San Salvador RFP 19ES60-23-R-0002 LES Health and Life Insurance Final 01_25_2023 (AutoRecovered).pdf

Embassy of the United States of America

San Salvador, El Salvador, C.A.

January 25, 2023

Dear Prospective Offeror:

SUBJECT: RFP Number 19ES60-23-R-0002

The Embassy of the United States of America invites you to submit a proposal for locally employed staff health and life 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 U.S. Government intends to award a contract to the responsible company submitting an acceptable offer at the lowest price. We intend to award a contract based on initial proposals, without holding discussions, although we may hold discussions with companies in the competitive range if there is a need to do so.

The Embassy intends to conduct a pre-proposal conference at the site, The pre-proposal conference will be held on February 09, 2023 at 10:00 a.m. (local time) at the US Embassy in El Salvador. Prospective offerors should contact Mayra Melara at melarame@state.gov by February 6, 2023 at 10:00 a.m. for additional information or to arrange entry to the building.

Proposals are due by February 20, 2023 at 10:00 a.m. No proposals will be accepted after this time. Proposals must be in English and incomplete proposals will not be accepted.

Your proposal must be submitted in a sealed envelope marked "Proposal Enclosed for RFP 19ES60-23-R-0002 for LES Health and Life Insurance Contract to the Contracting Officer, North Gate, Calle Conchagua. You may also include a CD with the proposal.

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 and B.7.

4. Section K, Representations and Certifications; and

5. Additional information as required in Section L.

6. Proof of SAM Registration

Offerors shall be registered in the SAM (System for Award Management) database at https://www.sam.gov prior to submittal of their offer/proposal as prescribed under FAR 4.1102.

Failure to be registered at time of proposal submission may deem the offeror’s proposal to be mailto:melarame@state.gov https://www.sam.gov/ considered non-responsible and no further consideration will be given. Therefore, offerors are highly encouraged to register immediately if they are interested in submitting a response to this requirement.

Sincerely, Calandra Hersrud Contracting Officer

Enclosure:

SECTION A – Model Contract

NSN 7540-01-152-8064 STANDARD FORM 33 (REV 9-97)

PREVIOUS EDITION NOT USABLE Prescribed by GSA

SOLICITATION, OFFER AND AWARD 1. THIS CONTRACT IS A RATED ORDER

UNDER DPAS (15 CFR 350)

RATING PAGE OF PAGES

2 | 90

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

3. SOLICITATION NO.

19ES60-23-R-0002

4. TYPE OF SOLICITATION

[ ] SEALED BID (IFB)

[x] NEGOTIATED (RFQ)

5. DATE ISSUED

January 25,2023

6. REQUISITION/PURCHASE NO.

7. ISSUED BY CODE 8. ADDRESS OFFER TO (If other than item 7) American Embassy, San salvador, El Salvador, C.A.

Phone: 2501-2999 Fax: 2501-3347

Same as Block 7.

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

SOLICITATION

9. Sealed offers in original and 3 copies for furnishing the supplies or services in the Schedule will be received at the place specified, in the depository located in until 10:00 am local time, on February 20, 2023. 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:

A. NAME Mayra E. Melara B. TELEPHONE NUMBER

(503) 2501-2806

B. E-MAIL ADDRESS

melarame@state.gov

11. TABLE OF CONTENTS

(x) SEC. DESCRIPTION PAGES (x) SEC. DESCRIPTION PAGES

PART I - THE SCHEDULE PART II - CONTRACT CLAUSES

X A SOLICITATION/CONTRACT FORM 3 X I CONTRACT CLAUSES 38

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

X C DESCRIPTION/SPECS/WORK STATEMENT 15 X J LIST OF ATTACHMENTS 52

X D PACKAGING AND MARKETING 28 PART IV - REPRESENTATIONS AND INSTRUCTIONS

X E INSPECTION AND ACCEPTANCE 29 X K REPRESENTATIONS, CERTIFICATIONS, AND 64

X F DELIVERIES OR PERFORMANCE 31 OTHER STATEMENTS OF OFFERORS

X G CONTRACT ADMINISTRATION 32 X L INSTRS., COND., AND NOTICES TO OFFERORS 81

X H SPECIAL CONTRACT REQUIREMENTS 34 X M EVALUATION FACTORS FOR AWARD 88

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.

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 (The offeror acknowledges receipt of amendments to the solicitation and

AMENDMENT

NO.

DATE AMENDMENT NO. DATE

related documents ) numbered and dated.

15A. NAME CODE FACILITY 16. NAME AND TITLE OF PERSON AUTHORIZED

AND ADDRESS

OF OFFEROR

TO SIGN OFFER (Type or print)

15B. TELEPHONE NO. (Include area code)

15C. CHECK IF REMITTANCE ADDRESS [ ]

IS DIFFERENT FROM ABOVE - ENTER SUCH

ADDRESS

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 TO ADDRESS SHOWN

IN

(4 copies unless otherwise specified)

ITEM

24. ADMINISTRATION BY (If other than Item 7)

CODE

25. PAYMENT WILL BE MADE BY CODE

26. NAME OF CONTRACTING OFFICER (Type or print) Calandra Hersrud

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.

SECTION B

PRICE

B.1. HEALTH INSURANCE SERVICES

The Contractor shall provide the Health Insurance services to employees of the Government of the United States of America in El Salvador and their eligible dependents as described in Section C. This insurance shall be provided in accordance with Section C.

B.1.1. Official Residence Expense (ORE) Staff are included under this contract only as a rider;

the Contractor shall bill the Chief of Mission and Deputy Chief of Mission (for ORE Staff), at the rates specified below. See Section G for billing procedures. Note that USG is not responsible, nor liable, for any riders.

B.2. PRICES

B.2.1 VALUE ADDED TAX.

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

B.2.2 This is a fixed price with economic price adjustment requirements type contract under which will be issued firm, fixed-price task orders. The fixed prices/premium rates for the health insurance services as specified in Section C are as follows:

JAMES ZADROGA 9/11 VICTIMS HEALTH AND COMPENSATION ACT OF 2010

NOTICE: UNLESS A WAIVER OR EXCEPTION APPLIES, PAYMENTS

SUBSEQUENT TO THIS PROCUREMENT ARE SUBJECT TO AN EXCISE TAX OF

2% PERSUANT TO 26 U.S.C. 5000C.

B.2.3 Base Year of Contract Bi-Weekly Rates

Per Premium

Category Estimated Number of Premiums*

Rate per Premium Extended Bi-Weekly Total

a. Self-Only: 1 covered individual.

b. Self Plus One (Two individuals)

c. Family (Three or more individual)

d. Subtotal Total Price for Base Year (d x 26)**

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

B.2.4 First Option Year of Contract

Rate per Premium

Extended Bi-Weekly Total

a. Self-Only: 1 covered individual. 137

b. Self Plus One (Two individuals) 80 individuals)

B.2.5 Second Option Year of

Rate per Premium

Extended Bi-Weekly Total

a. Self-Only: 1 covered individual. 137

b. Self Plus One (Two individuals) 80 individual)

B.2.6 Third Option Year of

Rate per Premium

Extended Bi-Weekly Total

a. Self-Only: 1 covered individual. 137

b. Self Plus One (Two individuals) 80

B.2.7 Fourth Option Year of

Rate per Premium

Extended Bi-Weekly Total

a. Self-Only: 1 covered individual. 137

b. Self Plus One (Two individuals) 80

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

B.3 ADMINISTRATIVE RETENTION AMOUNTS

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

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

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

B.3.2 Bi-Weekly Retention Amounts per separate premium paid per single employee and per family plan.

Period of Performance

Self-Only (1 covered individual)

Self Plus One (Two individuals)

Family (Three or more individuals)

Base Period

First Option Year

Second Option Year

Third Option Year

Fourth Option Year

B.4. ECONOMIC PRICE ADJUSTMENT-HEALTH INSURANCE PREMIUMS

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

Before any such adjustment is made, the Contractor agrees to provide the Government a balance sheet showing three main components for the time period: (1) receipts (premiums received) minus the retention amount, (2) number of insurance plans and (3) claims paid. This information shall be provided per type of premium, ie 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

ALTERNATE A – ORE Covered

B.5. GROUP LIFE INSURANCE SERVICES

The Contractor shall provide the Group Life Insurance services described herein to employees of the Government of the United States of America in El Salvador. The groups of employees who shall be provided this insurance are listed in C.2.3. This insurance shall be provided in accordance with Section C 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 and Deputy Chief of Mission (for ORE Staff), separately, at the rates specified below. See Section G for billing procedures.

B.6. GROUP LIFE INSURANCE RATES

This is a fixed-price with economic-price- adjustment-requirements type contract under which the Government will issue firm-fixed price task orders. The fixed prices/premium rates in US Dollars per one thousand of salary to provide life insurance, accidental death and dismemberment and partial and total disability coverage are as follows:

Type of Insurance Premium

(per 1,000 of Salary) Estimated Payroll

(Bi-Weekly in Thousands) Bi-Weekly Total

a. Basic Life 369 Employees

b. Accidental Death & Dismemberment 542,141.00$

c. Partial & Total Disability Coverage 542,141.00$

Bi-Weekly Rates per Employee

B.6.1. Base Year of Contract

d. Subtotal (a + b + c)

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

(per 1,000 of Salary) Estimated Payroll

(Bi-Weekly in Thousands) Bi-Weekly Total

a. Basic Life 369 Employees

b. Accidental Death & Dismemberment 542,141.00$

c. Partial & Total Disability Coverage 542,141.00$

Bi-Weekly Rates per Employee

B.6.3. Second Option Year of Contract

d. Subtotal (a + b + c)

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

Type of Insurance Premium

(per 1,000 of Salary) Estimated Payroll

(Bi-Weekly in Thousands) Bi-Weekly Total

a. Basic Life 369 Employees

b. Accidental Death & Dismemberment 542,141.00$

c. Partial & Total Disability Coverage 542,141.00$

Bi-Weekly Rates per Employee

B.6.2. First Option Year of Contract

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

(per 1,000 of Salary) Estimated Payroll

(Bi-Weekly in Thousands) Bi-Weekly Total

a. Basic Life 369 Employees

b. Accidental Death & Dismemberment 542,141.00$

c. Partial & Total Disability Coverage 542,141.00$

Bi-Weekly Rates per Employee

B.6.5. Fourth Option Year of Contract

d. Subtotal (a + b + c)

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

Type of Insurance Premium

(per 1,000 of Salary) Estimated Payroll

(Bi-Weekly in Thousands) Bi-Weekly Total

a. Basic Life 369 Employees

b. Accidental Death & Dismemberment 542,141.00$

c. Partial & Total Disability Coverage 542,141.00$

Bi-Weekly Rates per Employee

B.6.4. Third Option Year of Contract

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

B.7. ADMINISTRATIVE RETENTION AMOUNTS

B.7.1 If the Contractor requests a price adjustment under B.8 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.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.

NOTE TO OFFEROR: Fill in the fixed 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.6.6. 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

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

Period of Performance Basic Life Accidental Death and

Dismemberment Partial and Total

Disability Coverage

Base Period

First Option Year

Second Option Year

Third Option Year

Fourth Option Year

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

B.8.1. Premium Adjustment Based on Experience: For life insurance, prices may be adjusted upward or downward based on the experience rating of the Mission(s) covered by this contract, .

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. The information shall be provided per type of premium, ie per line item. The retention amount is not subject to adjustment. The Government reserves the right to select an independent third party to 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.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.

SECTION C

DESCRIPTION/SPECIFICATION/WORK STATEMENT

C.1. HEALTH INSURANCE SERVICES

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

C.1.1 Employee and Dependent Health Service Benefits

C.1.1.1 Hospitalization (Treatment in the Hospital for Inpatient Care): Minimum Coverage - 100% Services and supplies provided during hospitalization including services provided by a licensed healthcare provider, bed and board (semi-private accommodations), operating room, recovery room, intensive care, imaging and diagnostic testing, and general hospital nursing care, physical therapy, as well as drugs and medicines administered while in-patient. When private accommodations are provided, coverage will be limited to the cost of a semi-private room unless otherwise covered in an off the shelf plan. See Mental Health and Substance Abuse care (C.1.1.13) for details concerning inpatient psychiatric care.

See Outpatient Services (below) 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.

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 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 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: 100%;

Outpatient: 80% Care and services that women receive during pregnancy (prenatal care), throughout labor, delivery and post-delivery, and outpatient care for newborn babies. Hospitalization during pregnancy and/or delivery will be covered as Hospitalization (treatment in the hospital for inpatient care). All other treatments will be considered outpatient services.

C.1.1.6 Pediatric Services: Minimum Coverage - Inpatient: 100%, Outpatient: 80% Primary and preventive routine care services for covered dependent children, including, but not limited to: physical examinations, developmental assessments, laboratory tests, and immunizations recommended by local authorities or the World Health Organization.

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

Examinations and Treatment: 80% Minimum Coverage

Hearing Aid Apparatus: Limited to one apparatus per ear up to a maximum of USD 1,500 per covered individual per three-year period. 80% Minimum Coverage: with annual cap.

C.1.1.10 Optical Care:

Examinations and Treatment: 80% Minimum Coverage

Prescription lenses and frames, or contact lenses: Covered up to a maximum of USD 300 per covered individual every two years. 80% Minimum Coverage; with annual cap.

C.1.1.11 Dental Care:

Examinations and Treatment: Dentist’s fees, x-rays, examinations and treatment, cleanings, fillings, extractions, false teeth, crowns, and bridges up to a maximum of USD 3,200 per covered individual per contract year. 80% Minimum Coverage: with annual cap.

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

C.1.1.12 Reproductive Health: 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 carried out at a facility licensed for detoxification and rehabilitation.

C.1.1.14 Rehabilitative and Habilitative Services and Devices:

Minimum Coverage - 50% Rehabilitative services (e.g., recovering skills, such as speech therapy after a stroke or physical therapy after an accident) and habilitative services (e.g., developing skills, such as speech therapy for children, etc.) that help develop skills needed for everyday life.

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

C.1.1.15 HIV/AIDS: 100% up to USD 10,000 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 Reserved.

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:

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 Reserved.

C.1.1.20 Reserved.

C.1.2 Annual Maximum Limit - The maximum annual coverage per covered individual per contract year, not including expenses defined under Exclusions and Limitations (C.1.3), or those covered under C.1.1.15, HIV/AIDS is equivalent to $10,000.00.

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. 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

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 El Salvador 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 Identification of Eligible Employees and Dependents:

U.S. Mission El Salvador will provide a list of all eligible employees and dependents with relationship to employee (self/spouse/child) and DOB for each. Updates will be provided to add or remove individuals on a bi-weekly/monthly basis.

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

C.1.4.1.1 Definition of Dependents

C1.4.1.1.1 Legal spouse: one legal spouse as defined by local law may be covered. LE Staff with more than one legal spouse must select only one spouse for coverage.

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

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

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

Department of State (includes INL, OBO)

U.S. Agency for International Development (USAID) U.S. Commercial Service (FCS) Defense Attaché Office (DAO) U.S. Military Group (MILGP) Corps of Engineers (COE) Foreign Agricultural Services (FAS) Department of Justice (DEA, OPDAT, CD, FBI) Department of Homeland Security (DHS/ICE, DHS/CIS, DHS/CBP) Force Protection Detachment (FPD) Alcohol, Tobacco and Firearms (ATF) Center of Disease Control and Prevention (CDC)

ORE – Rider Exhibit B to this addendum

C.1.4.3 Participants Covered Under a Rider

Official Residence Expense (ORE) employees may be covered under a rider to the contract. The employing officer, not the USG, is responsible for the employer's share of the premium costs for an ORE employee.

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, 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.

C.1.6 Brochure Requirement

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

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

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

PART II: GROUP LIFE INSURANCE

C.2. GROUP LIFE INSURANCE

The Government of the United States of America requires group life insurance coverage for its employees, as further described in C.2.2, in El Salvador. The Government has determined that the prevailing practice by employers in El Salvador is that group life insurance coverage is representative of locally prevailing compensation practice and that the cost of such insurance protection is usually borne 100% by the employer. Therefore, the Government desires to adopt such locally prevailing practice as part of its compensation plan for its employees as further described in C.2.2. The specific group insurance coverage under this contract is set forth in this part of Section C and the Attachments in Section J.

C.2.1. Group Life Insurance Coverage

The amount of group life insurance coverage is as follows:

C.2.1.1 Amount of Employee Life Insurance.

Natural Death: 24 times the monthly basic salary up to a maximum of USD 200,000.

C.2.1.2 Amount of Accidental Death and Dismemberment Coverage.

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

1. Accidental Death: 36 times the monthly basic salary up to a maximum of USD 200,000.

2. Accidental Dismemberment: 25% - 100% of the accidental death benefit, depending on the loss, up to a maximum of USD 200,000.

If disbursement occurs, the benefit will be payable according to the following schedule of benefits. If the same insured employee suffers subsequent dismemberment(s), the benefit will be payable according to the schedule of benefits and shall not be cumulative of a previous dismemberment insurance claim. The loss of a hand or foot means the complete severance at or above the wrist or ankle joint. The loss of sight means the total and irrevocable loss of sight.

Accidental Dismemberment Coverage Amount Dismemberment Benefit - for Loss of Percent of Accidental Death Benefit Both Hands 100% Both Feet 100%

The Entire Sight of Both Eyes 100% One Hand and One Foot 100% One Hand and the Entire Sight of One Eye 100%

One Hand 50% One Foot 50% Entire Sight of One Eye 50% Thumb and Index Finger of Same Hand 25%

C.2.1.3 Partial and Total Disability Coverage

C.2.1.3.1 Total and Permanent Disability: 24 times the monthly basic salary up to a maximum of USD 200,000.00

C.2.1.3.2 Partial Disability: 12 times the monthly basic salary up to a maximum of USD 200,000.00

If a participating employee is separated from USG employment due to total and permanent disability, the employee will be paid a lump sum equal to 50% of the disability benefit within three (3) months after submitting proof of permanent and total disability, but not before the employee has been totally and permanently disabled for a period of six (6) months.

Subsequently, the employee will be paid the remaining 50% of the disability benefit in fixed monthly installments over 24 months starting one month after the initial lump sum payment is received.

C.2.2 Life Insurance Benefits Conditions and Limitations

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

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.

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:

C.2.2.1. Violating the law or in resisting detention or arrest.

C.2.2.2. Participation in competitions involving the use of wheeled vehicles, horses, boats or water skis.

C.2.2.3. 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.

C.2.2.4. Suicide will not be covered.

C.2.3. Eligible Participants

C.2.3.1 Eligible Employees are Locally Employed (LE) Staff who are (1) working on a full-time or part-time basis under non-temporary direct-hire appointments and under personal services agreements/contracts that are not time limited to less than one year and (2) paid under the terms of the Local Compensation Plan.

C.2.3.1.1 All current active employees of the United States Government, employed within the geographic boundaries of El Salvador, paid under the Local Compensation Plan, and certified by the Contracting Officer. Covered employees include:

C.2.3.1.2. Foreign Service Nationals (FSNs) employed under direct hire appointments, Personal Services Agreements (PSAs) and Personal Services Contracts (PSCs);

C.2.3.1.3. Locally hired U.S. citizens employed under direct hire appointments, PSAs, and PSCs.

C.2.3.2 Location of Employment

C.2.3.2 . The individuals covered by C.2.3.1 must be employed within the geographic boundaries of El Salvador by:

Department of State (includes INL, OBO) U.S. Agency for International Development (USAID) U.S. Commercial Service (FCS) Defense Attaché Office (DAO) U.S. Military Group (MILGP) Corps of Engineers (COE) Foreign Agricultural Services (FAS) Department of Justice (DEA, OPDAT, CD, FBI) Department of Homeland Security (DHS/ICE, DHS/CIS, DHS/CBP) Force Protection Detachment (FPD) Alcohol, Tobacco, and Firearms (ATF) Center of Disease Control and Prevention (CDC)

ORE – Rider Exhibit B to this addendum

C.2.3.3 Participants Covered Under a Rider

C.2.3.3.1 Official Residence Expense (ORE) employees may be covered under a rider to the contract. The employing officer, not the USG, is responsible for the employer's share of the premium costs for an ORE employee.

C.2.3.3.2 Reserved.

C.2.4 Individuals not Eligible for Coverage

C.2.4.1. Reserved.

C.2.4.2 Not eligible are LE Staff working under temporary appointments; those working under a PSA or PSC that is time limited to less than one year; those with an intermittent (When Actually Employed (WAE)) workweek schedule; non-personal services contract personnel and their employees, supplied by an independent contractor licensed to do business in El Salvador who provide services to other local organizations as well as to the U.S. Mission; employees of USAID institutional contractors; and Peace Corps personal services contractors as indicated in MS 743.

C.2.5. Reserved.

C.2.6 Eligibility and Effective Date

C.2.6.1. Term of Eligibility and Effective Date

Each current active eligible employee is enrolled for life 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.

During a period of Leave Without Pay (LWP) or unpaid leave that is one pay period or less, coverage under the insurance contract will continue. The USG will pay the total premium cost to the Contractor. The employee’s share of the premium will be collected through payroll deduction in that or the subsequent pay period.

C.2.6.2. Period of Ineligibility

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

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

C.2.7. BROCHURE REQUIREMENT

C.2.7.1. The Contractor shall provide a document (brochure/pamphlet/other written document) in Spanish (electronic version and one hard copy per enrolled employee) 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.

C.2.7.2. The document described in C.2.7.1 shall be provided to the COR not later than 30 days after date of contract award. The Contractor shall provide additional brochures for new employees within ten days of the COR’s request.

C.2.7.3. The Contractor assumes full responsibility for ensuring that the document described in C.2.7.1 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.

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 [Note to Contracting Officer: Include definition of covered dependents, as authorized by HR/OE/CM. If policy covers both health and life insurance, separately define covered dependents for each type of insurance.]

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 and C.2.3 for life insurance. [Note to Contracting Officer: Only include reference to ORE Staff and Peace Corp PSCs and enter name of Embassy Employee Association if covered under the contract.] This may also include ORE Staff, EAE, and Peace Corp PSCs, if this category of individual is listed as participating under a rider in C.1.3.3 for health insurance and C.2.3.3 for life insurance.

Employer The United States Government or in the case of ORE and [Note to Contracting Officer: Enter name of Embassy Employee Association and revise reference as appropriate] EAE 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.

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

Currency Premiums and benefits will be paid in US Dollars.

C.3.0 DEFINITIONS

SECTION D

PACKAGING AND MARKING

(RESERVED)

SECTION E

INSPECTION AND ACCEPTANCE

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

This contract incorporates 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)

C.1.0 thru C.1.6

All required services are performed and no more than one

(1) customer complaint is received per month

E.2.1 Surveillance. The COR will receive and document all complaints from Government personnel regarding the services provided. If appropriate, the COR will send the complaints to the Contractor for corrective action.

https://acquisition.gov/browse/index/far https://gov.ecfr.io/cgi-bin/text-idx?SID=d9a7851186785ba2b1896db79b1b6b29&mc=true&tpl=/ecfrbrowse/Title48/48tab_02.tpl

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

(1) customer complaint per month. The COR shall notify the Contracting Officer of the complaints so that the Contracting Officer may take appropriate action to enforce the inspection clause (FAR 52.246-4, Inspection of Services – Fixed Price (AUG 1996) or the appropriate Inspection of Services clause), if any of the services exceed the standard.

E.2.3 Procedures

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

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

(c) If the COR determines the complaint is invalid, the COR will advise the complainant.