19GE5020R0053-A0001 - updated SOW.pdf

19GE5020R0053_A0001 London, United Kingdom Private Medical Insurance

UPDATED STATEMEMT OF WORK

IV SPECIFICATIONS / STATEMENT OF WORK

IV.A PMI Services

The Government of the United States of America (USG) requires group PMI for a specific group of its employees in the UK as further described in Section 1.IV.B below to cover routine medical issues and medical emergencies.

The USG has determined that it will bear 100% of the cost of such insurance protection and will directly pay the premiums required. The specific health benefit coverage under the contract is set forth in this section.

The contractor shall ensure that health care under this contract does not exclude HIV / AIDS care. PMI shall be provided to employees as stated below for treatment of routine medical issues in the U.K. or outside the U.K. (i.e. while travelling).

PMI shall be provided to employees as stated below:

a. Provider shall accept all existing members of current plan on no worse terms.

b. All new member coverage shall be fully medically underwritten by provider.

c. Scale of Cover – Open Referral – Network.

d. £100 excess (deductible) per 12 month rolling period.

IV.B Employee Health Services Benefits The maximum health benefits under this contract are as follows.

IB.B.1 Diagnostic and Out-Patient

Type of Cover Limits

Out-patient consultations, therapies and diagnostic tests.

Up to £1000 combined limit each year.

Including remote consultations by telephone or via any other remote medium with a consultant if the consultant is, at the time of the treatment, recognized by the PMI to carry out remote consultations.

Out-patient complementary medicine (i.e. an acupuncturist, chiropractor or osteopath recognized by the insurer)

Up to £250 each year from within available out-patient consultations, therapies and diagnostic tests limit above

Including remote consultations by telephone or via any other remote medium with a consultant if the consultant is, at the time of the treatment, Out-patient MRI, CT and PET scans At provider-recognized facility – 100%

IV.B.2 Hospital Treatment

Consultants’ fees Provider-recognized partnership consultants in a provider-recognized facility – 100%

Consultants who are not provider recognized partnership consultants – up to the limit of the provider’s consultant fee schedule

Facility access Provider-recognized facility only

Parent accommodation Up to age 16

Facility charges for surgical operations carried out as outpatient treatment

Provider-recognized facility – 100%

Facility charges for day-patient treatment and in-patient treatment

Provider-recognized facility within scale of cover – 100%

IV.B.3 Cancer Treatment (after a confirmed diagnosis)

Out-patient consultations, therapies and diagnostic tests

100% - to include remote consultations by telephone or via any other remote medium with a consultant if the consultant is, at the time of the treatment, recognized by the PMI to carry out remote consultations.

Out-patient complementary medicine 100% - to include remote consultations by telephone or via any other remote medium with a consultant if the consultant is, at the time of the treatment, recognized by the PMI to carry out remote consultations.

Out-patient cancer drugs Provider-recognized facility – 100% when they;

• can only be dispensed by a hospital and are not available from a GP)

• when they are available from a GP and the patient is prescribed an initial small supply on discharge from the recognized facility to enable the patient to start their treatment straight away

IV.B.4 Mental Health Treatment

Mental Health Treatment Up to a maximum of 90 days each year for mental health day-patient treatment and mental health in-patient treatment combined and not individually.

Consultants’ fees, mental health and wellbeing therapists’ fees and diagnostic tests for out-patient mental health treatment

Up to and from within available outpatient benefit limits including remote consultations by telephone or via any other remote medium with a consultant if the consultant is, at the time of the treatment, Consultants’ fees for mental health day patient treatment and mental health in-patient treatment

For provider-recognized partnership consultants in a provider-recognized facility – 100%

For consultants who are not provider recognized partnership consultants in a provider-recognized facility – up to the limit of the provider’s consultant fee schedule

To include online supported therapy programme/service

Facility charges for mental health day-patient treatment and mental health in-patient treatment

Provider-recognized facility within scale of cover – 100%

One addiction treatment programme to be paid for in each member’s lifetime

IV.B.5 Additional Benefits

Treatment at home Only as agreed by provider

Home nursing Up to £600 per year

Private ambulance charges Up to £80 each single trip up to a maximum of £320 per year

IV.B.6 Overseas Emergency Treatment (Official Work Travel and Private Travel)

Out-patient treatment Paid up to and from within available limit for regular out-patient treatment

Out-patient MRI, CT, PET scans Up to £100 towards all the fees and charges

Consultants’ fees for outpatient surgical operations, day-patient and in-patient treatment

Paid up to the limit of the provider’s consultant fee schedule

Overseas facility charge Out-patient surgical operations up to £100, and day-patient and in-patient treatment up to £200 towards all the facility charges and not each charge individually

Note – This is not supposed to be a substitute for regular travel insurance.

IV.B.7 Repatriation and Evacuation Assistance

Patient repatriation / evacuation 100%

Accompanying partner / relative Up to £750

IV.B.8 Cash Benefits

NHS cash benefit for NHS inpatient treatment

£50 each night up to a maximum of 35 nights in a year

NHS cash benefit for NHS inpatient stays when patient receives radiotherapy, proton beam therapy chemotherapy or a surgical operation that is for cancer treatment

£100 per night

NHS cash benefit for NHS outpatient or day-patient treatment or NHS home treatment for cancer

£100 for each day the patient receives radiotherapy in a hospital setting

£100 for each day patient receives IVchemotherapy and for each three weekly interval of oral chemotherapy or part thereof

£100 on the day of surgical operation

IV.B.9 Waiting Periods

Type of Cover Waiting Period

Mental health treatment No waiting period applies / waived

Treatment for caesarian sections No waiting period applies / waived

IV.B.10 Exclusions This section does not apply to Cash benefits in B.8.

IV.B.10.1 Ageing, Menopause and Puberty

Treatment to relieve symptoms commonly associated with any bodily change arising from any physiological or natural cause such as ageing, menopause or puberty and which is not due to any underlying disease, illness or injury.

IV.B.10.2 Allergies or Allergic Disorders

Treatment to de-sensitise or neutralise any allergic condition or disorder including treatment for any food intolerance.

IV.B.10.3 Benefits that are not covered and / or are above your benefit limits

Treatment, services or charges that are not covered under the policy. Treatment costs in excess of the amounts covered under the policy.

IV.B.10.4 Birth Control, Conception, Sexual Problems and Sex Changes

Treatment:

for any type of contraception, sterilisation, termination of pregnancy for any type of sexual problems (including impotence, whatever the cause) - for any type of assisted reproduction (e.g. IVF investigations or treatment), surrogacy, the harvesting of donor eggs or donor insemination where it relates solely to the treatment of infertility sex changes or gender reassignments or treatment for or arising from any of these.

IV.B.10.5 Chronic Conditions

Treatment of chronic conditions, i.e. a disease, illness or injury which has at least one of the following characteristics:

it needs ongoing or long-term monitoring through consultations, examinations, - check-ups and / or tests it needs ongoing or long-term control or relief of symptoms it requires rehabilitation or for you to be specially trained to cope with it - it continues indefinitely it has no known cure it comes back or is likely to come back.

Cancer is not considered a chronic condition for the purposes of this solicitation.

Exception: Eligible treatment arising out of a chronic condition, or for treatment of acute symptoms of a chronic condition that flare up. However, this is only covered if the treatment is likely to lead quickly to a complete recovery or to the patient being restored fully to his / her previous state of health, without having to receive prolonged treatment. For example, treatment following a heart attack arising out of chronic heart disease.

This exception does not apply to treatment of a mental health condition.

IV.B.10.6 Complications from Excluded Conditions, Treatment and Experimental Treatment

Treatment costs, including any increased treatment costs, incurred because of complications caused by a disease, illness, injury or treatment for which cover has been excluded or restricted from the policy.

(For example, if cover for diabetes is excluded by a special condition, and the patient has to spend any extra days in hospital or a treatment facility after an operation because he / she has diabetes, we would not pay for these extra days.)

Treatment costs the insured incurs because of any complications arising or resulting from experimental treatment that the insured receives or for any subsequent treatment the insured may need as a result of the patient undergoing any experimental treatment.

IV.B.10.7 Contamination, Wars, Riots and Terrorist Acts

Treatment for any disease, illness or injury arising directly or indirectly from: - war, riots, terrorist acts, civil disturbances, acts against any foreign hostility, whether war has been declared or not, or any similar event

- chemical, radioactive or nuclear contamination, including the combustion of chemicals or nuclear fuel, or any similar event.

Exception: Eligible treatment required as a result of a terrorist act, provided that the terrorist act does not cause chemical, biological, radioactive or nuclear contamination.

IV.B.10.8 Convalescence, Rehabilitation and General Nursing Care

Recognised facility accommodation if it is primarily used for any of the following purposes:

convalescence, rehabilitation, supervision or any purpose other than receiving eligible treatment receiving general nursing care or any other services which could have been provided in a nursing home or in any other establishment which is not a recognised facility receiving services from a therapist, complementary medicine practitioner or mental health and wellbeing therapist.

Exception: The PMI, at its discretion, may pay for eligible treatment for rehabilitation, i.e.treatment which is aimed at restoring health or mobility or to allow the patient to live an independent life, such as after a stroke. This will only be considered in cases where the rehabilitation:

is an integral part of in-patient treatment starts within 42 days from and including the date you first receive that in-patient treatment, is part of a personalized programme involving at least two different medical therapies, takes place in a recognised facility, and the patient’s consultant confirms to the PMI that the patient is physically and mentally able to start the rehabilitation programme within the defined timescales.

The patient must have the PMI’s written agreement before the rehabilitation starts and the PMI needs full clinical details from the patient’s consultant before we can give our decision. If the PMI agrees they pay for up to a maximum of 21 consecutive days’ rehabilitation.

IV.B.10.9 Cosmetic, Reconstructive or Weight Loss Treatment

Treatment to change appearance, such as a remodeled nose or facelift whether or not it is needed for medical or psychological reasons. Breast enlargement or reduction or any other treatment or procedure to change the shape or appearance of your breast(s) whether or not it is needed for medical or psychological reasons, for example, for backache or gynaecomastia (which is the enlargement of breasts in males).

Treatment, including surgery:

which is for or involves the removal of healthy tissue (ie tissue which is not diseased), or the removal of surplus or fat tissue, or where the intention of the treatment, whether directly or indirectly, is the reduction or removal of surplus or fat tissue including weight loss (for example, surgery related to obesity including morbid obesity) whether or not the treatment it is needed for medical or psychological reasons. Treatment of keloid scars or scar revision.

Exception 1: Eligible treatment for an excision of a lesion if any of the following criteria are met;

a biopsy or clinical appearance indicates that disease is present, the lesion obstructs one of the special senses (vision/smell/hearing) or causes pressure on other organs, the lesion stops the patient from performing the activities of daily living.

Before any treatment starts the patient must have confirmation from the PMI that the above criteria have been met and the PMI will need full clinical details from the patient’s consultant before they can determine this.

Exception 2: The PMI will pay for one course/set of eligible treatment to restore your appearance of the specific part of the patient’s body that has been directly affected; by an accident, or if the benefits include cover for cancer treatment, as a direct result of surgery for cancer.

The PMI only pays if the accident or the cancer surgery takes place during the current continuous period of cover under this scheme and any of out schemes provided there has been no break in cover between this scheme and the other scheme. The PMI will only pay if this is part of the original eligible treatment resulting from the accident or cancer surgery and the patient has obtained the PMI’s written agreement before receiving the treatment.

The PMI does not pay for more than the one course/one set of surgical operation or for repeat cosmetic procedures.

IV.B.10.10 Deafness

Treatment for or arising from deafness caused by a congenital abnormality, maturing or ageing.

IV.B.10.11 Dental / Oral Treatment

Dental or oral treatment including:

the provision of dental implants or dentures, the repair or replacement of damaged teeth (including crowns, bridges, dentures, or any dental prosthesis made by a laboratory technician) the management of, or any treatment related to, jaw shrinkage or loss as a result of dental extractions or gum disease the treatment of bone disease when related to gum disease or tooth disease or damage.

Exception 1: Eligible surgical operation carried out by a consultant to:

put a natural tooth back into a jaw bone after it is knocked out or dislodged in an unexpected accidental injury treat a jaw bone cyst, but not if it is related to a cyst or abscess on the tooth root or any other tooth or gum disease or damage.

Exception 2: Eligible surgical operation carried out by a consultant to surgically remove a complicated, buried or impacted tooth root, such as an impacted wisdom tooth, but not if the purpose is to facilitate dentures or the acute condition relates to a pre-existing condition or a moratorium condition.

IV.B.10.12 Dialysis

Treatment for or associated with kidney dialysis (haemodialysis), meaning the removal of waste matter from your blood by passing it through a kidney machine or dialyser.

Treatment for or associated with peritoneal dialysis, meaning the removal of waste matter from your blood by introducing fluid into your abdomen which acts as a filter.

Exception 1: Eligible treatment for short-term kidney dialysis or peritoneal dialysis if the dialysis is needed temporarily for sudden kidney failure resulting from a disease, illness or injury affecting another part of your body.

Exception 2: Eligible treatment for short-term kidney dialysis or peritoneal dialysis if you need this immediately before or after a kidney transplant.

IV.B.10.13 Drugs and Dressings for Out-Patient or Take-Home Use and Complementary and Alternative Products

Any drugs or surgical dressings provided or prescribed for out-patient treatment or for you to take home with you on leaving hospital or a treatment facility.

Any complementary or alternative therapy products or preparations, including but not limited to homeopathic remedies or substances, regardless of who they are prescribed or provided by or the type of treatment or medical condition they are used or prescribed for.

Exception: If the policy includes cover for cancer treatment ,out-patient common drugs, advanced therapies and specialist drugs for eligible treatment of cancer are covered.

IV.B.10.14 Excluded Treatment or Medical Conditions

NOT covered Treatment of any medical condition, or any type of treatment that is specifically excluded from the insured’s benefits.

IV.B.10.15 Experimental Drugs and Treatment

Treatment or procedures which, by reasonable definition, are experimental or unproved based on established medical practice in the United Kingdom, such as drugs outside the terms of their licence or procedures which have not been satisfactorily reviewed by NICE (National Institute for Health and Care Excellence).

Exception: Experimental drug treatment for cancer subject to the following criteria;

The use of this drug treatment follows an unsuccessful initial licensed treatment where available, and The Patient speaks regularly to the PMI nurse as they may reasonable require in order to allow them to effectively monitor the treatment and provide support, and The drug treatment has been agreed by a multidisciplinary team that meets the NHS Cancer Action Team standards defined in The Characteristics of an Effective Multidisciplinary team (MDT), Or When the patient’s consultant provides the PMI with one of the following;

Evidence that the drug treatment has been found to have likely benefit on the condition through a predictive genetic test where appropriate/available, or Evidence there is a European Medicines Agency (EMA) licence for the drug used to treat the patient’s condition and the drug is used within its licensed protocol, or (NCCN)/European Society for Medical Oncology (ESMO) protocol exists,(ie the specific indication including tumour type, staging and phase of treatment if relevant), or a published positive opinion on the Orphan Drug EMA Register for the patient’s exact condition (ie the specific indication including tumour type, staging and phase of treatment if relevant), or Phase III clinical trial results showing clinical efficacy and safety for the drug treatment published in a peer-reviewed journal.

Before starting this type of treatment the patient must have confirmation from the PMI that the above criteria have been met and the PMI will need full clinical details from the patient’s consultant before they can determine this.

IV.B.10.16 Eyesight

Treatment to correct a patient’s eyesight, for example for long or short sight or failing eyesight due to ageing, including spectacles or contact lenses.

Exception 1: Eligible treatment for eyesight if it is needed as a result of an injury or an acute condition, such as a detached retina

Exception 2: Eligible treatment for cataract surgery using ultrasonic emulsification

IV.B.10.17 Pandemic

Treatment for or arising from any pandemic disease and / or epidemic disease. Pandemic: the worldwide spread of a disease with epidemics occurring in many countries and most regions of the world.

Epidemic: more cases of a disease than would be expected for that disease in that area at that time.

IV.B.10.18 Intensive Care (Other than Routinely Needed After Private Day-Patient Treatment or In-Patient Treatment) Any intensive care if:

it follows an unplanned or an emergency admission to an NHS hospital or facility - it follows a transfer (whether on an emergency basis or not) to an NHS hospital or facility from a private recognised facility it follows a transfer from an NHS critical care unit to a private critical care unit - it is carried out in a unit or facility which is not a critical care unit.

if it is not routinely required as a medically essential part of the eligible treatment being carried out.

IV.B.10.19 Learning Difficulties, Behavioural and Developmental Problems

Treatment related to learning difficulties, such as dyslexia, or behavioural problems, such as attention deficit hyperactivity disorder (ADHD), and autistic spectrum disorder (ASD), or developmental problems, such as shortness of stature.

Exception: If a patient’s benefits include Mental Heath Treatment the PMI will pay for eligible diagnostic tests to rule out ADHD and ASD when a mental health condition is suspected. The patient must have confirmation from the PMI before any diagnostic tests are carried out that the above criterion has been met and they will need full clinical details from the patient’s consultant before the can determine this.

IV.B.10.20 Overseas Treatment

Treatment that received outside the United Kingdom.

Exception 1: If the policy includes ‘Overseas emergency treatment’ we pay for eligible treatment needed as a result of a sudden illness or injury when you are travelling outside the UK as set out in the Benefits Section

Exception 2: If the treatment needed is not available in the UK and would have been eligible treatment except for it not being available in the UK, the PMI will pay a contribution up to the cost that they would have paid to have the standard alternative treatment available in the UK.

Confirmation from the PMI that the above criteria have been met and full clinical details from the patient’s consultant, including confirmation that the treatment is not available in the UK, are required before the PMI can determine this.

The claim should be settled directly with the medical provider or treatment facility and receipts submitted to the PMI before reimbursement up to the level of the alternative treatment available in the UK.

IV.B.10.21 Physical Aids and Devices

Supplying or fitting physical aids and devices (e.g. hearing aids, spectacles, contact lenses, crutches, walking sticks, etc).

IV.B.10.22 Pre-Existing Conditions

For underwritten members, treatment of a pre-existing condition, or a disease, illness or injury that results from or is related to a pre-existing condition is not covered.

Exception: For underwritten members we pay for eligible treatment of a pre-existing condition, or a disease, illness or injury which results from or is related to a preexisting condition, if all the following requirements have been met:

the patient has been sent their membership certificate which lists the person with the pre-existing condition (whether this is the insured or a dependent) - the insured gave us all the information we asked for, before we sent the first membership certificate listing the person with the pre-existing condition for their current continuous period of cover under the scheme neither the insured nor the person with the pre-existing condition knew about it before we sent the first membership certificate which lists the person with the preexisting condition for their current continuous period of cover under the scheme, and - cover is not excluded (for example under a special condition) for the costs of the treatment, when we sent the membership certificate.

IV.B.10.23 Pregnancy and Childbirth

Treatment for:

pregnancy, including treatment of an embryo or foetus childbirth and delivery of a baby termination of pregnancy, or any condition arising from termination of pregnancy.

Exception 1: Eligible treatment of the following conditions:

miscarriage or when the foetus has died and remains with the placenta in the womb still birth hydatidiform mole (abnormal cell growth in the womb) foetus growing outside the womb (ectopic pregnancy) heavy bleeding in the hours and days immediately after childbirth (post-partum haemorrhage) afterbirth left in the womb after delivery of the baby (retained placental membrane) - complications following any of the above conditions.

Exception 2: We pay for eligible treatment of an acute condition of the member (mother) that relates to pregnancy or childbirth but only if all the following apply;

The treatment is required due to a flare-up of the medical condition, and

The treatment is likely to lead quickly to a complete recovery or to the member being restored fully to their state of health prior to the flare-up of the condition with the member needing to receive prolonged treatment

IV.B.10.24 Screening, Monitoring and Preventive Treatment

Not covered:

health checks or health screening. Health screening: where the patient may not be aware you are at risk of, or are affected by a disease or its complications but are asked questions or have tests to find out if he /she are and which may lead to needing further tests or treatment routine tests, or monitoring of medical conditions, including:

routine antenatal care or screening for and monitoring of medical conditions of the mother or foetus during pregnancy routine checks or monitoring of chronic conditions such as diabetes mellitus or hypertension tests or procedures which, in our reasonable opinion based on established clinical and medical practice, are carried out for screening or monitoring purposes, such as endoscopies when no symptoms are present preventive treatment, procedures or medical services.

Medication reviews or appointments where the patient has had no change in their usual symptoms

Exception: If the patient is being treated for cancer, has strong direct family history of cancer and the patient’s consultant has;

Demonstrated that the patient is at high risk of recurring cancer, due ot having triple negative breast cancer, strong family history and/or through the use of a validated risk scoring system in line with NICE guidelines and Recommended that the patient receive a genetically-based test to evaluate future risk of developing further cancers

The PMI will pay for this test as well as the recommended prophylactic surgery when it is recommended by the patient’s consultant. Before the patient has any tests, procedures or treatment they must have PMI written confirmation that the above criteria have been met and they need full clinical details from their consultant before they can determine this.

IV.B.10.25 Sleep Problems and Disorders

Treatment for or arising from sleep problems or disorders such as insomnia, snoring or sleep apnoea (temporarily stopping breathing during sleep).

IV.B.10.26 Special Conditions

Treatment directly or indirectly relating to special conditions. The insured shall contact the provider for details.

IV.B.10.27 Speech Disorders

Treatment for or relating to any speech disorder, for example stammering.

Exception: At the PMI’s discretion: short-term speech therapy when it is part of eligible treatment. The speech therapy must be provided by a therapist who is a member of the Royal College of Speech and Language Therapists.

IV.B.10.28 Temporary Relief of Symptoms

Treatment, the main purpose or effect of which is to provide temporary relief of symptoms or which is for the ongoing management of a condition.

Exception: The PMI may pay for this type of treatment if it’s needed it to relieve the symptoms of a terminal disease or illness.

IV.B.10.29 Treatment in a Treatment Facility that is not a Recognised Facility

Consultants’ fees for treatment that the patient receives in a hospital or any other type of treatment facility that is not a recognised facility.

If this facility access is partnership facility, the PMI will not pay for facility charges for treatment that the patient receives in a hospital or any other type of treatment facility that is not a recognised facility.

Exception: The PMI may pay consultants’ fees and facility charges for eligible treatment in a treatment facility that is not a recognised facility when the proposed treatment cannot take place in a recognised facility for medical reasons. However, the patient will need the PMI’s written agreement before the treatment is received and the PMI needs full clinical details from the consultant before a decision.

IV.B.10.30 Unrecognised Medical Practitioners, Providers and Facilities

Treatment if the consultant who is in overall charge of treatment is not recognised by the PMI.

Treatment if any of the following apply:

the consultant, medical practitioner, therapist, complementary medicine practitioner, mental health and wellbeing therapist or other healthcare professional is: - not recognised by our company for treating the medical condition you have and / or for providing the type of treatment you need, and / or is not in the list of recognised practitioners that applies to your benefits - the hospital or treatment facility is:

not recognised by our company for treating the medical condition you have and / or for providing the type of treatment you need, and / or is not in the facility access list that applies to your benefits the hospital or treatment facility or any other provider of services is not recognised by the PMI and/or the PMI has sent a written notice saying that they no longer recognise them for the purpose of the private medical insurance schemes.

The PMI does not recognise consultants, therapists, complementary medicine practitioners, mental health and wellbeing therapists or other healthcare professionals in the following circumstances:

where the PMI does not recognise them as having specialised knowledge of, or expertise in, the treatment of the disease, illness or injury being treated - where the PMI does not recognise them as having specialised expertise and ongoing experience in carrying out the type of treatment or procedure needed - where the PMI has sent a written notice to them saying that they no longer recognize them for the purposes of their schemes.

IV.B.10.31 Moratorium Conditions

For moratorium members the PMI does not pay for treatment of a moratorium condition, or a disease, illness or injury that results from or is related to a moratorium condition.

Exception: If the insured applies to add its newborn baby as a dependent under its membership and the baby’s membership would be as a moratorium member the PMI will not apply this exclusion to the baby’s cover if the insured has been a member under this scheme (and if applicable previous scheme) for at least 12 continuous months before the baby’s birth and the insured includes the baby as a dependent within three months of their birth.

IV.B.10.32 Chronic Mental Health Conditions

Any mental health treatment for any member who has suffered from or is suffering from a chronic mental health condition.

IV.B.11 Eligible Employees Employees eligible for the PMI services under this contract are:

a. LE Staff employees of the U.S. Embassy in London and its constituent posts and outlying offices, who are paid under the Local Compensation Plan and who work on a full-time, part-time or intermittent basis under a direct-hire appointment or personal services agreement/contract;

b. LE Staff employees of OSC Caversham paid under OSC’s local compensation plan and who work on a full-time, part-time or intermittent basis under a direct-hire appointment or personal services agreement/contract;

c. Official Residence Expense (ORE) staff employee under a contract subject to the employing officer being responsible for the employer’s share of costs

d. Employees of the American Embassy Employees’ Association (AEEA) who are paid in local currency and employed under a contract subject to the AEEA being responsible for the employer’s share of costs

e. An employee is also considered active ("on the rolls") whenever such employee is on annual or sick leave, or leave without pay. During a period of Leave Without Pay coverage will apply provided the employee makes his / her contributions in that period.

f. Pre-existing Conditions: Employees employed by the Embassy at the time the contract becomes effective who may have pre-existing conditions shall be eligible for health coverage.

Each new employee upon entering on duty who may have preexisting conditions shall be eligible for health coverage during the performance period of this contract.

g. Individuals not eligible for coverage under this contract are nonpersonal services contract personnel and any other individual not falling within one of the categories of employees described in this clause.

IV.B.12 Pools and current employee count

Under age 65 Single 74 Couple 51 Family 56 Single Parent Family 15

Over age 65 Single 2 Couple 4 Family 0 Single Parent Family 0