Signed RFP 19AQMM21R0260-0001.pdf

19AQMM21R0260

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

1. CONTRACT ID CODE RATING

2. AMENDMENT/MODIFICATION NO.

3. EFFECTIVE DATE

10/26/2021

4. REQUISITION/PURCHASE REQ. NO. 5. PROJECT NO. (If applicable)

LMAQMCODE

OFFICE OF ACQUISITION MANAGEMENT (A/LM/AQM)

PO BOX 9115, ROSSLYN STATION

US DEPARTMENT OF STATE

ARLINGTON, VA 22219

Stephanie Reid-Smith

NAME

TEL.

Reid-SmithSJ@state.gov

EMAIL

6. ISSUED BY OPEAQMCODE

AQM Mexico City

OPE/AQM/IP/AQM MXC

Office of Acquisition (AQM) Mexico

7. ADMINISTERED BY (If other than Item 6)

9A. AMENDMENT OF SOLICITATION NO.

19AQMM21R0260

CONTACT: DUNS:

CODE FACILITY CODE

8. NAME AND ADDRESS OF CONTRACTOR (No., street, country, state and ZIP Code) (X)

X 9B. DATED (SEE ITEM 11)

09/24/2021

10A. MODIFICATION OF CONTRACT/ORDER NO.

10B. DATED (SEE ITEM 13)

11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS

X XThe above numbered solicitation is amended as set forth in item 14. The hour and date specified for receipt of Offers is extended, is not extended, Offers must acknowledge receipt of this amendment prior to the hour and date specified in the solicitation or as amended, by one of the following methods: (a) By completing items 8 and 15, and returning ____copies of the amendment;(b)By acknowledging receipt of this amendment on each copy of the offer submitted; or (c) By separate letter or telegram which includes a reference to the solicitation and amendment numbers. FAILURE OF YOUR ACKNOWLEDGMENT TO BE RECEIVED AT THE PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY RESULT IN REJECTION OF YOUR OFFER. If by virtue of this amendment you desire to change an offer already submitted, such change may be made by telegram or letter, provided each telegram or letter makes reference to the solicitation and this amendment, and is received prior to the opening hour and date specified.

12. ACCOUNTING AND APPROPRIATION DATA (If required)

13. THIS ITEM ONLY APPLIES TO MODIFICATION OF CONTRACTS/ORDERS. IT MODIFIES THE CONTRACT/ORDER NO. AS DESCRIBED IN ITEM 14.

CHECK ONE A. THIS CHANGE ORDER IS ISSUED PURSUANT TO: (Specify authority) THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE CONTRACT ORDER NO. IN ITEM 10A.

B. THE ABOVE NUMBERED CONTRACT/ORDER IS MODIFIED TO REFLECT THE ADMINISTRATIVE CHANGES (such as changes in paying office, appropriation date, etc.) SET FORTH IN ITEM 14, PURSUANT TO THE AUTHORITY OF FAR 43.103(b).

C. THIS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO AUTHORITY OF:

D. OTHER (Specify type of modification and authority)

E. IMPORTANT: Contractor is not, is required to sign this document and return copies to the issuing office.X

14. DESCRIPTION OF AMENDMENT/MODIFICATION (Organized by UCF section headings, including solicitation/contract subject matter where feasible.)

The purpose of this amendment is to: (1) Amend the following sections: C.1.1.7 Prescription Drugs, C.1.1.9 Hearing Aids,C.1.1.15 HIV/AIDS, SECTION L

- update W-14 website information, and Reserved changed to Section reserved for future use; if required; (2) Add J-006 - EXHIBIT F, J-007 - EXHIBIT G, and J-008 - EXHIBIT H; (3) Add 52.225-17 - Evaluation of Foreign Currency Offers (FEB 2000); and (4) Delete 52.214-35 - Submission of Offers in U.S.

Currency (Apr 1991). All other terms and conditions referenced this solicitation remain unchanged and in full effect.

NOTE: This amended solicitation reflects "print changes only" and not the entire original solicitation.

Except as provided herein, all terms and conditions of the document referenced in Item 9A or 10A, as heretofore changed, remains unchanged and in full force and effect.

15A. NAME AND TITLE OF SIGNER (Type or print) 16A. NAME AND TITLE OF CONTRACTING OFFICER (Type or print)

Stephanie Reid-Smith

(Signature of person authorized to sign)

15B. CONTRACTOR/OFFEROR 15C. DATE SIGNED

By (Signature of Contracting Officer)

16B. UNITED STATES OF AMERICA 16C. DATE SIGNED

10/26/2021

NSN 7540-01-152-8070

Previous edition unusable

STANDARD FORM 30 (REV. 10-83)

Prescribed by GSA FAR (48 CFR) 53.243

CGFS : : CGFS

Section A - Solicitation/Contract Form

Clause Title Fill-ins

52.214-35

DELETED

Submission of Offers in U.S. Currency (Apr 1991)

A-001 - NOTICE OF CHANGE

NOTE: This RFP replaces Draft notice sent under 19AQMM21R0026, in its entirety.

The North American Industry Classification System (NAICS) code for this acquisition: 524114 - Direct Health and Medical Insurance Carriers.

If applicable, the small business size standard is 38,5000,000.

B.1 - HEALTH INSURANCE SERVICES

The Contractor shall provide the Health Insurance services to employees of the Government of the United States of America Embassy in Santo Domingo, Dominican Republic and their eligible dependents as described in Section C. This insurance shall be provided in accordance with Section C.

B.1.1. Official Residence Expense (ORE) Staff and American Embassy Recreation Association (AERA) Embassy Association Employees (EAE) are included under this contract only as a rider; the Contractor shall bill the Chief of Mission and Deputy Chief of Mission (for ORE Staff), and the Embassy Association (for EAEs) at the rates specified below. See Section G for billing procedures.

Note that USG is not responsible, nor liable, for any riders.

Retirees and their spouses are included under this contract only as riders, the Contractor shall bill the USG at the rates specified below.

JAMES ZADROGA 9/11 VICTIMS HEALTH AND COMPENSATION ACT OF 2010 NOTICE: UNLESS A WAIVER OR EXCEPTION APPLIES, PAYMENTS SUBSEQUENT TO THIS PROCUREMENT ARE SUBJECT TO AN EXCISE TAX OF 2%

PURSUANT TO 26 U.S.C. 5000C

B.2 - PRICES

All prices shall be in DOMINICAN PESOS.

B.2.1 VALUE ADDED TAX.

The Government will not reimburse the Contractor for VAT under this contract. The Contractor shall not include a line for VAT on Invoices as the U.S. Embassy has a tax exemption certificate with the host government.

B.2.2 This is a FIXED PRICE, WITH ECONOMIC PRICE ADJUSTMENTS requirement type contract under which will be issued firm fixed-price task orders. The fixed prices/premium rates for the health insurance services as specified in Section C are as follows:

B.2.3 Base Year of Contract

Monthly Rates Per Premium Category

Category Estimated Number of Premiums*

Rate per Premium Extended Monthly Total

a. Self 150

b. Self Plus One 75

c. Family (3 or more individual) 235

d. Subtotal Total Price for Base Year (d x 12 months)**

* estimated number of premiums does not include any Riders (B.1.1)

** does not include any premiums for Riders.

Rider Category*** Estimated Number of Premiums* Monthly Rate per Premium Retirees 28 Retirees Plus One 8

*** not included in the Total Price for Base Year Calculation

B.2.4 Option Year One of Contract

Monthly Rates Per Premium Category Category Estimated Number of

Premiums* Rate per Premium Extended Monthly Total

a. Self 150

b. Self Plus One 75

c. Family (3 or more individual) 235

d. Subtotal Total Price for First Option Year (d x 12 months)**

*estimated number of premiums does not include any Riders (B.1.1)

** does not include any premiums for Riders.

Rider Category*** Estimated Number of Premiums* Monthly Rate per Premium Retirees 28 Retirees Plus One 8

*** not included in the Total Price for First Option Year Calculation

B.2.5 Option Year Two of Contract

Monthly Rates Per Premium Category Category Estimated Number of

Premiums* Rate per Premium Extended Monthly Total

a. Self 155

b. Self Plus One 80

c. Family (3 or more individual) 240

d. Subtotal Total Price for Second Option Year (d x 12 months)**

* estimated number of premiums does not include any Riders (B.1.1)

** does not include any premiums for Riders.

Rider Category*** Estimated Number of Premiums* Monthly Rate per Premium Retirees 26 Retirees Plus One 6

*** not included in the Total Price for Second Option Year Calculation

B.2.6 Option Year Three of Contract

Monthly Rates Per Premium Category Category Estimated Number of

Premiums* Rate per Premium Extended Monthly Total

a. Self 155

b. Self Plus One 80

c. Family (3 or more individual) 240

d. Subtotal Total Price for Third Option Year (d x 12 months)**

*estimated number of premiums does not include any Riders (B.1.1)

** does not include any premiums for Riders.

Rider Category*** Estimated Number of Premiums* Monthly Rate per Premium Retirees 25 Retirees Plus One 5

*** not included in the Total Price for Third Option Year Calculation

B.2.7 Option Year Four of Contract

Monthly Rates Per Premium Category Category Estimated Number of

Premiums* Rate per Premium Extended Monthly Total

a. Self 160

b. Self Plus One 85

c. Family (3 or more individual) 245

d. Subtotal Total Price for Fourth Option Year (d x 12 months)**

* estimated number of premiums does not include any Riders (B.1.1)

** does not include any premiums for Riders.

Rider Category*** Estimated Number of Premiums* Monthly Rate per Premium Retirees 25 Retirees Plus One 5

*** not included in the Total Price for Fourth Option Year Calculation

B.2.8 Grand Total of Base plus All Option Years

Base Year Total Option Year One Total Option Year Two Total Option Year Three Total Option Year Four Total Grand Total = Base and All Option Years

B.3 - ADMINISTRATIVE RETENTION AMOUNTS

B.3.1 If the Contractor requests a price adjustment under B.4 below, the Contractor shall present cost experience data that includes the retention amount. For purposes of any economic price adjustment, this retention amount is a fixed amount that is a part of the premium amounts in B.2. This retention amount will not be adjusted for any reason.

The retention amount is part of the premium and may include, but not be limited to, such costs as overhead and general and administrative costs. It will also include any profit. Essentially, it includes all costs except the actual portion of the premium intended to fund claims paid to the health care provider / claimant. B.3.2 sets forth the retention amounts per premium paid for each category of premium and for each period of performance.

NOTE TO OFFEROR: Fill in the fixed monthly retention amounts for each period of performance and for each category of premium. This fixed amount shall be expressed in the currency in which the premium amount is proposed: DOMINICAN PESOS. The fixed retention amount shall NOT be expressed in terms of a percentage of the premium.

B.3.2 Monthly Retention Amounts per separate premium paid per single employee and per family plan.

Period of Performance Self Self plus One Family (3 or more individual) Base Period First Option Year Second Option Year Third Option Year Fourth Option Year

B.4 - ECONOMIC PRICE ADJUSTMENT-HEALTH INSURANCE PREMIUMS

B.4.1. Premium Adjustment Based on Experience - For health insurance, prices may be adjusted upward or downward based on the experience rating of the Mission(s) covered by this contract, and it specifically excludes all riders in B.1.1. No adjustment will be allowed during the first twelve months. After such time, the Contractor or the Government may request an adjustment in premiums on an annual basis. Adjustments are not retroactive to previous contract terms.

Before any such adjustment is made, the Contractor agrees to provide the Government a balance sheet showing three main components for the time period:

(1) Receipts (premiums received) minus the retention amount

(2) Number of insurance plans and

(3) Claims paid

This information shall be provided per type of premium, i.e., per line item. The retention amount is not subject to adjustment.

The Government reserves the right to have an independent third party review the balance sheet and claims and make recommendations regarding the appropriateness of the requested adjustment. Any adjustment shall be subject to mutual agreement of the parties and shall result in a written modification to the contract. Mutually agreed to adjustments shall be effective 30 days after complete information is received by the Government. Any failure to reach agreement under this clause shall be subject to the procedures in the Disputes clause.

B.4.2. Premium Adjustment Based on Laws - The rates may also be adjusted during the performance period of the contract as a result of laws enacted by the host Government, if such change in the laws has a direct impact on the cost to the Contractor to perform this contract at the contracted rate. In that event, the Contracting Officer may enter into negotiations with the Contractor to modify the contract to adjust the premium rate. The Contractor agrees to provide all documentation necessary to support any requested adjustment.

B.4.2.1 Employee Pool – This clause is only in effect if the Contractor included details in its offer regarding a pooling arrangement, of which this contract is a part. Before any adjustment is made under this price adjustment clause, the Contractor shall include in its proposal for adjustment, details setting forth how the pool impacts the request for equitable adjustment.

C.1 - DESCRIPTION/SPECIFICATION/WORK STATEMENT

C.1. HEALTH INSURANCE SERVICES

This section defines the required minimum benefits and corresponding coverages. These are the minimally acceptable levels of coverage. If offerors choose to include additional benefits or higher coverages than the required minimums this is acceptable;

however, evaluations will be based on meeting the stated minimums only. For each benefit listed, proposals must clearly state its coverage. Any proposal that reduces a benefit definition or offers lower than the minimum required coverage may be determined technically unacceptable. The resultant contract will contain the actual proposed coverages or increased benefit offerings if they exceed the solicitation’s minimum requirements.

Multiple proposals - If an offeror has multiple plans available that meet or exceed the minimum benefit levels and wants to propose them, a separate proposal with its respective prices must be submitted individually for each.

The Government of the United States of America requires Health Insurance coverage for its employees as described herein.

Unless otherwise specified the annual maximum for any benefit will be tie to the Annual Maximum limit for the policy found in C.1.2.

C.1.1 Employee and Dependent Health Service Benefits

C.1.1.1 Hospitalization (Treatment in the Hospital for Inpatient Care): Minimum Coverage - 100%

Services and supplies provided during hospitalization including services provided by a licensed healthcare provider, bed, and board (semi-private accommodations), operating room, recovery room, intensive care, imaging and diagnostic testing, and general hospital nursing care, physical therapy, as well as drugs and medicines administered while in-patient. When private accommodations are provided, coverage will be limited to the cost of a semi-private room unless otherwise covered in an off the shelf plan.

See Mental Health and Substance Abuse care (C.1.1.13) for details concerning inpatient psychiatric care.

See Outpatient Services (below C.1.1.4) for details concerning professional services.

C.1.1.2 Emergency Services (Trips to Emergency Room): Minimum Coverage - 100%

Services provided for conditions that could lead to serious disability or death if not immediately treated, such as accidents or sudden illness.

C.1.1.3 Ambulance: Minimum Coverage - 80%

Professional ground transport to move a patient from the place where s/he is injured or becomes ill to the nearest hospital able to provide treatment or to move a patient from one medical facility to another.

C.1.1.4 Outpatient Services: Minimum Coverage - 80%

Services provided by a licensed healthcare provider on an ambulatory or outpatient basis (without being admitted to a hospital), including surgeon’s fees and other medical services provided at a hospital, clinic, doctor’s office, medical facility, etc. Examples include, but are not limited to:

- Annual physical examinations

- Specialist consultations and treatment, including second surgical opinion

- Minor surgical interventions

- Chemotherapy and radiation treatments

- Immunizations recommended by local authorities and/or the World Health Organization

- Diagnostic tests and diagnostic imaging

See Rehabilitative and Habilitative Services and Devices (C.1.1.14 below) for details concerning physical therapy.

See Mental Health and Substance Abuse Care (C.1.1.13 below) for details concerning psychiatric therapy.

C.1.1.5 Obstetric and Newborn Care: Minimum Coverage - Inpatient/Emergency: 100%; Outpatient: 80%

Care and services that women receive during pregnancy (prenatal care), throughout labor, delivery and post-delivery, and outpatient care for newborn babies. Hospitalization during pregnancy and/or delivery will be reimbursed as inpatient care. All other treatments will be considered outpatient services and will be reimbursed at that rate.

C.1.1.6 Pediatric Services: Minimum Coverage - Inpatient/Emergency: 100%, Outpatient: 80%

Primary and preventive routine care services for covered dependent children, including, but not limited to physical examinations, developmental assessments, laboratory tests, and immunizations recommended by local authorities and/or the World Health Organization.

C.1.1.7 Prescription Drugs: Minimum Coverage -Inpatient/Emergency: 100%, Outpatient: 80%

Medications prescribed by a licensed health care provider that are medically required. Examples include but are not limited to prescription antibiotics to treat an infection, medication used to treat an ongoing condition, such as high cholesterol, prophylaxis, contraceptive medication.

As described in C.1. HEALTH INSURANCE SERVICES “Unless otherwise specified the annual maximum for any benefit will be tied to the Annual Maximum limit for the policy found in C.1.2. ANNUAL MAXIMUM LIMIT”

C.1.1.8 Preventive and Wellness Services and Chronic Disease Management: Minimum Coverage - 80%

Counseling or preventive care designed to prevent or detect medical conditions and care for chronic conditions such as asthma and diabetes. Examples include, but are not limited to physicals, immunizations, and cancer screenings.

Outpatient services generally refers to a patient making appointments to address a pain or health problem. Preventative and Wellness -- a patient makes these appointments as part a routine visit to get the annual physical, get the annual screenings -- the goal is to identify problems early. So, every January many people schedule "annual" physicals. (Having a separate category for Preventative and Wellness ensures that employees are aware and become more accustomed to schedule these visits and that insurance companies understand that these patient visits and annual screenings are covered.)

C.1.1.9 Hearing Aids: Minimum Coverage – 80%

Examinations and Treatment: 80% Minimum Coverage

As described in C.1. HEALTH INSURANCE SERVICES “Unless otherwise specified the annual maximum for any benefit will be tied to the Annual Maximum limit for the policy found in C.1.2. ANNUAL MAXIMUM LIMIT”

Hearing exams and treatments includes but it is not limited hearing exams for hearing aid, hearing aid fitting exams and doctor visits, diagnostics studies for hearing, audiologist visits and exams, etc.

Hearing Aid Apparatus: Limited to ONE apparatus per year. 80% Minimum Coverage up to a maximum of DOP$ 90,000.00 per covered individual per three-year period.

C.1.1.10 Optical Care: Minimum Coverage – 80%

Examinations and Treatment: 80% Minimum Coverage

Prescription lenses and frames, or contact lenses: Covered up to a maximum of DOP$ 18,000.00 per covered individual every two years. 80% Minimum Coverage; with annual cap.

C.1.1.11 Dental Care: Minimum Coverage – 80%

Examinations and Treatment: Dentist’s fees, x-rays, examinations and treatment, cleanings, fillings, extractions, false teeth, crowns, and bridges up to a maximum of DOP$100,000.00 per covered individual per contract year. 80% Minimum Coverage: with annual cap.

Orthodontia: Treatment is covered only if treatment begins before age 18, or if required as the result of an accident. A maximum of four years of orthodontia treatment will be covered per covered individual up to a maximum of DOP$ 140,000.00 lifetime limit. 80% Minimum Coverage; with contract lifetime cap.

C.1.1.12 Reproductive Health: Minimum Coverage - 80%

Prescribed contraceptive devices, preventive care and routine examinations, voluntary sterilization, and diagnosis and treatment of conditions which may cause infertility. Assisted reproductive technology (ART), fertility treatments, and reversal of sterilization are not covered (see C.1.3 Exclusions to Coverage).

C.1.1.13 Mental Health and Substance Abuse Care: Minimum Coverage - 50%

Inpatient and outpatient care provided to evaluate, diagnose, and treat a mental health condition or substance abuse disorder.

This includes behavioral health treatment, counseling, and psychotherapy. Services must be provided by a licensed psychiatrist, psychoanalyst, psychologist, or psychiatric social worker. Inpatient care for alcohol and substance abuse must be provided at a facility licensed for detoxification and rehabilitation.

C.1.1.14 Rehabilitative and Habilitative Services and Devices: Minimum Coverage – 50%

Rehabilitative services (e.g., recovering skills, such as speech therapy after a stroke or physical therapy after an accident) and habilitative services (e.g., developing skills, such as speech therapy for children, etc.) that help develop skills needed for everyday life.

Devices to help gain or recover mental or physical skills lost due to injury, disability or a chronic condition, and devices needed for habilitative reasons.

C.1.1.15 HIV/AIDS: 100% up to DOP $600,000.00 per contract year / per covered individual

Medications to suppress opportunistic infections (such as tuberculosis or toxoplasmosis for covered individuals who have HIV/

AIDS).

Includes brief courses of anti-retroviral drugs during childbirth to prevent the transmission of HIV/AIDS to the child. Generally, excludes medication for the long-term suppression of HIV/AIDS through the combination of anti-retroviral drugs in locations with inadequate local healthcare infrastructures.

*C.1.1.16 Catastrophic Coverage

Additional coverage equal to DOP$1,000,000.00 per covered individual per contract year. Catastrophic conditions shall be defined as major medical conditions occurring because of a single/illness/accident or closely related set of major illnesses (or conditions relating to a single accident) that exceed the standard maximum coverage limit.

C.1.1.17 Section Reserved for future use; if required (placeholder only)

C.1.1.18 Section Reserved for future use; if required (placeholder only)

C.1.1.19 180 Day Coverage for Dependents After Employee’s Death

At the time of a covered employee’s death, his/her eligible dependents covered under post’s medical plan are eligible to continue receiving the same level of medical coverage for up to 180 days. This optional benefit is subject to availability of funds at post and no extensions are permitted.

The USG will cover 100% of the premium for covered dependents of a deceased employee for up to 180 days with no extensions. This benefit is subject to funding availability and can only be requested and authorized by the U.S. Government.

C.1.1.20 Employee Assistance Program (EAP)

An Employee Assistance Program (EAP) is a voluntary, work-based program that offers free and confidential assessments, short-term counseling, referrals, and follow-up services to employees who have personal and/or work-related problems. This optional benefit is subject to availability of funds at post.

The Employee Assistance Program benefit will be available for U.S. Government employees only and does not include dependents, retirees, or retiree’s dependents. This is an optional benefit for the policy, and if offered and becomes part of the benefit packages for the entire policy.

The use of these services is at the request of the U.S. Government only and it is intended to address employees’ issues affecting their work performance. The basic purpose of an EAP is to promote the well-being of the individual in a confidential and professional manner.

C.1.1.21 Section Reserved for future use; if required (placeholder only)

C.1.2 Annual Maximum Limit

The maximum annual reimbursement per individual per contract year, not including expenses defined under Exclusions and Limitations (C.1.3) and C.1.1.16, Catastrophic Coverage, or those covered under C.1.1.15, HIV/AIDS, is equivalent to DOP$ 1,000,000.00

C.1.2.1 Retirees Coverage Limit - The maximum coverage per calendar year will be reduced 50% for the retirees and retiree dependents, grandfathered under the previous plan.

C.1.3 Exclusions and Limitations

There is no coverage for elective cosmetic surgery; spa cures; rejuvenation cures; massage; exercise therapy; long-term rehabilitative therapy; non-medical hospital charges (e.g., telephone, television, etc.); home help, family help, or similar household assistance; fees of persons who are not certified health care providers; advanced reproductive technology (e.g., in-vitro fertilization, intra-cellular sperm injection, artificial insemination, microsurgical epididymal sperm aspiration, testicular sperm extraction, cryopreservation, etc.);

or services or supplies which have not been prescribed or approved by a certified health care provider. Exclusions to coverage may be amended if provided in an off the shelf plan and is the lowest-cost and technically acceptable. Removal of any exclusions require prior authorization.

There is no coverage for expenses that will be reimbursed or paid directly under a host country medical program or workers' compensation program, the U.S. workers’ compensation program, or post’s LE Staff workers’ compensation program.

There is no coverage for medical expenses incurred out-of-country. There is no reimbursement for out-of-country treatment.

C.1.4 Eligible Participants

C.1.4.1 Identification of Eligible Employees and Dependents: U.S. Mission Santo Domingo will provide a list of all eligible employees and dependents with relationship to employee (self/spouse/child) and Date of Birth (DOB) for each. Updates will be provided to add or remove individuals monthly.

C.1.4.1.1 Definition of Dependents

C1.4.1.1.1 Spouse: a limit of one legal spouse as defined by local law per employee will be covered.

C.1.4.1.1.2 Children: a child is defined as the LE Staff’s natural, adopted, stepchild, or foster child. The child must be unmarried and financially dependent upon the LE Staff. A child will be covered until the end of the contract year in which s/he reaches age 26.

An unmarried child determined to be incapable of self-support due to a physical or mental condition will continue to be eligible to participate in the medical plan if the condition persists, the child remains unmarried, and the LE Staff maintains coverage.

C.1.4.2 Location of Employment: The eligible employees covered by C.1.4.1 must be employed within the geographic boundaries of the Dominican Republic by:

DEPARTMENT OF STATE

DEPARTMENT OF TREASURY

DEPARTMENT OF DEFENSE

DEPARTMENT OF JUSTICE

DEPARTMENT OF INTERIOR

DEPARTMENT OF AGRICULTURE

DEPARTMENT OF COMMERCE

DEPARTMENT OF LABOR

DEPARTMENT OF HEALTH AND HUMAN SERVICES

DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT

DEPARTMENT OF TRANSPORTATION

DEPARTMENT OF ENERGY

DEPARTMENT OF EDUCATION

DEPARTMENT OF VETERAN AFFAIRS

DEPARTMENT OF HOMELAND SECURITY

UNITED STATES AGENCY FOR INTERNATIONAL DEVELOPMENT (USAID)

SOCIAL SECURITY ADMINISTRATION (SSA)

C.1.4.3 Participants Covered Under a Rider

a. All current active ORE Staff personally employed by the Chief of Mission and the Deputy Chief of Mission and assigned to their respective official Government residences and paid under an ORE account. All costs for coverage of ORE Staff are the responsibility of the Chief of Mission and the Deputy Chief of Mission, not the U.S. Government.

b. All current active employees of the Employee Association at Embassy/ Consulate Santo Domingo. All costs for coverage of American Embassy Recreation Association (AERA) EAEs are the responsibility of the Employee Association, not the U.S.

Government.

c. Retirees and Retirees Dependents. This plan will allow for continued coverage of current retired employees and their dependents as provided under the previous plan. All costs for coverage are the responsibility of the U.S. Government.

C.1.5 Eligibility

C.1.5.1 Term of Eligibility and Effective Date

Each current active eligible employee and their eligible dependents are enrolled for health benefits under this contract upon award and thereafter during the performance period of this contract. Each new eligible employee and eligible dependents will be enrolled upon entering on duty with the United States Government. An employee is considered active ("on the rolls") whenever such employee is on approved leave, whether paid or unpaid.

C.1.5.2 Newborn Coverage Effective Date.

All newborns under this contract shall be covered under their mother’s insurance card for the first 30 days from their date of birth.

During that period the COR shall request the child’s inclusion into the plan.

C.1.6 Brochure Requirement

C.1.6.1 The Contractor shall provide a document (brochure/pamphlet/other written document) in Spanish that sets forth a complete listing of the health insurance benefits to be provided under this contract. This brochure shall be provided in sufficient quantities so that each covered employee receives a copy. The Contractor shall furnish all copies of the brochures to the COR, who will ensure that appropriate distribution is made.

C.1.6.2 The Contractor shall provide the document described in C.1.6.1 to the COR not later than thirty (30) days after date of contract award. The Contractor shall provide additional brochures for new employees within ten (10) business days of the COR’s request.

C.1.6.3 The Contractor assumes full responsibility for ensuring that the document described in C.1.6.1 accurately reflects the requirements, coverage, and contract terms of the contract, as implemented by the Contractor’s technical proposal. In all cases, the contract shall take precedence. Should the COR discover that the document contains inaccuracies, the Contractor will be notified in writing; however, failure on the part of the U.S. Government to notice any inaccuracies shall in no way limit, revise or otherwise affect the requirement under this contract for the Contractor to fully comply with all contract terms.

SECTION D - PACKING AND MARKING - RESERVED

RESERVED FOR FUTURE USE; IF REQUIRED

E.2 - QUALITY ASSURANCE AND SURVEILLANCE PLAN (QASP)

E.2. QUALITY ASSURANCE AND SURVEILLANCE PLAN (QASP)

This plan is designed to provide an effective surveillance method to promote effective Contractor performance. The QASP provides a method for the Contracting Officer's Representative (COR) to monitor Contractor performance, advise the Contractor of unsatisfactory performance, and notify the Contracting Officer of continued unsatisfactory performance. The Contractor, not the Government, is responsible for management and quality control to meet the terms of the contract. The role of the Government is to conduct quality assurance to ensure that contract standards are achieved.

Performance Objective PWS Paragraph Performance Threshold Services

Performs all the insurance services set forth in the Performance Work Statement (PWS)

C.1.0 thru C.1.6

All required services are performed and no more than one (1) customer complaint is received per month.

Deliverables

All reports shall be delivered on a timely matter to the address set forth in Section F.4, in accordance with requirements described in Section H.5 – Report Requirements.

(a) Employee Claims Report.

(b) Overall Claims Rate Report (Indice de Siniestralidad).

(c) Employee Out of Network Reimbursement Claims Report

F.4. and H.5

All required reports are received by the COR no later than the 10th day of each month and no more than one (1) customer complaint is received per month.

Deliverables

All reports shall be delivered on a timely matter to the address set forth in Section F.4, in accordance with requirements described in Section H.5 – Report Requirements.

Report on rates at which out of network reimbursement claims will be processed.

F.4. and H.5

The initial required Report will be provided no later than 15 days after award and no later than five (5) business days when the report is updated either annually, each time changes in rates occur, or when requested by the COR.

E.2.1 Surveillance. The COR will receive and document all complaints from Government personnel regarding the services provided.

If appropriate, the COR will send the complaints to the Contractor for corrective action.

E.2.2 Standard. The performance standard is that the Government receives no more than one (1) customer complaint per month. The COR shall notify the Contracting Officer of the complaints so that the Contracting Officer may take appropriate action to enforce the inspection clause (FAR 52.246-4, Inspection of Services – Fixed Price (AUG 1996) or the appropriate Inspection of Services clause), if any of the services exceed the standard.

E.2.3 Procedures

(a) If any Government personnel observe unacceptable services, either incomplete work or required services not being performed, they should immediately contact the COR.

(b) The COR will complete appropriate documentation to record the complaint.

(c) If the COR determines the complaint is invalid, the COR will advise the complainant. The COR will retain the annotated copy of the written complaint for his/her files.

(d) If the COR determines the complaint is valid, the COR will inform the Contractor and give the Contractor additional time to correct the defect, if additional time is available. The COR shall determine how much time is reasonable.

(e) The COR shall, as a minimum, orally notify the Contractor of any valid complaints.

(f) If the Contractor disagrees with the complaint and challenges the validity of the complaint, the Contractor will notify the COR.

The COR will review the matter to determine the validity of the complaint.

(g) The COR will consider complaints as resolved unless notified otherwise by the complaint.

(h) Repeat customer complaints are not permitted for any services. If a repeat customer complaint is received for the same deficiency during the service period, the COR will contact the Contracting Officer for appropriate action under the Inspection clause.

F.2 - PERIOD OF PERFORMANCE

This contract shall be effective on the actual date of contract award. It is the Government’s intention to award a BASE YEAR (12 – months) and FOUR OPTION YEARS (12-months each) contract. However, there is no obligation for the Government to extend the contract beyond the Base Year.

The contract may be extended by the exercise of an option pursuant to FAR 52.217-9, Option to Extend the term of the Contract and FAR 52.217-8, Option to Extend Services.

(end of clause)

F.4 - REPORTS AND OTHER DELIVERABLES

All reports and other deliverables required under this contract shall be delivered to the following address:

SantoDomingoInsurance@state.gov

G-001 - ORDERING PROCEDURES

(a) In accordance with FAR 52.216-18 "ORDERING," the following individuals and activities are authorized to issue delivery orders or task orders hereunder:

The Office of Acquisitions Management and US Embassy Santo Domingo Contracting Officers

(b) Orders placed under this contract shall contain the following information:

(1) Date of order;

(2) Contract number and order number;

(3) Item number and description, quantity, and unit price;

(4) Delivery or performance date;

(5) Place of delivery or performance (including consignee);

(6) Packaging, packing, and shipping instructions, if any;

(7) Accounting and appropriation data;

(8) Security clearance level(s), applicable to the order, if any; and

(9) Any other pertinent information.

(c) Issuance of orders by facsimile is authorized in accordance with FAR 52.216-18 "ORDERING."

ADDITIONAL ORDERING PROCEDURES FOR OTHER GOVERNMENT AGENCIES:

Contracting Officers for the other Government agencies, identified in the clause entitled "ORDERING PROCEDURES,' are authorized to issue delivery orders or task orders under this contract only after obtaining prior written authorization from the designated Contracting Officer's Representative (COR). A copy of each delivery order or task order shall be provided to the U. S.

Department of State, Office of Acquisitions Management's Contracting Officer and COR at the time the order is issued. Method of payment is via task/delivery order.

(End of clause)

G.1.1 - 642.271 Government Technical Monitor (GTM) Duties and Responsibilities

(a) Policy. The Contracting Officer may appoint a Government Technical Monitor (GTM) to assist the Contracting Officer's Representative (COR) in monitoring a contractor's performance. The Contracting Officer may appoint a GTM because of physical proximity to the contractor's work site, or because of special skills or knowledge necessary for monitoring the contractor's work.

The Contracting Officer may also appoint a GTM to represent the interests of another requirements office or post concerned with the contractor's work.

The GTM may not add or modify the terms and conditions of the contract. Only the Contracting Officer may modify the contract, existing task orders or issue new task orders, reflecting these changes, since only the Contracting Officer can obligate funding and commit the Government.

NOTE: A GTM shall be a direct-hire U. S. Government employee.

G.2 - CONTRACTING OFFICER REPRESENTATIVE (COR) DUTIES AND RESPONSIBILITIES

G.2.1 The Contracting Officer's Representative (COR) is responsible for inspection and acceptance of services. These duties include review of Contractor invoices, including the supporting documentation required by the contract. The COR may provide technical advice, substantive guidance, inspections, invoice approval, and other technical purposes as deemed necessary under the contract.

G.2.2 In addition, the COR shall maintain updated list of employees and dependents insured, which will supersede the initial list provided under this contract and as reported to the insurer, without prejudice to the ineligibility clause.

G.2.3. The COR has the additional responsibility of maintaining the eligible listing of employees and dependents for insurance coverage.

G.2.4 The COR may not add or modify the terms and conditions of the contract. While the COR is authorized to provide the Contractor with updated listings of eligible employees and dependents, only the Contracting Officer may modify the contract, existing task orders or issue new task orders, reflecting these changes, since only the Contracting Officer can obligate funding and commit the Government.

NOTE: A COR shall be a direct-hire U. S. Government employee.

G.3 - PAYMENT IN LOCAL CURRENCY

Payment shall be made in DOMINICAN PESOS.

G.4 - SUBMISSION OF INVOICES AND PAYMENT

G.4.1. Invoices for U.S. Government employees shall be submitted in a non-editable format to the following address (designated billing office only for the purpose of submitting invoices:

Financial Management Office U.S. Embassy Santo Domingo SantoDomingoPayments@state.gov

G.4.2. Frequency of Payments. All funds under this contract will be obligated by issuance of task orders, as described in H.3 for all non-rider coverage. Each task order will fund a specific period of time and number of employees and the task orders will be issued at the frequency described in H.3. Contractor may submit invoices monthly for payment to be made at the beginning of the month for which insurance coverage is provided in accordance with FAR 32.404.

G.4.3. U.S. Government Employees. The Government shall make payments directly to the Contractor for all Government employees, whether or not the employee is contributing to the basic premium amount.

G.4.4 Riders:

a. ORE. The Chief of Mission and/or Deputy Chief of Mission will make payment directly to the Contractor for the entire premium amount of the ORE staff, whether or not the ORE employee is contributing to the premium amount.

b. EAE Staff. The Employee Association will make payment directly to the Contractor for the entire premium amount of the EA employee, whether or not the EA employee is contributing to the premium amount.

c. Retirees and Retirees Dependents. The USG will make payments directly to the Contractor for the entire premium amount.

G.5 - REFUNDS TO THE GOVERNMENT

If at any time during performance of the contract the Government finds that the Contractor has been overpaid because the number of employees and/or dependents covered has decreased, the Contracting Officer may either allow that overpayment to be credited to the Government’s account or require that the Contractor refund the overpayment. If the Contracting Officer requests a refund, the Contractor shall make that refund to the Government within 10 calendar days from the actual date of receipt of the request.

G.6 - VALUE ADDED TAX

VALUE ADDED TAX (ITBIS). The Government will not reimburse the Contractor for ITBIS under this contract. The Contractor shall not include a line for ITBIS on Invoices, as the U.S. Embassy has a tax exemption certificate with the host government.

H.5 - REPORTS REQUIREMENTS

The Contractor shall provide the following monthly report. The report shall be received by the COR no later than the 10th day of each month. The report shall report on the previous month's activities.

(a) Employee Claims Report. The report shall list all claims paid by the Contractor to a claimant, including the name of the claimant, date claim is received by the Contractor, and the amount claimed. This report shall also include all outstanding claims and a brief description of why claim has not been paid. The report shall not include any claims information for riders.

(b) Overall Claims Rate Report (Indice de Siniestralidad). The report shall include all claims made under this contract divided by premium category, service category, and contract year (annual), quarterly, and monthly. The report shall include any pertinent notes, and unusual activity (increases or decreases in claims by service category).

(c) Employee Out of Network Reimbursement Claims Report. The report shall list all claims paid by the Contractor to a claimant, including the name of the claimant, date claim is received by the Contractor, the amount claimed, rate/price at which the claim was processed, the amount paid, and the date of check or EFT disbursement. This report shall also include all outstanding claims and a brief description of why claim has not been paid. The report shall not include any claims information for riders.

The Contractor shall provide 15 calendar days after contract award with the rates at which out of network reimbursement claims will be processed. The contractor shall provide the COR no later than five (5) business days with an updated list either annually, each time changes in rates occur, or when requested by the COR.

(End of clause)

H.6 - MISCELLANEOUS CONTRACTOR REQUIREMENTS

H.6.1. General. The Contractor shall take all such steps as are necessary, and obtain and pay for all permits, taxes and fees as are required by the Dominican Republic government to establish and/or operate a commercial venture locally. A contract with the U.S.

Government conveys no special privileges or immunities to the Contractor. The Contractor is an independent commercial concern and not a part of the U.S. mission. The Contractor's employees are not U.S. Government employees. Registration of this contract with the Dominican Republic government, if required by law, will be the sole responsibility of the Contractor, and any fees, taxes, or other duties shall be payable by the Contractor without recourse to the Government of the amounts thereof.

H.6.2. Licenses and Local Laws. The Contractor shall possess all permits, licenses, and any other appointments required for the prosecution of work under this contract, all at no additional cost to the Government. The Contractor shall perform this contract in accordance with local laws.

H.7 - ERRONEOUS PAYMENTS

If the Government becomes eligible for a refund of payment because of erroneous overpayment or other cause, the Contractor shall refund the amounts or use them to offset future payments owed by the Government, whichever the Government prefers. The Contractor shall refund any refunds not complete or discovered after the completion date of this contract.

H.9 - KEY PERSONNEL

1) The Contractor agrees that a partial basis for award of this contract is the list of key personnel proposed. Accordingly, the Contractor agrees to assign to this contract those key persons whose resumes were submitted with the proposal necessary to fulfill the requirements of the contract. The Contractor shall assign to this contract the following key personnel:

Project/Account Manager:

The Contractor shall assign to this contract a Project/Account Manager and an alternate point of contact, other than their dedicated customer service and support line, both fluent in written/spoken English. This Project/Account Manager shall be responsible for, but not limited to, contract issues, billing queries, account management, customer complaints, etc.

Customer Service Representative:

The Contractor shall assign a Customer Service Representative and alternate to be stationed at the US Embassy Santo Domingo at no extra cost to the Government. The Customer Service Representative is to assist employees with claims submittal, benefit authorizations, benefits level inquiries, reimbursement requests, and information and assistant to add employee’s dependents the policy once authorized by the COR.

Training and Employee Schedules:

The Contractor shall be responsible for training their key personnel in all aspects of the contract, including benefits levels, claims procedures, annual limits, exclusions, and limitations, etc.

The Contractor shall be responsible for maintaining personnel schedules. The schedules shall take into consideration the hours that the staff can effectively perform their services without placing a burden on the security personnel of the Embassy. The Contractor shall provide the COR with a detailed plan as to the personnel to be used and the time frame to perform the services. The COR will verify Contractor’s schedule is being followed. The Customer Service Representative must be at the Embassy at least twice a week.

2)

Substitution of Key Personnel:

No substitution shall be made without prior notification to and concurrence of the Contracting Officer's Representative (COR).

During the first 90 days of performance, the Contractor shall make no substitutions of the key personnel unless the substitution is required due to illness, death, or termination of employment. The Contractor shall notify the Contracting Officer Representative (COR) within 10 calendar days after the occurrence of any of these events and provide the information required below to the COR at least 10 days before making any permanent substitutions.

The Contractor may substitute a key person if determined necessary, in which case, the Contractor shall notify the COR immediately, and will provide the information required for the replacement individual.

The Contractor shall provide a detailed explanation of the circumstances requiring the proposed substitution. The proposed substitute shall possess qualifications comparable to the original key person.

All proposed substitutes shall meet or exceed the qualifications of the person to be replaced. The COR shall be notified in writing of any proposed substitution at least 45 days, or if applicable 90 days if a security clearance is to be obtained, in advance of the proposed substitution. Such notification shall include:

(1) An explanation of the circumstances necessitating the substitution;

(2) A complete resume of the proposed substitute; and

(3) Any other information requested by the Contracting Officer to enable him to judge whether or not the Contractor is maintaining the same high quality of personnel that provided the partial basis for award.

H.9.1 - PERSONNEL SECURITY

The Contractor shall provide thirty (30) days after award of the contract, the following list of data for the Customer Service Representatives to be assigned at the Chancery compound under the contract. The Government will run background checks on these individuals. It is anticipated that security checks will take thirty (30) days to perform. For each individual the list shall include:

- Full Name

- Place and Date of Birth

- Current Address

- Identification number (Cédula de Identidad y Electoral or Passport)

Failure to provide any of the above information may be considered grounds for rejection and/or resubmittal of the application.

The Government shall issue identity cards to Contractor personnel, after they are approved. Contractor personnel shall display identity card(s) on their person at all times while providing services under this contract. These identity cards are the property of the US Government. The Contractor is responsible for their return at the end of the contract, when an employee leaves Contractor service, or at the request of the Government. This badge may be revoked at any time due to the falsification of data, or misconduct on site.

The Government reserves the right to deny access to U.S.-owned and U.S.-operated facilities to any individual.

H.9.2 - STANDARD OF CONDUCT

The Contractor shall maintain discipline at the site and shall take all reasonable precautions to prevent any unlawful, riotous or disorderly conduct by Contractor employees at the site. The Contractor shall preserve peace and protect persons and property on site.

The Government reserves the right to direct the Contractor to remove an employee from the worksite for failure to comply with the standards of conduct. The Contractor shall immediately replace such an employee to maintain continuity of services at no additional costs to the Government.

Employee Behavior. All Contractor employees shall be courteous at all times, present credentials identifying themselves as employees of the company, and refer any unresolvable questions to the Project…