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TERMS OF REFERENCE (TOR) for Provision of Medical Insurance Cover ADRA Staff
- BACKGROUND
ADRA Uganda delivers relief and development assistance to individuals regardless of their ethnicity, political affiliation, gender, or religious association. ADRA’s work touches close to a million lives in more than 11 districts in Uganda. ADRA’s partnership with faith-based organizations and community-based organizations allows immediate assistance in times of crisis and true partnership with the communities we serve.
We are seeking to procure comprehensive medical insurance coverage for staff members and eligible dependents. The organization currently has approximately 85 employees across various field offices.
- OBJECTIVE
To engage a reputable medical insurance service provider and deliver quality, affordable, and accessible medical insurance coverage that ensures the health and well being of staff members and their families.
- SCOPE OF WORK
3.1 Coverage Details
The service provider shall provide the following coverage:
- Inpatient Services:
- Hospital accommodation (general ward/private ward)
- Specialist consultations
- Surgical procedures
- Intensive Care Unit (ICU) services
- Medical investigations (laboratory, radiology, scans)
- Prescribed medication during hospitalization
- Pre-admission and post-discharge care
- Outpatient Services:
- General medical practitioner consultations
- Specialist consultations
- Diagnostic tests and investigations
- Prescribed medication
- Physiotherapy services
- Annual medical check-ups
- Maternity Services:
- Antenatal care
- Normal and caesarean deliveries
- Postnatal care
- Newborn care
- Dental and Optical Care:
- Routine dental check-ups and treatment
- Dental extractions and fillings
- Eye examinations
- Prescription glasses/contact lenses
- Emergency Services:
- 24/7 emergency care
- Ambulance services
- Accident and emergency treatment
- Additional Benefits:
- Chronic disease management (diabetes, hypertension, etc.)
- Cancer treatment
- Renal dialysis
- Psychiatric care
- Last expense /Funeral expense cover
3.2 Covered Persons
- Principal Members: All permanent staff members
- Dependents: Spouse .
Total estimated covered persons: Approximately 170 people
- CONTRACT PERIOD
The contract shall be for an initial period of 12 months commencing from 1st January 2025, with an option to renew upon mutual agreement and satisfactory performance.
- SERVICE PROVIDER REQUIREMENTS
5.1 Mandatory Requirements
- Valid operating license from IRA/ relevant regulatory authority.
- Minimum of 5 years’ experience in group medical insurance
- Financial statements for the last 3 years showing financial stability
- Tax compliance certificate
- Certificate of incorporation/registration
- Professional indemnity insurance
5.2 Technical Requirements
- Network of at least 100 accredited hospitals and clinics nationwide
- Presence of accredited facilities within and around the locations where ADRA is situated, i.e. Kampala, Yumbe, Kotido, Kaabong, Karenga, Abim, Kitgum, Agago, Pader, Palabek, Amuru, Kyegegwa, Kamwenga, Kakumiro Districts.
- Online claims management system
- 24/7 customer service hotline
- Maximum claim processing time of 1 working day.
- Provision of member cards within 1 week of enrollment
- DELIVERABLES
The successful bidder shall provide:
- Detailed policy document.
- Member identification cards
- Comprehensive list of accredited medical facilities
- Access to online portal for claims tracking
- Bi-annual utilization reports
- Dedicated account manager
- Regular wellness programs and health education sessions
- PREMIUM PAYMENT TERMS
- Premium payment shall be made annually
- Coverage shall not be suspended during the grace period
- EVALUATION CRITERIA
Bids will be evaluated based on the following criteria:
Criterion | Weight |
Financial proposal (premium rates) | 35% |
Scope and quality of coverage | 25% |
Network of medical facilities | 25% |
Company experience and reputation | 15% |
TOTAL | 100% |
- SUBMISSION REQUIREMENTS
Bidders must submit the following documents:
10.1 Technical Proposal
- Company profile and experience
- Valid operating license
- Certificate of incorporation
- Tax compliance certificate
- Audited financial statements (last 3 years)
- List of current clients and references
- Complete list of accredited medical facilities
- Sample policy document
- Proposed claims management process
- Details of value-added services
10.2 Financial Proposal
- Detailed premium breakdown by category (principal member, spouse, children)
- Premium rates for optional coverage
- Payment terms and conditions
- Validity period of the quotation (minimum 90 days)
- Compliance
The service provider must comply with all relevant laws and regulations governing medical insurance in Uganda.
- CONTACT INFORMATION
All queries and clarifications should be directed to:
Name: Viola Namutebi
Title: Procurement Officer
Email: [email protected].
Telephone: 0779863454
Address: ADRA Uganda, Kireka Hill. P. O. Box 9946, Kampala, Uganda
Bid submission deadline: Monday, 8th December, 2025.