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Q&A for RPCV Health Insurance Program
Q&A for RPCV Health Insurance Program
Q&A for RPCV Health Insurance Program
Peace Corps, Office of Planning Budget and Finance, Office of Contracts, 1111 20th Street, N.W., Room 4413, Washington, DC, 20526
Point of Contact
Christopher Smith, Contract Specialist, Phone 202-692-1626, Fax 202-692-1621, - Christopher Smith, Contract Specialist, Phone 202-692-1626, Fax 202-692-1621,
The following Q&A format are replies to questions submitted during the comment period on combine solicitation number PC-03-R-003 (?Returned Peace Corps Volunteers Health Insurance Program?). The comment period closed at Noon (12pm local Washington DC time) on Monday, 25 AUG 2003 and no more questions are being accepted. Peace Corps continues to solicit proposals from qualified prospective vendors by the closing date and time of Noon (12 pm local Washington DC time) on Thursday, 18 SEP 2003:
Q1: Where do plan participants live?
A1: Primarily in the United States; however, occasionally a Returned Peace Corps Volunteer (RPCV) may choose to stay overseas past the end of their Peace Corps assignment.
Q2: How will plan participants be billed after the first payment is made by the Peace Corps? Direct from carrier or through the Peace Corps?
A2: Direct from the carrier.
Q3: What is the current number of participants in the RPCV Health Insurance Program?
Q4: What is the average length of time a participant stays in the RPCV Health Insurance Program?
A4: Six & Six-Tenths (6.6) months.
Q5: Please provide the RPCV Health Insurance Program Claims experience per year for the past three (3) years.
A5: Experience Report as of 31 MAY 2003 (Note: The loss development tail for this program is approximately 36 months.
The paid losses are included in the year the volunteer closes service. Therefore, Years 3, 4, & 5 remain undeveloped and subject to this tail):
YEAR 1 (15 FEB 1999 to 29 FEB 2000): Earned Premium = 2,398,180; Claims: Paid Claims = 1,820,398; Reported & Pending = 0; Total Claims = 1,820,398; Loss Ratio = 76%.
YEAR 2 (01 MAR 2000 to 28 FEB 2001): Earned Premium = 2,526,525; Claims: Paid Claims = 1,794,161; Reported & Pending = 0; Total Claims = 1,794,161; Loss Ratio = 71%.
YEAR 3 (01 MAR 2001 to 28 FEB 2002): Earned Premium = 2,925,743; Claims: Paid Claims = 2,467,709; Reported & Pending = 93,367; Total Claims = 2,561,076; Loss Ratio = 88%.
YEAR 4 (01 MAR 2002 to 28 FEB 2003): Earned Premium = 2,004,717; Claims: Paid Claims = 883,478; Reported & Pending = 177,094; Total Claims = 1,060,572; Loss Ratio = 53%.
YEAR 5 (01 MAR 2003 to 31 MAY 2003): Earned Premium = 123,424; Claims: Paid Claims = 1,520; Reported & Pending = 8,193; Total Claims = 9,713; Loss Ratio = 8%.
Q6: What is the insurance premium and current census per month per insured tier?
A6: Employee only (eo) = $135; Employee & spouse (esp) = $135 + $135; Employee & Child(ren) (ec) = $110 each child under age 18; Employee & Family (ef).
Q7: Provide a copy of the current RPCV Health Insurance Plan design.
A7: A copy of the current plan can be provided by submitting a formal written request on company letterhead to the Contracting Officer via telefacsimile number (202) 692-1621.
Q8: Provide the Rates per age and gender category by tier.
A8: As stated in Q&A#6, there is no further breakdown in age or gender.
Q9: In addition to Medical, what other optional insurance products are offered (such as Dental, etc.)?
A9: No other insurance products are offered.
Q10: Please provide the most current bidder?s list.
A10: Please be advised that combined solicitation number PC-03-R-003 is being solicited via full & open competition methods, in accordance with FAR Subpart 6.1.
All qualified and responsible prospective vendors are invited to submit a proposal. Please note that the incumbent is Clements International (?www.clements.com?) of Washington DC 20036 under contract PC-99-3-0011.
Q11: Will the total coverage period be 19 months (one month paid by Peace Corps plus 18 additional months) or 18 months (one month paid by Peace Corps plus 17 additional months)?
A11: 19 months (one month paid by Peace Corps plus 18 additional months.
Q12: Regarding Emergency Medical Evacuation, the statement of work requires evacuation to either the United States or the closest facility. Is the intent of the Peace Corps to have all evacuations be made to the United States or to the closest qualified medical facility?
A12: Please be advised that the intent of Peace Corps is to have evacuations to the closest facility able to provide treatment in accordance with generally accepted standards routinely found in OECD (Organization for Economic Cooperation & Development) countries.
Q13: Are the same benefits required for spouse and minor dependents?
A13: No, but benefits should be reflective of the desire to protect the well being of the RPCV?s family.
Q14: Are the same premiums required for spouse and minor dependents as RPCVs?
Q15: If a RPCV is eligible for Medicare, is this plan still primary?
A15: Yes, unless or until the RPCV re-instates Medicare.
Q16: What is the loss experience for the plan since inception?
A16: (Please see Q&A#5).
Q17: Can you provide details of the extensive medical screening prior to entrance to Peace Corps service?
A17: The screening process includes individual guidelines set up by the major medical boards for each specialty. Peace Corps evaluates for the ability to adequately support a person medically during their Peace Corps service. The following is a sample of the screening guidelines for the diagnosis of amenorrhea (absence of menstrual periods). The Peace Corps uses over 400 such guidelines: ??Includes Menorrhagia, Metrorhagia, Oligomenorhea, and Polymenorrhea. For Amenorrhea; See ?Amenorrhea? Guideline. INFORMATION REQUIRED (Any history): All Applicants With Polymenorrhea or Oligiomennorhea: Report of Medical Examination to include the following: Description of bleeding pattern; Etiology, if known; Complications, if any; Treatment; Recommendations for follow-up over the next 3 years.
All Applicants With Metrorhagia or Menorrhagia: Specialist Evaluation (Gynecologist) within the past 6 months to include the following: Description of bleeding pattern; Etiology, if known; Complications, if any; Treatment; Recommendations for follow-up over the next 3 years. Copy of related diagnostic tests.
Abnormal or irregular menstrual bleeding pattern defined as one of the following:
CLEARANCE CRITERIA (Meets clearance criteria, AND): Menorrhagia: Evaluation and work-up complete; Resolved, hormonally controlled, or well tolerated, for at least the past 3 months; No significant associated complications. REVIEWER: RN. GUIDANCE: CLEAR.
CLEARANCE CRITERIA (Meets clearance criteria, AND): Metrorhagia: Evaluation and work-up complete; Resolved, hormonally controlled, or well tolerated, for at least the past 3 months; No significant associated complications. REVIEWER: RN. GUIDANCE: CLEAR.
CLEARANCE CRITERIA (Meets clearance criteria, AND): Oligiomenorhea (Not menopausal): Stable menstrual pattern for at least the past 1 year; No significant associated complications. REVIEWER: RN. GUIDANCE: CLEAR.
CLEARANCE CRITERIA (Meets clearance criteria, AND): Oligiomenorhea (Menopausal): No significant associated complications. REVIEWER: RN. GUIDANCE: CLEAR.
CLEARANCE CRITERIA (Meets clearance criteria, AND): Polymenorrhea: Resolved, hormonally controlled, or well tolerated, for at least the past 3 months; No significant associated complications. REVIEWER: RN. GUIDANCE: CLEAR.
CLEARANCE CRITERIA (Does not meet clearance criteria due to one or more of the following): Undefined abnormal or irregular menstrual bleeding pattern. REVIEWER: RN. GUIDANCE: (See ?Dysfunctional Uterine Bleeding? Guideline).
CLEARANCE CRITERIA (Does not meet clearance criteria due to one or more of the following): Menorrhagia or Metrorrhagia: Evaluation and work-up not complete; Not resolved, hormonally controlled, or well tolerated for at least the past 3 months. Oligiomenorrhea (Not menopausal): Menstrual pattern not stable for at least the past 1-year. Polymenorrhea: Not resolved, hormonally controlled, or well tolerated for at least the past 3 months. Significant associated complications. REVIEWER: MED ADVISOR. GUIDANCE: Risk varies ? assess based on detailed history. DIAGNOSTIC CODES: 626.2 Menorrhagia; 626.6 Metrorrhgia; 626.1 Oligiomenorhea; 626.2 Polymenorrhea; Cross Reference ICD.9.CM. NOTES AND INSTRUCTIONS FOR REVIEWERS: Reviewers to Consider: None. COMMENTS: Background: Any bleeding that is excessive in duration, frequency, or amount is considered abnormal and requires investigation accordingly. Terms are used to describe abnormal or irregular patterns of bleeding include: Oligiomenorrhea: Infrequently occurring menses at intervals greater than 35 days; Polymenorrhea: Frequently occurring menses at intervals of 21 days or less; Metrorrhagia: Irregularly occurring bleeding; Menorrhagia: Regularly occurring bleeding excessive in duration or flow, usually defined as 8 days in length or greater. Literature review available.?? Q18: How does the plan receive recovery from FECA should this plan, as primary, pay a FECA claim?
A18: Insurance carriers may learn after having made payment on a claim that it was a worker?s compensation claim. They should submit a completed HCFA-1500 or facsimile listing procedures, charges, and paid amounts for each individual provider (including tax identification number), and should attach signed certification of the payments made by the insurance company.
Any third party payee, such as a health insurance company, must be entered in the Provider Master File, using the corporate Tax Identification Number for payment to be made.
Q19: Who determines whether a pre-existing condition is precipitated, aggravated, or accelerated by Peace Corps service? Is their decision final, or can it be appealed?
A19: The U.S. Dept of Labor determines whether or not a condition is Peace Corps related. This decision is based upon the opinion of medical providers, medical and physical evidence. The Returned Volunteer or Peace Corps can appeal this decision.
Q20: How will the transfer of current enrollees be handled at the March 1, 2004 effective date?
A20: The new Contractor shall work with the existing Contractor to assure an effective transition period using insurance industry acceptable run-out times for the payment of claims. The Contracting Officer may negotiate a conversion period of no less than thirty (30) days with the incumbent; providing, but not limited to, extension of coverage for conversion and/or conversion contracts, providing benefits to an enrollee until the effective date of the new enrollment, and processing and paying claims incurred prior to the mutually agreed coverage end date.
Q21: Does Peace Corps intend to continue the exact coverage currently in effect? (i.e. covered benefits, exclusions, deductibles, co-payments, etc.)
A21: No, but the coverage must include the minimums listed in the Statement of Work.
Q22: Because this is a COBRA style benefit program, it is imperative to have three years of historical detailed claims and membership experience to submit a competitive price and work within a more level playing field with the current contractor. These reports are standard in the insurance industry and should be easily available from the current contractor. To be able to work with carriers for the best rate possible, potential offerors are requesting the following information: Most recent three years of experience that includes Patient ID, Diagnosis Codes, Procedure Codes, Service Type, Service Date, Paid Date, Billed Amount, and Paid Amount. The patient ID should be scrambled so that the patient cannot be identified, but it should allow bidders to group claims by patient. Most recent three years of membership summaries by month. The summaries should include the number of volunteers and the number of dependents.
A22: Please note that the claims experience by categories is a quarterly report and is not cumulative and is sorted by policy year. Peace Corps does not have three full years of reports; however, a review of the quarterly reports (may be faxed in response to a formal written request on company letterhead faxed to the Contracting Officer) combined with the loss ratio should provide the information needed to form a picture of the program?s performance.
Q23: What is the current enrollment process for the first month of coverage paid by Peace Corps?
A23: An eligibility file, which includes a listing of all volunteers entering service and terminating service, is transmitted electronically to the carrier on a weekly basis.
An invoice is generated listing all volunteers who leave service during the previous month.
Q24: What is the current enrollment process for RPCVs desiring to continue coverage?
A24: At the end of service each volunteer is told of the insurance benefit and is given an extension form. This is controlled by the RPCV?s signature attesting to being given this information. RPCVs may elect to have payments made from their re-adjustment allowance (stipend accumulated during Peace Corps service), or pay by credit card or check directly to the carrier.
Q25: What is the current process for distributing marketing brochures and materials?
A25: The carrier sends by the appropriate method (regular mail or DHL ?type express service) annual plan change enrollment brochures with cards to each Peace Corps office. Peace Corps supplies the most current address and advises on the best way of getting information out. If there is more than 6 weeks lead-time, Peace Corps will use its international diplomatic pouch service provided by the U.S. Dept of State. Peace Corps replenishes marketing brochures and fulfillment cards.
Q26: What is the current process for distributing ID cards to the RPCVs?
A26: Cards are distributed with the extension brochure at close of service.
Q27: Are updated mailing addresses available for RPCVs when they end their active volunteer status?
A27: The most current mailing addresses are those supplied by the RPCV on their extension forms.
Q28: Are e-mail addresses available for RPCVs?
A28: They are available as supplied by the RPCV on their extension forms.
Q29: Do RPCVs typically have access to e-mail while traveling overseas after completion of active service?
A29: Many do and the number is increasing each year. Peace Corps Office of Medical Services, Health Benefits Program Manager is Ms. Lorna D. Taylor, T: (202) 692-1523, F: -1501, E: ?email@example.com?. Point of contact for this procurement is Christopher T. Smith, Peace Corps Contracting Officer, Office of Planning, Budget, & Finance ? Contracts, Attn PC OPBF/C Room 4447, 1111 20th Street NW, Washington DC 20526 USA, T: (202) 692-1626, F: -1621, E: ?firstname.lastname@example.org?.
Place of Performance
Address: Peace Corps Office of Medical Services RPCV Health Benefits Program 1111 20th St NW Rm 5237 Washington DC
Zip Code: 20526
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