RFP_20R0002.doc

UNDER DPAS (15 CFR 350)

1 | 66

2. CONTRACT (Proc. Inst. Ident.) NO.

3. SOLICITATION NO.

19BE2020R0002

4. TYPE OF SOLICITATION

[ ] SEALED BID (IFB)

[ X] NEGOTIATED (RFP)

5. DATE ISSUED

Octpober 28, 2019

6. REQUISITION/PURCHASE NO.

7. ISSUED BY CODE

8. ADDRESS OFFER TO (If other than item 7)

American Embassy Phone: 02/811.4000 27 Regentlaan/Bd. du Régent 1000 Brussels

NOTE: In sealed bid solicitation "offer" and "offeror” mean "bid" and "bidder".

SOLICITATION

9. Sealed offers in original and 3 copies for furnishing the supplies or services in the Schedule will be received at the American Embassy, attn: Contracting Officer

27 Regentlaan/Bd. du Régent, 1000 Brussels until 16:00 Hrs local time on November 27, 2019 CAUTION - LATE Submissions, Modifications, and Withdrawals: See Section L. Provision No. 52.215-1. All offers are subject to all tems and conditions contained in this solicitation.

10. FOR INFORMATION

CONTACT:

A. NAME: Robert Bunnell

B. TELEPHONE (NO COLLECT CALLS) 02/811.4000

AREA CODE NUMBER EXT

C. E-MAIL ADDRESS

BrusselsBids@state.gov

11. TABLE OF CONTENTS

OTHER STATEMENTS OF OFFERORS

OFFER (Must be fully completed by offeror)

NOTE: ITEM 12 does not apply if the solicitation includes the provisions at 52.214-16, Minimum Bid Acceptance Period.

12. In compliance with the above, the undersigned agrees, if this offer is accepted within calendar days (120 calendar days unless a different period is inseted by the offer) from the date for receipt of offers specified above, to furnish any or all items upon which prices are offered at the price set opposite each item, delivered at the designated point(s), within the time specified in the schedule.

13. DISCOUNT FOR PROMPT PAYMENT

SEE 14

(See section I, Clause No 52.232-8)

10 CALENDAR DAYS

20 CALENDAR DAYS

30 CALENDAR DAYS

CALENDAR DAYS

(The offeror acknowledges receipt of amendments to the solicitation and related documents ) numbered and dated:

15A.

NAME

CODE

FACILITY

16. NAME AND TITLE OF PERSON AUTHORIZED

AND

ADDRESS

OF

OFFEROR

TO SIGN OFFER (Type or print)

15B. TELEPHONE NO. (Include area code)

15C. CHECK IF REMITTANCE ADDRESS [ ]

IS DIFFERENT FROM ABOVE - ENTER

SUCH ADDRESS

AWARD (To be completed by Government)

19. ACCEPTED AS TO ITEM NUMBERED

20. AMOUNT

21. ACCOUNTING AND APPROPRIATION

22. AUTHORITY FOR USING OTHER THAN FULL AND OPEN COMPETITION:

[ ] 10 U.S.C. 2304(c)( ) [ ] 41 U.S.C. 253(c)( )

23. SUBMIT INVOICES TO ADDRESS SHOWN IN

(4 copies unless otherwise specified)

ITEM

24. ADMINISTRATION BY (If other than Item 7) CODE

25. PAYMENT WILL BE MADE BY CODE

26. NAME OF CONTRACTING OFFICER (Type or print) Robert Bunnell

27. UNITED STATES OF AMERICA

(Signature of Contracting Officer)

28. AWARD DATE

IMPORTANT - Award will be made on this form, or on the Standard Form 26, or by other authorized official written notice.

NSN 7540-01-152-8064

STANDARD FORM 33 (REV 9-97)

PREVIOUS EDITION NOT USABLE

Prescribed by GSA

SECTION B

PART I PRICE – GROUP HOSPITALIZATION INSURANCE

B.1.

HOSPITALIZATION INSURANCE SERVICES

The Contractor shall provide Hospitalization Insurance services to employees of the Government of the United States of America in Belgium. The groups of employees who shall be provided this insurance are listed in C.1.3. This insurance shall be provided in accordance with Section C and the Exhibits in Section J. The intention of the U.S. Government is that the minimum criteria as mentioned are covered in the form of an off the shelf plan.

B.1.1.

Official Residence Expense (ORE) Staff 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) at the rates specified below. Retirees and extended family members are included under this contract only as riders; the Contractor shall bill the individual covered at the rates specified below. See Section G for billing procedures. Note that USG is not responsible, nor liable, for any riders.

B.2.

PRICES

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 adjustment requirements type contract under which will be issued firm, fixed-price task orders. The fixed prices/premium rates for Hospitalization Insurance services as specified in Section C are listed below.

B.2.3.

Base Year of Contract Bi-weekly Rates:

BI-WEEKLY TOTAL

a. Single Employee

Under age 65

b. Dependent Spouse/Legal Partner Under age 65

c. Dependent Child Under age 21

d. Dependent Child Over age 21

e. SUBTOTAL (a+b+c+d)

f. SUBTOTAL YEARLY PREMIUM (e x 26):

g. MANDATORY YEARLY TAXES ______% (**):

h. MANDATORY YEARLY SOCIAL SECURITY CHARGES______% (**):

i. TOTAL PRICE FOR BASE YEAR (f+g+h):

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

(**) Note to contractor: Indicate which specific taxes and social charges are being added and give their respective amounts and percentages.

B.2.4.

First Year of Contract Bi-weekly Rates:

BI-WEEKLY TOTAL

a. Single Employee

b. Dependent Spouse/Legal

c. Dependent Child

d. Dependent Child

f. SUBTOTAL YEARLY PREMIUM (e x 26):

g. MANDATORY TAXES ______% (*):

h. MANDATORY SOCIAL SECURITY CHARGES_______% (*):

i. TOTAL PRICE FOR FIRST OPTION YEAR (f+g+h):

(*) Note to contractor: Indicate which specific taxes and socal charges are being added and give their respective amounts and percentages.

(**) Note to contractor: Indicate which specific taxes and social charges are being added and give their respective amounts and percentages.

B.2.5.

Second Year of Contract Bi-weekly Rates:

BI-WEEKLY TOTAL

a. Single Employee

b. Dependent Spouse/Legal

c. Dependent Child

d. Dependent Child

f. SUBTOTAL YEARLY PREMIUM (e x 26):

g. MANDATORY TAXES ______% (*):

h. MANDATORY SOCIAL SECURITY CHARGES_______% (*):

i. TOTAL PRICE FOR SECOND OPTION YEAR (f+g+h):

(**) Note to contractor: Indicate which specific taxes and social charges are being added and give their respective amounts and percentages.

B.2.6.

Third Year of Contract Bi-weekly Rates:

BI-WEEKLY TOTAL

a. Single Employee

b. Dependent Spouse/Legal

c. Dependent Child

d. Dependent Child

f. SUBTOTAL YEARLY PREMIUM (e x 26):

g. MANDATORY TAXES ______% (*):

h. MANDATORY SOCIAL SECURITY CHARGES_______% (*):

i. TOTAL PRICE FOR THIRD OPTION YEAR (f+g+h):

(**) Note to contractor: Indicate which specific taxes and social charges are being added and give their respective amounts and percentages.

B.2.4.

Fourth Year of Contract Bi-weekly Rates:

BI-WEEKLY TOTAL

a. Single Employee

b. Dependent Spouse/Legal

c. Dependent Child

d. Dependent Child

e. SUBTOTAL (a+b+c+d+e+f+g)

f. SUBTOTAL YEARLY PREMIUM (e x 26):

g. MANDATORY TAXES ______% (*):

h. MANDATORY SOCIAL SECURITY CHARGES_______% (*):

i. TOTAL PRICE FOR FOURTH OPTION YEAR (f+g+h):

(**) Note to contractor: Indicate which specific taxes and social charges are being added

B.2.5 Grand Total of Base plus All Option Years

Base Year Total

First Option Year Total

Second Option Year Total

Third Option Year Total

Fourth Option Year Totral

Grand Total of Base plus All Option Years

B.3.

ADMINISTRATIVE RETENTION AMOUNTS

B. 3.1 If the Contractor requests a price adjustment under B.4 below, the Contractor must 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 claimant.

B. 3.2 Sets forth the retention amounts per premium paid for each category of premium and for each period of performance.

B. 3.3 Retention Amounts per Separate Premium Paid by the US Government:

Under age 65 Dependent spouse/legal partner

Under age 65 Dependent child

Under age 21 Dependent child

Over age 21 and up to age 25

Base Year

First Option Year

Second Option Year

Third Option Year

Fourth Option Year

B.4. ECONOMIC PRICE ADJUSTMENT LIFE INSURANCE PREMIUMS

B. 4.1. Premium Adjustment Based on Experience - For life insurance, prices may be adjusted upward or downward based on the experience rating of the Mission(s) covered by this contract. 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 and (2) claims paid. 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. 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 Law: 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 rate contracted for herein. 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.

SECTION C

DESCRIPTION/SPECIFICATION/WORK STATEMENT

HOSPITALIZATION INSURANCE

C.1.

HOSPITALIZATION INSURANCE SERVICES

The Government of the United States of America requires Hospitalization Insurance coverage for its employees as further described herein. The Government has determined that the prevailing practice by employers in Belgium is to provide for their employees hospitalization insurance protection and that the cost of such insurance protection is usually borne by both the employee and the employer as follows:

The specific hospitalization benefit coverage under this contract is set forth in Section C and the Exhibits in Section J.

C.1.1 MANDATORY/REQUIRED EMPLOYEE AND DEPENDENT HOSPITALIZATION INSURANCE SERVICES BENEFITS

The hospitalization insurance benefits under this contract are as follows. Reimbursement of covered expenses is limited to the stated percentages of reasonable and customary costs.

Reimbursements or payments shall be made for the following covered benefits, subject to reasonable and customary costs in the locality where treatment was provided.

C.1.1.1 Hospitalization (treatment in the hospital for inpatient care):

Services and supplies provided during hospitalization, including services provided by a licensed Healthcare provider (including a licensed center for palliative care), bed & board (semi-private accommodations, operating room, recovery room, intensive care, imaging and diagnostic testing, general hospital nursing care, physical therapy, mortuary costs, the cost of rooming-in for children up to age 14, donor costs, 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.

Reimbursement of the costs of medically necessary, ambulatory care provided or prescribed by a physician during the period of one month before and three months after the insured hospitalization. The ambulatory care must be included in the official list of medical and paramedical treatments or services (“nomenclature”) of the Belgian health benefits institution (INAMI/RIZIV). Moreover, the costs of the medicines will only be reimbursed if they were prescribed by the physician and dispensed by the pharmacist during the above‑stated period.

The costs must be directly related to the insured hospitalization, and they are added to the costs incurred during the hospitalization. This does not result in the application of a separate deductible (franchise).

100% Coverage

See Mental, Nervous and Substance Abuse care (below) for details concerning inpatient psychiatric care.

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

50% Coverage

For medical costs for which no legal reimbursement is provided are reimbursed at the rate of of 50% with a maximum of € 2,500 per insured person and per year.

C.1.1.2 Emergency Services (trips to emergency room):

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

100% Coverage

C.1.1.3 Ambulance:

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.

80% Minimum Coverage

C.1.1.4 Outpatient Services:

Services provided by a certified healthcare provider on an ambulatory or outpatient basis (without being admitted to a hospital), including surgeon’s fees and other medical services that may be provided in 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 -- Serious Illnesses

-- Maternity assistance 80% Minimum Coverage

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

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

50% Minimum Coverage

For medical costs for which no legal reimbursement is provided are reimbursed at the rate of of 50% with a maximum of € 2,500 per insured person and per year.

C.1.1.5 Obstetric and Newborn Care:

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

Inpatient: 100% Coverage; Outpatient: 80% Minimum Coverage

C.1.1.6 Pediatric Services:

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

Inpatient: 100% Coverage; Outpatient: 80% Minimum Coverage

C.1.1.7 Prescription Drugs:

Medications prescribed by a certified health care provider that are medically necessary. 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; or contraceptive medication.

Inpatient: 100% Coverage; Outpatient: 80% Minimum Coverage

C.1.1.8 Preventive and Wellness and Chronic Disease Management:

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

80% Minimum Coverage

C.1.1.9 Hearing Aids:

Examinations and Treatment: 80% Minimum Coverage

Hearing Aid Apparatus: Limited to one apparatus per ear up to a maximum of USD 1,500 per covered individual per three-year period.

80% Minimum Coverage; with annual cap C.1.1.10 Optical Care:

Examinations and Treatment: 80% Minimum Coverage

Prescription lenses and frames, or contact lenses: Covered up to a maximum of USD 300 per covered individual every two years.

80% Minimum Coverage; with annual cap

C.1.1.11 Dental Care:

Examinations and Treatment: Dentist’s fees, x-rays, examinations and treatment, cleanings, fillings, extractions, false teeth, crowns, and bridges up to a maximum of USD 3,200 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 USD 2,400 lifetime limit. 80% Minimum Coverage; with contract lifetime cap C.1.1.12 Reproductive Health:

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 Exclusions to Coverage).

80% Minimum Coverage

C.1.1.13 Mental Health and Substance Abuse Care:

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 carried out at a facility licensed for detoxification and rehabilitation.

50% Minimum Coverage

C.1.1.14 Rehabilitative and Habilitative Services and Devices:

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) 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.

50% Minimum Coverage

C.1.1.15 HIV/AIDS:

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

Note to Contracting Officer: Post should consider electing this option if HIV/AIDS treatment is not covered as prevailing practice by local medical insurance providers, or is prohibitively expensive.

100% up to USD 10,000 per contract year per covered individual

C.1.1.16 RESERVED

C.1.1.17 Medical Expenses Incurred Out-of-Country (OPTIONAL EMPLOYEE AND DEPENDENT

HOSPITALIZATION INSURANCE SERVICES BENEFIT):

Medical expenses incurred out-of-country will be covered, but coverage will be the same as medical expenses incurred in-country.

C.1.1.18 Transportation for Out-of-Country Treatment (OPTIONAL EMPLOYEE AND

DEPENDENT HOSPITALIZATION INSURANCE SERVICES BENEFIT):

Transportation for out-of-country medical treatment will be a covered expense for LE Staff and eligible family members. To be considered a covered expense, the attending certified health care provider must certify in advance that the treatment is medically necessary and unavailable locally. 80% of covered individual’s transportation expenses by the least expensive, appropriate means of transportation to the nearest city with adequate medical facilities will be covered. 80% of the transportation expenses of an attendant will also be covered, but only if the covered individual's attending certified health care provider certifies that an attendant for the patient is necessary, (e.g., a parent in the case of a patient who is a minor, or a family member to make medical decisions in the case of a patient who is unwell or unconscious). Transportation to a neighboring country without the attending certified health care provider certifying that the treatment is medically necessary and unavailable locally will not be covered.

C.1.1.19 RESERVED

C.1.2 Annual Maximum Limit The annual maximum coverage level is unlimited in accordance with customary practices in Belgium.

The USG retains the right to change the conditions of this benefit from year to year depending on funding and/or changes in Department policy.

C.1.3 Exclusions and Limitations There is no reimbursement 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 reimbursement 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.

C.1.4 Eligible Participants

C.1.4.1 Identification of Eligible Employees and Dependents: U.S. Mision Brussels will provide a list of all eligible employees and dependents with relantionship to employee (self/spouse/child) and DOB for each.

Eligible Employees - The employees eligible for the hospitalization insurance services include the following:

C.1.4.1.1 All current active employees (LE Staff) of the United States Government, employed within the geographic boundaries of Belgium, paid under the Local Compensation Plan (LCP), and certified by the Contracting Officer. Covered employees include:

C.1.4.1.2 Foreign Service Nationals (FSNs) employed under non-temporary direct hire appointments, Personal Services Agreements (PSAs) or Personal Services Contracts (PSCs); or C.1.4.1.3 Temporary direct hire appointments, PSA Fixed Term of one year or more.

C.1.4.2 Location of Employment

The individuals covered by C.1.4.1 must be employed within the geographic boundaries of Belgium by:

• Department of State

• Foreign Agricultural Service (USDA/FAS)

• Animal and Plant Health Inspection Service of the Department of Agriculture (USDA/APHIS)

• Federal Aviation Administration (FAA)

• the Transportation Security Administration (TSA)

• Department of Commerce (DOC)

• Health & Human Services/National Cancer Institute Office (HHS/NCI)

• Office of Defense Cooperation (ODC)

• Defense Attaché Office (DAO)

• Department of Homeland Security (DHS/ICE)

• Department of the Treasury (USEU)

C.1.4.3 Other Eligible Participants

Dependents:

LE Staff who are eligible to participate in the medical plan automatically confer coverage to eligible Family members who meet the following criteria:

C.4.3.1 Legal spouse: one legal spouse as defined by local law may be covered. LE Staff with more than one legal spouse must select only one spouse for coverage.

In cases where LE Staff and their legal spouse both work for the mission and both are eligible to participate in the medical plan, one will be designated as the lead for purposes of the medical plan, and the other will be considered a legal spouse.

C.4.3.2 Dependent 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 as long as the condition persists, the child remains unmarried, and the LE Staff maintains coverage.

C.1.4.4

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.

Retirees and dependents; all costs for coverage of retirees Staff are the responsibility of the retiree, not the U.S. Government.The insurance company must provide an individual contract proposal to employees who opt to continue their coverage after retirement (according to Act Verwilghen).

C.1.5.

Eligibility

C.1.5.1.

Term of Eligibility and Effective Date

Each current active eligible employee is enrolled for hospitalization benefits under this contract upon award and thereafter during the performance period of this contract. Each new eligible employee 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.

The coverage of employees is mandatory, and coverage takes effect upon the employee’s entrance on duty date; the coverage of family members, i.e. the employee's legal spouse or legal partner (see note below) and his/her dependent children, is optional. If an employee opts to also enroll his/her spouse or legal partner and/or dependent children, all family members will be enrolled concurrently.

A dependent child is defined as a child eligible for family allowances under the Belgian Social Security system, and residing with the employee (as attested by communal authorities on the "Composition of Family" (Composition de Ménage / Gezinssamenstelling)form. Coverage of newborn children will take effect as of the date of birth, provided that all other family members are also enrolled. Coverage of the legal spouse will take effect on the date of the civil marriage. Coverage of the legal partner will take effect on the date of the official declaration of cohabitation (see note below). Coverage of the employee is a prerequisite for the coverage of family members; the coverage of family members will cease upon the termination of the coverage of the employee.

Note: Legal partners (cohabitants): an employee’s legal spouse or the partner with whom he/she is legally cohabiting, i.e. who has filed a copy of the official declaration of cohabitation in accordance with article 1476 of the Civil Code to the Human Resources Office. No benefit will be extended to relatives who are legally cohabiting with the employee.

The coverage takes effect upon enrollment, and there will be no waiting period

The coverage of employees and their insured family members remains in effect as long as the employee is on the payroll; it will not be affected by periods of maternity leave, parental leave, extended sick leave.

The coverage of the employee's optionally insured family members can be terminated on the annual expiration date of the insurance policy, provided that the request for cancellation is received by the insurance company 3 months before that date. Re‑enrollment will not be possible.

Employees whose contract is either voluntarily or involuntarily terminated (i.e. through resignation or dismissal) will be given the option to convert their group insurance policy into an individual policy. The continuation will not be subject to medical formalities or waiting periods provided that the former employee (and/or family members) have been covered by the plan for at least two years. Requests for continuation on an individual basis should be submitted to the insurance company within 2 months after the termination of the affiliation to the group insurance policy.

The insurance company will collect premiums directly from the former employee.

C.1.5.2.

Period of Ineligibility.

Employees and their dependents are not entitled to hospitalization insurance benefits during any period of employment for which premiums are not paid.

Additionally, employee's dependents are not entitled to hospitalization benefits during any period of employment during which the employee was not eligible to participate.

During a period of Leave Without Pay or unpaid leave that is one pay period or less, coverage under the insurance contract will continue. The US Government will pay the total premium cost to the contractor.

The employee’s share of the premium will be collected through payroll deduction in that or the subsequent pay period.

During a period of extended (beyond one pay period) Leave Without Pay or unpaid leave, the employee is responsible for the full cost of the insurance premiums for self and dependents. The Mission will pay the premiums directly to the contractor, and will collect the full cost from the employee on a quarterly basis. Alternatively, the employee may elect to have coverage cease if that employee prefers not to pay the premium.

C.1.6

Medical Formalities

There will be no medical formalities C.1.7

Third Paying Party System

The insurance company will issue a “membership/coverage card” (credit card type) to all covered employees and their family members. The third paying party system (derdebetalersysteem - système tiers payant) provides for the direct payment to the hospital of all invoiced expenses related to a hospitalization that is covered by the Plan. The enrolled person no longer has to pay an advance upon entering hospital, even when he/she chooses to stay in a private room, provided that the hospital has concluded an agreement with the insurance company. The insurance company will then bill the insured person for the deductible and the expenses not covered under the Plan. Employees are expected to settle the bill promptly, as failure to do so may result in the immediate withdrawal of “membership/coverage card” privileges.

C.1.8 Premiums

Premiums are payable quarterly in arrears and are increased by the insurance tax and the contribution to the Belgian Health Benefits Institution (RIZIV/INAMI).

90% of the premiums for the LE staff are borne by the policyholder (U.S.G.) and 10% of the premiums are borne by the LE staff member. The employee’s contribution is deducted from his/her salary and is collected by the policyholder each pay period.

90% of the premiums for the LE staff dependents are borne by the policyholder and 10% of the premiums are borne by the LE staff member. The dependents’ contribution is deducted from the LE staff member’s salary and is collected by the policyholder each pay period.

The premiums for (early) retired LE staff are payable by the insured yearly in advance in addition to the insurance tax and the contribution to the Belgian Health Benefits Institution (RIZIV/INAMI).

The premiums for the LE staff members who retire early or at the mandatory retirement age and their family members are paid directly by the insured and collected through direct debit orders.

C.1.9 Brochure Requirement

C.1.9.1.

The contractor shall provide a document (brochure/pamphlet/other written document) English, Dutch and French that sets forth a complete listing of the hospitalization 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.1.9.2.

The contractor shall provide the document described in C.1.9.1 to the COR not later than twenty (20) days after date of contract award. The Contractor shall provide additional brochures for new employees within ten (10) days of the COR’s request.

C.1.9.3.

The contractor assumes full responsibility for ensuring that the document described in C.1.9.1 accurately reflects the requirements 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 brochure contains inaccuracies, the contractor will be notified in writing; however, failure on the part of the 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.

C.1.10

Spreadsheet Requirement

The contractor shall provide a single spreadsheet, giving the total annual cost (including the Employer and Employee contributions per employee as well as the Employer and Employee contributions for dependents) for each “employee number” for Group Hospitalization Insurance, using the information contained in Exhibit A referred to in Section J.

C.1.11

Communication Requirement

The contractor shall provide an online tool as well as a 24/7 telephone service.

Paragraph C.2 is Reserved C.3.0

DEFINITIONS

Cohabitant Employee’s legal spouse or the partner with whom he/she is legally cohabiting and. who has filed a copy of the official declaration of cohabitation in accordance with article 1476 of the Civil Code to the Human Resources Office.

COR

Contracting Officer's Representative (Human Resources Officer at post).

Contributory Insurance for which the employee contributes toward the premium.

Customary and A diagnostic test or medical treatment which is usually performed in the

Reasonable Community where the individual is being treated.

Treatment Dependent The employee's legal spouse or legal partner (see note below) and his/her dependent children. A dependent child is defined as a child eligible for family allowances under the Belgian Social Security system, and residing with the employee (as attested by communal authorities on the “Composition of Family” (Composition de énage/Gezinssamenstelling) form.

Employee An individual employed by the U.S. Government, under a direct-hire appointment, personal services contract or personal services agreement, as further defined in Section C.1.3

Employer The United States Government.

FMO

The Financial Management Officer or the paying office for all U.S. Government Agencies.

GSO

General Services Officer in charge of the General Services Office at post. This officer is usually the Contracting Officer for this contract.

Hospital An institution established and operated for the care and treatment of sick and injured persons. It provides 24-hour nursing care and has diagnostic, laboratory, treatment, and surgical facilities.

Any institution which does not meet this definition is not considered a hospital.

Hospital Patient An individual who has been admitted to a hospital, is assigned a bed, and is given diagnostic tests or receives treatment for a disease or an injury.

INAMI

Belgian health benefits institution (also called RIZIV).

RIZIV/INAMI is the overarching health benefits payments office of the Belgian Social Security system. This office establishes the rules (which medical services are reimbursed + the reimbursement rate) and also controls the so-called mutuelles/ziekenfondsen, the health benefits payments instrumentalities that employees must enroll with in order to access benefits.

Legal Partner Employee’s legal spouse or the partner with whom he/she is legally cohabiting, i.e. who has filed a copy of the official declaration of cohabitation in accordance with article 1476 of the Civil Code to the Human Resources Office.

A legal partner can be either of opposite sex or same sex.

Maximum The total amount that will be paid to any one covered individual for covered medical Benefit expenses.

ORE

Official Residence Expenses.

ORE employee Household Staff/Employees, including Residence Managers, performing household duties within the official residence of an ORE principal.

Pay Period (PP) Is a period of two weeks commencing on a Sunday and running through the Saturday of the subsequent week. A calendar year consists of 26 pay periods.

Physician An individual who has graduated from an accredited medical school and is licensed to practice medicine in the jurisdiction in which the contract is to be performed. If the individual is a medical specialist, then he or she is Board Certified in that specialty.

PSA

Personal Services Agreement. Type of contract used by the Department of State.

Personal Services agreements are concluded for a specified period of time

(generally one year), and may be extended in increments of one year.

PSC

Personal Services Contract. This type of contract is similar to that of Personal Services

Agreements, but is used by agencies other than the Department of State.

RIZIV

Belgian health benefits institution (also called INAMI).

RIZIV/INAMI is the over-arching health benefits payments office of the Belgian Social Security system. This office establishes the rules (which medical services are reimbursed + the reimbursement rate) and also controls the so-called mutuelles/ziekenfondsen, the health benefits payments instrumentalities that employees must enroll with in order to access benefits.

SGSO Senior General Services Officer in charge of General Services at Post. This officer is usually the Contracting Officer for this Contract.

Third Payer System that provides for the direct payment to the hospital of all invoiced expenses Agreement related to a hospitalization that is covered by the Plan.

SECTION D

PACKAGING AND MARKING

(RESERVED)

SECTION E

INSPECTION AND ACCEPTANCE

E.1.

52.252‑2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

This contract incorporates the following clauses by reference, with the same force and effect as if they were given in full text. Upon request, the Contracting Officer will make their full text available. Also, the full text of a clause may be accessed electronically at this address:

http://www.acquisition.gov/far/ or http://farsite.hill.af.mil/vffara.htm

These addresses are subject to change. If the Federal Acquisition Regulation (FAR) is not available at the locations indicated above, use the Department of State Acquisition website at http://www.statebuy.state.gov/ to see the links to the FAR. You may also use an internet “search engine” (for example, Google, Yahoo, Excite) to obtain the latest location of the most current FAR.

The following Federal Acquisition Regulation clause(s) is/are incorporated by reference:

CLAUSE

TITLE AND DATE

52.246-4 Inspection of Services - Fixed Price (AUG 1996)

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.

Services

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

C.1.0 thru C.3.0

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

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.

SECTION F

DELIVERIES OR PERFORMANCE

F.1.

This contract incorporates the following clauses by reference, with the same force and effect as if they were given in full text. Upon request, the Contracting Officer will make their full text available. Also, the full text of a clause may be accessed electronically at this address:

These addresses are subject to change. If the Federal Acquisition Regulation (FAR) is not available at the locations indicated above, use the Department of State Acquisition website at http://www.statebuy.state.gov/ to see the links to the FAR. You may also use an internet “search engine” (for example, Google, Yahoo, Excite) to obtain the latest location of the most current FAR.

The following Federal Acquisition Regulation clauses are incorporated by reference:

52.242-15 Stop Work Order (AUG 1989)

52.242-17 Government Delay of Work (APR 1984)

F.2 PERIOD OF PERFORMANCE. The performance period of this contract is five years beginning as stated in Notice to proceed.

F.3

OPTIONS

The Government may extend this contract in accordance with the option clause at Section I, clause I.2, FAR Clauses Incorporated by Full Text (FAR 52.217-9, Option to Extend the Term of the Contract), which also specifies the total potential duration of the contract.

The Government may exercise the option set forth at Section I, "FAR 52.217-8, Option to Extend Services".

F.4

REPORTS AND OTHER DELIVERABLES

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

American Embassy

Attn: Human Resources Officer

Regentlaan/Bd. Du Régent 27

1000 Brussels

SECTION G

CONTRACT ADMINISTRATION DATA

G.1.

652.242-70 CONTRACTING OFFICER’S REPRESENTATIVE (COR) (AUG 1999)

The Contracting Officer may designate in writing one Government employee, by name or position title, to take action for the Contracting Officer under this contract. This designee shall be identified as a Contracting Officer’s Representative (COR). Such designation shall specify the scope and limitations of the authority so delegated; provided, that the designee shall not change the terms or conditions of the contract, unless the COR is a warranted Contracting Officer and this authority is delegated in the designation.

The COR for this contract is the Human Resources Assistant.

G.2

COR DUTIES

G.2.1 The 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 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 through the broker, 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 change 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 existing task orders or issue new task orders, reflecting these changes, since only the Contracting Officer can obligate funding and commit the Government.

G.3.

Payment shall be made in Euro.

G.4

SUBMISSION OF INVOICES AND PAYMENT

G.4.1.

The Contractor shall submit electronic invoices in English to the following address: BruFMCAccountsProc@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. 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. All payments under this contract will be made at the conclusion of the period covered. Invoices may be submitted monthly or quarterly with payments being made monthly or quarterly, in accordance with teir frequency, by the Government.

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 premium amount.

G.4.4 Riders

a. ORE Staff. 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. Retirees and dependents. The retiree will make payment 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 ten calendar days of receipt of the request.

G.6

VALUE ADDED TAX

VALUE ADDED TAX (VAT). 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.

SECTION H

SPECIAL CONTRACT REQUIREMENTS

H.1 SECURITY. On occasion, a Contractor employee may require entry into U.S. Government-owned or -operated facilities. If so, the Contractor should be prepared to provide the necessary identification to permit escorted access within that facility.

H.2 STANDARDS OF CONDUCT. The Contractor shall maintain satisfactory standards of employee competency, conduct, cleanliness, appearance, and integrity and shall be responsible for taking such disciplinary action with respect to employees as may be necessary. Each Contractor employee is to adhere to standards that reflect credit on themselves, their employer, and the United States Government.

H.3 ORDERING PROCEDURES. The Government will issue a task order as soon as possible after contract award to identify all employees to be covered by the insurance described in this contract and the coverage selected by each employee, including dependents to be covered. The COR will make subsequent additions or deletions to this list in writing and provide the revised list to the Contractor. All such revisions shall be consolidated, and a new or modified task order will be issued by the Contracting Officer. If any changes have been made to the coverage listing, the Government anticipates issuance of a new task order on a [X] monthly or [X] quarterly basis. This new task order will include all changes made since the previous task order was issued and will include any increase or decrease in necessary funding. The changes to the list of eligible individuals will supersede the initial list provided under prior task orders without prejudice to the ineligibility clause. Task orders will indicate the effective date of employment, for purposes of calculating the premium due.

H.3.1 Riders are not included under the task orders issued by the Contracting Officer.