Terms Of Reference (TOR) For Staff Health Insurance Cover For SOS Children’s Villages Somalia.

TERMS OF REFERENCE (TOR)

 FOR STAFF HEALTH INSURANCE COVER FOR SOS CHILDREN’S VILLAGES  SOMALIA.

1. • About US

SOS Children’s Villages Somalia (SOS CVS) is a member organization of the federation of SOS Children’s Villages International and has been in existence since 1985 in Somalia.  In addition, SOS CV Somalia has over 37 years of experience in the provision of long-term alternative childcare, youth programming and direct delivery of humanitarian assistance for drought, floods, and protracted displacement affected populations in the sectors of integrated WASH, Health, Nutrition, Education, Child Protection in emergencies, Gender-Based Violence and Livelihood support through the Family Strengthening programs. SOS Health Program in Somalia dates back to 1991 when SOS Mother and Child Hospital was established in Mogadishu at the brink of the civil war. The hospital is one of the oldest and most well-established health facilities in the Banadir Region. The Hospital is located in Heliwa District and caters to the health care needs of thousands of vulnerable mothers and children and accords the highest standards of medical care to all its patients indiscriminately. Considering the need for healthcare services, SOS expanded its Health and Nutrition program and established district-level hospitals in Baidoa, Hudur and Balcad districts in South West and the HirShabelle States of Somalia. In addition, SOS CVS manages two other health facilities in the Afgoye corridor and Lafole of Lower Shabelle. SOS CVS also manages 4 nutrition centers in the Banadir region in collaboration with the Banadir Regional Administration, further to the Stabilization Center (SC) that is established in the main Hospital in Heliwa, Mogadishu.

• Background of consultancy

SOS Children’s Villages Somalia provides medical insurance cover for its staff and their dependents as per table 1. In this tender, SOS Children’s Villages Somalia is seeking detailed proposals from eligible insurance firms who offer quality services, increase choice and competitiveness. Ensure responsibilities and have mechanisms that eliminate discrimination and unfair treatment during service delivery. The number of staff to be included in the coverage will be subject to changes due to staff leaving and staff being hired.

2. The need/Purpose:

The  purpose of the ToR for the staff health insurance service are:-

1. To administer competitive and comprehensive benefits that provide outpatient and inpatient health schemes  for employees and their families in a cost-effective
2. Respond to all emergency cases in 24/7
3. Scope of work

SOS intends to seek quotation from qualified insurance companies to provide quotations based on the below territorial coverage. Incase the companies may have different rates for different territories- a similar table which clearly indicates the different options and prices.

The selected health insurance provider  will provide the following:

4. In-Patient Treatment

In-patient treatment will be provided to employees and their 2 dependants (M+2). The cover has to be a cashless system; therefore, the selected company ought to have a wide network with specialist hospitals across Somalia and in Kenya(Nairobi, more specifically).

5. Out-Patient Treatment

The out-patient treatment provided to employees and their dependants will be a cashless system and

6. 6. Optical, Dental and maternity cover for option 2 category
7. Medical Evacuation coverage

The Medical Evacuation coverage for staff only such as Tele-Medical Consultation, Evaluation and Referral 24 hours, Medical Evacuation and Repatriation, Hospital Admission, Monitoring of Medical Condition, Dispatch of Medicine in the event of Emergency, Emergency Message Transmission.

8. Providing service agreement to cover SOS for 24 months (2 years)

The selected company should be willing to provide a service agreement covering SOS for 2 years, based on annual renewal with the possibility of terms and conditions changes.

8. CRITERIA FOR PROPOSAL EVALUATION

Technical Proposal.

Each bidder shall submit a technical proposal addressing the services required and how they will meet SOS requirements. The technical proposal will account for 70% of the total combined score. The proposal will be evaluated according to the following criteria:

1. Company & personnel qualifications
2. Comprehensive benefit coverage of both in patient and out patient
3. Network of Medical providers
4. Coverage Area – Geographical and international
5. Quality of service (Reservation, billing and reporting systems)
6. License and certificate of registration
7. Extensive experience and proven track record in the health insurance business and Sound experience in servicing international organizations

Additional services provided

• Reliable health coverage services
• Ability to provide 24-hours service
• Ability to provide reimbursement system by sending the claim to employee’s bank account
• Real-time administrative support systems
• Ability to respond immediately to emergencies, whilst maintaining high-quality standards of service delivery

Financial Proposal

The financial proposal shall be evaluated according to the price structure proposed and will account for 30% of the total combined scoring.

GENERAL PROVISIONS

This bid is open for all Islamic Health Insurance Companies.

Detail data is in the tables enlisted in the scope of work section, consisting of:

• Health insurance benefit requested
• Total number of employees and
• Please submit the health insurance proposal according to the health insurance benefit as requested which contains the below information:

– Inpatient benefit

– Outpatient benefit

– Dental

– Optical

– Maternity

– Provider coverage

– Premium price

– General condition

– General Exclusion

Each bidder may have their proposal version, but the technical proposal must be submitted as a separate document from the financial proposal.

Only proposals that fully address the mandatory services listed in the bidding requirement will be evaluated.

Application Procedures

Interested health insurance companies who meet the conditions specified herein are invited to submit their technical and financial proposals including the proposed quotation in USD, company profile  and a clear demonstration of understanding and interpretation of Terms of Reference (TOR) to: procurement@sossomalia.org  and indicate  Health insurance services  for SOS Children’s village  staff in Somalia the subject line of the e-mail, to reach us not later than 30rd April 2022

 

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