19GE5018R0005-001.pdf

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

1. CONTRACT ID CODE RATING

2. AMENDMENT/MODIFICATION NO.

3. EFFECTIVE DATE

11/16/2017

4. REQUISITION/PURCHASE REQ. NO. 5. PROJECT NO. (If applicable)

FRANKCODE

AMERICAN CONSULATE GENERAL FRANKFURT

GIESSENER STRASSE 30

ATTN: RPSO

FRANKFURT, 60435

GERMANY

Wencke Jacobsen

NAME

TEL.

jacobsenw@state.gov

EMAIL

6. ISSUED BY FRANKCODE

AMERICAN CONSULATE GENERAL FRANKFURT

GIESSENER STRASSE 30

ATTN: RPSO

FRANKFURT, 60435

GERMANY

7. ADMINISTERED BY (If other than Item 6)

9A. AMENDMENT OF SOLICITATION NO.

19GE5018R0005

CONTACT DUNS

CODE FACILITY CODE

8. NAME AND ADDRESS OF CONTRACTOR (No., street, country, state and ZIP Code) (X)

X 9B. DATED (SEE ITEM 11)

11/06/2017

10A. MODIFICATION OF CONTRACT/ORDER NO.

10B. DATED (SEE ITEM 13)

11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS

X XThe above numbered solicitation is amended as set forth in item 14. The hour and date specified for receipt of Offers is extended, is not extended, Offers must acknowledge receipt of this amendment prior to the hour and date specified in the solicitation or as amended, by one of the following methods: (a) By completing items 8 and 15, and returning ____copies of the amendment;(b)By acknowledging receipt of this amendment on each copy of the offer submitted; or (c) By separate letter or telegram which includes a reference to the solicitation and amendment numbers. FAILURE OF YOUR ACKNOWLEDGMENT TO BE RECEIVED AT THE PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY RESULT IN REJECTION OF YOUR OFFER. If by virtue of this amendment you desire to change an offer already submitted, such change may be made by telegram or letter, provided each telegram or letter makes reference to the solicitation and this amendment, and is received prior to the opening hour and date specified.

12. ACCOUNTING AND APPROPRIATION DATA (If required)

13. THIS ITEM ONLY APPLIES TO MODIFICATION OF CONTRACTS/ORDERS.

IT MODIFIES THE CONTRACT/ORDER NO. AS DESCRIBED IN ITEM 14.

CHECK ONE A. THIS CHANGE ORDER IS ISSUED PURSUANT TO: (Specify authority) THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE CONTRACT ORDER NO. IN ITEM 10A.

B. THE ABOVE NUMBERED CONTRACT/ORDER IS MODIFIED TO REFLECT THE ADMINISTRATIVE CHANGES (such as changes in paying office, appropriation date, etc.) SET FORTH IN ITEM 14, PURSUANT TO THE AUTHORITY OF FAR 43.103(b).

C. THIS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO AUTHORITY OF:

D. OTHER (Specify type of modification and authority)

E. IMPORTANT: Contractor is not, is required to sign this document and return copies to the issuing office.X

14. DESCRIPTION OF AMENDMENT/MODIFICATION (Organized by UCF section headings, including solicitation/contract subject matter where feasible.)

The above cited solicitation is hereby amended as follows:

1) Questions and Answers letter is hereby incorporated and made part of Amendment 0001.

2) The proposal due date of December 1, 2017, 15:00 hours C.E.T remains unchanged.

Except as provided herein, all terms and conditions of the document referenced in Item 9A or 10A, as heretofore changed, remains unchanged and in full force and effect.

15A. NAME AND TITLE OF SIGNER (Type or print) 16A. NAME AND TITLE OF CONTRACTING OFFICER (Type or print)

Fabiola A. Bellevue

(Signature of person authorized to sign)

15B. CONTRACTOR/OFFEROR 15C. DATE SIGNED

By (Signature of Contracting Officer)

16B. UNITED STATES OF AMERICA 16C. DATE SIGNED

11/16/2017

NSN 7540-01-152-8070

Previous edition unusable

STANDARD FORM 30 (REV. 10-83)

Prescribed by GSA FAR (48 CFR) 53.243

19GE5018R0005

Line Item Solicitation Number: vontract Number: Title: BF-OUAGUADOUGOU Summary

19GE5018R0005

HEAL TH INSURANCE

Line Item Description Quantity No.

001 BASE YEAR - HEAL TH INSURANCE 1.00

This CIN is inclusive of the following Sub-CLINs: Q,_QQ

1.00 001A Single Employees (Self Only) 001 B Family Plan

Doc Ref No:

Delivery Date (Start to End) Date FOB:

03/01/2018 to 02/28/2019

1001 OPTION YEAR ONE - HEAL TH INSURANCE 1.00

This Cl N is inclusive of the following Sub-CLI Ns: Q,_QQ

1.00 1001A Single Employees (Self Only) 1001 8 Family Plan

Doc Ref No:

Delivery Date (Start to End) Date FOB:

03/01/201 9 to 02/29/2020

2002 OPTION YEAR TWO - HEAL TH INSURANCE 1.00

This CI N is inclusive of the following Sub-CLINs: Q,_QQ

1.00 2001A Single Employees (Self Only) 2001 B Family Plan

Doc Ref No:

Delivery Date (Start to End) Date FOB:

03/01/2020 to 02/28/2021

3001 OPTION YEAR THREE - HEAL TH INSURANCE 1.00

This CIN is inclusive of the following Sub-CLINs: Q,_QQ

1.00 3001A Single Employees (Self Only) 3001 B Family Plan

Doc Ref No:

Delivery Date (Start to End) Date FOB:

03/01/2021 to 02/28/2022

4002 OPTION YEAR FOUR - HEAL TH INSURANCE 1.00

This CI N is inclus ive of the following Sub-CLINs: Q,_QQ

1.00 4001A Single Employees (Self Only) 4001 B Family Plan

Doc Ref No:

Delivery Date (Start to End) Date FOB:

03/01/2022 to 02/28/2023

Unit

LT

LT

LT

LT

LT

Unit Price

19GE501 8R0005

Date of Solicitation :

11/16/201 7

Total Cost

Health Insurance Solicitation 19GE5018R0005-0001 November 15, 2017 U.S. Embassy Ouagadougou, Burkina Faso

RPSO has received the following nineteen (19} questions (Q), and is hereby providing the following answers (A}.

Year

1. Q: Please provide Age/DOB, Sex - Female or Male.

A: see Exhibit A , Band C ofthe Solicitation .

2. Q: Please provide Dependent status i.e., Coverage for:

• Employee (E)

• Employee & Spouse (E/S)

• Employee & Children (E/C)

• Employee, Spouse & Children (E/S/C)

A: see Exhibit A, B and C of the Solicitation .

3. Q: Please provide Claims history:

• 2012, 2013, 2014, 2015, 2016, and YTD 2017 - the insurance carrier has this information.

A:

Number fa milies Singles Tota l a moun t of insurance cla ims (USD)

275 69 $23 1,848.00

350 75 $246,854.24

355 77 $249,645.24

360 80 $308,070.75

365 82 $339,402.118

YTD 8.36 85

months 370 2017 (incurred or paid) $200,657.97

4. Q: Please provide the date contract is expected to start.

A: March 1, 2018.

Health Insurance U.S. Embassy Ouagadougou, Burkina Faso

Solicitation 19GE5018ROOOS-0001 November 15, 2017

5. Q: Advise if previous benefit schedule for health insurance is the same as the benefit schedule currently being requested. If so, please provide a description of benefits.

A: The benefits are the same as before.

6. Q: Are there any persons who are currently hospitalized? If yes, please provide number.

A: There were 307 cases of hospitalization during the last year (March 1, 2016- February 28, 2017) in Burkina Faso and 3 outside of Burkina Faso.

7. Q: Are any major illnesses (i.e. hemodynamics, open heart surgery, orthopedic major surgeries, organ transplants, traumatic accident, cancer and oncology cases) being treated? If yes, please provide number.

A: Refer to limitation under B.3 (Page 10) of the solicitation.

8. Q: Are there any pregnant employees/spouses? If yes, please provide number.

A: There were 34 births during the last year (March 1, 2016-February 28, 2017). The average is about 30 per year.

9. Q: Are there any catastrophic cases (in excess of $10,000) within the last year to date? If yes, please provide numbers and the status of claim (paid/incurred).

A: There was one such case in the past year (March 1, 2016-February 28, 2017). The claim was for $10,435.

10. Q: Are there any HIV/ AIDS cases? If yes, please provide total number.

A: No.

11. Q: Please provide current vendor information . (Name, contract number, value, Date of award, date of expiration).

A:

Generale des Assurances Burkina Faso http://www.generaledesassurances.com boureima.diallo@generaledesassurances.com {+226) 25 3115 53/25 41 07 44

{+226} 70 21 70 02 Contract Number: SUV70013D0001 Value: 1,514,963.82 Date of Award : 02/25/2013

Solicitation 19GE5018R0005-0001 November 15, 2017

12. Q: Please provide membership each of last 3 years by Single, Married and Family Status.

A:

Year Singles Family

2015 80 450 2016 82 455 201 7 85 500

13. Q: Please provide percentage of local nationals.

A: 95.3% of the insured are Burkina Faso nationals.

14. Q: Are there dependent children to be covered who are studying outside the country? If yes, please provide the country and number of dependent children studying there.

A: Not applicable per the solicitation. In any case, less than 5 at any given time.

15. Q: Please provide locations(s) of insured employees.

A: The employees themselves work for the United States Embassy in Ouagadougou.

Coverage will be mainly in Ouagadougou and other major cities in Burkina Faso.

Please refer to solicitation .

16. Q: Please provide claims history [example attached] for health insurance for the current year and each of the last 5 years.

A: Same as question #3.

17. Q: Do the above claim numbers include claims from ORE employees? (if applicable)

A: Yes

Solicitation 19GE5018ROOOS-0001 November 15, 2017

18. Q: Please provide premium history [example attached] for health insurance for the current year and each of the last 5 years.

A:

Number Number of Year

Families Singles Total amount of insurance claims (USD)

2012 275 69 $236,666.66

2013 350 75 $248,200.00

2014 355 77 $249,907.85

2015 360 80 $305,043.33

2016 365 82 $299,154.58 YTD # of 85 months 370 2017 (incurred or paid) $301,857.11

19. Q: Did the premium history for insurance include the VAT? If so, what percentage of

VAT was included in the historical premiums?

A: No VAT was/is applicable as the Embassy has tax-exempt status.