REQUEST FOR PROPOSALS (RFPs)- REQUEST FOR BROKER TO PROVIDE MEDICAL AID FUND ADMINISTRATION SERVICES

Title

REQUEST FOR BROKER TO PROVIDE MEDICAL AID FUND ADMINISTRATION SERVICES

Location

Harare

Type of Contract

Consultant

Deadline

15/10/2021 (Expired)

About

1) GENERAL BACKGROUND

Zimbabwe Health Interventions (ZHI) is a not-for-profit human development organization which is registered as a Trust under the Zimbabwe Deeds Registries Act (Chapter 20:05). ZHI’s mission is to develop and deliver innovative and sustainable high impact integrated health interventions with local communities while working with and strengthening existing institutions.

ZHI provides comprehensive medical aid cover to all full-time employees and their spouse and unmarried children up to 18 years of age, or up to 23 years of age if enrolled as a full- time student, up to a maximum of 4 children.

ZHI employees are based in Harare, Manicaland – Buhera, Chipinge, Mutare, Mutasa, Makoni, Midlands – Gweru, Kwekwe, Gokwe South, Mberengwa, Bulawayo; Matabeleland South – Gwanda, Beitbridge, Matobo, Insiza, Plumtree with a staff complement of approximately 400 full-time staff and their dependents.




Scope Of Work










2) OBJECTIVES OF THE ASSIGNMENT
The objective of this Terms for Reference (TOR) is to select and get into contractual agreement with suitable contractors who will set-up and administer a Self-Administered Medical Fund for the purposes of providing medical aid cover for ZHI employees. Bidders are requested to propose the best and most cost-effective solution to meet ZHI requirements, while ensuring a high level of service. If replying to the proposal, you are to follow the TOR instructions and specifications. The vendor should submit a proposal including:


1) Product Design


2) Drafting of Fund Rules


3) Membership On-boarding


4) Membership Administration


5) Claims Administration


6) Managed Care Services


7) Wellness Management


8) Account Performance Reports


9) Advisory Services











3) DELIVERABLES
3.1 Structuring of the Fund


 The selected vendor will be required to structure a Self-Administered Medical Fund with a plan that provides the same or greater benefits than what is currently being offered. ZHI currently provides medical and drug coverage to all full-time employees and their spouse and unmarried children up to 18 years of age, or up to 23 years of age if enrolled as a full- time student, up to a maximum of 4 children.


3.2 Fund Administration


The selected vendor must demonstrate access to a comprehensive network of Medical Service Providers across the country. The vendor will be responsible for membership processing, claims administration, service provider management and producing fund performance reports. Additionally, plan management/medical management components such as wellness, disease management, will be administration responsibilities of the vendor.


3.3 Membership Processing


•       Provide effective and accurate member services.


•       Enrolment, amendment, and termination of membership to the medical scheme.


•       Printing membership cards for all members and dependents covered under the ZHI medical fund.


•       Complete Monthly reconciliation. Instructions on additions, amendments and termination will come from the client. 


3.4 Claims Administration


•       Deliver accurate, responsive, and timely claims payment.


•       Review, process, and payment of claims.


•       “Clean Claims” should be processed within 7 business days of receipt.


•       Claims monitoring investigation and analysis to manage waste.


3.5 Customer Service


•       Provide timely and efficient claims services and responsiveness to members.


•       Avail customer service call centers for members.


•       Produce timely fund performance reporting.


3.6 Additional Services


•       Provide disease management and wellness management programs.


•       Produce Fund Performance Reports periodically.


•       Provide members access to a wide network of Medical Service Providers across the country.


Implementation


•       Produce a detailed implementation plan and calendar with specified time periods, types of information required and responsibilities. Assume that you will be notified of administrator selection prior to 01 December 2021. Detail both pre-implementation and post implementation strategies.


•       Review all plan and confirm plan provision.











4)EVALUATION CRITERIA
 






























Criteria Submission Requirement Weight (%)
Technical Proposal A detailed description of the proposed methodology, Fund structure, proposed benefits structure and planned schedule to establish the execution of services and achieve objectives. List of exclusions 40
Structure of Management fees Brief outline of Administration model clearly outlining administration fees


 

 30
Professional Indemnity Cover Active Professional Indemnity Cover issued on or before 30 September 2021 is a must.


 

 10
Technical expertise and experience CVs with a brief description of Management’s Experience at least 10 years.


Demonstrated experience in providing similar services preferably to similar organisations like ZHI, with at least 3 contactable referees.

 20















Application Requirements






















 


5) MANDATORY REQUIREMENTS
The Medical Aid Fund Administrative broker should submit the following documents:



  • Company profile

  • Certificate of Incorporation

  • Accreditation by the Government Association of Healthcare Funders

  • NSSA and Tax Clearance Certificate

  • CR14

  • CR6


This bid is open to brokers only, but they may partner with a medical aid provider of their choice.


Submission Instructions


Proposals, including a covering letter and at least 3contactable trade references, should be emailed to: procurement@zhi.co.zw , with subject: “(Self-Administered Medical Fund Broker)”.


The successful organization will be informed once a decision is made by ZHI management and staff.


The deadline for submission of detailed proposals is 15 October 2021 23:59pm.


 
6) TERMS AND CONDITIONS
·       ZHI reserves the right to eliminate bids deemed not to be in the best interest of ZHI and award the contract to the bidder whose submission is considered to be in the best interest of the ZHI.


·       ZHI reserves the right to accept or reject any proposals received at any time, without thereby incurring any liability to the affected bidder(s) or any obligation to provide information on the grounds for the action.


·       ZHI reserves the right to enter into agreements not specified herein.


·       All responses must be received on or before the deadline of submission date.


·       Incomplete proposal submissions that do not comply with all specifications will be rejected.