

under the maternity benefit

New born/Neonatal conditions, Premature babies and Birth

trauma: Covered under congenital and neonatal conditions benefit.

A. INPATIENT BENEFITS AND LIMITS

IN-PATIENT BENEFITS

Hospital Accommodation/Room & Board Limit: Private Standard Room Limit up to USD 100

within Inpatient Limit

ICU/CCUIHDU Limit Per Confinement; Covered

Doctor’s (Physician, Surgeon & Anaesthetist) Fees: Covered (Consultation fee limit up to USD 30 for GP and USD 50 for Specialist)

Tests, Diagnosis, Treatments and Surgeries: Covered

Prescribed Medicines and Drugs administered whilst in-patient day-care patient: Covered

Accommodation for a person accompanying an insured child up to 10 years of age, per night: Covered

Accommodation for a person accompanying an insured member in the same room in cases of medical necessity at the recommendation of the treating doctor, per night: Covered

Inpatient Physiotherapy: Covered

Day Care Surgery: Covered

Congenital infirmity and premature babies conditions: Covered up to USD 1,000 within inpatient limit per family

Psychiatric Disorders: Covered up to USD 1,000 within inpatient limit per family

Inpatient Optical Hospitalization resulting from an illness (excluding correction of refractive errors and laser treatment). This excludes outpatient optical costs and procedures e.g. frames & lenses AND Emergency Outpatient Optical Treatment by an Accident. This excludes outpatient optical costs and procedures e.g. frames & lenses. : Covered (up to USD 500 within inpatient limit per family)

Inpatient dental Hospitalization resulting from an illness. This excludes outpatient procedures e.g. braces, crowns, bridges & other prosthesis; Covered (up to USD 500 within inpatient limit per family)

Emergency Outpatient Dental Treatment by an Accident. This excludes outpatient procedures e.g. braces, crowns, bridges & other prosthesis: Covered (up to USD 500 within inpatient limit per family)

· Pre-existing Diseases, Chronic, Cancer & HIV/AIDS (subject to Disclosure/Declared of Earlier to Contract), Radiotherapy & Chemotherapy [subject to pre authorization], Newly Diagnosed HlV, Cancer and Chronic Conditions: Covered (Up to S 3,500 within the in-patient limit and Full Outpatient Limit per family)

Post Hospitalization Treatment: Covered Up to USD 200 within Inpatient Limit for a maximum of 03 Weeks after Discharge

Discharge take Home Medication: Covered – up to 30 days after Discharge

Pre-Hospitalization Services (Diagnostic & Consultation): Covered (Consultation fee limit up to USD 30 for GP and USD 50 for Specialist)

Funeral expenses (Sickness and Accident-Common Carrier Only):** Covered (up to USD 600 within inpatient limit per family)

Medical expenses arising from Terrorism: Covered within inpatient limit up to USD 4,000

Ground transportation/ Local road ambulance to hospital services in the Territorial Limits provided for medical emergency cases: Covered within inpatient Limit up to USD 40

Commercial Air Evacuation out of Somalia and Somaliland (must be pre authorized) for treatment not available or not safe to undertake locally: Covered within inpatient limit subject to landing rights at the time of evacuation.

EVALUATION OF PROPOSALS

Bids shall be subjected to evaluation as follows;

I. Compliance with Mandatory Requirements evaluation and submission of ALL requested Mandatory documents

II. Technical Evaluation-For bidders who have met the mandatory requirements (I above)

III. Financial Evaluation-Only bidders who have qualified technically (II above)