Terms of Reference: Medical Insurance Services tender at Water Mission

 Terms of Reference: Medical Insurance Services tender at Water Mission Uganda

1.0 Background and Purpose

Water Mission Uganda is a nonprofit Christian engineering organization providing safe water, sanitation, and hygiene solutions. In Uganda, the organization operates from Jinja with field operations in Buyende, Luuka.

Water Mission Uganda seeks to engage a reputable, licensed medical insurance provider to deliver comprehensive medical insurance services for its employees and eligible dependents. The cover should promote staff wellbeing, ensure timely access to quality healthcare, and support organizational productivity.

2.0 Objective

The objective of this assignment is to procure a comprehensive medical and Group Personal Accident insurance scheme that provides employees and their eligible dependents with reliable access to quality inpatient, outpatient, emergency, and supplementary healthcare services through an extensive network of accredited healthcare providers. The scheme should ensure efficient service delivery, effective claims management, and enhanced employee health, well-being, and productivity.

3.0 Scope of Services

The provider shall offer medical insurance coverage covering the following core service areas:

4.0 Beneficiaries

The cover shall apply to permanent employees, eligible contract employees where applicable, and eligible dependents in line with Water Mission Uganda policy. The final proposal should clearly state the premium applicable to each principal member and up to four dependents, or as otherwise specified by the organization.

Number of staff: 45 staff with 4 dependants for each staff

5.0 Provider Eligibility and Deliverables

Bidders must be licensed by the relevant insurance regulatory authority and demonstrate at least three years of experience providing medical insurance services to organizations of comparable size. They must show financial stability, a strong network of accredited hospitals, clinics, laboratories, and pharmacies, and capacity to provide national and international coverage, including support for staff in field locations.

The selected provider shall issue membership cards, orient enrolled members, provide a dedicated contact person, maintain responsive customer support, process claims promptly, and submit quarterly utilization and performance reports.

6.0 Service Levels and Contract Period

• Provide a 24-hour customer support hotline.
• Issue membership cards within the agreed timeframe.
• Maintain an accessible provider network that meets beneficiary needs.
• Resolve complaints and claims within agreed timelines.

The contract shall run for one year and may be renewed subject to satisfactory performance and mutual agreement.

7.0 Evaluation Criteria

Proposals will be assessed on technical capacity, provider network, benefits package, premium rates, financial stability, references, and relevant past performance.

8.0 Proposal Submission Requirements

Interested providers shall submit a company profile, certificate of incorporation, valid insurance regulatory license, audited financial statements for the last three years, provider network list, detailed benefits schedule, proposed premium rates, and at least three client references.

9.0 Reporting, Confidentiality and Payment

The provider shall work closely with the Human Resources Department and submit periodic reports on claims utilization, membership statistics, service satisfaction, and emerging health trends. All employees and dependent medical information must be handled confidentially and in accordance with applicable data protection requirements.

Payment shall be made in accordance with the agreed contract terms upon submission of approved invoices or quotations.

10.0 Contact Information

All proposals and inquiries should be addressed to Water Mission Uganda through WMU-Procurementwatermission.org

 The strict deadline for all submissions is October 30, 2026