LES Health Insurance Services

Tenders are invited for LES Health Insurance Services DESCRIPTIONSOLICITATION CONTRACT FORMSUPPLIES OR SERVICE AND PRICES COSTS DESCRIPTION SPECS WORK STATEMENTPACKAGING AND MARKETINGINSPECTION AND ACCEPTANCEDELIVERIES OR PERFORMANCECONTRACT ADMINISTRATIONC 1 HEALTH INSURANCE SERVICESThe Government of the United States of America requires Health Insurance coverage for its employees as described herein C 1 1 Employee and Dependent Health Service BenefitsC 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 licensedhealthcare provider bed and board semi private accommodations operating room recoveryroom intensive care imaging and diagnostic testing and general hospital nursing care physical therapy as well as drugs and medicines administered while in patient When privateaccommodations are provided coverage will be limited to the cost of a semi private roomunless otherwise covered in an off the shelf plan See Mental Nervous and Substance Abuse Care below for details concerning inpatientpsychiatric care See Outpatient Services below 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 notimmediately treated such as accidents or sudden illness C1 1 3 Ambulance Minimum Coverage 100 Professional ground transport to move a patient from the place where s he is injured or becomesill to the nearest hospital able to provide treatment or to move a patient from one medicalfacility to another C 1 1 4 Outpatient Services Minimum Coverage 100 Maximum AED 50Employee Co PaymentServices provided by a certified healthcare provider on an ambulatory or outpatient basis without being admitted to a hospital including surgeon s fees and other medical servicesprovided at a hospital clinic doctor s office medical facility etc Examples include but arenot 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 OrganizationC 1 1 5 Obstetric and Newborn Care Minimum Coverage Inpatient 100 Outpatient Maximum AED 50 Employee Co PaymentCare and services that women receive during pregnancy prenatal care throughout labor delivery and post delivery and outpatient care for newborn babies Hospitalization duringpregnancy and or delivery will be reimbursed as Hospitalization treatment in the hospital forinpatient care All other treatments will be considered outpatient services C 1 1 6 Pediatric Services Minimum Coverage Inpatient 100 Outpatient Maximum AED 50 Employee Co PaymentPrimary and preventive routine care services for covered dependent children including butnot limited to physical examinations developmental assessments laboratory tests andimmunizations recommended by local authorities and or the World Health Organization C 1 1 7 Prescription Drugs Minimum Coverage Inpatient 100 Outpatient 80 Minimum CoverageMedications prescribed by a certified health care provider that are medically necessary 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 forchronic conditions such as asthma and diabetes Examples include but are not limited to physicals immunizations and cancer screenings C 1 1 9 Hearing Aids Minimum Coverage 80 Examinations and Treatment 80 Minimum CoverageHearing Aid Apparatus Limited to one apparatus per ear up to a maximum of USD 1 500per covered individual per three year period 80 Minimum Coverage with annual cap C 1 1 10 Optical Care Minimum Coverage 80 Examinations and Treatment 80 Minimum CoveragePrescription lenses and frames or contact lenses Covered up to a maximum of USD 300per covered individual every two years 80 Minimum Coverage with annual cap C 1 1 11 Dental Care Minimum Coverage 80 Examinations and Treatment Dentist s fees x rays examinations and treatment cleanings fillings extractions false teeth crowns and bridges up to a maximum of USD 3 200 percovered individual per contract year 80 Minimum Coverage with annual cap Orthodontia Treatment is covered only if treatment begins before age 18 or if required asthe result of an accident A maximum of four years of orthodontia treatment will be coveredper covered individual up to a maximum of USD 2 400 lifetime limit 80 MinimumCoverage with contract lifetime cap C 1 1 12 Reproductive Health Minimum Coverage 80 Prescribed contraceptive devices preventive care and routine examinations voluntarysterilization and diagnosis and treatment of conditions which may cause infertility Assistedreproductive technology ART fertility treatments and reversal of sterilization are notcovered 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 conditionor substance abuse disorder This includes behavioral health treatment counseling andpsychotherapy Services must be provided by a licensed psychiatrist psychoanalyst psychologist or psychiatric social worker Inpatient care for alcohol and substance abuse mustbe carried out 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 physicaltherapy after an accident and habitability services e g developing skills such as speechtherapy for children etc that help develop skills needed for everyday life Devices to helpgain or recover mental or physical skills lost due to injury disability or a chronic condition and devices needed for habitability reasons C 1 1 15 HIV AIDS 100 Reimbursement at a minimum of 10 000 per yearper covered individualMedications to suppress opportunistic infections such as tuberculosis or toxoplasmosis forcovered individuals who have HIV AIDS Brief courses of anti retroviral drugs duringchildbirth to prevent the transmission of HIV AIDS to the child Generally excludesmedication for the long term suppression of HIV AIDS through the combination of antiretroviral drugs in locations with inadequate local healthcare infrastructures Reimbursementunder this benefit is excluded from the annual maximum limit C 1 2 C 1 1 16 Catastrophic CoverageAdditional coverage equal to AED 298 000 per covered individual per contract year Catastrophic conditions shall be defined as major medical conditions occurring as a result of asingle illness accident or closely related set of major illnesses or conditions relating to a singleaccident that exceed the standard maximum coverage limit

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Global Tender Document	Tender Notice