Tenders Are Invited For Provision Of Staff Medical Insurance Services

Tenders are invited for Terms of Reference (Tor) Provision of Staff Medical Insurance Services The Somalia Programme Strategy, derived from Islamic Relief Worldwides Global Strategy, aims to reduce suffering and losses resulting from conflict, climate shocks, and natural disasters through timely and appropriate humanitarian assistance. IRW-S further seeks to empower communities to overcome poverty and vulnerability by improving livelihoods, increasing food security, enhancing access to economic opportunities, and strengthening resilience. Guided by Islamic values, IRW-S mobilizes resources, builds partnerships, and develops local capacities to: Enable communities to mitigate, prepare for, respond to, and recover from disasters; Promote integrated and sustainable development initiatives; Support environmental stewardship and climate resilience; Empower marginalized and vulnerable groups to address the root causes of poverty and vulnerability. Purpose of the Assignment Islamic Relief Somalia intends to procure comprehensive medical insurance services for approximately 270 employees and their eligible dependents located across Somalia. IRW-S hereby invites qualified and reputable health insurance providers to submit technical and financial proposals for the provision of medical insurance coverage for staff members and their dependents. The number of insured staff and dependents may increase or decrease during the contract period due to recruitment, separation, or changes in family status. Purpose of the Assignment Islamic Relief Somalia intends to procure comprehensive medical insurance services for approximately 270 employees and their eligible dependents located across Somalia. IRW-S hereby invites qualified and reputable health insurance providers to submit technical and financial proposals for the provision of medical insurance coverage for staff members and their dependents. The number of insured staff and dependents may increase or decrease during the contract period due to recruitment, separation, or changes in family status. Scope of Coverage The successful insurance provider shall provide comprehensive medical insurance services covering, at a minimum, the following categories. A. Premium Quotation Schedule ISLAMIC RELIEF WORLDWIDE SOMALIA The bidder shall provide annual premium quotations for the following categories: Category Option 1 Option 2 Option 3 Member Only Member + 1 Dependent Member + 2 Dependents Member + 3 Dependents Member + 4 Dependents Member + 5 Dependents The proposal should clearly indicate: Outpatient limits Inpatient limits Funeral benefits Maternity benefits Dental benefits Optical benefits Any additional benefits offered B. Outpatient Services The outpatient cover shall include, but not be limited to: Routine medical consultations Specialist consultations Diagnostic laboratory investigations Radiological services Prescribed physiotherapy Prescribed drugs and dressings Vaccinations (KEPI and Baby-Friendly Programmes) Private vaccines up to outpatient limits Treatment of chronic and pre-existing conditions HIV/AIDS management, including ARVs Ambulance services for emergencies Congenital conditions Gynecological services Antenatal care Postnatal care up to six weeks after delivery Annual medical check-ups up to USD 200 per principal member and spouse Counseling and psychosocial support services C. Inpatient Services ISLAMIC RELIEF WORLDWIDE SOMALIA The inpatient cover shall include, but not be limited to: Hospital accommodation charges Physician, surgeon, and anesthetist fees ICU and HDU services Theatre charges Prescribed medicines and consumables Diagnostic investigations MRI, CT Scan, ECG, Ultrasound, and X-ray services Chemotherapy and radiotherapy Inpatient physiotherapy Emergency road and air evacuation Day-care surgery Home nursing care Internal prosthesis Rehabilitation services Hospice care D. Bed Category: Standard Private Room E. Dental Benefits: Coverage should include: Consultations Fillings Extractions Root canal treatment Emergency dental procedures Related anesthesia and theatre costs where applicable F. Optical Benefits: Coverage should include: Eye examinations Frames Lenses Contact lenses G. Maternity Benefits Coverage should include: Routine antenatal care Normal delivery Emergency Caesarean section Premature deliveries Postnatal care up to six weeks after delivery ISLAMIC RELIEF WORLDWIDE SOMALIA H. Specialized Benefits Coverage should include: Psychiatric hospitalization Psychosocial support and counseling Congenital and neonatal conditions Oncology treatment Organ transplant support Acute renal care and dialysis Internal and external prosthesis Wheelchairs and mobility aids Non-accidental inpatient ophthalmology services Non-accidental inpatient dental services Accidental inpatient dental and optical treatment Lodger fees for parents accompanying hospitalized children below six years Political violence and terrorism-related injuries I. Medical Evacuation: The insurer shall provide: Emergency road evacuation Emergency air evacuation Medical evacuation within East Africa and the Horn of Africa Overseas referral treatment where services are unavailable in Somalia, East Africa, or the Horn of Africa J. Wellness Programmes: The insurer shall provide: Periodic health education sessions Wellness campaigns Health awareness webinars and workshops Exclusions: The following services shall not be covered: Family planning services Fertility and infertility treatment Treatment related to impotence Injuries resulting from intoxication or substance abuse Extreme sports injuries Nutritional supplements unless prescribed as treatment Cosmetic surgery unless medically necessary due to an accident Chiropractic services Acupuncture services Herbal treatments Massage therapy ISLAMIC RELIEF WORLDWIDE SOMALIA Beauty treatments Optional Voluntary Add-ons: Bidders are encouraged to propose optional services that staff members may elect to purchase independently without affecting the premiums paid by IRW-S. Examples may include: Chiropractic services Nutritional supplements Enhanced optical packages Enhanced dental packages International travel medical insurance Additional wellness services Contract Duration: The successful bidder shall enter into a contract with Islamic Relief Somalia for an initial period of one (1) year. The contract may be renewed annually for up to three (3) years, subject to: Satisfactory performance; Availability of funding; and Mutual agreement between both parties. Territorial Coverage Comprehensive coverage throughout Somalia through an established network of accredited healthcare providers. Regional Coverage Coverage shall extend to: Somalia Kenya Ethiopia Other countries within East Africa and the Horn of Africa where applicable International Coverage Global medical coverage shall be provided for at least five (5) expatriate staff members. Proposal Requirements Technical Proposal ISLAMIC RELIEF WORLDWIDE SOMALIA The technical proposal shall include: Company profile Years of operation Organizational structure Relevant experience List of at least three major clients served during the last three years Network of healthcare providers Service delivery model Claims management process Emergency response arrangements Reporting systems Data protection measures Dedicated account management arrangements Financial Proposal The financial proposal shall include: Detailed premium schedule Applicable taxes Administrative charges Pro-rata premium calculations Refund policy for exiting staff Reimbursement procedures Free riders and value-added services Evaluation Criteria Technical Evaluation (70%) Criteria Weight Company Experience and Qualifications 20% Benefit Coverage 25% Provider Network and Geographic Coverage 15% Service Delivery and Claims Management Systems 10% Total Technical Score 70% Financial Evaluation (30%) Only bidders achieving the minimum technical threshold established by IRW-S shall proceed to financial evaluation. Required Qualifications ISLAMIC RELIEF WORLDWIDE SOMALIA The successful bidder must demonstrate: Proven experience in health insurance services Experience serving international NGOs and humanitarian organizations Extensive national and regional healthcare provider networks Ability to provide comprehensive statistical and utilization reports 24-hour customer support services Dedicated relationship/account manager Efficient claims management systems Capacity to respond rapidly during emergencies Compliance with applicable regulatory requirements General Conditions This tender is open to qualified and licensed health insurance providers. Technical and financial proposals must be submitted separately. Only proposals meeting all mandatory requirements shall be evaluated. Late submissions shall not be considered. Shortlisted bidders may be invited to make presentations. Quoted prices shall remain valid for a minimum of ninety (90) days. IRW-S reserves the right to accept or reject any proposal in whole or in part without assigning reasons. Tender Link : https://somalijobs.com/tenders

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