Request For Proposal To Provide a Comprehensive Medical Insurance for CRS Gambia National Staff 85 views

SCOPE OF WORK (SOW) FOR THE PROVISION OF HEALTH INSURANCE FOR CRS NATIONAL STAFF & THEIR DEPENDENTS FOR THE PERIOD, JANUARY 1, 2025 – DECEMBER 31, 2025- RENEWABLE

REQUEST FOR PROPOSALS.

Purpose

The purpose of this Scope of Work is to describe the conditions and responsibilities of the Insurance Company that will provide quality and adequate medical services to CRS/The Gambia national staff and their dependents as thus;

• • 55 staff,
  • 36 spouses (This can increase but can never be more than the staff number)
• 200 children under 18 years of age (This is the maximum figure based on policy requirement, therefore will surely reduce when it comes to actuals)

Background

Catholic Relief Services is the official international humanitarian agency of the Catholic community in the United States. CRS works to save, protect, and transform lives in need in more than 100 countries, without regard to race, religion or nationality. CRS’ relief and development work are accomplished through programs of emergency response, HIV, health, agriculture, education, microfinance and peacebuilding.

Work to be accomplished.

CRS management would like to agree with the contracting Insurance Company that will be willing and accessible at all times when needed particularly during working hours from 08.00hrs to 16.30hrs Monday to Thursday and on Friday from 08.00hrs to 13.00hrs.

Conditions and work to be accomplished by the Insurance Company shall include the following:

1. 1. Provision of medical and health insurance cover for CRS staff and their dependents.
   2. Maintain a database of all CRS registered staff and their dependents and supply each member with quality membership card not more than three days after registration.
   3. Identify a focal person with contact details (telephone and e-mail), who will be receptive and available at all times to respond immediately to our queries.
   4. Inform the office for any intended changes relevant to the Agreement (e.g. termination or addition of any health facility in the scheme with reasons if termination).
   5. Both parties have the mandate to alter any agreement in the contract after consultation in writing.
   6. Confidentiality of medical information is a high priority and must be protected to the greatest extent possible.
   7. CRS cannot accept their staff member (s) or dependent(s) being rejected at a facility in your approved list just because you have not paid them
   8. Insurance Company must not be found wanting by Health facilities, Doctors, Clinics that provide medical services to CRS staff/dependents.
   9. Insurance Company’s prompt settlement of refunds to staff and payment to Health Facilities/Doctors, etc. is a great concern to CRS
   10. Willing to attend meetings at CRS Office upon request and/or when necessary, submit written and oral opinion on all matters affecting or relating to the scheme
   11. Work closely with the CRS focal person, the Administration/HR Officer on all matters relating to the medical scheme.
   12. The Agreement will be reviewed every quarter by the Senior Management Team (SMT) and the Insurance company will be informed accordingly
   13. All queries or complaints from both the focal person and the Senior Management Team must be redressed by the Insurance Company within 48 hours
   14. Popular and good Public/Private Health Facilities, Doctors & Clinics should be in the scheme
   15. Procedures for refund and treatment in both Dakar, Senegal and The Gambia should be agreed upon, documented and respectfully honored.
   16. Insurance company should ensure prompt settlement of claims from staff and clinics and indicate duration to process such claim/bills.
   17. Focal persons for both CRS and Insurance Company and mode of communication

• Contract agreement must include; Contract commencement date, expiration, Membership registration, membership, refund, benefit limits, including admission/ward fees, premium, payment, renewal, termination, etc.

Applicant Selection Criteria:

• Submission of all relevant documents relating to the scheme as indicated in the advert and SOW (including list of doctors/clinics currently working with you)
• Valid Business Registration, Municipal Certificate, Valid Tin Certificate, Full contact address of office
• Knowledge/experience on similar work particularly with International NGOs, UN Systems, etc will be an advantage.
• Capability of the Insurance Company to adequately meet CRS requests/standards
• Insurance Company’s availability to CRS when needed and timely accomplishment of assigned tasks, additional benefits, (queries, refunds payment to health facilities)
• Reference from Key Health facilities, Doctors, Clinics, Brokers, etc.
• Annual premium per cost category (adult dependents, Child dependents and staff).
• Developed strategy to protect confidentiality of medical information of CRS staff and their dependent(s).

CRS REQUIREMENTS WITH THE SUCCESSFUL BIDDER

1. If the Insurance company goes into liquidation, it will refund CRS all outstanding balance owed.
2. All costs in the agreement/policy should be in the local currency (GMD).
3. Coverage should be 100% and it should include all kinds of Medical & Health services.
4. Eye care and dental services should be covered 100%.
5. Replacement of lenses and frames should purely be based on medical recommendation and not the insurance because the optometrist and the ophthalmologist knows it better. Assessment and diagnosis of the eye condition dictates treatment and management.
6. Emergency ambulance charges should include all means of evacuation to treatment site.
7. Coverage for hearing aid should be included in the scheme.
8. Private accommodation in a private facility should be included in the scheme
9. Disclosure of one’s condition is dependent on consent. HIV aid must be covered in the scheme
10. All mental health disorder should be included in the policy
11. Infertility, Pregnancy and childbirth 100% cover.
12. STIs should be covered at 100%
13. Medical checks at least once per annum with an increase of the cost allocation. 100% coverage
14. Insurance Company should indicate how much they can accept and refund staff upon submission of valid medical payment receipt without prescriptions.
15. Pre-conditions of entitlement should be in consultations and consent of the claimant or the sponsor

Key Working Relationships

The Insurance Company’s work will be monitored by the Senior Management of the Gambia office. The Country Manger is the head of the Senior Management Team. The focal staff person of the Insurance Company is the operations manager.

Place of Performance

The place of performance shall be at the CRS Office, 40 Atlantic Road, Fajara.

Period of Performance

The period of performance for this contract to be accomplished shall be ONE YEAR from January 1, 2025 – December 31, 2025, renewal for another ONE YEAR maximum.

LATEST SUBMISSION DATE, 6TH OF DECEMBER 2024.