JOB DESCRIPTION
TENDER NOTICE
World Vision International (WVI) is a Relief and Development Organization working to promote the well-being of children. WVI invites tenders for provision of Medical Insurance Services for a period of one (1) year as from 1st May 2021 – 30th April 2022 (Renewable), for its staff.
Eligible insurance firms are invited to apply for the tenders for medical insurance for the under mentioned insurance covers:
Application Process
All interested bidders are requested to submit their Technical Proposals and Financial Proposals in Separate documents as attachments (Bidders who will combine both technical and financial proposals shall be disqualified) via email somo_supplychain@wvi.org on or before 1st March 2021. Bids received after deadline shall not be considered.
Email title should be; WVS-OT-001/21-MEDICAL INSURANCE
Your financial proposal should be as per schedule on the TOR document. Financial proposal should not be part of the technical proposal, it should be a separate document .Each tender must be accompanied with a Bid Security of USD 10,000.00 in form of a Bank Guarantee from Dahabshiil Bank. The Bid Security must be valid for at least 120 Days from the tender closing date.
World Vision International Somalia reserves the right to accept or reject any bid and is not bound to give reasons for its decision
- MANDATORY REQUIREMENTS
The Underwriter must provide and ensure the following conditions are met:
- Bid Security of USD 10,000.00 in form of a Bank Guarantee from Dahabishil Bank
- A brief description of your company with an outline of your experience in provided similar services (attach registration for the last three years 2017-2020)
- Submit audited accounts for the last three (3) years 2017, 2018 and 2019.(Certified by auditor)
- Attach last six months bank statements-Signed by the issuing Bank
- List and locations of your current health providers (e.g. hospitals, clinics, specialists pharmacies etc)
- A list and contacts of your clients receiving similar services from your company. Attach at least five reference letters from your clients(INGO’S) on Medical Insurance
- Provide evidence of at least one client with with minimum annual premium value of USD 400,000 and above
- Submit a certified copy of certificate of Incorporation/Registration.(Attach a copy)
- Submit a copy of current tax compliance certificate from the respective Regional/Government Tax Agency/Department. Attach current copy
- Submit a copy of Tax Certificate the respective Regional/Government regional Tax Agency/Department.
- Must Fill the Price Schedule in the format provided.
- Detailed scope of the medical cover you propose to provide (as per the format provided below)Must be as per the attached format
- Properly arranged/paginated/serialized document. (Document should be arranged as per this numbers1-13) in PDF
Note: Bidders who will not adhere to mandatory requirements will automatically be disqualified.
- TECHNICAL REQUIREMENTS
The Technical Proposal shall provide the following information (but not limited to the below):
Bidders must meet all the mandatory requirements to qualify technically
TECHNICAL EVALUATION CRITERIA
| No | Criteria |
| 1. | Submit recommendation letters from at least Five (5) INGOs and/or corporate clients served in a similar assignment in the last three (3) years (2018, 2019 and 2020). |
| 2. | Attach evidence of at least one client with minimum annual premium value of USD 400,000(attach LPOS/award letters/Contracts. |
| 3. | Provide Audited Accounts for three years 2017, 2018, and 2019 with Gross Premiums in the year 2019 of not less than USD. 1,000,000 |
| 4. | Provide the last six months bank statement signed by issuing bank |
| 5. | 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 |
| 6. | List of Health Providers and their geographical distribution in the region. Give a schedule of approved hospitals and Doctors and region located |
| 7. | Proposed supervisory team engaged with this assignment – CVs, profiles and role of each member and expected communication protocols |
| 8. | Comply with the minimum requirements for inpatient, outpatient, maternity, dental and optical cover as provided below. |
| 9. | Propose Methodology or process of claim settlement(Describe the process of settling a claim with expected timeline) |
| 10. | Describe any additional benefits/riders(if any) give a clear description of each benefit and its application.Each additional benefit/riders must be describe in detail and clearly show if offered for free or chargeable.If charged,clearly indicate cost against it |
- BENEFITS LIMITS
STAFF MEDICAL SCHEME – INPATIENT AND OUT PATIENT
- 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
Optical 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 charges | 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 assignedto treat the insured person | Covered |
| Radiology diagnostic services carried out in the authorized facilityassigned 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 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 relatedcomplications and for medically necessary elective andsubsequent C-section, complications and medicallynecessary termination within Maternity Limitsb) All claims from pre-existing pregnancies will be payableunder the maternity benefit |
| New born/Neonatal conditions, Premature babies and Birthtrauma | Covered under congenital and neonatal conditions benefit. |
- INPATIENT BENEFITS AND LIMITS
| IN-PATIENT BENEFITS | |
| Hospital Accommodation/Room & Board Limit | Private Standard Room Limit up to USD 100within Inpatient Limit |
| ICU/CCUIHDU Limit Per Confinement | Covered |
| Doctor’s (Physician, Surgeon & Anaesthetist) Fees | Covered (Consultation fee limit up to USD 30 forGP and USD 50 for Specialist) |
| Tests, Diagnosis, Treatments and Surgeries | Covered |
| Prescribed Medicines and Drugs administeredwhilst in-patient day-care patient | Covered |
| Accommodation for a person accompanying aninsured child up to L0 years of age, per night | Covered |
| Accommodation for a person accompanying aninsured member in the same room in cases ofmedical necessity at the recommendation of thetreating doctor, per night | Covered |
| Inpatient Physiotherapy | Covered |
| Day Care Surgery | Covered |
| Congenital infirmity and premature babiesconditions | Covered up to USD 1,000 within inpatient limitper family |
| Psychiatric Disorders | Covered up to USD 1,000 within inpatient limitper 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. | Covered(up to USD 500 within inpatient limit per family) |
| Emergency Outpatient Optical Treatment by anAccident. This excludes outpatient optical costs and procedures e.g. frames & lenses. | |
| 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 anAccident. This excludes outpatient procedures e.g.braces, crowns, bridges & other prosthesis | |
| · 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 Limitfor 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 forGP 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 4000 |
| Ground transportation/ Local road ambulance to hospital services in the Territorial Limits providedfor medical emergency cases | Covered within inpatient Limit up to USD 40 |
| Commercial Air Evacuation out of Somalia andSomaliland (must be pre authorized) for treatmentnot available or not safe to undertake locally | Covered within inpatient limit subject to landing rights at the time of evacuation. |
| COVID – 19 INSURANCE COVER – USD 2,500/= SUB LIMIT WITHIN INPATIENT LIMIT | ||
| 1 | Hospital Accommodation/Room & Board limit | Private Standard Room Limit up to USD 50 within Inpatient limit |
| 2 | ICU/CCU/HDU Limit per confinement | Covered |
| 3 | Doctor’s (Physician, Surgeon & Anesthetist) Fees | Covered (Consultation fee limit up to USD 30 for GP and USD 50 for Specialist) |
| 4 | Tests, Diagnosis, Treatments | Covered |
| 5 | Prescribed medicines and drugs administered whilst in-patient & day-care patient | Covered |
| 6 | Ground transportation local road ambulance to designated COVID-19 hospitals | Covered |
EVALUATION OF PROPOSALS
Bids shall be subjected to evaluation as follows;
- Mandatory Requirements evaluation
- Technical Evaluation-For bidders who have met the mandatory requirements
- Financial Evaluation-Only bidders who have qualified technically
PRICE SCHEDULES
a). Out-Patient
| Out-Patient Limit | Family Size | PREMIUM PAYABLE(USD) | ||||
| Office | Principal Members | Spouses | Children | Total Population | ||
| TOTALS |
b). In-Patient
| Out-Patient Limit | Family Size | PREMIUM PAYABLE(USD) | ||||
| Office | Principal Members | Spouses | Children | Total Population | ||
| TOTALS |
