Comprehensive Health Care Plan for Sixty Two (62) Tender - 17035070

Procurement Summary

Country: Philippines

Summary: Comprehensive Health Care Plan for Sixty Two (62) Incumbent Employees of MCWD (Optional Dependents & MCWD Board of Directors) for one (1) year inclusive of VAT.

Deadline: 11 Oct 2017

Posting Date: 05 Oct 2017

Other Information

Notice Type: Tender

TOT Ref.No.: 17035070

Document Ref. No.: PR# 17-09-1172

Competition: ICB

Financier: Self Financed

Purchaser Ownership: -

Tender Value: Refer Document

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Tender Details

Comprehensive Health Care Plan for Sixty Two (62) Incumbent Employees of MCWD (Optional Dependents & MCWD Board of Directors) for one (1) year inclusive of VAT.
PR# 17-09-1172
ABC 538, 348.75
Line Items
Item No.Product/Service NameDescriptionQuantityUOMBudget (PHP)
1Comprehensive Health Care Plan forSixty Two (62) Incumbent Employees of MCWD (optional dependents & MCWD Board of Directors) for one (1) year inclusive of VAT. Please see below for Terms and Conditions1Lot538, 348.75
Other Information
SPECIFICATION
-œProcurement of a Comprehensive Health Care Plan for Sixty-two (62) Incumbent Employees of Metro Cotabato Water District (MCWD) for One (1) Year-.
I AGE ELIGIBILITY
1. Principal : 35 to 65 years old
II PROGRAM TYPE and PROVIDER ACCESS
1. Program Type : Hospital-based
2. Provider Access: Within the Philippines, must have two (2) accredited level 2 hospitals in Cotabato City.
III PREVENTIVE CARE
ANNUAL PHYSICAL EXAMINATION
1. Complete blood count : Covered
2. Physical examination : Covered
3. Urinalysis : Covered
4. Fecalysis : Covered
5. Chest-X ray : Covered
6. Electrocardiogram ; (for members age thirty-five [35] years and above, or if indicated) : Covered
7. Pap smear ; (For Female members age thirty-five[35] years and above, or if prescribed) : Covered
8. Evaluative doctor-s consultation.
IV EMERGENCY CARE
Accredited Hospitals
1. Professional fees of attending physicians : Covered
2. Use of operating room and ICU/recovery room facilities : Covered
3. Medicines administered during treatment for immediate relief : Covered
4. Oxygen and IV fluids : Covered
5. Laboratory tests, x-rays and other diagnostic procedures : Covered
6. Blood transfusions and intravenous fluids : Covered
Non-Accredited Hospitals : One hundred percent (100%) reimbursable hospital bills and professional fees based on Relative Value Scale (RVS)
Areas without Accredited Hospitals : One hundred percent (100%) reimbursable hospital bills and professional fees based on Relative Value Scale (RVS)
Room Upgrade in Case of Room Unavailability : Up to 24 Hours
Ambulance Services : Covered
V OUT-PATIENT CARE
1. Medical consultation during regular clinic hours, excluding prescribed medicines: Covered
2. Emergency room care: Covered
3. Referral to accredited specialist/s: Covered
4. Eye, Ear, Nose and Throat consultations: Covered
5. Treatment of minor injuries or illness (including ATS and Toxoid vaccines if indicated, except anti-rabies);: Covered
6. Laboratory test, x-ray, and other diagnostic examinations prescribed ny the INTELLICARE physician; : Covered
7. Minor surgery not requiring confinement ( including cautery of warts neck down) : Covered
8. Speech and physical therapy are covered up to twelve (12) sessions per year respectively: Covered
9. Pre- natal and post-natal consultation are covered up to fourteen (14) consultations per year: covered
VI IN-PATIENT CARE
1. Room and board benefits specified in Schedule per category: Covered
2. Use of operating room and recovery room facilities: Covered
3. Professional services of all attending accredited specialists: Covered
4. Anesthesia and medications: Covered
5. Blood transfusion and intravenous fluids: Covered
6. Human blood products (e.g. platelets/packed RBC) and its processing except gamma globulin and cost of donor;: Covered
7. Laboratory test, x-ray and other diagnostic examinations: Covered
8. Administered medicines: Covered
9. Admission kit including ice cap/wee bag: Covered
10. Dressings, plaster casts, sutures and other items directly related to the medical management of the patient : Covered
11. ICU confinement is covered up to Pre - existing Condition Limit: Covered
12. Ambulance service is covered up to three thousand pesos (PHP 3, 000.00) per conduction, hospital to hospital and point of incident to hospital: Covered
13. Assistance in administrative requirements through the liaison officer; and
14. All other hospital charges deemed necessary by INTELLICARE Accredited Physician in the treatment of the patient.: Covered
VII PRE-EXISTING CONDITIONS
1. Hypertension: Covered
2. Thyroid disease, goiter : Covered
3. Cataracts, glaucoma, pterigium : Covered
4. Ear, nose and throat conditions requiring surgery : Covered
5. Asthma : Covered
7. Tuberculosis : Covered
8. Chronic cholecystitis/choletithiasis and other forms of calcification : Covered
9. Hernia : Covered
10. Prostate disorders : Covered
11. Hemorrhoids and fistulae : Covered
12. Tumors : Covered
13. Uterine myoma, ovarian cyst, endometriosis : Covered
14. Buerger-s disease : Covered
15. Varicose veins : Covered
16. Scoliosis : Covered
17. Arthritis : Covered
18. Chronic allergies : Covered
19. Gastric and duodenal ulcers : Covered
20. Dreaded diseases: Covered
VIII TREATMENT/IN-PATIENT CARE
1. Accredited doctor-s services: Covered
2. Medicines administered during treatment, or for immediate relief: Covered
3. Oxygen and intravenous fluids: Covered
4. Dressing, plaster casts, and sutures: Covered
5. Laboratory tests, x-rays, and other diagnostic examinations directly related to the emergency management of patient. : Covered
6. Heart Surgery/ Angiography/ Angiogram/ Angioplasty: Covered
7. Transurethral Microwave Therapy of Prostate: Covered
8. Percutaneous Ultrasonic Nephrolithotomy : Covered
9. Lithotripsy : Covered
10. Laparoscopic Procedure: Covered
11. Arthroscopic Procedure : Covered
12. Hysteroscopic Procedure (i.e. Hysteroscopic Myoma Resection and Hysteroscopically-Guided D&C) : Covered
13. Other Hysteroscopic Procedure : Covered
14 Stereotactic Brain Biospsy : Covered
15. Hemorrhoidectomy (i.e. Conventional and Scalpel) : Covered
16. Dialysis: Covered
17. Chemotherapy / Radiotherapy: Covered
6. Gamma Knife surgery (based on cobalt/ radiotherapy): Covered
7. CT Scan: Covered
8. Ultrasound (except for maternity cases): Covered
9. Thallium Scintigraphy: Covered
10. Benign Prostatic Hypertrophy: Covered
11. 2D-Echo with doppler : Covered
12. 24-Hour Holter Monitoring : Covered
13. Herniorraphy : Covered
14. Electromyography : Covered
15. Treadmill Stress Test : Covered
16. Myelogram: Covered
17. Video Gastroscopy : Covered
18. Mammography / Sonomammogram : Covered
19. Bone Densitometry Scan (Dexascan) : Covered
20. Magnetic Resonance Imaging : Covered
21. Nuclear Radioactive Isotope Scan : Covered
22. Neuroscan : Covered
23. Perfusion Scan : Covered
24. Positron Emission Tomography (PET) Scan: Covered
25. Cryosurgery : Covered
IX. OTHER BENEFITS
1. Dental examination : Optional
2. Annual oral prophylaxis : Covered
3. Oral health education through chairside instruction : Covered
4. Orthodontic consultation (braces and malposition of teeth) : Covered
5. Pre - check up of teeth and gums : Covered
6. Temporo mandibular joint consultation (clicking of jaws) : Covered
7. Conduct activities on dental health education (e.g. regarding AIDS) : Covered
8. Emergency dental treatment for the relief of pain: Covered
9. Gum treatment for cases like inflammation or bleeding: Covered
10. Temporary fillings : Covered
11. Simple extraction of unsavable tooth: Covered
12. Recementation of fixed bridges, crowns, jackets, inlays/outlays.
X. EXCLUSIONS
1. Services rendered by non-IntelliCare doctors, except with the prior written authorization of an IntelliCare coordinator, or in emergency cases.
2. Hospital charges for special or private nursing services, supplemental foods and medicines like vitamins and minerals (unless prescribed), extra accommodation and non-medical personal appliances such as radio, television, telephone, computer.
3. Health/Annual/Pre-employment check-ups for other companies, government requirements, insurance purposes, or travel abroad.
4. Recuperation such as confinement in sanitartium or convalescent home, rehabilitation medicines (including work-ups), custodial, domiciliary care, and government imposed quarantines.
5. Medical certificates
6. Professional fees in medico-legal cases.
7. Refusal to undergo recommended treatment or demanding treatment for which IntelliCare doctors believe a professionally acceptable alternative exists.
8. Blood screening.
9. Vaccines for immunization, anti-rabies, anti-venom, steroid injections.
10. Organ transplants or acquisition of an organ.
11. Procurement or use of eyeglasses, special braces, steel implants, buckles for retinal detachment, wheelchairs or prosthetic appliances including but not limited to items such as artificial limbs, hearing aids, crutches, intraocular lens, contact lenses.
12. Determining/ruling out of REC during the first 12 months of membership if result is positive.
13. Determining/ruling out of hepatitis or tuberculosis if result is negative.
TREATMENT / PROCEDURES
1. Circumcision, infertility or fertility and virility/potency (erectile dysfunctions), artificial insemination, sex change;
2. Laser eye surgery for myopia or error of refraction;
3. Acupuncture, chiropractic treatment, iridology, chelation; cell implant therapy;
4. Speech or physical therapy in excess of twelve (12) sessions;
5. Sleep study, unless directly related to an organic illness and the maximum limit is PHP 5, 000.00;
6. Reconstructive surgery except to treat a functional defect directly caused by accident or illness covered herein, milia, xyringoma, facial moles, aesthetic, cosmetic or beautification alternations, sclerotheraphy;
7. Out-patient medicines and medical suipplies except in emergency cases;
8. All other treatments, laboratory examinations, diagnostic procedures and surgical procedures not specifically defined in this Agreement are considered ( Example but not limited to the following: dental Surgery, Dental X-Ray, etc.).
EXTERNAL FORCES / ACTIVITIES
1. War-like or combat operations, Government declared acts of rebellion, active participation in riots or demonstrations, strikes or labor disputes, terrorism, provoked criminal acts, violation of a law or ordinance, commission of a crime whether consummated or not, serving in military, naval, or air forces of any country or international authority, unnecessary exposure to imminent danger or hazard, active participation in setting off and/or handling pyrotechnic materials, attempted suicide, self inflicted injuries;
2. Participation in hazardous activities such as skydiving, motor sports, judo, karate, taekwondo, boxing, wrestling, bungee jumping, scuba diving, snorkelling, horseback riding, polo, hunting, mountain climbing, rock climbing, hang gliding, spelunking, ballooning, gymnastics, as a paid professional or semi-professional in any sports;
3. Government declared epidemics; complete or partial destruction of hospital by fire; flood, or other perils; earthquake, tsunami, volcanic eruption; act or order of Government, brownouts;
4. Aviation or aeronautics or sea travel other than as a fare-paying passenger on a licensed aircraft/vessel operated by a recognized airline/operator;
ILLNESSES / CONDITIONS
1. Congenital abnormalities such as neonatal hernia, indirect hernia, hemangioma, phimosis, harelip, clubfoot, cerebral palsy, renal diseases such as medullary sponge kidney, pediatric cardiovascular work-up and the like;
2. Development delay;
3. Neuro-developmental disorders such as ADHD - Attention Deficit Hyperactive Disorder, Austism; Genetic Disoder which may result to Mental Retardation (e.g. down Syndrome); and other condition which may require speech/ physical and other related therapies;
4. Sexually transmitted diseases, AIDS and AIDS-related complex or condition;
5. Substance addition or reaction to use of prohibited drugs, alcoholism, alcohol intake anxiety reaction, psychiatric and psychological illness, neurotic behaviour disorder, or accidents arising from these conditions;
6. Guillaine-Barre Syndrome;
7. PEC during the first twelve (12) months of cover;
8. Hypersensitivity tests to check for allergies and desensitization;
9. Any disability which may have affected a Dependent prior to the thirtieth (30th) day after birth;
10. Pregnancy, compications due to abnormal pregnancies such asbut not limited to ectopic pregnancy, tube pregnancy, h-mole, abruption placenta, placinta previa etc., childbirt6h, miscarriage, abortion.
TERMS and CONDITIONS:
1. Includes pre-existing and dreaded diseases up to the Maximum Benefit Limit (MBL).
2. Quotation shall be based on the R & B and maximum benefit limit.
3. Quotation shall be inclusive of VAT.
4. Effectively of the contract shall be on October 24, 2017 to October 23, 2018.
5. Payment shall be made not later than thirty (30) days after signing of contract.
6. The approved budget is based on the number of sixty-four (62) incumbent employees of MCWD with the amount of Php538, 348.75, viz; Number of Employees accordingly:
a.) 48 x 8, 139.78 = 390, 709.44
b.) 1 x 8, 252.42 = 8, 252.42
c.) 9 x 10, 170.37 = 91, 533.33
d.) 4 x 11, 963.39 = 47, 853.56
Total---...Php538, 348.75
7. The contractor shall provide for all the services necessary to manage and/or administer the Comprehensive Healthcare Plan for the MCWD Incumbent Employees in accordance with the requirements and conditions set herein.
8. The contractor guarantees to deliver efficient and effective service consistent with the objectives and purposes of the contract.
9. All Pre-existing Conditions and Illnesses including Dreaded and Non-Dreaded Illnesses (please refer to Annex B) shall be waived or shall be covered immediately upon effective date of coverage. The list of Exclusions is indicated in Annex C.
10. All expenses for emergency care services enumerated in Section B used in the emergency treatment of the patient and rendered in a non-accredited hospital or clinic and by a non-accredited physician, specialist, and/or sub-specialist shall be covered and will be reimbursed as follows;
a. In areas where the contractor has no accredited hospital or clinic, the contractor shall reimburse all expenses including doctor-s fees incurred by the patient up to the MCL based on approved charges and RUV rates.
b. In areas where the contractor has an accredited hospital or clinic, the contractor shall reimburse all expenses including doctor-s fees incurred by the patient based on the contractor-s existing RUV rates as if the patient had been confined in the accredited hospital or clinic and/or seen by the accredited physicians, specialists and/or sub-specialists.
11. All expenses for hospitalization/in-patient services such as but not limited to, professional fees, laboratory and other diagnostic services, referrals, medicines and other drugs used in the treatment of the patient and rendered in an accredited hospital or clinic and by an accredited physician/s, specialist/s, and/or sub-specialist/s shall be covered up to the MCL and subject to policy terms and conditions unless otherwise specified.
12. The professional services of a non-accredited physician, specialist or sub-specialist, rendered to a member while hospitalized for emergency treatment in a non-accredited hospital shall be reimbursed based on the contractor-s existing RUV rates.
a. Expenses in excess of what is allowed shall be shouldered by the patient.
b. Information on the contractor-s prevailing surgical and hospital rates shall be within thirty (30) days from execution of contract by the contractor for the information of the members.
13. All expenses for out-patient services rendered in an accredited hospital or clinic and done by an accredited physician, specialist and sub-specialist shall be on a -œno cash-out basis- and will be covered up to the MCL based on the contractor-s existing RUV rates.
14. In case it becomes inevitable or necessary for an accredited physician or specialist to refer the member to a non-accredited physician, specialist, or sub-specialist, 100% of the actual professional fees based on existing RUV rates shall be settled by the contractor directly with the non-accredited physician on a best effort basis. Otherwise, the same shall be settled by the contractor through reimbursement basis.
15. Expenses in non-accredited hospitals shall be reimbursed in accordance with No. 12 above. However, the transfer of a patient from a non-accredited hospital to an accredited hospital shall be covered by the contractor up to the MCL based on existing RUV rates in the following situations only:
a. In serious or life-threatening cases where the immediate transfer of the patient is medically contraindicated, 100% of actual expenses shall be defrayed by the contractor including ground ambulance until transfer is eventually effected.
b. In serious or life-threatening cases where the immediate transfer by any means is an absolute necessity for the patient-s survival, the contractor will defray 100% of all related expenses until transfer is eventually effected.
16. All claims for reimbursement must be submitted to the contractor within sixty (60) working days from the date of discharge or consultation.
17. All claims for reimbursement should be processed and paid by the contractor within thirty (30) working days from the date of receipt of complete documents.
18. The contractor shall provide liaison officers in key cities nationwide, medical coordinators (preferably hospital-based) and hotline services.
19. The contractor shall be required to submit the following:
a. A Utilization Report containing the following information, among others: Services (Emergency Care, Hospitalization/In-Patient, Out-Patient, Reimbursements, burial, etc.) and benefits availed of and amount of utilization, the census of cases according to illness, age, submitted on a semestral basis to MCWD.
20. The Nationwide list of Health Care Provider coordinators, accredited hospitals, clinics, physicians, dentists including centers, accredited for special services such as but not limited to dialysis, eye care, animal bites or poisoning management, slimming and biometric programs. These informational materials shall be submitted, within thirty (30) days from the execution of the contract to MCWD through Administrative Services - Human Resource Department.
21. Announcements/Pamphlets/Member Guideline Booklets for proper information and dissemination to the incumbent employees of MCWD, through the Administrative Services - Human Resource Department within thirty (30) days from execution of the contract.
22. To effectively monitor contract compliance and any observation and concern regarding the delivery of services and benefits under the Plan, the Administrative Services - Human Resource Department is designated as the health care plan coordinator, and will be tasked with coordinating with the contractor and/or his authorized representatives.
23. The benefits under the PhilHealth and/or Employees Compensation Commission (ECC) are deemed integrated with the benefits under this Plan. Hence, the contractor shall not be required to pay or advance the cost of benefits under PhilHealth and/or ECC. In case of hospital confinements, members should accomplish and submit the required PhilHealth Claim Form. Otherwise, the contractor shall not be required to pay the PhilHealth portion of the hospital bill. The member who fails to claim the benefit under the PhilHealth shall pay the cost of the unclaimed benefit.
24. If the member-s bodily injuries are claimed to have been caused by an act of omission of a third party through a motor vehicle, the services and benefits shall be covered if the member executes an agreement to subrogate to the contractor whatever rights the member may have by reason of the accident or event that gave rise to the claim.
25. The contractor shall maintain a satisfactory standard of competency, conduct and integrity among its employees. In this regard, the contractor shall act on complaints/feedbacks brought to its attention by the MCWD Administrative Services - Human Resource Department.
Contract Period:
1. The terms and conditions of the contract under this TOR shall cover a period of one (1) year subject for renewal.
2. Notwithstanding any provisions to the contrary, the MCWD shall have the right, power and privilege to terminate the services of the contractor without the need of any judicial action for any violation of the provision of the contract, as may be determined by the MCWD Bids and Awards Committee (BAC) by giving thirty (30) calendar days written notice to the contractor in which event the MCWD shall be entitled to proportionate return of the contract price based on the unutilized premium.
INSTRUCTIONS/ NOTES TO BIDDERS:
1. Please indicate the following information in your bid: a) Company Name, Address, Tel/Fax nos.;
b)PhilGEPS Registration Certificate No. and date of validity; c) Bidder-s offer ( Technical
Specification/brand) per item; d) unit & total price; e) Name of Bidder-s authorized representative;
and f) Signature and date.
2. Bids/ quotations may be submitted thru fax, email, or directly to the BAC Secretariat Office on or
before the deadline of submission of Bids.
3. Suppliers are required to submit the following prior to the notification by the BAC of the award: a)
Valid and Current Mayor-s/ Business Permit (2017); b) Valid and Current PhilGEPS Registration
Certificate/ Number; c) Income/Business Tax Return; and d) Omnibus Sworn Statement.
4. Bids should be valid for 45 days counted from the deadline of submission.
5. Warranty shall be for a period of six (6) months for Supplies & Materials, one (1) year for Equipment
from date of acceptance by the Procuring Entity.
6. Delivery Period: 15 Calendar Days
7. Term of Payment: 30 Calendar Days
8. The total price quoted above is subject to withholding tax.
Closing Date : 2017-10-11

Documents

 Tender Notice