Locally Employed Staff Health Insurance Services for U.S. Embassy Bishkek, Kyrgyzstan

RFP 19GE5026Q0123 – LES Health Insurance Services for U.S. Embassy Bishkek Page 1 of 17 ATTACHMENT 1 – STATEMENT OF WORK C - DESCRIPTION/SPECIFICATION/WORK STATEMENT C.1. HEALTH INSURANCE SERVICES The Government of the United States of America requires Health Insurance coverage for its employees as described herein. The benefit levels listed from section C.1.1.1 through C.1.1.15 are a standard package that must be provided. C.1.1 Employee and Dependent Health Service Benefits C.1.1.1 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 (C.1.1.13) for details concerning inpatient psychiatric care. See Outpatient Services (C.1.1.4) for details concerning professional services. C.1.1.2 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. C1.1.3 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. C.1.1.4 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 that may be provided in a hospital, clinic, doctor’s office, medical facility, etc. -- 1 of 17 -- RFP 19GE5026Q0123 – LES Health Insurance Services for U.S. Embassy Bishkek Page 2 of 17 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 (C.1.1.14) for details concerning physical therapy. See Mental Health and Substance Abuse Care (C.1.1.13) for details concerning psychiatric therapy. C.1.1.5 Obstetric and Newborn Care: Minimum Coverage - Inpatient: 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 inpatient care All other treatments will be considered outpatient services and will be reimbursed at that rate. C.1.1.6 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. C.1.1.7 Prescription Drugs: Minimum Coverage -Inpatient: 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. C.1.1.8 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. C.1.1.9 Hearing Examinations and Treatment: Minimum Coverage – 80% -- 2 of 17 -- RFP 19GE5026Q0123 – LES Health Insurance Services for U.S. Embassy Bishkek Page 3 of 17 Hearing Aid Apparatus: Limited to one apparatus per ear up to a maximum of USD 1,500 per covered individual per three-year period. 80% Minimum Coverage: with annual cap. C.1.1.10 Optical Examinations and Treatment: Minimum Coverage – 80% Prescription lenses and frames, or contact lenses: Covered up to a maximum of USD 300 per covered individual every two years. 80% Minimum Coverage; with annual cap. C.1.1.11 See individual country packages below. C.1.1.12 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). C.1.1.13 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. C.1.1.14 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.…