19CA5221R0005 GMC LD Insurance Services RFP 20201204.pdf

December 4, 2020

Embassy of the United States of America

490 Sussex Drive, Ottawa, Ontario, K1N 1G8

Solicitation Number: 19CA5221R0005

SUBJECT: Medical, Life and Disability Insurance Services for Canadian Employees of the United States Government

Dear Prospective Offeror:

The Embassy of the United States of America invites you to submit a proposal for Medical, Life and Disability Insurance Services for Locally Employed Staff by the U.S. Embassy in Ottawa and its Constituencies in Vancouver (BC), Calgary (AB), Winnipeg (MB), Toronto (ON), Montreal (QC), Quebec (QC) and Halifax (NS). The U.S. 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 details included in Section L of the attached Request for Proposals (RFP).

Printed, signed copies of proposal must be accompanied by a quality electronic PDF copy and delivered in a sealed envelope marked "Proposal Enclosed" to the following address:

323 Coventry Road, U.S. Embassy, Box 101, Ottawa, ON, K1K 3X6, Canada marked: “Proposal Enclosed – RFP #19CA5221R0005” on or before 16:00 EST on January 8, 2021. No proposal will be accepted after this time.

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

� Section A, Solicitation Cover Page, Standard Form-33 � Section B, Pricing Schedule;

� Section B, Retention Amounts in B.3;

� Section K, Representations and Certifications;

� Additional information as required in Section L;

� If applicable, the Offeror shall submit a completed IRS Form W-14, found at www.irs.gov/w14, to ensure compliance with FAR 52.229-11.

Direct any questions regarding this solicitation to Contracting Officer in writing by email to ContractsOttawa@state.gov

SOLICITATION, OFFER AND AWARD

1. THIS CONTRACT IS A RATED ORDER

UNDER DPAS (15 CFR 350)

RATING PAGE OF PAGES

3 | 104

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

3. SOLICITATION NO.

19CA5221R0005

4. TYPE OF SOLICITATION

[ ] SEALED BID (IFB)

[ x ] NEGOTIATED (RFP)

5. DATE ISSUED

December 4, 2020

6. REQUISITION/PURCHASE NO.

7. ISSUED BY CODE 8. ADDRESS OFFER TO (If other than item 7) Embassy of the United States of America 490 Sussex Drive, Ottawa, Ontario, K1N 1G8 Email: ContractsOttawa@state.gov

323 Coventry Road, U.S. Embassy, Box 101 Ottawa, ON, K1K 3X6, CANADA Ph: 613-842-9900Proposal Enclosed – RFP #19CA5220R0001

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

SOLICITATION

9. Sealed offers in original and 2 copies for furnishing the supplies or services in the Schedule will be received at the place specified, in the depository located in

323 Coventry Road, U.S. Embassy, Box 101, Ottawa, ON, K1K 3X6, Canada until 16:00 hour Eastern Standard Time on January 8, 2021

CAUTION - Late Submissions, Modifications, and Withdrawals: See Section L. Provision No. 52.215-1.

All offers are subject to all terms and conditions contained in this solicitation.

10. FOR INFORMATION

CALL:

Contract Specialist Contracting Officer

A. NAME

Vincent Lemesheff Hunter J. Crowder

B. TELEPHONE (NO COLLECT

CALLS)

(613) 218-1743

(613) 688-5450

C. E-MAIL ADDRESS

ContractsOttawa@state.gov

11. TABLE OF CONTENTS

(x) SEC. DESCRIPTION PAGE(S) (x) SE

C.

DESCRIPTION PAGE(S)

PART I - THE SCHEDULE PART II - CONTRACT CLAUSES

X A SOLICITATION/CONTRACT STANDARD FORM 33 X I CONTRACT CLAUSES

X B CONTRACT TYPE, PRICES AND COSTS PART III - LIST OF DOCUMENTS, EXHIBITS, AND OTHER ATTACH.

X C REQUIREMENTS: MEDICAL INSURANCE X J LIST OF ATTACHMENTS

X D REQUIREMENTS: LIFE AND DISABILITY INSURANCE PART IV - REPRESENTATIONS AND INSTRUCTIONS

X E INSPECTION AND ACCEPTANCE X K REPRESENTATIONS, CERTIFICATIONS, AND

X F DELIVERIES OR PERFORMANCE OTHER STATEMENTS OF OFFERORS

X G CONTRACT ADMINISTRATION X L INSTRS., COND., AND NOTICES TO OFFERORS

X H SPECIAL CONTRACT REQUIREMENTS X M EVALUATION FACTORS FOR AWARD

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 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.

IMPORTANT: James Zadorga 9/11 victims health and compensation act of 2010 notice: unless a waiver or exception applies, payments subsequent to this procurement are subject to an excise tax of 2% pursuant to 26 U.S.C. 5000c.

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

14. ACKNOWLEDGMENT OF

AMENDMENTS

AMENDMENT NO. DATE AMENDMENT NO. DATE

(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.(Incl. area code)

15C. CHECK IF REMITTANCE

ADDRESS [ ] IS DIFFERENT FROM

ABOVE - ENTER SUCH ADDRESS

17. SIGNATURE 18. OFFER DATE

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 ELECTRONICALLY TO:

OttawaInvoices@state.gov

ITEM

24. ADMINISTRATION BY (If other than Item 7) CODE 25. PAYMENT WILL BE MADE BY CODE

Electronic Funds Transfer (EFT) from the United States Government Global Financial Management Center in Charleston (SC)

26. NAME OF CONTRACTING OFFICER (Type or print)

Hunter J. Crowder

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

CONTRACT TYPE, PRICES AND ECONOMIC PRICE ADJUSTMENTS

B.1 CONTRACT TYPE

This is a Fixed-Price, Indefinite-Quantity, Definite-Delivery, Requirements type contract with Economic Price Adjustment, providing for upward and downward revision of the stated contract price upon the occurrence of specified contingencies. Neither the Contractor, nor the Government may benefit from the Economic Price Adjustments. The Government anticipates the need for recurring requirements but cannot predetermine the precise quantities of services needed for a definite period. This contract type provides for filling all actual requirements for insurance services during a specified contract period, with deliveries or performance to be scheduled by placing multiple fixed-price variable quantity task orders with the contractor. Orders under this contract may be funded fully or incrementally throughout the period of performance specified in the contract term, option periods and Task Orders.

PART I: PRICE – MEDICAL INSURANCE

B.1. MEDICAL INSURANCE SERVICES

The Contractor shall provide the medical insurance services to Locally Employed Staff by the Government of the United States of America in Canada and their eligible dependents as described in Section C. This insurance shall be provided in accordance with Section C, Statement of Requirements.

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, Deputy Chief of Mission and Consuls General (for ORE Staff) at the rates specified below. Note that United States Government is not responsible, nor liable, for ORE Staff. See Section G for billing procedures.

B.1.2 Retired employees who are in receipt of early retiree health care benefit shall be grandfathered and included in the contract as a separate rider category and covered by health insurance services (excluding dental care). The Contractor shall separately bill the Government for grandfathered retired employees at the rates specified below. See Section G for billing procedures.

B.2. PRICES, PREMIUM RATES AND CURRENCY

Canadian and may submit proposals in Canadian Dollars and be paid in Canadian Dollars.

U.S. firms may submit proposals in Canadian Dollars and be paid in Canadian Dollars.

Alternatively, U.S. firms may submit proposals in U.S. Dollars and be paid in U.S. Dollars.

U.S. Firms must indicate the type of currency used in their response to the RFP.

Foreign firms may submit offers and be paid in Canadian Dollars only.

B.2.1 VALUE ADDED TAX (VAT)

The Contractor shall include applicable Value Added Tax (HST, GST, PST, QST, Excise Tax, Etc.) as separate charges on the Invoice and as separate values in Section B.

If the VAT amount varies by Province, the Offeror shall quote the VAT amounts at 15% across the board. The Task Orders under this contract may also include the median VAT rate at 15%, however, the invoices submitted by service provider must detail the actual amount of VAT according to Provincial laws for each sub-group of insured individuals by Province.

B.2.2 The fixed prices and premium rates for the medical insurance services further detailed in Section C, shall be as follows:

B.2.3 Base Year Medical Insurance Services: Fixed Premium Rates, Estimated Quantities and Contract Price

Contract Line Item

Number

(CLIN)

Description of Product

Unit of Issue

Estimated Quantity of Units per Month

Fixed Monthly

Unit Price Before Tax

Annual Price Before Tax

(Qty of Units x Unit Price x 12 Months)

Value Added Tax

(VAT)

Estimated Annual Price

Including VAT

#0100 Medical Plan Implementation Cost

All 1 N/A

#0001

Medical Insurance: Self Only

Monthly Premium

#0002

Medical Insurance: Self Plus One

#0003

Medical Insurance: Family (3 or More Individuals)

#0004

Retiree Health Insurance: Self

#0005

Plus One

#0006

Retiree Health Insurance: Family

Medical Insurance Estimated Base Year Price

Year

N/A

Note: total price and estimated number of premiums does not include any Riders (B.1.1)

B.2.4 Option Year One Medical Insurance Services:

Projected Premium Rates, Estimated Quantities and Contract Price

Item

Issue

Estimated Quantity of Units per Month

Projected Monthly

Unit Price Before Tax

Annual Price Before Tax

(Qty of Units x Unit Price x 12 Months)

Value Added Tax

(VAT)

Estimated Annual Price

Including VAT

#1001

#1002

#1003

#1004

#1005

#1006

Option Year One Projected Contract Price

B.2.5 Option Year Two Medical Insurance Services:

Item

Issue

Estimated Quantity of Units per Month

Projected Monthly

Unit Price Before Tax

Annual Price Before Tax

(Qty of Units x Unit Price x 12 Months)

Value Added Tax

(VAT)

Estimated

#2001

#2002

#2003

#2004

#2005

#2006

Option Year Two

B.2.6 Option Year Three Medical Insurance Services:

Item

Issue

Estimated Quantity of Units per Month

Projected Monthly

Unit Price Before Tax

Annual Price Before Tax

(Qty of Units x Unit Price x 12 Months)

Value Added Tax

(VAT)

Estimated

#3001

#3002

#3003

#3004

#3005

#3006

Option Year Three

N/A N/A

B.2.7 Option Year Four Medical Insurance Services:

Item

Issue

Estimated Quantity of Units per Month

Projected Monthly

Unit Price Before Tax

Annual Price Before Tax

(Qty of Units x Unit Price x 12 Months)

Value Added Tax

(VAT)

Estimated

#4001

#4002

#4003

#4004

#4005

#4006

Option Year Four

B.2.8 Medical Benefits Total Estimated Price of Base Year and all Option Years

Medical Insurance Base Year Estimated Total Price Including VAT

Medical Insurance Option Year One Projected Total Price Including VAT

Medical Insurance Option Year Two Projected Total Price Including VAT

Medical Insurance Option Year Three Projected Total Price Including VAT

Medical Insurance Option Year Four Projected Total Price Including VAT

Projected Total Price of Base Year and all Option Years

B.3 ADMINISTRATIVE RETENTION AMOUNTS – MEDICAL INSURANCE

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.

B.3.2 Employee Monthly Retention Amounts per separate premium paid per plan category.

Period of Performance

Employee:

Self Only

Employee:

Self Plus One

Employee:

Family of Three or More

Base Year

Option Year One

Option Year Two

B.3.3 Retiree Monthly Retention Amounts per separate premium paid per plan category.

Retiree:

Self Only

Retiree:

Self Plus One

Retiree:

Family of Three or More

Base Year

Option Year One

Option Year Two

B.4. ECONOMIC PRICE ADJUSTMENT - MEDICAL INSURANCE PREMIUMS

B.4.1. Premium Adjustment Based on Claim Experience - For medical 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 included, but not limited to the following 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.

PART II: PRICE - GROUP LIFE INSURANCE AND DISABILITY BENEFIT

B.5. GROUP LIFE INSURANCE AND DISABILITY BENEFIT SERVICES

The Contractor shall provide the group life insurance and disability benefit services described herein to employees of the Government of the United States of America in Canada. The groups of employees who shall be provided this insurance are listed in section D. This insurance shall be provided in accordance with Section D and the Exhibits in Section J.

B.5.1. Official Residence Expense (ORE) Staff are included under this contract only as a rider;

the Contractor shall bill the Chief of Mission, Deputy Chief of Mission and Consuls General (for ORE Staff), at the rates specified below. See Section G for billing procedures.

B.6. GROUP LIFE AND DISABILITY INSURANCE RATES

This is a fixed-price, definite-delivery, indefinite-quantity with economic-price-adjustment, requirements type contract under which the Government will issue firm-fixed price task orders.

The fixed prices/premium rates shall be calculated per thousand of salary to provide life insurance, accidental death and dismemberment and partial and total disability coverage are as follows:

B.6.1 Base Year Disability Benefit and Life Insurance Services:

Fixed-Price Premium Rates, Estimated Quantities and Estimated Contract Price

Item

Issue

Estimated Quantity of Units per

Month

Fixed Monthly

Unit Price Before

Tax

Annual Price Before Tax

(Qty of Units x Unit Price x 12 Months)

Value Added Tax

(VAT)

Estimated Annual Price

Including VAT

#0200 Life/Disability Plan Implementation Cost

1 All N/A

#0007

Life Insurance: Natural Death

Premium per $1,000 of Coverage

38770

#0008

Life Insurance: Accidental Death and Dismemberment per

51650

#0009

Long Term / Total Disability Benefit

Monthly Premium per $100 of

14380

#0010

Early Intervention Disability Management Service (Advice to Pay)

Hour

Disability and Life Insurance Base Year Estimated Contract Price

Note: total price and estimated number of premiums does not include any Riders (B.5.1)

B.6.2 Option Year One Disability Benefit and Life Insurance Services:

Projected Premium Rates, Estimated Quantities and Projected Contract Price

Item

Issue

Estimated Quantity of Units per

Month

Projected Monthly

Unit Price Before

Tax

Annual Price Before Tax

(Qty of Units x Unit Price x 12 Months)

Value Added Tax

(VAT)

Projected

#1007

Premium per

#1008 per

#1009

Monthly Premium per $100

#10010

Option Year One

B.6.3 Option Year Two Disability Benefit and Life Insurance Services:

Item

Issue

Estimated Quantity of Units per

Month

Projected Monthly

Unit Price Before

Tax

Annual Price Before Tax

(Qty of Units x Unit Price x 12 Months)

Value Added Tax

(VAT)

Projected

#2007

Premium per

#2008 per

#2009

Monthly Premium per $100

#2010

Option Year Two

B.6.4 Option Year Three Disability Benefit and Life Insurance Services:

Item

Issue

Estimated Quantity of Units per

Month

Projected Monthly

Unit Price Before

Tax

Annual Price Before Tax

(Qty of Units x Unit Price x 12 Months)

Value Added Tax

(VAT)

Projected

#3007

Premium per

#3008 per

#3009

Monthly Premium per $100

#3010

B.6.5 Option Year Four Disability Benefit and Life Insurance Services:

Item

Issue

Estimated Quantity of Units per

Month

Projected Monthly

Unit Price Before

Tax

Annual Price Before Tax

(Qty of Units x Unit Price x 12 Months)

Value Added Tax

(VAT)

Projected

#4007

Premium per

#4008 per

#4009

Monthly Premium per $100

#4010

B.6.6 Disability Benefit and Life Insurance Total Estimated Price of Base Year and all Option Years

Disability and Life Insurance Base Year Estimated Total Price Including VAT

Disability and Life Insurance Option Year One Projected Total Price Including VAT

Disability and Life Insurance Option Year Two Projected Total Price Including VAT

Disability and Life Insurance Option Year Three Projected Total Price Including VAT

Disability and Life Insurance Option Year Four Projected Total Price Including VAT

Disability Benefit and Life Insurance Projected Total Price of Base Year and all Option Years

B.7. ADMINISTRATIVE RETENTION AMOUNTS – LIFE / DISABILITY INSURANCE

B.7.1 If the Contractor requests a price adjustment under B.8 below, the Contractor must present cost/claim 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.6. 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.7.2 Sets forth the retention amounts per premium paid for each category of premium and for each period of performance.

B.7.2. Retention Amounts per Separate Premium Paid per Employee:

Life Insurance:

Natural Death

Life Insurance:

Accidental Death

Long Term / Total Disability Benefit

Base Period

First Option Year

Second Option Year

Third Option Year

Fourth Option Year

B.8. ECONOMIC PRICE ADJUSTMENT (EPA)-LIFE / DISABILITY INSURANCE

B.8.1. Premium Adjustment Based on Claim Experience: For disability benefit and life insurance services, 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 the main components for the time period.

As part of response to this RFP, the Offeror shall provide detailed explanation of their Economic Price Adjustment (EPA) methodology for each Contract Line Item Number (CLIN), detailing all price determination factors, such as assumptions regarding future levels of claims, retention, reserve requirements, marketing discounts and the method used for calculating renewal rate adjustments, etc. In an equitable cost adjustment method, no party under the contract shall benefit at the expense of other party. The contractor shall explain advantages and disadvantages of the economic price adjustment methods, as well as include methods (formulas), which will be used by the service provider.

All EPA factors must be organized as formulas supported by clarifications detailing the service provider methodology which will be used for calculation of premium rate adjustments, clearly showing correlations amongst the experience rate, manual rate, credibility factor, demographics and how each rate/factor is determined. The EPA methodology and formulas must be included in Exhibit D and will be evaluated as part of the contract award decision.

The information included in the Exhibit D shall clearly identify the financial arrangement which will be used for each CLIN, explain how each particular CLIN will be underwritten, as well as the balance of risks and liabilities assumed by each party in this contract.

The information shall be provided per type of premium, i.e. per contract line item included in Section B.6. The retention amount is not subject to adjustment. The Government reserves the right to select an independent third party to review the proposed methodology, the balance sheet and claims and make a determination of methodology most advantageous for the Government, as well as 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.8.2. 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.

B.9 CONTRACT MAXIMUM AMOUNT

Contract Maximum Amount is the Grand Total price of all contract periods and options:

B.9.a

Projected Total Price of Base Year and all Option Years

B.9.b

Disability Benefit and Life Insurance Projected Total Price of Base Year and all Option Years

B.9.c

Total Projected of All Contract Requirements and Options (= B.9.a + B.9.b)

B.9.d

Accommodation for Economic Adjustments and Contingencies at 10% of Contract Projected Total (=B.9.e + 10%)

B.9.d

Contract Maximum Amount (B.9.c + B.9.d)

B.10 CONTRACT TERM

Term of this contract is for 1 (one) year with 4 (four) 1-year options to exercise.

Tentative service commencement date under this contract shall be within 90 days of the contract award date to allow for mobilization and implementation activities take place. Tentative schedule of base year and option periods is contingent upon the contract award date and may be changed at the time of award without a modification to contract and based on mutual agreement of parties.

B.10.1 Proposed Contract Periods:

Base Year: April 1, 2021 – March 31, 2022

Option Year One: April 1, 2022 – March 31, 2023

Option Year Two: April 1, 2023 – March 31, 2024

Option Year Three: April 1, 2024 – March 31, 2025

Option Year Four: April 1, 2025 – March 31, 2026

SECTION C

STATEMENT OF REQIREMENTS – MEDICAL INSURANCE SERVICES

C.1. MEDICAL INSURANCE LEVELS OF COVERAGE

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

C.1.1 Employee and Dependent Medical Insurance Benefits

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

Services and supplies provided during hospitalization including services provided by a licensed healthcare provider, bed and board (semi-private accommodations), operating room, recovery room, intensive care, imaging and diagnostic testing, and general hospital nursing care, physical therapy, as well as drugs and medicines administered while in-patient. When private accommodations are provided, coverage will be limited to the cost of a semi-private room unless otherwise covered in an off the shelf plan. See Mental Health and Substance Abuse care (C.1.1.13) for details concerning inpatient psychiatric care.

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

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

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.

C1.1.3 Ambulance

Minimum Coverage - 80%

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

C.1.1.4 Outpatient Services Minimum Coverage - 80%

Services provided by a licensed healthcare provider on an ambulatory or outpatient basis

(without being admitted to a hospital), including surgeon’s fees and other medical services provided at a hospital, clinic, doctor’s office, medical facility, etc. Examples include, but are not limited to:

- Annual physical examinations

- Specialist consultations and treatment, including second surgical opinion

- Minor surgical interventions

- Chemotherapy and radiation treatments

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

Organization

- Diagnostic tests and diagnostic imaging

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

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

C.1.1.5 Obstetric and Newborn Care

Minimum Coverage - Inpatient/Emergency: 100% Minimum Coverage - Outpatient: 80%

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

C.1.1.6 Pediatric Services

Minimum Coverage - Inpatient/Emergency: 100%

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

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

Medications prescribed by a licensed health care provider that are medically required.

Examples include, but are not limited to prescription antibiotics to treat an infection, medication used to treat an ongoing condition, such as high cholesterol, prophylaxis, contraceptive medication.

C.1.1.8 Preventive and Wellness Services and Chronic Disease Management

Minimum Coverage - 80%

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

C.1.1.9 Hearing Aids Minimum Coverage – 80%

Examinations and Treatment: 80% Minimum Coverage

Hearing Aid Apparatus: Limited to one apparatus per ear up to a maximum of CAD $2,000 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 CAD $400 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 CAD $4,200 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 CAD $3,200 lifetime limit. 80% Minimum Coverage; with contract lifetime cap.

C.1.1.12 Reproductive Health

Minimum Coverage - 80%

Prescribed contraceptive devices, preventive care and routine examinations, voluntary sterilization, and diagnosis and treatment of conditions which may cause infertility.

Assisted reproductive technology (ART), fertility treatments, and reversal of sterilization are not covered (see Exclusions to Coverage).

C.1.1.13 Mental Health and Substance Abuse Care

Minimum Coverage - 50%

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

C.1.1.14 Rehabilitative and Habilitative Services and Devices

Minimum Coverage - 50%

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

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

C.1.1.15 HIV/AIDS

up to CAD $13,200 per contract year per covered individual

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.

C.1.1.16 Catastrophic Coverage Minimum Coverage - 100% Maximum Amount - CAD $105,100 per covered individual per year

Additional coverage equal to CAD $105,100 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 Out-of-Country/Province Coverage Minimum Coverage – 100%

The emergency medical assistance and services, including medical evacuation, relating to a medical emergency while away from the province of residence for business or pleasure.

C.1.1.18 180 Day Coverage for Dependents After Employee’s Death

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

C.1.1.19 Employee Assistance Program (EAP)

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

C.1.2 Annual Maximum Limit

The maximum annual reimbursement per covered individual per contract year, not including expenses covered under C.1.1.15, HIV/AIDS, is equivalent to CAD $105,100 per covered individual per year.

C.1.3 Exclusions and Limitations

There is no coverage for elective cosmetic surgery; spa cures; rejuvenation cures; exercise therapy; long-term rehabilitative therapy; non-medical hospital charges (e.g., telephone, television, etc.); home help, family help, or similar household assistance; fees of persons who are not certified health care providers; advanced reproductive technology (e.g., in-vitro fertilization, intra-cellular sperm injection, artificial insemination, microsurgical epididymal sperm aspiration, testicular sperm extraction, cryopreservation, etc.); or services or supplies which have not been prescribed or approved by a certified health care provider. Exclusions to coverage may be amended if provided in an off the shelf plan and is the lowest-cost and technically acceptable.

Removal of any exclusions require prior authorization.

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

C.1.4 Eligible Participants

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

To be eligible to participate in the medical plan, LE Staff must 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 a temporary direct hire appointment or PSA Fixed Term of one year or more.

Not eligible are those working under temporary appointments; those working under a PSC or PSA that is time limited to less than one year; non-personal services contract personnel and their employees, supplied by an independent contractor licensed to do business in Canada who provides services to other local organizations as well as to the U.S. Mission; employees working on an intermittent or When Actually Employed (WAE) schedule; employees of USAID institutional contractors; Peace Corps personal services contractors as indicated in MS 743; and Recreation Association employees.

C.1.4.1.1 Definition of Dependents

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

C.1.4.1.1.2 Children: a child is defined as the LE Staff’s natural, adopted, stepchild, or foster child. The child must be unmarried and financially dependent upon the LE Staff. A child will be covered until the end of the contract year in which s/he reaches age 26. An unmarried child determined to be incapable of self-support due to a physical or mental condition will continue to be eligible to participate in the medical plan 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 Canada.

C.1.4.3 Participants Covered Under a Rider

a. All current active ORE Staff personally employed by the Chief of Mission, the Deputy Chief of Mission, and Consuls General 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, the Deputy Chief of Mission and Consul General, not the U.S. Government.

b. All grandfathered retired employees authorized to receive health insurance coverage provided by 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 Periods 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 Leave Without Pay (LWOP) or unpaid leave beyond one pay period, except for the periods of statutory leave in accordance with local provincial employment legislation, 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 they prefer not to pay the premium.

The periods of statutory unpaid leave are treated the same as if employee is actively at work.

C.1.6 Brochure Requirement

C.1.6.1 The Contractor shall provide a document (brochure/pamphlet/other written document) in English 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 after the contract is awarded, not later than 30 calendar days prior to the service commencement date indicated in the task order and in the Notice to Proceed. The Contractor shall provide additional brochures for new employees within ten (10) business days of the COR’s request.

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

SECTION D

STATEMENT OF REQIREMENTS

LIFE INSURANCE AND DISABILITY BENEFIT SERVICES

D.1. GROUP LIFE INSURANCE SERVICES

The Contractor shall provide the Group Life and Disability Insurance services described herein to employees of the Government of the United States of America in Canada. The groups of employees who shall be provided this insurance are listed in C.1.4. This insurance shall be provided in accordance with Section D and the Exhibits in Section J.

Official Residence Expense (ORE) Staff and are included under this contract only as a rider; the Contractor shall bill the Chief of Mission, Deputy Chief of Mission and Consul General (for ORE Staff) separately, at the rates specified below. See Section G for billing procedures.

The Government of the United States of America requires Employee Life and Disability Insurance coverage for its Locally Employed Staff as described herein.

D.1.1 DEATH BENEFIT

The following benefit will be paid to the participant's named beneficiaries or estate upon the death of the participant:

D.1.1.1 Natural Death: 18 (Eighteen) times the amount of monthly basic salary.

D.1.1.2 Accidental Death and Dismemberment

D.1.1.2.a Accidental Death: 24 (Twenty Four) times the amount of monthly basic salary.

D.1.1.2.b Accidental Dismemberment: Payments for partial or total disability will be according to the insurance company's schedule of payments (varying by type of disability). Both death and disability benefits will not be paid for the same injury, should it be fatal.

D.2 LONG TERM / TOTAL DISABILITY BENEFIT

D.2.1 Active employees, with written evidence of approved insurability, whose monthly earning are more than C$7,500 – 67% of monthly earnings up to C$11,500

D.2.2 Other active employees – 67% of monthly earnings up to C$7,500

D.2.3 Elimination Period – 126 days

D.2.4 Cost of Living Adjustment (COLA) Increase – 1% or increase of Consumer Price Index

(CPI)

D.3 CONDITIONS, LIMITATIONS AND DEFINITIONS

D.3.1 Conditions. No benefits shall be payable if an employee's death or other insurance event was caused directly or indirectly by war. War shall be defined as declared or non-declared war or any martial operations or invasion, hostile acts of foreign powers, rebellion, riot, civil war, uprising, mutiny, operations by military or usurpatory authorities, martial law or state of siege or any other similar event or reason for declaring martial law or war. A terrorist attack shall not be considered war.

D.3.2 Limitations. No benefit shall be payable under this contract if the employee's bodily injuries have been caused directly or indirectly and totally or partially by:

D.3.2.1 Violating the law or in resisting detention or arrest.

D.3.2.2 Participation in competitions involving the use of wheeled vehicles, horses, boats or water skis.

D.3.2.3 An accident resulting from the employee being under the influence of alcohol, drugs or other toxic substance unless administered by a physician. Death as a result of a disease or physical or mental infirmities and medical or surgical treatment thereof (except pyogenic infection due to an accidental cut or wound) shall be considered a natural and not an accidental death. Suicide will not be covered.

D.3.4 Dependents are not covered.

D.3.5 Retired employees are not covered

D.4 Definitions.

D.4.1 Salary: monthly salary is one-twelfth of the employee's annual basic salary, exclusive of premium pay, allowances, bonuses, or any other separate payments.

D.4.2 Currency: premiums and benefits shall be paid to employees in Canadian Dollars.

D.5 Life Insurance Benefits Conditions and Limitations

Conditions and limitations on the entitlement to life insurance benefits under this contract are as follows:

D.5.1. Eligible Participants

To be eligible to participate in the Life and Disability Insurance Plan, LE Staff must 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 a temporary direct hire appointment or PSA Fixed Term of one year or more.

• Locally hired U.S. citizens employed under direct hire appointments, PSAs, and PSCs.

D.5.2 Location of Employment

The individuals covered by D.5.1 must be employed within the geographic boundaries of Canada.

D.5.3 Participants Covered Under a Rider

All current active employees of the Chief of Mission, the Deputy Chief of Mission, and Consuls General assigned to their respective official Government residences and paid under an ORE account (see Exhibit B). All costs for ORE employees are the responsibility of the employing officer, not the U.S. Government.

D.5.4 Individuals not Eligible for Coverage

Not eligible are those working under temporary appointments; those working under a PSC or PSA that is time limited to less than one year; non-personal services contract personnel and their employees, supplied by an independent contractor licensed to do business in Canada who provides services to other local organizations as well as to the U.S. Mission; employees working on an intermittent (When Actually Employed (WAE)) workweek schedule; employees of USAID institutional contractors; Peace Corps personal services contractors as indicated in MS 743; and Recreation Association employees

D.5.5 Term of Eligibility and Effective Date

Each current active eligible employee is enrolled for life and disability insurance 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.

D.5.6 Periods of Ineligibility

Employees are not entitled to life insurance and disability benefits hereunder during any period of employment for which premiums are not paid.

During a period of extended Leave Without Pay (LWOP) or unpaid leave beyond one pay period, except for the periods of statutory leave in accordance with local provincial employment legislation, 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 they prefer not to pay the premium.

The periods of statutory unpaid leave are treated the same as if employee is actively at work

D.6 BROCHURE REQUIREMENT

D.6.1 The Contractor shall provide a document (brochure/pamphlet/other written document) in English language that sets forth a complete listing of the life 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.

D.6.2 The document described in D.6.1 shall be provided to the COR not later than 30 calendar days after date of contract award. The Contractor shall provide additional brochures for new employees within ten days of the COR’s request.

D.6.3 The Contractor assumes full responsibility for ensuring that the document described in D.6.1 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.

SECTION E

INSPECTION AND ACCEPTANCE

E.1. 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

This contract incorporates one or more 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. In addition, the full text of a clause may be accessed electronically at: Acquisition.gov this address is subject to change.

If the Federal Acquisition Regulation (FAR) is not available at the location indicated above, use the Department of State Acquisition website at e-CFR to see the links to the FAR. You may also use an Internet “search engine” (for example, Google, Yahoo or 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)

Sections C and D

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.