TAB_A_19BK8019R0015_RFP.pdf

October 04, 2019

The Embassy of the United States of America Roberta C. Frasurea 1 71000 Sarajevo, Bosnia and Herzegovina

Dear Prospective Offeror:

SUBJECT: Solicitation Number 19BK8019R0015, Health Insurance Services for the U.S.

Embassy in Sarajevo Locally Employed Staff and their Eligible family members

The Embassy of the United States of America invites you to submit a proposal for locally employed staff health insurance coverage. The Embassy encourages prospective offerors to offer off-the-shelf plans that meet at least the minimum benefit levels required in this solicitation.

The Embassy intends to conduct a pre-proposal conference, and all prospective offerors are invited to attend. See Section L of the attached Request for Proposals (RFP).

Your proposal must be submitted in a sealed envelope marked "Proposal Enclosed" to the U.S.

Embassy in Sarajevo; Procurement & Contracting Office; Roberta C. Frasurea 1; 71000 Sarajevo, Bosnia and Herzegovina on or before 10:00 AM the U.S. Eastern time, or 04:00 PM Local (Central European Time – CET) on Monday, November 04, 2019. No proposal will be accepted after this time.

In order for a proposal to be considered, you must also complete and submit the following:

1. SF-33

2. Section B, Pricing Schedule;

3. Section B, Retention Amounts in B.3;

4. Section K, Representations and Certifications; and

5. Additional information as required in Section L.

Direct any questions regarding this solicitation to the Embassy Primary Point of Contact: Mr.

Jimmy Don Canada, Contracting Officer in writing to the following group e-mail address:

GSOPROCUREMENTSARAJEVO@STATE.GOV or to the following international facsimile number: +387(33) 704-429. Subject line of an e-mail or facsimile submitted shall contain the following in the subject line: “19BK8019R0015 – Question, date”. Questions submitted shall be in attention to the Embassy Contacting Officer, Mr. Jimmy Don Canada.

Please note: Proposals that contain less than the minimum reimbursement levels or do not provide all benefit categories may be deemed technically unacceptable.

The successful offeror shall be registered in the SAM (System for Award Management) database https:llwww.sam.gov prior to contract award pursuant to FAR provision 5.207.

Therefore prospective offerors are encouraged to register prior to the submittal of their proposal.

The guidelines for registration in SAM are also available at: https:llwww.fsd.gov/fsd gov/learning-center-system.do?sysparm system=SAM

The U.S. Government intends to award a contract to the responsible company submitting an acceptable offer at the lowest price. We intend to award a contract based on initial proposals, without holding discussions, although we may hold discussions with companies in the competitive range if there is a need to do so.

Sincerely, Jimmy Don Canada Contracting Officer

SOLICITATION, OFFER AND AWARD

1. THIS CONTRACT IS A RATED ORDER

UNDER DPAS (15 CFR 700)

RATING PAGE OF PAGES

01 69

2. CONTRACT NUMBER

3. SOLICITATION NUMBER 4. TYPE OF SOLICITATION 5. DATE ISSUED 6. REQUISITION/PURCHASE

19KB8019R0015

SEALED BID (IFB)

NEGOTIATED (RFP)

Oct. 04, 2019 PR8404108

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

THE EMBASSY OF THE UNITED STATES OF AMERICA

Procurement and Contracting Office Roberta C. Frasurea 1 71000 Sarajevo, Bosnia and Herzegovina

See Block 7

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

SOLICITATION

9. Sealed offers in original and 2 (TWO) copies for furnishing the supplies or services in the Schedule will be received at the place specified, in item 8, or if hand carried, in the depository located in Am Embassy Sarajevo, Roberta C. Frasurea 1, Sarajevo, BiH until 16:00 local time Nov. 04, 2019 (Hour) (Date) CAUTION - LATE Submissions, Modifications, and Withdrawals: See Section L. Provision No. 52.214-7 or 52.215-1. All offers are subject to all terms and conditions contained in this solicitation.

10. FOR

INFORMATION

CALL:

A. NAME B. TELEPHONE (NO COLLECT CALLS) C. E-MAIL ADDRESS

Jimmy Don Canada

AREA CODE

+387(33)

NUMBER

704-000

EXTENSION

4489 CANADAJD2@state.gov

11. TABLE OF CONTENTS

(X) SEC. DESCRIPTION PAGE(S) (X) SEC. DESCRIPTION PAGE(S)

PART I - THE SCHEDULE PART II - CONTRACT CLAUSES

A SOLICITATION/CONTRACT FORM 1 I CONTRACT CLAUSES 31 - 42

B SUPPLIES OR SERVICE AND PRICES/COSTS 2 - 10 PART III - LIST OF DOCUMENTS, EXHIBITS, AND OTHER ATTACH.

C DESCRIPTION/SPECS/WORK STATEMENT 11 - 20 J LIST OF ATTACHMENTS 43 - 45

D PACKAGING AND MARKETING 21 PART IV - REPRESENTATIONS AND INSTRUCTIONS

E INSPECTION AND ACCEPTANCE 22 - 23

K REPRESENTATIONS, CERTIFICATIONS, AND

OTHER STATEMENTS OF OFFERORS 46 - 59

F DELIVERIES OR PERFORMANCE 24

G CONTRACT ADMINISTRATION 25 - 27 L INSTRS.,COND., AND NOTICES TO OFFERORS 60 - 66

H SPECIAL CONTRACT REQUIREMENTS 28 - 30 M EVALUATION FACTORS FOR AWARD 67 - 69

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 (60 calendar days unless a different period is inserted 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 Section I, Clause No 52.232-8)

10 CALENDAR DAYS (%)

20 CALENDAR DAYS (%) 30 CALENDAR DAYS (%) CALENDAR DAYS (%)

14. ACKNOWLEDGMENT OF AMENDMENTS

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

AMENDMENT NO. DATE AMENDMENT NO. DATE

15A. NAME AND

ADDRESS OF

OFFEROR

CODE FACILITY 16. NAME AND TITLE OF PERSON AUTHORIZED TO SIGN OFFER

(Type or print) COMPANY NAME

Office Street No.

ZIP/Post City COUNTRY

Name, Title

15B. TELEPHONE NUMBER

15C.CHECK IF REMITTANCE ADDRESS

IS DIFFERENT FROM ABOVE - ENTER

SUCH ADDRESS IN SCHEDULE.

17. SIGNATURE 18. OFFER DATE

AREA CODE

NUMBER

EXTENSION

AWARD (To be completed by Government)

19. ACCEPTED AS TO ITEMS 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)( )

22. 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 See Block 7 THE EMBASSY OF THE UNITED STATES OF AMERICA

Financial Management Office Roberta C. Frasurea 1; 71000 Sarajevo Bosnia and Herzegovina

26. NAME OF CONTRACTING OFFICER (Type or print) 27. UNITED STATES OF AMERICA 28. AWARD DATE Jimmy Don Canada

(Signature of Contracting Officer)

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

AUTHORIZED FOR LOCAL REPRODUCTION STANDARD FORM 33 (REV. 6/2014)

Previous edition is unusable Prescribed by GSA – FAR (48 CFR) 53.214(c)

SBU - CONTRACTING AND ACQUISITIONS

SECTION B

PRICE

B.1. HEALTH INSURANCE SERVICES

The Contractor shall provide the Health Insurance services to employees of the Government of the United States of America in Bosnia and Herzegovina 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 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 premium rates specified below.

Coverage After Retirement Employees who were covered under the medical insurance plan at the time of retirement may elect to continue coverage, for themselves and dependents, under a rider contract. The retiree, not the U.S. Government, is responsible for 100% of the premium costs associated with the plan. The administration of the plan is handled by the retiree and insurance provider.

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 the health insurance services as specified in Section C are as follows:

B.2.3. BASE YEAR OF CONTRACT

Locally Employed Staff (LE Staff) covered under the Post’s medical benefit plan will pay a 10% share of the premium. Premiums will be based on the number of individuals covered:

CLIN INSUREE CATEGORY

Est. No.

of Insurees

MONTHLY

PREMIUM RATE

EXTENDED MONTHLY

PREMIUM TOTAL

B.2.3.a. SELF-ONLY (one covered individual. Local Employee) 80

B.2.3.b.

SELF PLUS ONE

(two individuals. Local Employee + one eligible dependent)

B.2.3.c.

FAMILY

(three or more individuals. Local Employee + two or more eligible dependents)

MONTHLY SUBTOTAL FOR ALL CATEGORIES

TOTAL PRICE BASE YEAR**

(subtotal x 12 Months)

NOTE: *Est. No. of Insurees does not include any riders addressed in paragraph B.1.1.

** TOTAL PRICE BASE YEAR does not include any premiums for riders addressed in paragraph B.1.1.

OPTIONAL BENEFITS PREMIUMS

Represents additional/voluntary health insurance coverage as defined in C.1.1.19., premium is paid 100% by participating LE Staff. Premium for Excess Coverage shall not be included into the Contract Total Price Base Year calculation.

EXCESS COVERAGE

(See C.1.1.19. for definition)

Item Line INSUREE CATEGORY Per

INSUREE

MONTHLY

PREMIUM RATE

a.101. SELF-ONLY- EXCESS COVERAGE (one covered individual. Local Employee) a.102. SELF PLUS ONE- EXCESS COVERAGE (two individuals. Local Employee + one eligible dependent) a.103

FAMILY- EXCESS COVERAGE

(three or more individuals. Local Employee + two or more eligible dependents)

B.2.4. THE FIRST OPTION YEAR OF CONTRACT

Locally Employed Staff (LE Staff) covered under the Post’s medical benefit plan will of Insurees

MONTHLY

PREMIUM RATE

EXTENDED MONTHLY

PREMIUM TOTAL

B.2.4.a. SELF-ONLY (one covered individual. Local Employee) 80

B.2.4.b.

SELF PLUS ONE

(two individuals. Local Employee + one eligible dependent)

B.2.4.c.

FAMILY

(three or more individuals. Local Employee + two or more eligible dependents)

MONTHLY SUBTOTAL FOR ALL CATEGORIES

TOTAL PRICE THE FIRST OPTION YEAR**

** TOTAL PRICE THE FIRST OPTION YEAR does not include any premiums for riders addressed in paragraph B.1.1.

OPTIONAL BENEFITS PREMIUMS

Represents additional/voluntary health insurance coverage as defined in C.1.1.19., premium is

Contract Total Price the First Option Year calculation.

Item Line INSUREE CATEGORY Per

INSUREE

MONTHLY

PREMIUM RATE

a.201. SELF-ONLY- EXCESS COVERAGE (one covered individual. Local Employee) a.202. SELF PLUS ONE- EXCESS COVERAGE (two individuals. Local Employee + one eligible dependent) a.203

FAMILY- EXCESS COVERAGE

(three or more individuals. Local Employee + two or more eligible

B.2.5. THE SECOND OPTION YEAR OF CONTRACT

Locally Employed Staff (LE Staff) covered under the Post’s medical benefit plan will pay a 10% share of the premium. Premiums will be based on the number of individuals covered:

of Insurees

MONTHLY

PREMIUM RATE

EXTENDED MONTHLY

PREMIUM TOTAL

B.2.5.a. SELF-ONLY (one covered individual. Local Employee) 80

B.2.5.b.

SELF PLUS ONE

(two individuals. Local Employee + one eligible dependent)

B.2.5.c.

FAMILY

(three or more individuals. Local Employee + two or more eligible dependents)

MONTHLY SUBTOTAL FOR ALL CATEGORIES

TOTAL PRICE THE SECOND OPTION YEAR**

** TOTAL PRICE THE SECOND OPTION YEAR does not include any premiums for riders addressed in

Contract Total Price the Second Option Year calculation.

Item Line INSUREE CATEGORY Per

INSUREE

MONTHLY

PREMIUM RATE

a.301. SELF-ONLY- EXCESS COVERAGE (one covered individual. Local Employee) a.302. SELF PLUS ONE- EXCESS COVERAGE (two individuals. Local Employee + one eligible dependent) a.303

FAMILY- EXCESS COVERAGE

(three or more individuals. Local Employee + two or more eligible

B.2.6. THE THIRD OPTION YEAR OF CONTRACT

Locally Employed Staff (LE Staff) covered under the Post’s medical benefit plan will of Insurees

MONTHLY

PREMIUM RATE

EXTENDED MONTHLY

PREMIUM TOTAL

B.2.6.a. SELF-ONLY (one covered individual. Local Employee) 80

B.2.6.b.

SELF PLUS ONE

(two individuals. Local Employee + one eligible dependent)

B.2.6.c.

FAMILY

(three or more individuals. Local Employee + two or more eligible dependents)

MONTHLY SUBTOTAL FOR ALL CATEGORIES

TOTAL PRICE THE THIRD OPTION YEAR**

** TOTAL PRICE THE THIRD OPTION YEAR does not include any premiums for riders addressed in

Contract Total Price the Third Option Year calculation.

Item Line INSUREE CATEGORY Per

INSUREE

MONTHLY

PREMIUM RATE

a.401. SELF-ONLY- EXCESS COVERAGE (one covered individual. Local Employee) a.402. SELF PLUS ONE- EXCESS COVERAGE (two individuals. Local Employee + one eligible dependent) a.403

FAMILY- EXCESS COVERAGE

(three or more individuals. Local Employee + two or more eligible

B.2.7. THE FOURTH OPTION YEAR OF CONTRACT

Locally Employed Staff (LE Staff) covered under the Post’s medical benefit plan will of Insurees

MONTHLY

PREMIUM RATE

EXTENDED MONTHLY

PREMIUM TOTAL

B.2.7.a. SELF-ONLY (one covered individual. Local Employee) 80

B.2.7.b.

SELF PLUS ONE

(two individuals. Local Employee + one eligible dependent)

B.2.7.c.

FAMILY

(three or more individuals. Local Employee + two or more eligible dependents)

MONTHLY SUBTOTAL FOR ALL CATEGORIES

TOTAL PRICE THE FOURTH OPTION YEAR**

** TOTAL PRICE THE FOURTH OPTION YEAR does not include any premiums for riders addressed in

Contract Total Price the Fourth Option Year calculation.

Item Line INSUREE CATEGORY Per

INSUREE

MONTHLY

PREMIUM RATE

a.401. SELF-ONLY- EXCESS COVERAGE (one covered individual. Local Employee) a.402. SELF PLUS ONE- EXCESS COVERAGE (two individuals. Local Employee + one eligible dependent) a.403

FAMILY- EXCESS COVERAGE

(three or more individuals. Local Employee + two or more eligible

B.2.7. GRAND TOTAL OF BASE PLUS ALL OPTION YEARS

TOTAL PRICE BASE YEAR

TOTAL PRICE THE FIRST OPTION YEAR

TOTAL PRICE THE SECOND OPTION YEAR

TOTAL PRICE THE THIRD OPTION YEAR

TOTAL PRICE THE FOURTH OPTION YEAR

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 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 must be expressed in the currency in which the premium amount is proposed. 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

(Employee only)

SELF + ONE

(Employee + one eligible dependent)

FAMILY

(Employee + two or more eligible dependents)

BASE YEAR

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 thirty 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.

SECTION C

DESCRIPTION/SPECIFICATION/WORK STATEMENT

C.1. HEALTH INSURANCE SERVICES

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

C.1.1. Employee and Dependent Health Service Benefits

C.1.1.1. Hospitalization (Treatment in the Hospital for Inpatient Care):

Reimbursement Rate - 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, 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 (C.1.1.4) for details concerning professional Services

C.1.1.2. Emergency Services (Trips to Emergency Room):

Reimbursement Rate - 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 Reimbursement Rate - 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.1.1.5. Outpatient Services:

Minimum Reimbursement Rate - 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.) for details concerning physical therapy.

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

C.1.1.6. Obstetric and Newborn Care:

Minimum Reimbursement Rate - 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 Reimbursement Rate - 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.1.1.8. Prescription Drugs:

Minimum Reimbursement Rate -Inpatient/Emergency: 100%, Outpatient:

80%

Medications prescribed by a licensed health care provider that are medically necessary to treat a specified diagnosis. Examples include, but are not limited to prescription antibiotics to treat an infection, medication used to treat an ongoing condition, such as high cholesterol, or birth control medication.

C.1.1.8. Preventive and Wellness Services and Chronic Disease Management:

Minimum Reimbursement Rate - 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.

C.1.1.9. Hearing Aids

Hearing Aid Apparatus Limited to one apparatus per ear up to a maximum of BAM 2,685.00 per covered individual per three-year period. 80% Minimum Coverage; with annual cap.

C.1.1.10. Optical Care Minimum Reimbursement Rate for Examinations and Treatment – 80%

Prescription lenses and frames or contact lenses: covered up to a maximum of BAM 537.00 per covered individual every two years. 80% Minimum Coverage;

with annual cap.

C.1.1.11. Dental Care Minimum Reimbursement Rate – 80%

Examinations and Treatment: Dentist’s fees, x-rays, examination and treatment, cleanings, fillings, extractions, false teeth, crowns, and bridges up to a maximum of BAM 5,727.00 per covered individual per contract year. 80% Minimum Reimbursement Rate, 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 shall be covered per individual up to a maximum of BAM 4,295.00 lifetime limit. 80% Minimum Coverage; with contract life cap.

C.1.1.12. Reproductive Health Minimum Reimbursement Rate - 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 and Limitations)

C.1.1.13. Mental Health and Substance Abuse Care

Minimum Reimbursement Rate - 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 Reimbursement Rate - 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% Reimbursement up to $10,000 per contract year per covered individual

Medications to suppress opportunistic infections (such as tuberculosis or toxoplasmosis for employees and dependents 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.

Reimbursement under this benefit is excluded from the annual maximum limit (C.1.2).

C.1.1.17. Catastrophic Coverage

Additional coverage equal to BAM 119,306.00 per covered individual per contract year. Catastrophic conditions shall be defined as major medical conditions occurring as a result 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. Medical Expenses Incurred Out-of-Country:

Medical expenses incurred out-of-country will be covered at the same benefit levels and subject to the same total maximum annual limit as for medical expenses incurred in-country

C.1.1.18. Transportation for Out-of-Country Treatment 80% Reimbursement

Transportation for out-of-country medical treatment will be a covered expense for covered employees 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).

All coverage for transportation for out-of-country medical treatment is subject to the total maximum annual limit. 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. Excess Coverage

Additional coverage equal to BAM 119,306.00 per covered individual per contract year. This excess coverage will be offered as an optional benefit to LE Staff. LE Staff must pay 100% of the premium if they elect Excess Coverage.

C.1.2. Annual Maximum Limit

The maximum annual reimbursement per covered individual per contract year, not including expenses defined under Exclusions and Limitations (C.1.3) or those covered under C.1.1.16, Catastrophic Coverage, or those covered under

C.1.1.15. HIV/AIDS, and C.1.1.19, Excess Coverage is equivalent to BAM 119,306.00.

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 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. Mission in Bosnia and Herzegovina will provide a list of all eligible employees and dependents with relationship to employee (self/spouse/child) and DOB for each. Updates will be provided to add or remove as changes occur.

C.1.4.1.1. Definition of 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.1.4.1.1.1. Legal Spouse: a limit of one legal spouse as defined by local law per employee will be covered.

C.1.4.1.1.2. Common – Law Spouse: one Common-Law Spouse may be covered. A Common-Law spouse is defined as cohabitation of male and female, for a minimum of three years, who are not married and do not live in common-law marriage with another person. The minimum period of three years may be shorter if the cohabitants have legal dependent children together.

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

C.1.4.1.1.3. 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.1.4.2. Location of Employment: The eligible employees covered by C.1.4.1 must be employed within the geographic boundaries of Bosnia and Herzegovina by:

Department of State; U.S. Agency for International Development (USAID);

Department of Defense; U.S. Department of Agriculture; U.S. Department of Justice, and will be:

- Paid under the terms of the Local Compensation Plan (LCP); and –

- Under a non – temporary direct hire appointment, personal services agreement (PSA), or personal services contract (PSC); or

- Under temporary direct hire appointment or PSA Fixed Term of one year or more

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 the U.S.

Embassy in Bosnia and Herzegovina. All costs for coverage of EAEs are the responsibility of the Employee Association, not the U.S. Government.

c. Retirees; all costs for coverage of retirees Staff are the responsibility of the retiree, not 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. Period of Ineligibility

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

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

During a period of extended (beyond one pay period) of 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. Brochure Requirement

C.1.6.1. The Contractor shall provide a document (brochure/pamphlet/other written document) in English and Bosnian language 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 30 (thirty) calendar 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.

C.2. RESERVED

C.3. DEFINITIONS

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

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

Customary and Reasonable Treatment

A diagnostic test or medical treatment which is usually performed in the community where the individual is being treated.

Disability, Total and Permanent A physical or mental impairment which precludes the individual from performing ordinary motor or bodily functions and which requires separation from employment. If the impairment is the result of a previous impairment, it shall be considered a continuation of the prior impairment.

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.1.4.2.for health insurance, this may also include ORE Staff. If ORE Staff category of individual is listed as participating under a rider in C.1.4.3.a. for health insurance.

Employer The United States Government or in the case of ORE and, the Chief of

Mission/Deputy Chief of Mission.

Family As defined by Bosnia and Herzegovina Family Law, Article 2 paragraph 1: “is community of parents and children and other blood relatives, relatives by marriage, adopters and adoptees, and persons from the common-law marriage, if living in one household”

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.

Spouse applies to legal married and to common-law marriage. As defined by Bosnia and

Herzegovina Family Law article 3 the common-law marriage is a cohabitation of a female and a male who are not married, or do not live in the common-law marriage with another person, which lasts at least three years or shorter, if there is a child to that marriage. Further definitions is provided in: C.1.4.1.1.1. and C.1.4.1.1.2.

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.

Surgical procedure

Any invasive medical procedure by manual or instrument operation undertaken for diagnosis or treatment of a diseased patient

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.

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

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. 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

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 clauses are incorporated by reference:

CLAUSE TITLE AND DATE

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 one year beginning on January 29, 2020 with four (4) one-year options to renew.

F.3. OPTIONS

(a) 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.

(b) 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:

The Embassy of the United States of America Human Resources Officer Roberta C. Frasurea 1 71000 Sarajevo Bosnia and Herzegovina

SECTION G

CONTRACT ADMINISTRATION DATA

G.1. 652.242-70 CONTRACTING OFFICER’S REPRESENTATIVE (COR) (AUG 1999)

(a) 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.

(b) The COR for this contract is the Human Resources Officer.

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 [Note to Contracting Officer: Add “through the broker” if the Contractor is a 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 the currency of awarded contract.

G.4. SUBMISSION OF INVOICES AND PAYMENT

G.2.1. Invoices for U.S. Government employees shall be submitted in an original and three (3) copies to the following address (designated billing office only for the purpose of submitting invoices):

The Embassy of the United States of America Financial Management Office Roberta C. Frasurea 1 71000 Sarajevo Bosnia and Herzegovina

G.2.2. Frequency of Payments. All funds under this contract for non-rider coverage 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 with payments being made monthly by the Government.

G.2.3. 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.2.4. 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. 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

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 monthly, 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. Because their coverage is under a rider, either their employer are themselves are responsible for directly interacting with the Contractor to order any coverage. When contacted, the Contractor shall advise the person of the paperwork and payment that will be necessary to order coverage for the identified individuals. The Contractor may be contacted by more than one individual.

H.4. CONTRACTOR RESPONSIBILITY IN CLAIMS AND REIMBURSEMENT TO CLAIMANTS

General.

The Contractor shall be responsible for all planning, estimating, programming, project management, scheduling, dispatching, supervision, and inspection of work. The Contractor shall maintain his own reference library of technical reference works and local laws and regulations, including current tariffs and registries. The Contractor shall treat the information provided by the Embassy concerning employee' personal data, medical information, and salaries as highly sensitive and not divulge any employee information to unauthorized persons. The Contractor shall establish procedures for handling medical insurance claims as follows:

(a) Administrative Records

(1) The Contractor shall maintain medical insurance files for each covered employee and each covered dependent including receipts and proof of paid…