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REQUEST FOR MEDICAL HEALTH INSURANCE SERVICES
Introduction
Jhpiego, an international non-profit health organization affiliated with The Johns Hopkins University, seeks to engage a qualified medical insurance provider or insurance broker to deliver comprehensive, high-quality medical insurance services to its employees and eligible dependents across Zambia. The selected provider shall ensure accessible, efficient, and cost-effective healthcare services that meet industry standards and support the health and well-being of Jhpiego staff and their families.
Jhpiego is inviting insurance companies and insurance brokers to submit proposals for the provision of quality medical insurance services from 1st October 2026 to 30th September 2027 that meet the market standards to Jhpiego Zambia, its field offices and the rest of the provinces.
Objectives
The objective of this engagement is to provide comprehensive medical insurance coverage and healthcare management services for Jhpiego Zambia employees and eligible dependents for a period of twelve (12) months, ensuring timely access to quality healthcare services nationwide.
Jhpiego Schedule
The following is the planned schedule for this RFP process. All dates are listed in the local time for central Africa Time, Lusaka, Zambia (GMT+2). We will update you if circumstances dictate a change to this schedule.
Ø Publication of the RFP 28 August 2026
Ø Bidder Questions Due: 04 September 2026/ 13:00 Hours.
Ø Proposals Due: 11 September 2026 / 13:00 Hours.
Ø Note: We highly encourage you to comply with the above deadlines or it will be interpreted as your intention to not participate in this RFP.
Contact Details
Please direct all questions to the following primary contact:
Scope of Work
Criteria for evaluation of proposals
Insurance companies and brokers that have met the above-mentioned minimum requirements will be evaluated and assessed according to the following criteria:
Technical proposal:
· Scope of cover or services clearly stating both inclusions and exclusions.
· List of services provided using the services listed
· Geographical coverage in Zambia by the insurance providing a list of hospitals/clinics that can provide services under your medical insurance/brokerage
· In-patient and outpatient services.
· Biometric card provision / Manual.
· Premium price/commission of packages/plans/products and a description of what is included.
· Quality of service as assessed by the accessibility of services, billing, and reporting systems.
· Qualification of staff that will be allocated to Jhpiego by presenting CVs of such staff
· Any additional services or functionality that may enhance your proposal
Financial proposal
The financial proposal shall be evaluated according to the price structure of the premiums/commission in the local currency.
Proposal submitters must detail all costs identified and any other costs whatsoever that could be incurred in the usage of services and/or the availing of options that may not be explicitly identified/requested.
In the event of an Agreement being awarded, the attempted imposition of undeclared costs will be considered a condition for default.
Presentation and interview
Only shortlisted insurer/brokers will be contacted and invited to make presentations and be interviewed by the evaluation team.
Jhpiego shall make available any necessary and available information required for your submission.
1. Objective
The objective of this engagement is to provide comprehensive medical insurance coverage and healthcare management services for Jhpiego Zambia employees and eligible dependents for a period of twelve (12) months, ensuring timely access to quality healthcare services nationwide.
2. Scope of Services
The successful insurer/broker shall provide and administer on behalf of JHPIEGO medical health scheme services covering approximately 470 beneficiaries, comprising:
1. 94 Principal Members
2. 94 Spouses
3. 282 Children below 21 years
The scope of services shall include, but not be limited to, the following:
3.1 Medical Coverage
Provide comprehensive medical insurance benefits, including:
a) Inpatient Services
1. Hospital admissions and accommodation
2. Surgical procedures
3. Specialist consultations
4. Diagnostic and laboratory investigations
5. Emergency medical treatment
6. Intensive care services where applicable
b) Outpatient Services
1. General practitioner consultations
2. Specialist consultations
3. Diagnostic and laboratory services
4. Prescribed medications
5. Minor surgical procedures
c) Optical Services
1. Eye examinations
2. Prescription lenses and frames
3. Optical treatment as applicable under the policy
d) Dental Services
1. Routine dental consultations
2. Preventive dental care
3. Dental procedures and treatments
e) COVID-19 Coverage
1. Testing services
2. Treatment and related medical care
f) Chronic Disease Management
1. Long-term treatment and monitoring of chronic conditions
2. Medication support programs
3. Case management services
g) Specialized Medical Treatment
1. Access to specialist medical care
2. Referral management
3. Advanced diagnostic and treatment services
h) Travel Insurance
1. Medical coverage during authorized travel
2. Emergency evacuation and related benefits as applicable
i) Funeral Benefits
1. Funeral assistance benefits as stipulated under the proposed plan
4. Healthcare Provider Network Management
The insurer/broker shall:
1. Maintain an extensive network of accredited hospitals, clinics, pharmacies, laboratories, and specialist healthcare providers throughout Zambia.
2. Provide a comprehensive and updated list of participating healthcare providers.
3. Ensure quality standards are maintained by all contracted providers.
4. Negotiate competitive pricing and service rates with healthcare providers.
5. Membership Administration
The insurer/broker shall:
1. Register all eligible members and dependents.
2. Issue biometric and/or manual membership cards.
3. Maintain accurate and confidential member records.
4. Facilitate enrolment, additions, deletions, and updates of beneficiaries throughout the contract period.
5. Provide dedicated customer support services to Jhpiego and its beneficiaries.
6. Claims and Benefits Administration
The insurer/broker shall:
1. Manage and process claims efficiently and accurately.
2. Ensure timely settlement of claims with healthcare providers.
3. Minimize service interruptions resulting from payment delays.
4. Establish clear escalation and dispute-resolution mechanisms.
7. Geographic Coverage
The insurer/broker shall provide medical insurance coverage throughout Zambia, including Jhpiego field offices and operational locations. The proposal shall include a detailed list of healthcare facilities available under the medical scheme in all covered provinces.
8. Reporting and Performance Management
The insurer/broker shall submit regular reports to Jhpiego, including:
1. Quarterly utilization reports.
2. Claims experience and expenditure reports.
3. Membership statistics and updates.
4. Emerging healthcare trends and risk analysis.
5. Service performance and provider network updates.
6. Recommendations for improving service delivery and cost management.
The provider shall also maintain ongoing communication with Jhpiego management and employees regarding benefits, claims processes, and policy updates.
9. Service Levels
The insurer/broker shall:
1. Ensure continuous access to healthcare services.
2. Maintain responsive customer support channels.
3. Provide dedicated account management personnel.
4. Conduct beneficiary education and awareness sessions where required.
5. Respond to service-related inquiries and complaints within agreed service timelines.
10. Compliance Requirements
The insurer/broker shall:
1. Hold all valid licenses, certifications, and regulatory approvals required to operate in Zambia.
2. Comply with all applicable insurance, healthcare, and data protection laws and regulations.
3. Maintain professional indemnity and operational standards as required by relevant regulatory bodies.
11. Contract Duration
The contract shall be for a period of twelve (12) months with the possibility of renewal subject to satisfactory performance and mutual agreement between Jhpiego and the selected service provider.
12. Deliverables
The selected insurer/broker shall deliver:
1. Comprehensive medical insurance coverage for all eligible beneficiaries.
2. Membership registration and issuance of medical cards.
3. Access to an approved nationwide healthcare provider network.
4. Claims and healthcare provider payment administration.
5. Quarterly utilization and performance reports.
6. Dedicated account management and customer support services.
7. Ongoing communication and health scheme administration throughout the contract period.
This Scope of Work shall form part of the tender and subsequent contractual agreement between Jhpiego Zambia and the successful medical insurance provider or broker.
The Evaluation of bids will be conducted in THREE stages namely;
· Preliminary Evaluation
· Technical Evaluation; and
· Financial Evaluation
PRELIMINARY MINIMUM REQUIREMENTS AND EVALUATION CRITERIA
The vendors shall meet the following minimum requirements:
a. Certificate of incorporation and registration with PACRA.
References will be considered as an evaluation factor if you are selected as a finalist. The references will not be contacted unless Jhpiego informs you in advance.
Directions for Response
All responses to this RFP must include the components and follow the guidelines below. Any proposal that does not follow these guidelines shall be disqualified.
Complete and submit the following component in your proposal:
1. All prices shall be quoted in Zambian Kwacha.
2. Company Profile with qualifications for the key Technical Staff (3 copies)
3. Proposals shall be submitted on your company’s original letterhead (Not the one for Jhpiego) and signed.
4. Complete description/specifications of the services.
5. Unit price shall be indicated separately.
6. A VAT Local Purchase Order shall be issued for the VAT amount indicated on the quotation.
7. The Proposal validity period shall be 90 days from the date of submission.
Direct all questions to the primary contact (see “Contact Details” section) via e-mail by the time indicated “Central Africa Time, Lusaka, Zambia (GMT+2)” on the day indicated in the schedule.
Questions about the designated primary contact are entirely welcome. However, any violation of these directions will be considered an attempt to gain an unfair advantage over the other competitors and will result in disqualification of the violating bidder. Any disqualified bidders will be removed from the process and any further submissions by that bidder will not be accepted.
Jhpiego reserves the right to reject proposals and bears no responsibility for any costs of preparing any proposal.
Questions From Bidders
In the interest of fairness and completeness of answers, all questions from all bidders will be aggregated, answered and sent to all bidders on the date and time indicated in the schedule.
Please submit your questions to the primary contact identified above via email by the day they are due (see “Schedule” section).
Proposal Validity
Vendor shall submit a proposal that is valid for 60 days after the proposal due date per the “Schedule” section above.
Award of Contract
The firm that, in the opinion of Jhpiego, has submitted the proposal providing the best value for Jhpiego based on the evaluation criteria will be selected as best evaluated Vendor for the agreed period of task execution.
Contract Terms
Any resulting agreement will be conditional upon the vendor’s acceptance of Jhpiego Corporation’s Terms and Conditions Annexed to this RFP. Jhpiego’ s standard payment terms are 30 Days.
SUBMISSION AND CLOSING DATE OF THE PROPOSALS
The REQUEST FOR PROPOSALS shall be submitted in four packs (One. Original and Three Copies) in sealed envelopes clearly marked “SELF MANAGED MEDICAL HEALTH SCHEME FOR JHPIEGO ZAMBIA” to Plot 8 Ngumbo Road Long acres, Lusaka, Jhpiego Zambia Country Office on or before 13:00 hours, September 11, 2026 in the Tender box placed at the RECEPTION and signed off in the tender register book. Quotations submitted after the set deadline shall not be received or accepted and returned unopened to the marked bidder.
Jhpiego Zambia Country Office reserves the right to accept or reject any quotation and annul the bidding process and reject all bids at any time prior to contract award, without thereby incurring any liability to bidders.
