AMENDMENT No. 1

BID 16/14

REQUEST FOR PROPOSALS

FOR

ADMINISTRATING SERVICES OF THE GS/OAS SELF-INSURED HEALTH CARE PLAN

DEPARTMENT OF HUMAN RESOURCES

SECRETARIAT FOR ADMINISTRATION AND FINANCE

(SAF)

GENERAL SECRETARIAT OF THE ORGANIZATION OF AMERICAN STATES

(GS/OAS)

Department of Procurement

October 3, 2014

TABLE OF CONTENTS

  1. Background
  1. Objective
  1. Terms of Reference
  1. Governing Law
  1. Bidders’ Inquiries
  1. Proposal Submission
  1. Evaluation
  1. Award
  1. Contractual Terms and Conditions

Appendixes

Appendix 1Terms of Reference

Appendix 2Contractual Terms and Conditions

Appendix 3

  • Format 1: Acceptance of the Contractual Terms and Conditions Statement
  • Format 2: Conflict of Interest Statement

Annexes

  • Annex I: Signed Statement of Compliance/Signature by Bidder page
  • Annex II : GS/OAS RFP Data (See ANNEX II_GS_OAS_RFP Data.xlsx attached):
  • Format 1:Questionnaire Part 1 and Part 2
  • Format 2: Plan Design and Deviationskkk
  • Format 3: Medical Financial Quote
  • Format 4: Dental Financial Quote
  • Format 5: Prescription Drug
  • Format 6: Medical GeoAccess Summary
  • Format 7: Network Discounts
  • Format 8: CPT Codes
  • Format 9: Dental R&C
  • Format 10: Medical Claims Repricing Summary
  • Format 11: Dental Claims Repricing Summary
  • Format 12: Dental GeoAccess Summary
  • Format 13: Medical-Dental Disruption Summary
  • Annex III[1]:
  • Format 1: OAS Current Fees
  • Format 2: Claims Experience
  • Format 3: Employee Census (Active Employees and Retirees) – Separate Attachment
  • Format 4: Description of Covered Services - Please note that SPDs have not been updated recently – Please use the Summary of Benefits attached for current levels of coverage, while referring to the Description of Covered Services, also attached for more details.
  • Format 5: Summary of Benefits 2014 – Separate Attachment.
  • Format 6: BICC30759 Medical Disruption
  • Format 7: BICC30759 Medical Repricing for Release
  • Format 8: BICC30761 Dental Disruption
  • Format 9: BICC30761 Dental Repricing for Release
  • Format 10: High Claims report 2012, 2013, 1- 5-2014
  • Format 11: OAS - Dental Procedures
  • Format 12: OAS - Enrollment totals by tier -Subscribers - Medical-Dental

BID 16/14

REQUEST FOR PROPOSALS

FOR

ADMINISTRATING SERVICES OF THE GS/OAS SELF-INSURED HEALTH CARE PLAN

DEPARTMENT OF HUMAN RESOURCES

SECRETARIAT FOR ADMINISTRATION AND FINANCE

(SAF)

  1. BACKGROUND

1.1.The Organization of American States (OAS) is a Public International Organization created by international treaty, and is comprised of Member States that are represented by the Governments of 35 countries, including the Government of the United States of America. In the USA, the OAS along with its General Secretariat is recognized as a public international organization with privileges and immunities pursuant to the International Organizations Immunities Act (22 U.S.C. 288 et seq), the Headquarters Agreement the OAS with the U.S. Government signed by the President of the United States, and other instruments and agreements.[2] The General Secretariat (GS/OAS) is the central and permanent organ of the Organization of American States. Headquartered in Washington, D.C., The GS/OAS has approximately 1,018 employees and retirees enrolled in their plan: forty-eight percent are active employees and fifty-two percent are retirees. However, note that of the 1,018 enrolled, seventeen percent reside outside of the United States.

Summary Chart
Number of Enrollees: / Approximately 1,018 enrolled in the GS/OAS self-insured health care plan
Locations: /
  • Headquarters – Washington, D.C.

  • International – Away from Headquarters:

  • Antigua and Barbuda
  • Argentina
  • Bahamas
  • Barbados
  • Belize
  • Bolivia
  • Brazil
  • Canada
  • Chile
  • Colombia
  • Costa Rica
  • Dominica
  • Dominican Republic
  • Ecuador
  • El Salvador
  • Grenada
  • Guatemala
/
  • Guyana
  • Haiti
  • Honduras
  • Jamaica
  • Mexico
  • Nicaragua
  • Panama
  • Paraguay
  • Peru
  • Saint Kitts and Nevis
  • Saint Lucia
  • Saint Vincent and the Grenadines
  • Suriname
  • Trinidad and Tobago
  • Uruguay
  • Venezuela

1.2.Retirees are located in several States in the USA as shown on the Census (See Annex III Format 3).

Note that GS/OAS does not maintain National Offices in all the above-listed countries, but may have retirees or dependents living in these countries, or employees traveling in these countries.

1.3.Special Considerations:

  • As a public international organization, the GS/OAS may have employees working in overseas duty stations as well as traveling overseas as part of official business of the Organization.
  • Also as a public international organization, The GS/OAS is immune from court jurisdiction as well as executive or administrative jurisdiction within the United States. Because of its immunity to court jurisdiction in the US, the GS/OAS accepts arbitration as its sole means of dispute resolution with outside contractors and vendors.
  • The GS/OAS Health Insurance plan is a self-funded plan that is funded by employee contributions as well as institutional contributions. The resources of the self-funded plan are held in trust by the GS/OAS Medical Benefits Trust Fund. The GS/OAS Health Insurance plan pays for health-related services through its Plan Administrator, CareFirst BlueCross BlueShield, pursuant to an Administrative Services Agreement signed by the GS/OAS and the current Plan Administrator.

For more information please visit the Organization’s website at: and for information about GS/OAS privileges and immunities in the USA, please see:

Please note that the GS/OAS currently also offers Kaiser Permanente as a plan option and has approximately 20 enrollees. There are also approximately 66 employees who have coverage through their spouses and are therefore exempt from GS/OAS health coverage. These 86 persons will be given the opportunity to enroll in the GS/OAS Health Plan under this contract. Each Bidder is required to confirm that its pricing takes this into account.

  1. OBJECTIVE

Client Goal/Strategy:

2.1.The objective of GS/OAS is to obtain excellent benefits, claims administration and customer service with ample geographic access at the most competitive costs for their employees and retirees. The successful bidder will have demonstrated experience, knowledge and technology capabilities in the performance of high-quality claims administration and customer service both inside and outside the U.S. Of utmost importance is the bidder’s ability to provide service in two languages: English and Spanish. It is desirable that the administrator be able to provide service in Portuguese and French as well. The bidder will be required to expertly administer international claims incurred mostly in Latin America and the Caribbean. A knowledgeable and responsive Account Representative is essential. The ability to track enrollment and costs by separate reporting divisions is critical. Ease of plan administration and reporting capabilities, as well as demonstrated use of technology to support GS/OAS are additional key requirements.

2.2.The GS/OAS currently provides coverage for its international members under the self-funded plan used for its domestic employees. Although the GS/OAS would prefer to continue the current self-funded arrangement, it will consider providing fully insured coverage to its international employees under a carrier’s international division if this will address the servicing difficulties that the GS/OAS has experienced with its international employees in the past. However, it is very important that the current level of benefits be continued for the international members and that it be the same both inside and outside the U.S.

2.3.A financial proposal with a multiple year rate guarantee and/or a rate cap on the Administrative fees is strongly encouraged. A rate cap on the stop loss for two years is also preferred. The resulting contract base period will be three (3) years, (if a three (3) year rate guarantee and/or a rate cap on the Administrative fees can be provided and a three (3) year rate cap on the stop loss can be provided) starting January 1st, 2015 and may be renewed and extended thereafter, based on the results of annual vendor performance assessment by the Department of Human Resources for successive (twelve) months period, up to six (6) years.

However, the resulting contract base period will be less than three (3) years if a three (3) year rate guarantee and/or a rate cap on the Administrative fees cannot be provided, and a three (3) year rate cap on the stop loss cannot be provided. In that case, the resulting contract base period will match the number of years provided under the rate guarantee/rate caps that can be provided (for example, 2 years).

2.4.The GS/OAS has a January 1st renewal with the incumbent carrier and as noted, the desired effective date of the contract is January 1, 2015. However, it is important to note that historically the GS/OAS has conducted Open Enrollment in January with changes effective February 1st. The GS/OAS would like to continue Open Enrollment in that way (at least for this first year). Historically, very few employees have made changes at Open Enrollment (2% or so). To summarize, the contract will be effective January 1, 2015, the new rates will be effective January 1, 2015 and employees will be responsible for their new contributions effective January 1, 2015. However in the month of January 2015, employees will be given the opportunity to go through Open Enrollment and make changes to their current elections for a February 1, 2015 effective date. Please confirm your understanding of an agreement with this request.

2.5.This RFP does not in any manner whatsoever constitute a commitment or obligation on the part of GS/OAS to accept any Proposal, in whole or in part, received in response to this RFP, nor does it constitute any obligation by GS/OAS to acquire any goods or services.

  1. TERMS OF REFERENCE

The Terms of Reference (TOR) for the Project are outlined in Appendix 1 of this RFP and are considered integral to the project’s implementation.

  1. GOVERNING LAW

The selection process of the consultant services are regulated by:

4.1This RFP.

4.2The Procurement Contract Rules of the GS/OAS, approved by Executive Order No. 00-1.

4.3The Performance Contract Rules, approved by Executive Order No. 05-04, Corr. No. 1.

4.4The Executive Orders, memoranda and other dispositions and official documents of the GS/OAS applicable to this process.

  1. BIDDERS’ INQUIRIES

5.1Bidders may submit any inquiry or request for more information and clarification regarding technical specifications in this RFP no later than five (5) business days prior to the bid closing date.

5.2The requests must be submitted in a written format to the attention of Mr. Alex P. Grahammer, Director a.i. of the Department of Procurement (DP), by e-mail to: with copies to ; and .

5.3The responses to these requests will be submitted in written format to all Bidders no later than three (3) business days before the bid closing date.

  1. PROPOSAL SUBMISSION

6.1Submittal Format

6.1.1Proposals shall be submitted in 3 sealed envelopes. The first envelope will contain the Technical Proposal; the second envelope will contain the Price Proposal; and the third envelope will contain the legal documentation required in Section 6.2.3.

6.1.2The Proposals shall be submitted in hard copy: one (1) original and two (2) copies. The sealed envelope containing Bidder’s Proposal shall be labeled:

GS/OAS BID No. 16/14 – ADMINISTRATING SERVICES OF THE GS/OAS SELF-INSURED HEALTH CARE PLAN

______(Bidder’s Name)

6.1.3The Proposals shall be delivered to:

The General Secretariat of the Organization of American States

Department of Procurement

1889 F Street, N.W., 4th Floor

Washington, DC 20006

USA

6.1.4Additionally, the Proposals shall be submitted by electronic mail to the attention of Mr. Alex P. Grahammer, Director a.i. of the Department of Procurement. Proposals sent by e-mail should be in PDF format, sent to with copies to , nd , and each document, including attachments, that conforms the Proposal must not exceed 15 MB each.

6.1.5The Proposals shall be signed by the Bidder’s legal representative.

6.1.6The Proposals shall remain valid and open for acceptance for a period of at least ninety (90) calendar days after date specified for receipt of proposals. The term of validity of the Proposals must be expressly stated on the same Proposal.

6.1.7By submitting a Proposal, the Bidder gives express warranty of its knowledge and acceptance of RFP and the rules and conditions that governs the bidding process. Likewise, the Bidders shall warrant the accuracy and reliability of all information they submit in this procurement process.

6.1.8The Bidders shall bear any and all costs or expenses associated with or incurred in the formulation or development of a Proposal in response to this RFP.

6.2Required Documents and Formats in the Proposals

6.2.1Content of the Technical Proposal:

The Technical Proposal shall include the following information/documents:

Technical Documents

a)The following completed forms presented in Annex II : GS/OAS RFP Data:

  1. Format 1: Questionnaire Part 1 and Part 2
  2. Format 2: Plan Design and Deviations
  3. Format 6:Medical GeoAccess Summary
  4. Format 12: Dental GeoAccess Summary
  5. Format 13: Medical-Dental Disruption Summary

Documents related to Contractor’s Experience

b)A minimum of five (5) references from Bidder’s clients to which similar or relevant services were provided during the last three (3) years. (SeeAnnex II : GS/OAS RFP Data, Format 1 Questionnaire Part 1, Question # 86). These references should include: the name of the client, contact person, title, telephone and fax numbers and e-mail address, and a description of the work performed and the duration of the project. These references are for current clients of similar size and funding arrangement, which we may contact on your behalf. To avoid delays in the bidding process, please contact your reference sources and receive the approval to include them on your reference list, so they are aware of the possible request for reference check by the GS/OAS Department of Procurement.

c)The contact information for two former Bidder’s clients of your organization. Preferably clients of similar size and funding arrangement, which the GS/OAS may contact. (SeeAnnex II : GS/OAS RFP Data, Format 1 Questionnaire Part 1, Question # 87).

d)A general description of the background of the bidding firm.

e)A detailed description of the Bidder’s work experience similar or relevant to this Project. The description shall indicate what work it did, when and where it did it, whom it did it for, and what methods it used.

If the Bidder plans to perform the work with subcontractors and/or in joint venture with other firms, the Work Plan should address the relationship between the firms and how potential inefficiencies in the organization, communications, and project processes can be avoided. If the form of a joint venture is considered, the Technical Proposal should additionally address joint and other liabilities for all partners.

Other information

f)Information of Bidder’s point(s) of contact. Provide the name, position, telephone number, email, and fax of the person or persons serving as coordinator or focal point of information of the Bidders concerning this bidding process.

g)Other documentation and/or information that supports each of the technical evaluation factors as per Section 7.4.1, a) of this RFP.

6.2.2Content of the Price Proposal:

The Bidders shall submit a Price Proposal expressed in US Dollars (US$), in numbers and with a description, in accordance with the TORs in Appendix 1 of this RFP. The Price Proposal shall include the following completed forms presented in Annex II: GS/OAS RFP Data:

a)Format 3: Medical Financial Quote

b)Format 4: Dental Financial Quote

c)Format 5: Prescription Drug

d)Format 7: Network Discounts

e)Format 8: CPT Codes

f)Format 9: Dental R&C

g)Format 10: Medical Claims Repricing Summary

h)Format 11: Dental Claims Repricing Summary

i)The pricing proposal should also include the Signed Statement of Compliance/Signature by Bidder page contained in Annex I.

6.2.3Legal Documentation:

a)A copy of the Bidder’s certificate of incorporation.

b)A copy of the Bidder’s bylaws.

c)A copy of the Bidder’s license to do business in the corresponding jurisdiction (if required under the law of the duty station where the work is to be performed).

d)A copy of the W-9 Form for US Companies and the Employer Identification Number for companies outside of the US.

e)A list of the directors, officers, and the names of any stockholder with more than 50% of the stock.

f)A statement where Bidder acknowledges that he or she has read and understood the Contractual Terms and Conditions as per Appendix 2 of this RFP. The statement should follow Format 1 of Appendix 3. If the Bidder does not agree with any of the Contractual Terms and Conditions of GS/OAS, he or she should expressly indicate so in its Proposal, offer alternative language, and present the rationale of its proposal.

g)A disclosure statement of conflict of interest. The statement should follow Format 2 of Appendix 3.

h)A copy of the Bidder’s latest general balance sheet of 2012 or 2013; and copy of the Bidder’s latest three (3) audited financial statements, for the years 2011, 2012 or 2013. These financial statements must be signed and/or appropriately certified by the Chief Financial Officer of the Bidder. In addition, the Bidder’s DUNS number, only if applicable. Please note: If the bidder is a US registered company, the provision of the DUNS number is mandatory.

6.3Closing Date for Receipt of Proposals

6.3.1Both the sealed and electronic proposals must be received by the GS/OAS no later than close of business (COB), 5:30 p.m. EST, on October 23, 2014.

6.3.2Proposals submitted after the deadline will not be considered.

6.4Limited Use of Data

If the Proposal includes data that the Bidder does not want to disclose to the public for any purpose or used by the GS/OAS except for evaluation purposes, the Bidder shall include in its Proposal a statement signed by its legal representative with the following legend:

USE AND DISCLOSURE OF DATA

This Proposal includes data that shall not be disclosed outside the GS/OAS and shall not be duplicated, used, or disclosed— in whole or in part—for any purpose other than to evaluate this Proposal. If, however, a contract is awarded to this Bidder as a result of—or in connection with—the submission of this data, the GS/OAS shall have the right to duplicate, use, or disclose the data to the extent provided in the resulting contract. This restriction does not limit the GS/OAS' right to use information contained in this data if it is obtained from another source without restriction. The data subject to this restriction are contained in sheets [insert numbers or other identification of sheets].

  1. EVALUATION

7.1Evaluation Authority

The Proposals will be evaluated by the Contract Awards Committee (CAC) of the GS/OAS.

7.2Requests for Clarifications

7.2.1In order to enhance the CAC’s understanding of Proposals, allow reasonable interpretation of the Proposal, or facilitate the CAC’s evaluation process, the CAC may submit, in writing, any inquiry or request to the Bidders for explanation, substantiation or clarification of certain aspects of its Proposals.