Request For Proposals: Provision Of Staff Medical Health Services In Kenya Ken/cfeoi/2026/nbo/061
full-time
Terms of Reference. Background Terre des hommes is the leading Swiss child relief agency. We are committed to improving the lives of millions of the world's most vulnerable children. Children are the first to suffer in times of war, natural disasters and because of poverty. At Terre des Hommes, our goal is to steadily improve the conditions of the most vulnerable children worldwide. The Need/Purpose TDH-Kenya Foundation provides nationwide health insurance coverage for its employees and their dependents. As of October 1, 2026, the organization has approximately 54 staff members based in Nairobi, Kiambu, Turkana (Kakuma), and Garissa (Dadaab and Garissa sub-counties). TDH-Kenya Foundation invites eligible insurance firms to submit detailed proposals for medical insurance coverage for its staff and their dependents. The staff number will be subject to change due to staff leaving and staff being hired. NOTE: INSURANCE BROKERS ARE NOT ELIGIBLE TO PARTICIPATE IN THIS PROCESS. Membership Categories Annual Premium should be in categories of Member (M)- Member +4 (M+4). Medical Insurance coverage should be based on the following. Outpatient coverage: Proposed annual limit Kes.300,000 Inpatient Benefits: Proposed annual limit Kes.3,000,000 Maternity (Delivery Coverage) for both Normal and C Section Optical Coverage per family Dental Coverage per family Emergency Evacuation Funeral/Last Expense per Member Telemedicine Services Geographical Area of Cover. Territorial Limit -East Africa (Kenya, Uganda, Tanzania, Rwanda, Burundi, Somalia, and South Sudan Scope of Work For this assignment and for fair selection, the applicant underwriters should provide detailed quotations for the Insurance cover for the following categories of benefits at the minimum. Please note the list is not exhaustive. Outpatient Services Benefits – Proposed annual limit Kes.300,000 Co Pay-Not applicable Routine outpatient consultation, General Practitioner Kes.3,500 and Specialists Kes.4,000 (Access to Specialists is not restricted to the bidders list of providers) Diagnostic Laboratory and Radiology services Prescribed physiotherapy. Prescribed drugs and dressings. Vaccines: KEPI & Baby Friendly up to 10 years of age within OP limit Private vaccines up to full outpatient limits. Travel vaccines covered up to Kes.20,000 for member and dependents Family planning-Covered up to Kes. 20,000 Annual Check-ups Options: up to Kes.20,000 for the principal member & spouse once per year, for specific conditions Dental - up to Kes.60,000 per family – Routine consultation, examination, extraction, fillings, scaling and polishing, other approved dental procedures. Optical - up to Kes.60,000 per family, - examinations, prescription lenses and frames; frames limit Kes.40,000 replaceable annually. Chronic, pre-existing conditions & HIV/AIDS including cost of ARVs - up to the full out-patient cover limit per family per annum. Prescribed drugs and dressings. Ambulance Services (for emergency treatment only) Congenital conditions up to the full outpatient cover Elective circumcision Post-natal care for up to six weeks post-delivery. Antenatal and postnatal. Covered within the outpatient up to the full limit with No limitation on number of scans Counselling services-Covered to the full outpatient limit Home nursing care Health education Renal treatment Direct access to specialists Supplements Covered where they have direct action in managing a diagnosed condition. Chiropractic treatment- covered on referral by orthopedic surgeon Occupational & Speech therapy-on pre-authorization relevant to condition Prescribed External Appliances-on pre-authorization relevant to condition Soaps, Creams & Lotions for skin related conditions-Covered subject to pre-authorization within outpatient limit Terrorism - full outpatient limits Inpatient Services Benefits - Proposed annual limit Kes.3,000,000 Hospital Accommodation Charges-Standard Private Room up to Kshs.28,000 net of SHIF. Doctor’s (Physician, Surgeon & Anesthetist) fees. ICU/HDU and Theatre charges. Drugs/Medicines, Dressings and Internal Surgical appliances. Pathology, X-ray, Ultrasound, ECG and Computerized Tomography, MRI Scans. Radiotherapy and Chemotherapy. In-patient Physiotherapy. Emergency Road and Air Evacuation subject to overall cover limit. Day care surgery Home nursing care Internal prosthesis Inpatient non- accidental dental cover - Kes.400,000 within inpatient limit. Benefits include Anesthetist’s fees, hospital and operating theatre costs, fillings, extractions, root canal treatment, and scaling or cleaning required for a medical condition and prescribed by the appointed dentist. Inpatient non- accidental Optical Cover – Kes.400,000 within inpatient limit. Benefits - Eye Test, Frames, Contact & Optical Lenses - Frames, Lenses -Frames Limited to Kshs.40,000 replaced once every year. Accidental Dental & Optical Cover - full inpatient limit Circumcision – Kes.250,000. Maternity, Normal deliveries, Elective and Subsequent Caesarean shall be covered up Kshs.250,000 within inpatient Norma Delivery - Kes.250,000 within inpatient limit First Ever Emergency Caesarean Section & Subsequent Caesarean - Kes.250,000 within inpatient limit Maternity-related complications; before, during and after delivery - Kes.300,000 within inpatient limit. Routine antenatal check-ups Postnatal care for up to six weeks post delivery Neonatal and pre-maturity-related conditions – Kes.800,000 Congenital conditions -Kes.500,000 Psychiatric & Psychosocial hospitalization Family per annum – Kes.900,000 Mentel health and Counselling (Employment Assistance Program) Hospitalization for pre-existing chronic conditions, HIV/AIDS and related illness – Kes.1,000,000 per family per year within the inpatient limit. Newly diagnosed Chronic conditions – Full inpatient limit. Covid-19 Cover - Kes. 1,000,000 per family - Group limit Kes.5,000,000 Prescribed External Appliances -Kes.150,000 within inpatient -Included corsets, crutches, wheelchairs, motored appliances, hearing aid Post hospitalization benefit- Kes.50,000 for follow-up reviews following admission. Rehabilitation & Drug addiction including Alcohol related admission- Kes.150,000. Last Expense - A cash benefit from Kes.150,000 per person payable to the nominated beneficiary. Benefit is payable within 48 hours, subject to provision of complete documentation. Oncology, Organ Transplant, Acute Renal and Peritoned Dialysis Organ Transplant (cost of donor or securing the organ is excluded -Covered up the chronic limit Free Health Education webinars/workshops – 3 sessions per year Political Violence & Terrorism & Political - full inpatient limit and outpatient limits Emergency evacuation - Road & Air ambulance within the country Home nursing palliative or analgesic care - State payable lumpsum. Critical Illness Lump sum cash pay-out upon first diagnosis of either cancer, stroke, heart attack, kidney failure or paralysis. State payable lumpsum. External Appliances & Internal Surgical Appliances and Prosthesis (wheelchair, crutches, lumbar corset etc.). per family – provide limit Non-motorized wheelchairs & cress – provide limit International Treatment Cover Outside territorial limit. Overseas referral - for treatment not available locally. Cover on credit is available at select providers Provide list of available providers Provide limit/ sublimit. Air ticket in economy class for a scheduled flight & accommodation for patient accompanying guardian in case the patient is a minor Days covered outside Kenya in any one visit Lodger fees for accompanying guardian i.e. accommodation and meals for a guardian accompanying a dependent below the age of 12 years and or a Children with special needs covered up to 18 years. N.B. For each proposed benefit and sub-limit, bidders must indicate whether they accept the prescribed limit by responding Yes or No, where no limit is proposed bidders must propose a limit and specify any proposed extension beyond the stated limits. Note to Quote: Please quote rate applicable for: Short term Cover or prorata premium calculation refund of premium when staff leave refund policy of medical expense incurred when staff use other medical providers Please quote any free rider on cover Waiting Periods There should be 2 dedicated contact persons assigned to the Tdh Kenya team The insurer will provide smart cards to employees and their dependents for easy access to services or allow them to use their existing smart cards. Reimbursements- will be 100% of the total costs. Duration of Cover The successful company will enter into a two-year contract with TDH-Kenya, subject to annual review based on satisfactory performance. Criteria for Proposal Evaluation The following criteria will be used in the evaluation of all bids. The submission of the required documents will be used in the determination of the Completeness and Suitability of the Bid. Bids that do not meet all the mandatory requirements will be declared non-responsive and shall not be evaluated further. Mandatory Requirements Certificate of Registration – Must provide a copy of the certificate of registration CR12 – Must provide a copy generated within the last 6 months Registration with Insurance Regulatory Authority (IRA) – Must provide valid IRA registration certificate for provision of medical insurance cover. KRA Certificate – Must provide a copy of the certificate Tax Compliance – Must provide valid Tax Compliance Certificate Industry Membership - Must provide a valid 2026 membership certificate from the Association of Kenya Insurers (AKI) Inpatient and Outpatient cover – must be provided by one underwriter as a package Technical Evaluation – 100 marks Each bidder shall submit a technical proposal addressing the services required and clearly demonstrating how they will meet TDH-Kenya. The proposal will be evaluated according to the following criteria: Smart Access – 2 marks Provide biometric identification system at no additional cost Co Pay – 2 marks- Tdh expects no co pay arrangement for scheme members Previous experience – 12 marks Provide 4 client contracts (preferably NGOs or international organization’s); proof of previous experience in Kenya with the same type of services. Must provide Evidence of Experience (Certificates of good performance / certified contracts) with annual premium of more than 50 million. Each contract, 3 marks. Countrywide Network Healthcare Provider - 4 marks Provide list of approved health care providers across Kenya where the underwriter maintains active credit facilities. Scoring criteria; Coverage in less than 20 counties with 2 approved healthcare providers on each location i.e. Kakuma township and Dadaab township – 2 marks Coverage in 21 to 33 counties with more than 2 approved healthcare providers on each location i.e. Kakuma township and Dadaab township – 3 marks Coverage in more than 33 counties with more than 2 approved healthcare providers on each location i.e. Kakuma township and Dadaab township – 4 marks 5. Audited Financial Statements – 2 marks Submit certified audited annual financial statements for the last 3 years i.e. 2023, 2024 & 2025. 6. Annual medical checkup – 3 marks Provide at least one annual medical examination for members and one spouse, including a personal one-on-one consultation with a health physician. 7. Cash Claims and Reimbursement – 4 marks Demonstrate reimbursement of services sought from other medical providers in areas without approved healthcare providers as per consultation limits and 100% for other services. 8. Refund Policy – 3 marks Demonstrate applicability of premium refund and conditions 9, Minimum Cover Period – 3 marks Scoring criteria; One month 3 marks, Two months 2 marks, Three months 1 mark. 10. Provision of 2 Key Account Managers for Tdh – 2 marks Maintain the rates of premium fixed for a period of 2 years without annual incremental requirement – 2 marks - Scoring criteria; Yes - 2 marks, No - Zero Marks 11. Pre-authorization value limits for outpatient medical attention/services listed in the medical Scheme – 4 marks Scoring Criteria; Kes.10,000 and above 2 marks, Kes.15,000 and above 4 marks 12. Pre-authorization waiting timeline – 2 marks Scoring Criteria; 15mins 1 mark, 10mins 2 marks 13. Cover for dependents beyond Tdh approved category (M+5) – 2 Marks 14. Territorial Limit Coverage – East Africa (Kenya, Uganda, Tanzania, Rwanda, Burundi, Somalia, and South Sudan. 2 Marks 15. Oversee treatment coverage. 2 Marks 16. Credit facility payment timeline: 4 Marks Scoring Criteria; 30 days or less 4 marks, 45 days 2 marks, 60 days zero marks 17. Quarterly reporting schedule to Tdh. 1 Mark 18. Other value-added benefits – 4 marks. Compliance with both outpatient and inpatient limits- Full marks will be awarded where the proposed cover meets the prescribed limits and sub-limits under outpatient and inpatient. Zero marks will be awarded Where the requirements are not met, zero marks will be awarded Compliance with Neonatal and pre-maturity-related conditions sub limit – 5 marks Compliance with Inpatient non- accidental dental cover sub limit – 5 marks Compliance with Inpatient non- accidental Optical cover limit – 5 marks Compliance with Accidental Dental & Optical full inpatient limit – 5 marks Compliance with Psychiatric & Psychosocial hospitalization – 5 marks Compliance with maternity cover limits – 5 marks Compliance with outpatient dental and optical prescribed sub limits. – 5 marks Compliance with Hospitalization for pre-existing chronic conditions, HIV/AIDS and related illness – 5 marks Note. A bidder scoring less than 80% shall not be considered technically responsive and therefore shall not be considered for financial evaluation. Financial Proposal Evaluation will be based on the criteria below. Bidders’ financial proposal must indicate premium for outpatient, inpatient, dental and optical as per below categories and any other levies. Member Member + 1 Member + 2 Member + 3 Member + 4 Member + 5 Bidders’ financial proposal must demonstrate short term cover rate based an annual premium. Applicable percentage from one month cover to 12 months. Submitted bids will be subjected to checks of arithmetic errors, comparative analysis, ranking and most competitive bid will be awarded.