Health insurance for employees of the Port Authority of Ceuta

Summary

The tender is for a group health-insurance policy for the staff of the Port Authority of Ceuta and related insured persons. The insurer must provide one master policy with two plans: Basic cover provides medical care without hospitalisation, basic dental benefits and digital services; Expanded cover adds hospital treatment, surgery, prostheses and implants, and transplants. Both plans include, among other things, general and specialist care, diagnostics and 24-hour emergency assistance. The minimum Expanded-plan cover includes hospitalisation except for psychiatry, whose terms must be specified in the offer. Cover applies throughout Spain. The Basic plan is automatic for active employees; the Expanded plan is voluntary, and the employee pays any premium above EUR 500 per year through a payroll deduction authorised in writing. Eligible family members may also join the employee’s plan. Retired employees and people leaving employment on qualifying equivalent grounds, together with their insured family members, must be able to join a separate open group. The insurer must have at least 8 owned or contracted healthcare facilities in total in Ceuta and Andalusia and must provide a complete nationwide directory of its medical network. There are no waiting periods, and pre-existing conditions, including congenital conditions, must be covered. Basic-plan co-payments may not exceed EUR 10 per medical act or EUR 3 per dental act; emergency care and video consultations must have no co-payment. The Expanded plan must have no co-payments. The initial contract term is 12 months, with the possibility of one 12-month extension. The initial budget is EUR 135,000, the extension budget is EUR 138,375 and the estimated total value is EUR 273,375. Annual premium ceilings for employee and family plans are EUR 500 for Basic and EUR 900 for Expanded in 2027; in 2028 they are EUR 500 and EUR 922.50 respectively per person. Initial annual ceilings for the open group are EUR 700 for Basic and EUR 1,260 for Expanded per person. The Port Authority contributes up to EUR 500 per employee per year; the additional cost of the Expanded plan and family-member premiums are deducted from the employee’s pay, while open-group members pay the insurer directly. Bids are scored automatically: price accounts for 30 points and quality for 70. Quality scoring includes, among other matters, the number of doctors and facilities in Ceuta, in-person local service, additional diagnostic and treatment services, dental cover, nationwide provider-network coverage and reimbursement outside the network under the Expanded plan. Bids must be submitted electronically under an open procedure; the submission period is at least 18 days from dispatch of the contract notice.