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Indonesia Elections Administration Program

Request for Proposal to Purchase Health Insurance in Indonesia

No. RFQ-14-066

March 6, 2014

Statement of Work

Purpose

The purpose of this Request for Quotes (RFQ) is to invite prospective vendors to submit a

quote to supply Health Insurance Coverage for IFES Indonesia local staff. The RFQ provides

vendors with the relevant operational, performance, application, and capability.

Coverage & Participation

IFES reserves the right not to enter into any contract, to add and/or delete elements, or to

change any element of the coverage and participation prior to the award at any time without

any liability or obligation of any kind or amount.

General Information

The Organization

The International Foundation for Electoral Systems (IFES) is an independent,

nongovernmental organization providing professional support to electoral democracy. IFES

promotes democratic stability by providing technical assistance and applying field-based

research to the electoral cycle worldwide to enhance citizen participation and strengthen civil

societies, governance and transparency

Schedule of Events

The following is a tentative schedule that will apply to this RFQ, but may change in accordance

with the organization’s needs or unforeseen circumstances. Changes will be communicated

by e-mail to all bidders submitted Notice of Intention to bid.

Issuance of RFP March 6, 2014

Technical Questions/Inquiries Due March 11, 2014, 17:00 Jakarta

time

Answers/Addenda from IFES March 13, 2014, 17:00 Jakarta

time

RFP Closes March 17, 2014 17:00 Jakarta

time

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1 Scope of Work, Specifications & Requirements

The insurance company is to deliver a coverage plan that covers Indonesian employees according

to and equivalent with the requirements in the Indonesian Labor Law.

The coverage shall be for Indonesian employees for Health Insurance Coverage.

Description ITEM NO. Quantity Required

(pax) Unit

Premium Per Person

Total Cost

1 IFES Health Insurance membership

In-Patient 90

Employees 26 Person

Spouses 23 Person

Children 41 Person

2 Out-Patient 90

Employees 26 Person

Spouses 23 Person

Children 41 Person

3 Dental 90

Employees 26 Person

Spouses 23 Person

Children 41 Person

4 Vision 90

Employees 26 Person

Spouses 23 Person

Children 41 Person

5 Medical Check Up (only employees) 26

Employees 26 Person

Total Costs for all Health Insurance

If the unit price per Insurance type (e.g. In-Patient or Out-Patient) is the same for all

individuals, please feel free to list the price just once at the top of the category.

Required Policy Benefit details

2 Benefit Maximum Limit Minimum Benefit (in IDR)

2.1 In Patient Unlimited (per year)

Room per day 800,000

ICU Room per day 800,000

Doctor Visit per day 175,000

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Consultation with Specialist Doctor per day 225,000

Surgery per in-patient period

- Complex Surgery per in-patient period 42,500,000

- Major Surgery per in-patient period 27,625,000

- Medium Surgery per in-patient period 19,125,000

- Small Surgery per in-patient period 10,625,000

Miscellaneous expenses (Medicine, etc) per in-patient period 8,000,000

Treatment before In patient per in-patient period (30 days before)

1,200,000

Treatment after In patient per in-patient period (30 days before)

1,200,000

Ambulance per in-patient period 400,000

Out Patient because of accident per incident (within 14 days)

2,250,000

Life Insurance - -

2.2 Out Patient

Consultation with General Doctor per visit

175,000

(30 visit per year)

Consultation with Specialist Doctor per visit

220,000

(10 visit per year)

Medicines per year 2,500,000

Diagnostic Examination per year 1,700,000

Physiotherapy per visit

175,000 (10 visit per year)

2.3 Dental

Prevention Treatment per visit

300,000 (2 visit per year)

Basic Dental Treatment per year 1,700,000

Complex Dental Treatment per year 1,700,000

Denture per year 2,000,000

2.4. Medical Check Up For Employee Only (once a year)

-

Eye Examination

Radiology : Thorax AP/ PA

Complete Blood Count, Blood Type & Rhesus

Diabetic Screen : Fasting Blood GLUCOSE, GLUCOSE(2pp)

Liver Function Screen : SGOT-SGPT, Phosphatase Alkaline

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Lipid Screen : TOTAL CHOLESTEROL, TRIGLYCERIDES

Kidney Function Screen : UREUM, CREATININE

Serology : HbsAg

Complete Urinalysis

Stool Routine Analysis

2.5. Vision

Eye Examination 1 visit per year 200,000

Frame 1 per year 850,000

Lens 1 per year 850,000

Other Requirements

Please be sure to mention any additional out-of-pocket expenses in relation to the above

requested coverage and other miscellaneous expenses such as a co-pay amount.

Mention any restrictions on access to doctors/clinics/hospitals.

Explain how new employees/ spouses/children can be added during the term and also

how the total premium may be prorated should employees leave.

Provide guidelines on process associated with any possible rate increase in future years.

Vendor Qualifications & References

The offer must be communicated preferably in English but Bahasa Indonesia is accepted.

All vendors must provide the following information in order for their proposal to be considered:

1. A brief outline of the vendor company and services offered, including:

• Full legal name and address of the company

• Full legal name of company’s President and / or Chief Executive Officer

• Provide the name, email address, and telephone number of the contact person to

facilitate communication

2. Evidence of successful completion of a project of a similar size and complexity.

3. References: Contact information for no less than three references from projects similar in

size, application, and scope and a brief description of their implementation (including

location and year)

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Budget & Estimated Pricing

The vendor must agree to keep these prices valid for minimum 60 calendar days as of March 17,

2014. The awarded vendor will provide services for ten (10) months, with a one (1) year option

for renewal of services.

Pricing must be in Indonesian rupiah (IDR) and US Dollar (USD). Unit price is required and in the

case of discrepancies between unit price and total price, the unit price will be taken as reference

basis in the evaluation. The detailed costs should be expressed in Indonesian rupiah with the

applicable tax/charges clearly identified.

Quote Preparation Instructions

Vendor’s Understanding of the RFQ

In responding to this RFQ, the vendor accepts full responsibility to understand the RFQ in its

entirety, and in detail, including making any inquiries to IFES as necessary to gain such

understanding. IFES reserves the right to disqualify any vendor who demonstrates less than

such understanding. Further, IFES reserves the right to determine, at its sole discretion,

whether the vendor has demonstrated such understanding. That right extends to cancellation

of award, if award has been made. Such disqualification and/or cancellation shall be at no

fault, cost, or liability whatsoever to IFES.

Good Faith Statement

All information provided by IFES in this RFQ is offered in good faith. Individual items are

subject to change at any time. IFES makes no certification that any item is without error. IFES

is not responsible or liable for any use of the information or for any claims asserted there

from.

Communication

Verbal communication shall not be effective unless formally confirmed in writing by a

specified procurement official in charge of managing this RFQ process. In no case shall verbal

communication govern over written communication.

Vendors’ Inquiries. Applicable terms and conditions herein shall govern

communications and inquiries between IFES and vendors as they relate to this

RFQ. Inquiries, questions, and requests for clarification related to this RFQ are to

be directed in writing to:

IFES / Indonesia

Attention: Ingrid Sally, Human Resources Officer

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Telephone: +62 21 5795 6795

E-mail: ingrid@ifesindonesia.com

And

IFES / HQ

Attention: Ms. Elizabeth Durbin, Senior Contracts and Grants

Administrator

Telephone: 1 (202) 350-6700

E-mail: edurbin@ifes.org

1.1.1 Formal Communications shall include, but are not limited to:

• Questions concerning this RFQ must be submitted in writing.

• Errors and omissions in this RFQ and enhancements. Vendors shall

recommend to IFES any discrepancies, errors, or omissions that may exist

within this RFQ. With respect to this RFQ, vendors shall recommend to IFES

any enhancements, which might be in IFES best interests.

• Inquiries about technical interpretations must be submitted in writing.

Inquiries for clarifications/information that will not require addenda may be

submitted verbally to the buyer named above at any time during this process.

• Verbal and/or written presentations and pre-award negations under this

RFQ.

• Addenda to this RFQ.

1.1.2 Addenda: IFES will make a good-faith effort to provide a written response to the

questions or request for clarification that requires addenda by March 13, 2014.

1.2 Quote Submission

Vendors must send quotes in electronic copy via e-mail, on or prior to March 17, 2014 17:00

Jakarta time to Ingrid Sally, Human Resources Officer, at ingrid@ifesindonesia.com and

Elizabeth Durbin, Senior Contracts and Grants Administrator, at edurbin@ifes.org.

1.3 Criteria for Selection

The evaluation of each response to this RFQ will be based on its demonstrated competence,

compliance, format, and organization. IFES anticipates basing an award to the best value

response.

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Evaluation Criteria:

Price 50%

Coverage Level and Quality of Benefits 40%

Organizational References 10%

1.4 Selection and Notification

Vendors determined by IFES who possess the capacity to compete for this contract will be

selected to move into the negotiation phase of this process. Written notification will be sent

to these vendors via mail. Those vendors not selected for the negotiation phase will not be

notified.

Additional Terms & Conditions

Non-Disclosure Agreement

IFES reserves the right to require any vendor to enter into a non-disclosure agreement.

Costs

The RFQ does not obligate IFES to pay for any costs, of any kind whatsoever, which may be

incurred by a vendor or any third parties, in connection with the response. All responses and

supporting documentation shall become the property of IFES, subject to claims of

confidentiality in respect of the response and supporting documentation.

Intellectual Property

The vendor should not use any intellectual property of IFES including, but not limited to, all

logos, registered trademarks, or trade names of IFES, at any time without the prior written

approval of IFES, as appropriate.

Respondent’s Responses

All accepted responses shall become the property of IFES and will not be returned.

Governing Law

This RFQ and the vendor’s response shall be governed by the laws of the District of Columbia,

United States.

Partial Awarding

IFES reserves the right to accept all or part of the quotation when awarding the purchase

order.

No Liability

IFES reserve the right to accept or reject any quotation or stop the procurement process at

any time, without assigning any reason or liability.

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IFES shall not be liable to any vendor, person, or entity for any losses, expenses, costs, claims,

or damages of any kind:

• Arising out of, by reason of, or attributable to, the vendor responding to this RFQ; or

• As a result of the use of any information, error, or omission contained in this RFQ

document or provided during the RFQ process.

Entire RFQ

This RFQ, any addenda to it, and any attached schedules, constitute the entire RFQ.

Vendor Certification

This certification attests to the vendor’s awareness and agreement to the content of this RFQ and

all accompanying calendar schedules and provisions contained herein.

The vendor must ensure that the following certificate is duly completed and correctly executed

by an authorized officer of your company.

This proposal is submitted in response to RFQ/14/066 issued by IFES. The undersigned is a duly

authorized officer, hereby certifies that:

(Vendor Name)

agrees to be bound by the content of this proposal and agrees to comply with the terms,

conditions, and provisions of the referenced RFQ and any addenda thereto in the event of an

award. Exceptions are to be noted as stated in the RFQ. The quote shall remain in effect for a

period of 60 calendar days as of March 17, 2014.

The undersigned further certify that their firm (check one):

IS

IS NOT currently debarred, suspended, or proposed for debarment by any federal entity.

The undersigned agree to notify IFES of any change in this status, should one occur, until such

time as an award has been made under this procurement action.

Person[s] authorized to negotiate on behalf of this firm for purposes of this RFP are:

Name: Title:

Signature of Authorized Officer:

Signature: Date:

Name: Title:

Signature: Date:

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Name: Title:

Signature: Date:

Good Faith Statement

All information provided by IFES in this RFQ is offered in good faith. Individual items are subject

to change at any time. IFES makes no certification that any item is without error. IFES is not

responsible or liable for any use of the information or for any claims asserted there from.

Communication

Verbal communication shall not be effective unless formally confirmed in writing by a specified

procurement official in charge of managing this RFQ process. In no case shall verbal

communication govern over written communication.

Formal Communications

Formal Communications shall include, but are not limited to:

• Questions concerning this RFQ must be submitted in writing.

• Inquiries about technical interpretations must be submitted in writing.

• Addenda to this RFQ.

Addenda

IFES will make a good-faith effort to provide a written response to the questions or request for

clarification that requires addenda per the Schedule of Events in this RFQ.

Eligibility

All bidders must have permanent offices in Indonesia. Additionally, bidders must:

a) Not be affiliated with any political parties or engaged in any political activities;

b) Organization must:

i. Not be included in the “List of Parties Excluded from Federal Procurement and Non

procurement Programs”

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ii. Not provide material support or resources to any individual or entity that it knows, or

has reason to know, is an individual or entity that advocates, plans, sponsors, engages

in, or has engaged in terrorist activity, including but not limited to the individuals and

entities listed in the Annex to Executive Order 13224 and other such individuals and

entities that may be later designated by the United States under any of the following

authorities: § 219 of the Immigration and Nationality Act, as amended (8 U.S.C. § 1189),

the International Emergency Economic Powers Act (50 U.S.C. § 1701 et seq.), the

National Emergencies Act (50 U.S.C. § 1601 et seq.), or § 212(a)(3)(B) of the

Immigration and Nationality Act, as amended by the USA Patriot Act of 2001, Pub. L.

107- 56 (October 26, 2001)(8 U.S.C. §1182).

- Executive Order No. 13224 can be found at :

http://transition.usaid.gov/business/business_opportunities/cib/pdf/aapd0

4_14.pdf

- List of Parties Excluded from Federal Procurement and Non- procurement

Program can be found at:

https://www.sam.gov/

- U.S. Treasury Specially Designated Nationals List (SDN)

http://www.treasury.gov/resource- center/sanctions/SDN- List/Pages/default.aspx

- The UN Security Council Committee pursuant to resolutions 1267 (1999) and

1989 (2011) concerning Al-Qaida and associated individuals and entities

http://www.un.org/sc/committees/1267/aq_sanctions_list.shtml\

c) No award (in-kind or cash) will be made to governmental organizations.

Offer requirements

1. Offers should be written in English. Applicants must submit a detailed application with

an itemized budget and budget notes for the above listed deliverables and potential

add-ons. The detailed budget should be in IDR.

2. Applicant must be neutral with no affiliation with political party.

3. Applicant must submit general information about the company’s history and similar

experience.

4. Include a contact name, email address, and telephone number to facilitate

communication between IFES and the Applicant.

5. Applicant must ensure that the service provided to IFES is the subject of attention and

monitoring of the highest quality. Therefore it must institute a mechanism to monitor

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carefully the quality of its services and ensure, permanently, that IFES benefits of the

best known benefits.

6. All questions and responses must adhere to the schedule noted above and shall be to

the attention of Ingrid Sally, Human Resources Officer, at ingrid@ifesindonesia.com

and Elizabeth Durbin, Senior Contracts and Grants Administrator, at

edurbin@ifes.org.