Tenders are invited for Terms of Reference for Provision of Group Medical Insurance Cover 1 Hospital Accommodation/Room & Board Limit USD 120 per night 2 ICU/CCU/HDU Limit Per Confinement Covered 3 Doctors (Physician, Surgeon & Anesthetist) Fees Covered 4 Tests, Diagnosis, Treatments and Surgeries Covered 5 Prescribed Medicines and Drugs administered Covered 6 Accommodation for a person accompanying an insured child up to 15 years of age, per night Covered 7 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 8 Inpatient Physiotherapy Covered 9 Day Care Surgery Covered 10 Congenital Infirmity & premature babies Covered up to USD 2,500 within inpatient limit per family 11 Psychiatric Disorders Covered up to USD 1,800 within inpatient limit per family 12 1st Emergency caesarean section Covered up to USD 2,000 within inpatient limit per family 13 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 1,800 within inpatient limit per family 14 Inpatient Dental Hospitalization resulting from an Illness. This excludes outpatient procedures e.g., braces, crowns, bridges & other prosthesis Covered up to USD 1,800 within inpatient limit per family 15 Discharge take Home Medication Covered up to 30 days of discharge 16 Pre-existing Diseases, Chronic, Cancer & HIV/AIDS Covered up to USD 4,000 within inpatient limit per family 17 Post Hospitalization Treatment Covered up to USD 300 within inpatient limit per family 18 Pre-Hospitalization Services (Diagnostic & Consultation) Covered up to USD 300 within inpatient limit per family 19 Epidemics, Pandemics (COVID-19) and Unknown Diseases Covered up to USD 3,000 within inpatient limit per family 20 Funeral expenses Covered up to USD 600 within inpatient limit per family 21 Medical expenses arising from Terrorism Covered Ground transportation/ Local Road ambulance to Hospital services Covered 22 Emergency Evacuation services within the territorial limits Covered b) OUTPATIENT BENEFIT S/N OUTPATIENT COVER-USD 2,500 OVERALL LIMIT PER FAMILY LIMIT OF COVER 1 Consultation with a General Practitioner Covered 2 Consultation with a Specialist upon referral by a General Practitioner Covered 3 Prescription Drugs Covered 4 Gynecological illness and Treatment Covered 5 Pre-existing, Chronic, Cancer, Psychiatric, Congenital Conditions and Covered HIV/AIDS and related treatment Covered 6 Examination, Diagnostic and Treatment services by authorized General Practitioners, Specialists and Consultants Covered 7 Laboratory test services carried out in the authorized facility assigned to treat the insured person Covered 8 Radiology diagnostic services carried out in the authorized facility assigned to treat the insured person Covered 9 MRI, CT scans and Endoscopies in case of medical non-emergency Covered 10 Annual Medical Check up Covered 11 Medical expenses arising from Terrorism Covered 12 Vaccines Covered c) DENTAL BENEFIT S/N DENTAL COVER-USD 500 OVERALL LIMIT PER FAMILY LIMIT OF COVER 1 Consultation Covered 2 Medication Covered 3 Tooth Extractions (Simple & Surgical) Covered 4 Tooth Fillings (Amalgam, Resin Plastic & Composite) Covered 5 Prescribed Scaling Covered 6 X-rays Covered 7 Root Canal Treatment Covered 8 Crown (If Followed by R.C.T) Covered 9 Dentures (If in the Event of An Accident) Covered d) OPTICAL BENEFIT S/N OPTICAL COVER-USD 500 OVERALL LIMIT PER FAMILY LIMIT OF COVER 1 Outpatient Ophthalmologists Expenses Covered 2 Prescribed Frames and Lenses Covered 3 Medication Covered 4 Contact Lenses Covered 5 Visions tests for errors of refraction Covered 6 Surgery to correct refractive errors Covered 7 Laser Correction of Eyesight Covered 8 Prescribed Plano (flat)/Non degree lenses for Covered. Photophobia/Photosensitivity Covered e) MATERNITY BENEFIT S/N MATERNITY COVER-USD 1,500 OVERALL LIMIT PER FAMILY LIMIT OF COVER 1 Out-patient Ante-natal and post-natal services Covered 2 Necessary termination, all claims from pre- existing pregnancies and normal delivery Covered 3 In-patient Maternity services Covered within the inpatient limit per family Objective The objective is to secure a multi-year medical insurance contract (initially valid for one year, renewable annually based on availability of funds and performance) that delivers the following: a) Ensures easy and equitable access to high-quality inpatient, outpatient, dental, and optical healthcare services within the territorial limits. b) Includes efficient emergency medical evacuation services both air and local road transportation, at no extra cost. c) Provides coverage for chronic illnesses, mental health services, and access to referral systems for specialized treatment in at least three designated countries outside the territorial limits, with no extra financial burden. 3. Scope of work For this assignment and for fair selection, the applicant companies should provide detailed quotations for the insurance cover for the following categories of benefits; Applications should be sent to rfq-in-som@windle.org with the words STAFF MEDICAL INSURANCE COVER 2026 as the title of the mail. The deadline for application submission is 24th November 2025 by 1000AM For clarifications and further inquiries email wisomprocurement@windle.org Tender Link : https://somalijobs.com/tenders
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