Request for Proposal For Search For Medical Insurance Service Provider For Water

Request for proposals for Search for Medical Insurance Service Provider for Water for People in Rwanda. 3. SCOPE OF COVERED BENEFITS The chosen program must operate as a Premium First Category Corporate Framework offering a strict 0% co payment on all inpatient treatments and a 10% co-payment on outpatient services. 3.1. Inpatient Care Specifications 100% full coverage within standard limits for hospital admissions. This covers intensive care units (ICU), High Dependency Units (HDU), Neonatal Intensive Care Units (NICU), operating theatre charges, physician and specialist fees, surgeon fees, anesthetist fees, blood transfusions, major internal surgical appliances, day-care surgeries, and post-hospitalization rehabilitation management. 3.2. Outpatient Care Specifications Comprehensive access across provider facilities. This covers general consultations (all specialties), pathology, laboratory tests, physiotherapy, diagnostic radiology, echography, digital X-rays, ECGs, computerised tomography, and advanced MRI scans. 3.3. Specialty Care & Chronic Management Chronic Diseases: 100% full coverage within main contract limits. This covers oncology treatments, chemotherapy, radiotherapy, organ transplants, acute renal dialysis, diabetes, hypertension, asthma, and HIV/AIDS management. Newborn Malformations: 100% full coverage for newborn neonatal services, incubator care, abnormalities, constitutional disabilities, and congenital malformation treatments. Mental Health Track: Comprehensive coverage for clinical psychiatric treatments, inpatient psychiatric hospitalizations, and psychosocial/mental health/counseling support. 3.4. Pharmacy & Preventative Inclusions Pharmaceutical Scope: Direct billing access to generic and brand-name drugs authorized by the Ministry of Health. This includes full cover for specialist-prescribed vitamins linked to a documented illness and specialized therapeutic toothpaste. Preventative Care: Full coverage for routine childhood immunizations, baby-friendly vaccines, routine annual wellness physical check-ups, and complete Hepatitis B vaccine multi-dose courses per patient. Family Planning: Full network access to modern family planning consultations and procedures up to RWF 50,000 per visit. 3.5. Emergency, Support and Value added Services Evacuation: Emergency road and air ambulance services within Rwanda for life-threatening cases (covered on a reimbursement basis). Travel Insurance: Complimentary international travel insurance for members travelling on official duty in the East African Community (EAC), India, and other European/America /Australia and Asian countries. Reporting and Account Management: Provision of quarterly utilization reports and regular health talks/sensitization sessions for all insured members upon request. Customer Support: Dedicated 24/7 emergency telephone hotlines. 4. TECHNICAL ASSIGNMENT CHECKLISTS & PROTECTED LIMITS FLOORS Bidders must complete these exact tables. Any reduction of these Limits floor values, structural alteration of rows, or insertion of arithmetic estimation errors results in automatic disqualification. Geographical Scope: Nationwide coverage spanning all public, private, and faith-based health facilities in Rwanda. Regional & International Scope: East African Community (EAC) coverage, and referral to India and specify if it is subject or not to medical recommendation and pre-authorization. Out-of-Network Claims: Reimbursement for claims incurred where no network providers exist (at 100% cost) or outside the geographical scope (based on applicable EAC tariff rates). Waiting Periods: All waiting periods must be waived (coverage active from Day 1 of the contract). Table 1: Mandatory Ceilings and Structural (Section L) Ref Code Medical Benefit Category Mandatory Tender Standard Limit Floor Bidders Offered Limit (RWF) Structural Limit Model Type (Select: Standalone Pool / (Inside Main Pool) L.1 Inpatient Cover RWF 12,000,000 per family per annum. ( ) Separate Limit ( ) Combined General Basket L.2 Outpatient Cover RWF 2,500,000 per family per annum. ( ) Separate Limit ( ) Combined General Basket L.3 Maternity Benefit RWF 1,200,000 Standalone Pool per family. (0% co-pay floor covering delivery, prenatal, postnatal, and complications). ( ) Standalone Pool ( ) Inside Inpatient L.4 Dental Benefit RWF 505,000 Standalone Pool Per Person. ( ) Standalone Pool ( ) Inside Outpatient L.5 Optical Benefit RWF 505,000 Standalone Pool Per Person. ( ) Standalone Pool ( ) Inside Outpatient L.6 Spectacle Frames Cap RWF 400,000 Standalone Cap per beneficiary per annum. ( ) Standalone limit / ( ) Sub-Limit L.7 Care Abroad Overall RWF 8,720,000 Standalone Overall Overseas Allocation. ( ) Standalone Pool ( ) Shared Inside Inpatient L.8 Automatic Free Top Up 100% Free Automatic Limit Top Up anytime needed with zero additional premium, provided the group loss ratio is under 70%. ( ) Accepted /( ) Rejected L.9 Plano Lenses Covered to distinct beneficiaries per annum, subject to advisor approval. ( ) Standalone limit /( ) Rejected L.10 Prostheses Limit Full cover for visceral/orthopedic prostheses or external appliances up to RWF 1,000,000 per family. ( ) Standalone limit / ( ) Sub-Limit L.11 Last Expense (Funeral) RWF 1,000,000 Standalone Benefit per deceased life. Standalone Benefit Allocation Table 2: Special Clauses and Operating Protocols (Section S) Bidders must legally accept these guidelines. Any "Declined" selection or insertion of standalone co-insurance weights results in systemic failure. Ref Code Special Operating Protocol Parameter Required Target Framework Specification Bidders Response (Agreed / Declined) Reference Page in Technical File S.1 Hospital Room Accommodation Full Coverage in the inpatient overall limit for Standard Private Room accommodation charges, strictly excluding all VIP rooms. No numeric local currency caps allowed. S.2 Waiting Periods Waiver 100% waived. Full scheme activation from Day 1 of contract execution across all staff. S.3 Out-of-Network Access 100% cost reimbursement where no network providers exist or outside geographical scope. S.4 Reimbursement TAT(Turnaround Time ) Maximum of four (4) working days to fully process and transfer out-of-pocket cash claim refunds. S.5 Card Issuance TAT(Turnaround Time ) Mandatory production and system activation of member biometric smart cards within 2 working days from list receipt. S.6 Invoice Settlement Timeline Standard thirty (30) calendar days invoice settlement lifecycle upon validated receipt of an official RRA EBM invoice. S.7 No Additional Premium Rule Zero extra premium loading for adding newly registered legal dependents onto active family clusters during the policy year. S.8 Prorated Exit Refunds 100% clean prorated premium refund returned to the employer for leaving staff, even if an active claim was reported. S.9 Free Staff Replacements Incoming staff replace departing employees at zero premium cost, inheriting the remaining unspent pool of the exited staff. S.10 Co-Pay Management Reports Mandatory commitment to deliver signed, audited quarterly 10% Co-Pay claims reports to facilitate employer staff refunds. S.11 Quarterly Account Audits Mandatory physical quarterly account performance and utilisation reviews by the Account Manager at our Kigali head office. Location: KIGALI Deadline: Sunday, 23/08/2026 23:59 Tender Link : https://www.jobinrwanda.com/job/request-proposal-search-medical-insurance-service-provider-water-people-rwanda