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Terms of Reference for Provision of Medical Services for CARE Somalia/Somaliland Staff

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  • Post date:21 May 2020
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Job Description

Terms of Reference for Provision of Medical Services for CARE Somalia/Somaliland Staff.

 Background:

CARE has been providing emergency relief and lifesaving assistance to the Somali people since 1981. Our main program activities since then have included projects in water and sanitation, sustainable pastoralist activities, civil society and media development, small-scale enterprise development, primary school education, teacher training, adult literacy and vocational training. We work in partnership with Somali and international aid agencies, civil society leaders and local authorities.

CARE is an organization driven by its mission to overcome poverty and social injustice. We currently work in over 93 countries and focus primarily on women and girls, as the most disproportionately affected by poverty, while engaging men and boys in our work too. CARE International is an international NGO working in Somalia and Somaliland. CARE Somalia/Somaliland and its partners work with vulnerable communities to address the underlying causes of poverty and promote peace and development, as well as mitigating immediate suffering caused by drought, conflict and displacement.

We will be running a tender process intending to award contracts for the provision of Medical Insurance, Group Life Insurance and Group Personal Accident (WIBA Compliant) covers as per below specifications.

  1. Purpose

The main purpose of this TOR is to find a suitable medical insurance companies to provide its service to all Care International – Somalia/Somaliland staff for a period of one year (1st July 2020 – 30th June 2021). The CSOM staff are living in Somalia/Somaliland and in Kenya well. So, we are looking for a companies who has entire coverage in Somalia/Somaliland and in Kenya as well. They can be two separated firms not necessary one firm with entire services.

  1. Scope of Work

The company which is selected to perform the work will have to cover the following functions:

Staff & Dependents Medical Insurance Scheme covering per family:

  • Out-patient medical services
  • In-patient medical services
  • Maternity cover medical services
  • Optical medical services
  • Dental medical services
  • Management of the entire employee medical claims and service processes
  • Pre-negotiated rates with providers, i.e. hospitals, claims, doctors
  • Clear evidence of credit worthiness from providers
  • Claims Management (Receiving of claims, Claims processing, Records reconciliation etc.)
  • Care management (proper and timely managing of pre-authorization for treatment, coordinating hospitalization of beneficiaries, ensure all facilities are aware of exclusions, out-patient treatment follow up especially following on post-hospitalization etc.)
  • Emergency Rescue & Evacuation (International & local)
  • Emergency Air Evacuation from Somalia or Kenya allowed subject to landing rights at the time of evacuation. The cover will take care of emergency evacuations up to the inpatient limit.
  • Work Injury Benefits Act (WIBA)
  • Group Personal Accident (GPA)

The selected company will have to explicitly give a detailed explanation of each of the above categories and also what is covered (inclusions) and what is not covered (exclusions). The company shall also provide the below information in a detailed way.

  1. Lot 1- Provision of Medical Cover (in-patient, out-patient, optical and dental)
  • The cost and eligibility out-patient cover
  • The cost and eligibility of in-patient cover
  • The cost and eligibility of maternity cover
  • The cost and eligibility of Optical cover
  • The cost and eligibility of Dental cover
  1. Lot 2- Provision of Group life insurance cover
  2. Lot 3- Provision of Group Personal Accident – WIBA compliant
  1. The family size to be quoted upon

Section A:

Somalia/Somaliland Staff
Family size No. of people covered Premium Total
M+O 1    
M+1 1    
M+2 1    
M+3 1    
M+4 1    
M+5 1    

 Section B:

Regional Hire Staff in Kenya
Family size No. of people covered Premium Total
M+O 1    
M+1 1    
M+2 1    
M+3 1    
M+4 1    
M+5 1    

 Section C:  Group Personal Accident /WIBA:

  • Eight years’ salary in case of total disability or accidental death

Section D: Group Life Insurance

  • Three years’ salary          
  1. Timetable for provision
S/N Item Date
1 Tender Release 21st  May 2020
3 Closing date and time for receipt of tenders 6th June 2020
4 Tender opening location TBC
5 Tender opening date and time 7th June 2020 at 10:00 am
6 Notification of Award date 15th June 2020
7 Signing the contract date 22nd June 2020

 6. Requirements: Below are the specific conditions that bidder should meet to be eligible for consideration

Section A: Mandatory for insurance Firms

  • Certificates of registration from Somaliland/Somalia insurance regulators.
  • Business permit
  • Tax compliance certificate:
  • List of current clients, preferably INGOs.
  • Provide evidence that the company has been registered and in operation for at least (2 years):
  • Financial auditing report for the last 2 years
  • Bank statement for the last 6 months;
  • Provide evidence to provide country-wide network coverage including border points: Somaliland, Somalia, Kenya and Ethiopia
  • Provide panel providers:
  • Must attach a detailed company profile, including CVs of the principal officer and key personnel.
  • Reference: clients and hospitals.

Section B: Mandatory of insurance brokerage services

  • Certificates of registration from Somaliland/Somalia insurance regulators.
  • Business permit
  • Tax compliance certificate:
  • List of current clients, preferably INGOs.
  • The company must be registered with relevant authorities-
  • Financial auditing report for 1 year
  • Bank statement for the last 6 months;
  • Provide evidence to provide country-wide network coverage including border points: Somaliland, Somalia, Kenya and Ethiopia
  • Must have attached detailed company profile including CVs of the principal officer and key personnel.
  • Registration member of a regulatory body

How to apply

If you are interesting this bid please email your detailed proposals including minimum three referees to sombids@care.org  on or before 6th June, 2020, 16:30Pm quoting in the subject line ‘Provision of Medical Services for CARE Somalia/Somaliland Staff. Late submitted bids will not be considered.

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