19GE5018R0066_A0001.pdf

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

1. CONTRACT ID CODE RATING

2. AMENDMENT/MODIFICATION NO.

3. EFFECTIVE DATE

08/14/2018

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.

19GE5018R0066

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)

07/23/2018

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.)

A0001 The above cited solicitation is hereby amended as follows:

1) Questions and Answers letter is hereby incorporated and made part of Amendment A0001.

2) Claims and Premium history for the last 3 years is being provided.

3) The proposal due date is extended until August 31, 2018, 15:00 hours C.E.T.

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)

Susan D. Taylor

(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

08/13/2018

NSN 7540-01-152-8070

Previous edition unusable

STANDARD FORM 30 (REV. 10-83)

Prescribed by GSA FAR (48 CFR) 53.243

19GE5018R0066

Health Insurance Locally Employed Staff 19GE5018R0066‐A001

US Embassy Baku, Azerbaijan

Questions and Answers (Q&A) Set One

RPSO has received the following twenty‐seven (27) questions (Q), and is hereby providing the following answers (A).

1) Q: Please provide: a) Age/DOB b) Sex – Female or Male

A: see Exhibit A – Employee Statistic

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: Please see Section 1, IV. B for coverage, C.1.5 for dependent Coverage and Exhibit A for number and statistics about dependents.

3) Q: Please provide Claims History:

o 2013, 2014, 2015, 2016 and 2017 and YTD the insurance carrier has this information.

o Catastrophic Cases ‐ the insurance carrier will be able to identify any catastrophic claims.

A: Please find Premium / Claims History attached.

3 catastrophic cases within the last year to date.

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

A: Please see Section 1, V.12

5) Q: Advise if previous benefit schedule for life/health/disability insurance is the same as the benefit schedule currently being requested.

A: Yes

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

A: 4

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: 7 in the current year.

8) Q: Are there any pregnant employees/spouses?

A: 16 persons (7 employees, 9 spouses.

9) Q: Are there any catastrophic cases (in excess of $10,000) within the last year to date?

a. If yes, please provide numbers.

b. Status of claim – paid/incurred.

A: 3 cases. All claims paid.

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

A: N/A

11) Q: Are any employees currently disabled? If yes please provide total number

A: more than 4.

12) Please provide Current vendor information:

a) Name: “A‐Qroup” Insurance Company

b) Contract Number: SАJ2001бD0001

c) Value: see Premium/Claims History attached.

d) Date of award: Oct 18, 2015

e) Date of expiration: Option year expiration date is 10/13/18. The next option year will not be exercised.

13) Q: What currency should proposers use in submitting bids.

A: The offeror may choose the currency they are quoting in. The contract will then be issued in this currency and the currency cannot be changed later by contract modification.

14) Q: Please provide Membership each of last 3 years by Single, Married and Family Status.

A: 2017 – Single 50; Family – 304; 2016 – Single 64; Family – 293; 2015 – Single 63; Family – 286

15) Q: Percentage of local nationals.

A: 99.7%

16) 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: 6 persons.

17) Q: Please provide Location(s) of insured employees.

A: Azerbaijan

18) Q: Please provide Claims history for health insurance for the current year and each of the last 5 years. ( see sample)

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

A: Yes

20) Q: please provide Premium history for health insurance for the current year and each of the last 5 years.(see sample)

21) Q: Did the premium history for insurance include the VAT? If so, what percentage of VAT was included in the historical premiums?

A: Does not include VAT.

22) Q: Did the premium history for insurance include Insurance Premium Tax (IPT). If so, what percentage of

IPT was included in the historical premiums?

A: There is no Insurance Premium Tax applied to the Insurance premium.

23) Q: Price tables have 3 categories: Single Employees (Self Only), Family Plan and Retirees, whereas the retention table has only 2 categories: Single Employees (Self Only) and Family Plan.

Should we include Retirees also in the retention table?

A: Yes.

24) Q: Q: Please provide Average insured member counts for the current year and EACH of the last 5 years ‐ 2018 (till now), 2017, 2016, 2015, 2014, 2013.

A:

2013 928,5

2014 937,6

2015 981,5

2016 1072,4

2017 1088,7

2018 1061,1

25) Q: Q: Advise if 2017 benefit schedule for health insurance is the same as the benefit schedule currently being requested under 19GE5018R0066; and if not advise us on the differences.

A: same benefits as previous contract.

26) Q: The Solicitation # on the cover page of the solicitation reads 19GE5018R0028 but everywhere else, including the SF1449 it is 19GE5018R0066. Please confirm the Solicitation number.

A: 19GE5018R0066

27) Q: Q: Please provide the total number of people needing insurance.

A: As of today 1046

Base year 10/18/15 - 10/15/16 121,292.40$ Invoice 2,145.45$ Invoice

144,670.26$ Invoice 87.33$ Invoice

123,762.12$ Invoice 5,582.97$ Invoice

576.26$ Invoice 159,340.65$ Invoice

(1,192.25)$ Credit Note Total amount paid to insurance provider 556,265.19$

Amounts reimbursed to employees October $33,528.79 AZN 35,875.81 November $42,615.96 AZN 45,599.08 December $24,225.69 AZN 39,245.61 January $20,317.89 AZN 33,727.70 February $24,475.34 AZN 39,160.55 March $22,704.66 AZN 36,554.50 April $33,124.30 AZN 51,011.42 May $28,763.24 AZN 44,007.75 June $27,257.03 AZN 43,338.68 July $40,847.12 AZN 66,172.33 August $44,402.37 AZN 75,040.00 September $17,588.70 AZN 29,724.90 Total for the base year $359,851.08 AZN 539,458.33

1st option year 10/16/16 - 10/14/17 139,397.82$ Invoice 1,251.88$ Invoice

164,760.40$ Invoice 123.91$ Invoice

141,574.68$ Invoice 397.77$ Invoice

165,533.27$ Invoice 166.70$ Invoice

Total amount paid to insurance provider 613,206.43$

Amounts reimbursed to employees October $23,119.38 AZN 39,302.95 November $22,014.30 AZN 39,405.60 December $22,335.63 AZN 40,874.21 January $16,448.16 AZN 32,402.88 February $19,887.30 AZN 36,393.76 March $18,761.26 AZN 32,832.20 April $22,469.82 AZN 38,423.40 May $27,424.04 AZN 46,895.10 June $27,663.45 AZN 47,304.50 July $27,633.35 AZN 47,253.03 August $24,473.35 AZN 41,849.43 September $19,167.04 AZN 32,775.64 Total for the 1st option year $271,397.09 AZN 475,712.70

2nd option year 10/15/17 - 10/13/18 146,684.40$ Invoice (697.54)$ Credit Note

Total amount paid to insurance provider 145,986.86$

Amounts reimbursed to employees October $36,602.70 AZN 62,224.59 November $46,531.80 AZN 79,104.06 December January February March April May June July August September Total for the 2nd option year $83,134.50 AZN 141,328.65

Claims-Premium History