GMC_medical_insurance_Solicitation_19EG3019R0001_Apr_04_2019.pdf

Health Insurance Services Solicitation No. 19EG3019R0001 American Embassy Cairo, Egypt Page 1 of 64

US Embassy Cairo 8 Kamal El-Din Salah Garden City

Date: April 04, 2019

Dear Prospective Offeror:

SUBJECT: Solicitation Number 19EG3019R0001 Health Insurance Services

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 who have received a solicitation package are invited to attend. See Section L of the attached Request for Proposals (RFP).

Your proposal must be submitted by email to CairoContracts@state.gov on or before May 27, 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 CairoContracts@state.gov by email during regular business hours.

Please note: that proposals that contain less than the stated minimum benefit levels or fewer benefits than those stated in this solicitation may be deemed technically unacceptable.

The successful offeror shall be registered in the SAM (System for Award Management) database https://www.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://www.statebuy.state.gov/pd/Pages/AdditionalVendorReg.aspx

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, American Embassy Cairo, Egypt Page 2 of 64 without holding discussions, although we may hold discussions with companies in the competitive range if there is a need to do so.

Sincerely, Jill Larson Contracting Officer

PAGE OF PAGESSOLICITATION, OFFER AND AWARD 1. THIS CONTRACT IS A RATED ORDER RATING

UNDER DPAS (15 CFR 700) 3 64

2. CONTRACT NUMBER 3. SOLICITATION NUMBER

19EG3019R0001

4. TYPE OF SOLICITATION

SEALED BID (IFB)

NEGOTIATED (RFP)

5. DATE ISSUED

03/19/2019

6. REQUISITION/PURCHASE NUMBER

PR8011218

7. ISSUED BY CODE

AMERICAN EMBASSY CAIRO

US EMBASSY CAIRO 8 KAMAL EL DIN SALAH, ATTN:

PROCUREMENT/CONTRACTING OFFICE

CAIRO 11519

EGYPT

EG300 8. ADDRESS OFFER TO (If other than item 7)

11519

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

SOLICITATION

9. Sealed offers in original and 1 copies for furnishings 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 until local time

(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.

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 3 I CONTRACT CLAUSES 27

B SUPPLIES OR SERVICES AND PRICES/COSTS 4 PART III - LIST OF DOCUMENTS, EXHIBITS AND OTHER ATTACH.

C DESCRIPTION/SPECS./WORK STATEMENT 10 J LIST OF ATTACHMENTS 39

D PACKAGING AND MARKING 18 PART IV - REPRESENTATIONS AND INSTRUCTIONS

E INSPECTION AND ACCEPTANCE 19

F DELIVERIES OR PERFORMANCE 21

K REPRESENTATIONS, CERTIFICATIONS AND OTHER

STATEMENTS OF OFFERORS 42

G CONTRACT ADMINISTRATION DATA 22 L INSTRUCTIONS, CONDITIONS, AND NOTICES TO OFFERORS 55

H SPECIAL CONTRACT REQUIREMENTS 24 M EVALUATION FACTORS FOR AWARD 62

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 offeror) from the date for receipt of offers specified above, to furnish any or all items upon which prices are offered at the 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(%)

AMENDMENT NO. DATE AMENDMENT NO. DATE14. ACKNOWLEDGMENT OF AMENDMENTS

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

CODE FACILITY

15A. NAME AND

ADDRESS

OF OFFER-

OR

16. NAME AND THE TITLE OF PERSON AUTHORIZED TO SIGN OFFER

(Type or print)

15B. TELEPHONE NUMBER

AREA CODE NUMBER EXTENSION

15C. CHECK IF REMITTANCE ADDRESS IS

DIFFERENT FROM ABOVE - ENTER SUCH

ADDRESS IN SCHEDULE.

17. SIGNATURE 18. OFFER DATE

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)( )

23. SUBMIT INVOICES TO ADDRESS SHOWN IN ITEM

(4 copies unless otherwise specified)

25. PAYMENT WILL BE MADE BY CODE24. ADMINISTERED BY (If other than Item 7)

AMERICAN EMBASSY CAIRO

US EMBASSY CAIRO 8 KAMAL EL DIN SALAH, ATTN: PROCUREMENT/CONTRACTING

OFFICE

CAIRO 11519

EGYPT

AMERICAN EMBASSY CAIRO

US EMBASSY CAIRO 8 KAMAL EL DIN SALAH, ATTN: FINANCIAL MANAGEMENT OFFICE - DBO

CAIRO 11519

EGYPT

26. NAME OF CONTRACTING OFFICER (Type or print 27. UNITED STATES OF AMERICA

(Signature of Contracting Officer)

28. AWARD DATE

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

AUTHORIZED FOR LOCAL REPRODUCTION

Previous edition is unusable STANDARD FORM 33 (REV. 6/2014)

Prescribed by GSA - FAR (48 CFR) 53.214 (c)

B. TELEPHONE (NO COLLECT CALLS)10. FOR

INFORMATION

CALL:

A. NAME

Hany B. Gerguis AREA CODE NUMBER

2797-3055

EXTENSION

C. E-MAIL ADDRESS

GerguisHB@state.gov

American Embassy Cairo, Egypt Page 4 of 64

SECTION B

PART I: PRICE - HEALTH INSURANCE

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 Egypt as described in Section C and the Exhibits in Section J.

This insurance shall be provided in accordance with Section C and the Exhibits in Section J.

B.1.1. Official Residence Expense (ORE) Staff and the American Employees Cooperative and Welfare Association (AECWA) employees 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 AECWA employees at the rates specified below. See Section G for billing procedures.

B.1.2. Optional benefit coverage is included under this contract only as a rider at the rates specified below.

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

B.2.3. Base Year of Contract

Bi-Weekly Rates per Employee

Category Estimated Number of Employees Rate per

Employee Bi-Weekly

Total

a. Single Employees (Self Only) 1400

b. Family Plan 3100

c. Subtotal (a + b)

d. Total Price for Base Year (c x 26)

American Embassy Cairo, Egypt Page 5 of 64

B.2.4. First Option Year of Contract

Estimated Number of Employees Rate per

Employee Bi-Weekly

Total

d. Total Price for First Option Year (c x 26)

B.2.5. Second Option Year of Contract

Estimated Number of Employees Rate per

Employee Bi-Weekly

Total

d. Total Price for Second Option Year (c x 26)

B.2.6. Third Option Year of Contract

Estimated Number of Employees Rate per

Employee Bi-Weekly

Total

d. Total Price for Third Option Year (c x 26)

American Embassy Cairo, Egypt Page 6 of 64

B.3 Pricing for Rider CLINS

The firm fixed price/premium rates in Egyptian Pounds for the Rider CLINS are as follows and are to be paid 100% by the enrollee; these Rider CLINS will NOT be evaluated as part of the overall price evaluation:

B.3.1 Base Year for Rider CLINS:

No Category Bi-Weekly Rates per Employee

1 Official Residence Expense (ORE) Staff and the American Employees Cooperative and Welfare Association (AECWA) and their Dependents

2 Excess Coverage: up to 365,000 EGP

B.3.2 First Option Year for Rider CLINS:

B.3.3 Second Option Year for Rider CLINS:

B.2.7. Fourth Option Year of Contract

Estimated Number of Employees Rate per

Employee Bi-Weekly

Total

d. Total Price for Fourth Option Year (c x 26)

B.2.8. Grand Total of Base plus All Option Years

Base Year Total

First Option Year Total

Second Option Year Total

Third Option Year Total

Fourth Option Year Total

Grand Total of Base plus All Option Years

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B.3.4 Third Option Year for Rider CLINS:

B.3.5 Fourth Option Year for Rider CLINS:

B.3.6. Grand Total of Base Plus All Option Years for Rider CLINS:

These Rider CLINS will NOT be evaluated as part of the overall price evaluation

No. Category Total

1 Base Year Total 2 First Option Year Total 3 Second Option Year Total 4 Third Option Year Total

5 Fourth Option Year Total

GRAND TOTAL of BASE plus ALL OPTION YEARS of RIDER CLINS:

The remainder of this page is intentionally blank.

American Embassy Cairo, Egypt Page 8 of 64

B.4 ADMINISTRATIVE RETENTION AMOUNTS

B.4.1 If the Contractor requests a price adjustment under B.4 below, the Contractor must present cost experience data that includes the retention amount. For purposes of any economic price adjustment, this retention amount is a fixed amount that is a part of the premium amounts in B.2. This retention amount will not be adjusted for any reason.

The retention amount is part of the premium and may include, but not be limited to, such costs as overhead and general and administrative costs. It will also include any profit. Essentially, it includes all costs except the actual portion of the premium intended to fund claims paid to the 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 bi-weekly 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.4.2 Bi-Weekly Retention Amounts per separate premium paid per single employee and per family plan.

Period of Performance Single Employees (Self Only) Family Plan

Base Period

First Option Year

Second Option Year

Third Option Year

Fourth Option Year

B.5. ECONOMIC PRICE ADJUSTMENT-HEALTH INSURANCE PREMIUMS

B.5.1. 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

American Embassy Cairo, Egypt Page 9 of 64 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.5.2. 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.5.2.1 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 must include in its proposal for adjustment, details setting forth how the pool impacts the request for equitable adjustment.

American Embassy Cairo, Egypt Page 10 of 64

SECTION C

DESCRIPTION/SPECIFICATION/WORK STATEMENT

PART I - MEDICAL INSURANCE

C.1. MEDICAL INSURANCE SERVICES

The Government of the United States of America requires Medical Insurance coverage for its employees as described in Section C and the Exhibits in Section J.

C.1.1 Employee and Dependent Health Services 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 & board (semi-private accommodations), operating room, recovery room, intensive care, imaging and diagnostic testing, 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, Nervous 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): Minimum Coverage 100%

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

C.1.1.3 Ambulance: Minimum Coverage 80%

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

C.1.1.4 Outpatient Services: Minimum Coverage 80%

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

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

- Annual physical examinations

- Specialist consultations and treatment, including second surgical opinion

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- 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: Inpatient: 100% Coverage Outpatient: Minimum

Coverage 80%

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

C.1.1.6 Pediatric Services: Inpatient: 100% Coverage Outpatient: 80% Minimum

Coverage

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

C.1.1.7 Prescription Drugs: Inpatient: 100% Coverage Outpatient: 80% Minimum

Medications prescribed by a certified health care provider that are medically necessary.

Examples include, but are not limited to: prescription antibiotics to treat an infection;

medication used to treat an ongoing condition, such as high cholesterol; prophylaxis or contraceptive medication.

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

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

physicals, immunizations, and cancer screenings.

C.1.1.9 Hearing Aids: 80%Minimum Coverage

Examinations and Treatment: 80% Minimum Coverage

Hearing Aid Apparatus: Limited to one apparatus per ear up to a maximum of USD

1,500 per covered individual per three-year period. 80% Minimum Coverage; with annual cap.

American Embassy Cairo, Egypt Page 12 of 64

C.1.1.10 Optical

Examinations and Treatment: 80% Minimum Coverage

Prescription lenses and frames, or contact lenses: Covered up to a maximum of USD 150 per covered individual per contract year. 80% Minimum Coverage; with annual cap.

C.1.1.11 Dental Care: 80% Minimum Coverage

Examinations and Treatment:

Dentist’s fees, x-rays, examinations and treatment, cleanings, fillings, extractions, false teeth, crowns, and bridges up to a maximum of USD 3,200 per covered individual per contract year

80% Minimum Coverage; with annual cap

Orthodontia Treatment is covered only if treatment begins before age 18, or if required as the result of an accident. A maximum of four years of orthodontia treatment will be covered per covered individual up to a maximum of USD 2,400 lifetime limit.80% Minimum Coverage; with contract lifetime cap.

C.1.1.12 Reproductive Health: 80% Minimum Coverage

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

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

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

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

Rehabilitative services (e.g., recovering skills, such as speech therapy after a stroke) and habilitative services (e.g., developing skills, such as speech therapy for children or physical therapy after an accident) 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 Medications: 100% up to USD 10,000 per contract year per covered individual

American Embassy Cairo, Egypt Page 13 of 64

HIV/AIDS medications to suppress opportunistic infections (such as tuberculosis or toxoplasmosis for covered individuals who have HIV/AIDS). Brief courses of anti-retroviral drugs during childbirth to prevent the transmission of HIV/AIDS to the child. Generally excludes medication for the long-term suppression of HIV/AIDS through the combination of anti-retroviral drugs in locations with inadequate local healthcare infrastructures.

C.1.1.16 Catastrophic Coverage:

Additional coverage equal to 365,000 EGP (Equal to Annual Max) 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 Medical Treatment:

Medical expenses incurred out-of-country will be covered, but coverage will be the same and subject to the same total maximum annual limit as for medical expenses incurred in-country.

C.1.1.18 Out-of-Country Medical Travel 80% Minimum Coverage

Transportation for out-of-country medical treatment will be a covered expense for LE

Staff and eligible family members. To be considered a covered expense, the attending certified health care provider must certify in advance that the treatment is medically necessary and unavailable locally. 80% of covered individual’s transportation expenses by the least expensive, appropriate means of transportation to the nearest city with adequate medical facilities will be covered. 80% of the transportation expenses of an attendant will also be covered, but only if the covered individual's attending certified health care provider certifies that an attendant for the patient is necessary, (e.g., a parent in the case of a patient who is a minor, or a family member to make medical decisions in the case of a patient who is unwell or unconscious). 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.1.1.19 180 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.

OPTIONAL BENEFITS WITH SEPARATE ANNUAL MAXIMUM LIMITS:

Employees have the option of electing the benefits outlined under 1.1.20 at the beginning of the contract and may then subsequently opt in/out at the time of each extension.

American Embassy Cairo, Egypt Page 14 of 64

C.1.1.20 Excess Coverage:

Additional coverage equal to 365,000 EGP (Equal to Annual Max) 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 covered under HIV/AIDS benefits and not including expenses covered under optional benefits with separate annual maximum limits 1.1.20, is 365,000 EGP.

C.1.3 Exclusions to Coverage:

There is no reimbursement for elective cosmetic surgery; spa cures; rejuvenation cures; massage;

exercise therapy; long-term rehabilitative therapy; non-medical hospital charges (e.g., telephone, television, etc.); home help, family help, or similar household assistance; fees of persons who are not certified health care providers; advanced reproductive technology (e.g., in-vitro fertilization, intra-cellular sperm injection, artificial insemination, microsurgical epididymal sperm aspiration, testicular sperm extraction, cryopreservation, etc.); or services or supplies which have not been prescribed or approved by a certified health care provider. Exclusions to coverage may be amended if provided in an off the shelf plan and is the lowest-cost and technically acceptable.

Removal of any exclusions require prior authorization.

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

C.1.4 Eligible Participants:

C.1.4.1 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.

C.1.4.2 Official Residence Expense (ORE) and Employee Association (EA) employees may be covered under a rider to the contract. The employing officer/EA, not the U.S.

Government, is responsible for the employer's share of the premium costs for an ORE employee.

C.1.5 Location of Employment

American Embassy Cairo, Egypt Page 15 of 64

C.1.5.1 Individuals covered by C.1.4 must be employed within the geographic boundaries of Egypt.

C.1.6 Participants and Benefits Covered Under a Rider

C.1.6.1 All current active employees of the Chief of Mission and the Deputy Chief of Mission assigned to their respective official Government residences and paid under an ORE account (see separate rider, Exhibit B). All costs for ORE employees are the responsibility of the employing officer, not the U.S. Government.

C.1.6.2 All current active employees of the Employee Association at Embassy

Egypt (see separate rider, Exhibit C). All costs for AECWA employees are the responsibility of the Employee Association, not the U.S. Government.

C.1.6.3 Optional excess coverage per above item C.1.1.20. If elected, all costs for excess coverage are the responsibility of the employee, not the U.S. Government.

C.1.7 Other Eligible Participants

Dependents:

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

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

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

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.1.8 Brochure Requirement

C.1.8.1. The Contractor shall provide a document (brochure/pamphlet/other written document) in English and Arabic that sets forth a complete listing of the health insurance benefits to be provided under this contract.

C.1.8.2. The Contractor shall provide the document described in C.1.7.1 to the

COR not later than 15 Days after date of contract award.

American Embassy Cairo, Egypt Page 16 of 64

C.1.8.3. The Contractor assumes full responsibility for ensuring that the document described in C.1.8.1 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.

American Embassy Cairo, Egypt Page 17 of 64

C.3.0 DEFINITIONS

FMO The Financial Management Officer (FMO) or the paying office for all U.S. Government

Agencies, except U.S. AID.

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

Contributory Insurance Insurance for which the employee contributes toward the premium.

Customary and Reasonable Treatment

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

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

Legal spouse: one legal spouse as defined by local law may be covered. LE Staff with more than one legal spouse must select only one spouse for coverage. In cases where LE Staff and their legal spouse both work for the mission and both are eligible to participate in the medical plan, one will be designated as the lead for purposes of the medical plan, and the other will be considered a legal spouse. 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.

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 (PSC), or personal services agreement (PSA), as further defined in Section C.1.3 for health insurance. The ORE staff as well as employees of the American Employees Cooperative and Welfare Association (AECWA) are included under a rider.

Employer The United States Government or in the case of ORE and American Employees Cooperative and Welfare Association (AECWA) employees, the Chief of Mission/Deputy Chief of Mission and the Employee Association, respectively.

GSO General Services Officer in charge of the General Services Office at post. This officer is usually the Contracting Officer (CO) 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.

Maximum Benefit The total amount that will be paid to any one covered individual for covered medical expenses or life insurance/disability benefit.

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.

Bi-Weekly Bi-Weekly to be considered as 14 days

American Embassy Cairo, Egypt Page 18 of 64

SECTION D

PACKAGING AND MARKING

(RESERVED)

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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.3.0

All required services are performed and no more than three (3) 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.

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E.2.2 Standard. The performance standard is that the Government receives no more than three

(3) 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.

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SECTION F

DELIVERIES OR PERFORMANCE

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

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 November 1, 2019 with four 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:

Human Resource Office American Embassy, Cairo Cairo II Building, 4th floor 8 Kamal El Din Salah Streets, Garden City, Cairo – Egypt

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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 through the broker, without prejudice to the ineligibility clause.

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

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

G.3. Payment shall be made in Egyptian Pounds.

G.4 SUBMISSION OF INVOICES AND PAYMENT

G.4.1. Invoices for U.S. Government employees shall be emailed in an original to CairoDBO@state.gov.

G.4.2. Frequency of Payments. All funds under this contract will be obligated by issuance of task orders, as described in H.3. Each task order will fund a specific period of time and number of employees, and the task orders will be issued at the frequency described in H.3.

Contractor may submit invoices monthly for payment to be made at the beginning of the month for which insurance coverage is provided in accordance with FAR 32.404.

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

G.4.4. ORE Staff. The Chief of Mission and/or Deputy Chief of Mission will make payment directly to the Contractor for the entire premium amount of the ORE staff, whether or not the ORE employee is contributing to the premium amount.

G.4.5. AECWA Staff. The Employee Association will make payment directly to the Contractor for the entire premium amount of the AECWA employee, whether or not the AECWA employee is contributing to the premium amount.

G.4.6 Optional benefits: Contractor will submit individual invoices for each of those insured persons who are responsible for paying 100% of the premium if they elect the Excess Coverage in C.1.1.19.

G.5 REFUNDS TO THE GOVERNMENT

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

G.6 VALUE ADDED TAX

VALUE ADDED TAX (VAT). The Government will not reimburse the Contractor for VAT under this contract. The Contractor shall not include a line for VAT on Invoices as the U.S.

Embassy has a tax exemption certificate with the host government.

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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, [X] quarterly basis. This new task order will include all changes made since the previous task order was issued and will include any increase or decrease in necessary funding. The changes to the list of eligible individuals will supersede the initial list provided under prior task orders without prejudice to the ineligibility clause. Task orders will indicate the effective date of employment, for purposes of calculating the premium due.

H.3.1. The ORE staff and AECWA employees under separate riders are not included under the task orders issued by the Contracting Officer. Because their coverage is under a rider, their employer is responsible for directly interacting with the Contractor to order any coverage for their employees. When contacted by the employer, the Contractor shall advise the employer of the paperwork and payment that will be necessary to order coverage for the identified individuals. Because more than one employer may have ORE staff, the Contractor may be contacted by more than one employer (typically the Chief of Mission and Deputy Chief of Mission).

H.3.2. The Optional benefits employees under separate riders, who elect the Excess

Coverage in C.1.1.19., are not included under the task orders issued by the Contracting Officer.

Because their coverage is under a rider, they are responsible for directly interacting with the Contractor to order any optional coverage. When contacted, the Contractor shall advise them of the paperwork and payment that will be necessary to order coverage for the identified individuals.

H.4. CONTRACTOR RESPONSIBILITY IN CLAIMS AND REIMBURSEMENT TO

CLAIMANTS

General.

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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 claims, requests for claim reimbursements, and accounting of paid benefits with balances of amounts remaining in the annual per person reimbursement ceiling.

(2) The Contractor shall provide the COR with the necessary claim forms for each type of benefit that can be claimed under the contract. These forms shall specify a list of documents required to be appended to each claim and otherwise provide instructions for claim filing.

(3) The Contractor shall use the English spelling of the employees' names in all transactions, including reimbursement checks.

(4) The Contractor shall send employee claim reimbursement checks to employees not later than two weeks after a claim is submitted.

(b) Medical Insurance Claims. Settlement of medical insurance shall be completed as follows:

(1) All medical claims shall be submitted directly to the Contractor by employees, through a drop box in the COR's office. The claims shall be picked up from the COR each Tuesday.

(2) The Contractor shall date stamp and screen all claims submitted on the day of receipt. If there are any missing documents or information thereby disallowing said claim to be payable, the Contractor shall notify the employee within two days, with a copy to the COR (if notification is written).

(3) The Contractor shall settle the claims no later than two weeks from the date the claim is submitted to the Contractor.

(4) Settlement shall be by issuance of checks in the name of the employee for each claim submitted. Each check shall be accompanied by a form providing details of the amount reimbursed with an explanation of deductions, if any.

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(5) The Contractor shall accept the employee's or dependent's choice to go for surgery to hospitals designated by the Contractor in order that the Contractor will pay the expenses directly to the hospitals.

H.5. REPORT REQUIREMENTS. The Contractor shall provide the following reports monthly. All reports must be received by the COR no later than the 10th day of each month.

These reports shall report on the previous month's activities.

(a) Employee Claims Report. The report will list all claims, excluding any claims for riders (see B.1.1), paid by the Contractor to a claimant, including the name of the claimant, date claim is received by the Contractor, and the amount claimed. This report shall also include all outstanding claims and a brief description of why claim has not been paid. The report shall not include any claims for riders (see B.1.1)

H.6. MISCELLANEOUS CONTRACTOR REQUIREMENTS

H.6.1. General. The Contractor shall take all such steps as are necessary, and obtain and pay for all permits, taxes and fees as are required by the Egypt government to establish and/or operate a commercial venture locally. A contract with the U.S. Government conveys no special privileges or immunities to the Contractor. The Contractor is an independent commercial concern and not a part of the U.S. mission. The Contractor's employees are not U.S.

Government employees. Registration of this contract with the Egypt government, if required by law, will be the sole responsibility of the Contractor, and any fees, taxes, or other duties shall be payable by the Contractor without recourse to the Government of the amounts thereof.

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

H.7 ERRONEOUS PAYMENTS. If the Government becomes eligible for a refund of payment because of erroneous overpayment or other cause, the Contractor shall refund the amounts or use them to offset future payments owed by the Government, whichever the Government prefers. The Contractor shall refund any refunds not complete or discovered after the completion date of this contract.

H.8 REQUIRING ACTIVITY. The requiring activity under this contract is the U.S.

Embassy/Consulate.

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SECTION I

CONTRACT CLAUSES

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

they were given in full text. Upon request, the Contracting Officer will make their…