19GE5021R0009.pdf

19GE5021R0009

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS

OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24 & 30

1. REQUISITION NUMBER

5. SOLICITATION NUMBER

19GE5021R0009

2. CONTRACT NO. 3. AWARD/EFFECTIVE DATE 4. ORDER NUMBER 6. SOLICITATION ISSUE

DATE

01/26/2021

7. FOR SOLICITATION

INFORMATION CALL:

a. NAME

Wencke Jacobsen

b. TELEPHONE NUMBER (No collect calls)

c. EMAIL jacobsenw@state.gov

8. OFFER DUE DATE / LOCAL

TIME

CODE FRANK

AMERICAN CONSULATE GENERAL FRANKFURT

GIESSENER STRASSE 30

ATTN: RPSO

60435, FRANKFURT, GERMANY

9. ISSUED BY X UNRESTRICTED OR SET ASIDE: % FOR

SMALL BUSINESS

HUBZONE SMALL

BUSINESS

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

WOMEN-OWNED SMALL BUSINESS (WOSB)

ELIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM

EDWOSB

8(A)

NAICS:

SIZE STANDARD:

10. THE ACQUISITION IS

SEE

SCHEDULE

11. DELIVERY FOR FOB DESTINATION

UNLESS BLOCK IS MARKED

12. DISCOUNT TERMS

13a. THIS CONTRACT IS

RATED ORDER UNDER DPAS

(15 CFR 700)

13b. RATING

RFQ IFB X RFP

14. METHOD OF SOLICITATION

CAIROCODE15. DELIVER TO

AMERICAN EMBASSY CAIRO

US EMBASSY CAIRO 8 KAMAL EL DIN SALAH

ATTN: SPM RECEIVING OFFICE

CAIRO, EGYPT 11519

CODE FRANK16. ADMINISTERED BY

AMERICAN CONSULATE GENERAL FRANKFURT

GIESSENER STRASSE 30

ATTN: RPSO

60435, FRANKFURT, GERMANY

FACILITY

CODE

CODE

Contact Duns Telephone No.

17a. CONTRACTOR/

OFFEROR

FRANKCODE18a. PAYMENT WILL BE MADE BY

AMERICAN EMBASSY CAIRO

8 KAMAL EL-DIN SALAH ST, GARDEN CITY

ATTN:FMC AND GSO

CAIRO, EGYPT

17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN

OFFER SEE ADDENDUM

18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK BELOW IS

CHECKED

19. ITEM NO. 20. SCHEDULE OF SUPPLIES/SERVICES

(Use Reverse and/or Attach Additional Sheets as Necessary)

21. QUANTITY 22. UNIT 23. UNIT PRICE 24. AMOUNT

See Line Items Section

25. ACCOUNTING AND APPROPRIATION DATA 26. TOTAL AWARD AMOUNT (For Govt. Use Only)

X 27a. SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1, 52.212-4. FAR 52.212-3 AND 52.212-5 ARE ATTACHED. ADDENDA X ARE ARE NOT ATTACHED

27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA ARE ARE NOT ATTACHED

X 28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN 1 COPIES TO

ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND DELIVER ALL ITEMS SET FORTH

OR OTHERWISE IDENTIFIED ABOVE AND ON ANY ADDITIONAL SHEETS SUBJECT TO THE

TERMS AND CONDITIONS SPECIFIED.

29. AWARD OF CONTRACT: REF. _____________________________ OFFER

DATED _________________ . YOUR OFFER ON SOLICITATION (BLOCK 5)

INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE SET FORTH HEREIN,

IS ACCEPTED AS TO ITEMS:

30a. SIGNATURE OF OFFEROR/CONTRACTOR 31a. UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER)

30b. NAME AND TITLE OF SIGNER (TYPE OR PRINT) 30c. DATE SIGNED 31b. NAME OF THE CONTRACTING OFFICER (TYPE OR PRINT) Eric N. Moore

31c. DATE SIGNED 01/26/2021

AUTHORIZED FOR LOCAL REPRODUCTION

PREVIOUS EDITION IS NOT USABLE

STANDARD FORM 1449 (REV. 02/2012)

Prescribed by GSA - FAR (48 CFR) 53.212

CGFS : : CGFS

Line Item Summary

Solicitation Number:

19GE5021R0009

Contract Number: Title: EG-CAIRO HEALTH AND LIFE

INSURANCE

Date of Solicitation:

01/26/2021

Line Item No.

Description Quantity Unit Unit Price Total Cost

001 BASE YEAR

Health Insurance, inclusive of the following Sub CLINs:

0001a Single Employee (Self Only) 0001b Family Plan Type of Contract Pricing:

Doc Ref No:

Delivery Date FOB:

0.00 EA

002 BASE YEAR

Life Insurance, inclusive of the following Sub CLINs 0002a Basic Life 0002b Accidental Death and Dismemberment 0002c Partial and Total Disability Type of Contract Pricing:

Doc Ref No:

Delivery Date FOB:

0.00 EA

1001 OPTION YEAR ONE

Health Insurance, inclusive of the following Sub CLINs:

1001a Single Employee (Self Only) 1001b Family Plan Type of Contract Pricing:

Doc Ref No:

Delivery Date FOB:

0.00 EA

1002 OPTION YEAR ONE

Life Insurance, inclusive of the following Sub CLINs 1002a Basic Life 1002b Accidental Death and Dismemberment 1002c Partial and Total Disability Type of Contract Pricing:

Doc Ref No:

Delivery Date FOB:

0.00 EA

2001 OPTION YEAR TWO

Health Insurance, inclusive of the following Sub CLINs:

2001a Single Employee (Self Only) 2001b Family Plan Type of Contract Pricing:

Doc Ref No:

Delivery Date FOB:

0.00 EA

2002 OPTION YEAR TWO

Life Insurance, inclusive of the following Sub CLINs 2002a Basic Life 2002b Accidental Death and Dismemberment 2002c Partial and Total Disability Type of Contract Pricing:

Doc Ref No:

Delivery Date FOB:

0.00 EA

3001 OPTION YEAR THREE

Health Insurance, inclusive of the following Sub CLINs:

3001a Single Employee (Self Only) 3001b Family Plan Type of Contract Pricing:

Doc Ref No:

Delivery Date FOB:

0.00 EA

3002 OPTION YEAR THREE

Life Insurance, inclusive of the following Sub CLINs 3002a Basic Life

0.00 EA

Line Item Summary

Solicitation Number:

19GE5021R0009

Contract Number: Title: EG-CAIRO HEALTH AND LIFE

INSURANCE

Date of Solicitation:

01/26/2021

Line Item No.

Description Quantity Unit Unit Price Total Cost

3002b Accidental Death and Dismemberment 3002c Partial and Total Disability Type of Contract Pricing:

Doc Ref No:

Delivery Date FOB:

4001 OPTION YEAR FOUR

Health Insurance, inclusive of the following Sub CLINs:

4001a Single Employee (Self Only) 4001b Family Plan Type of Contract Pricing:

Doc Ref No:

Delivery Date FOB:

0.00 EA

4002 OPTION YEAR FOUR

Life Insurance, inclusive of the following Sub CLINs 4002a Basic Life 4002b Accidental Death and Dismemberment 4002c Partial and Total Disability Type of Contract Pricing:

Doc Ref No:

Delivery Date FOB:

0.00 EA

19GE5021R0009 Cairo, Egypt Health & Life Insurance for LES Page 4 of 103

TABLE OF CONTENTS

Section 1 – The Schedule

SF 1449 cover sheet

Continuation To SF-1449, Prices, Block 23

Continuation To SF-1449, Schedule Of Supplies / Services, Block 20 Description / Specifications / Work Statement

Attachment 1 – Prices

Attachment 2 – Contract Information / Experience Listing

Attachment 3 – IRS Form W14

Exhibits A, B and C – Employee Statistics, ORE Employee Rider, Employee Association Employees Rider

NOTE: Further contractor-provided attachments will be included after award

Section 2 – Contract Clauses

Contract Clauses

Addendum to Contract Clauses - FAR and DOSAR Clauses not Prescribed in Part

Section 3 – Solicitation Provisions

Solicitation Provisions

Addendum to Solicitation Provisions - FAR and DOSAR Provisions not Prescribed in Part 12

Section 4 – Evaluation Factors

Evaluation Factors

Addendum to Evaluation Factors - FAR and DOSAR Provisions not Prescribed in Part 12

Section 5 – Representations and Certifications

Offeror Representations and Certifications

Addendum to Offeror Representations and Certifications - FAR and DOSAR Provisions not Prescribed in Part 12

Health & Life Insurance for LES Page 5 of 103

SECTION 1 – THE SCHEDULE

CONTINUATION TO SF-1449

PRICES – BLOCK 23

I BACKGROUND / SCOPE OF SERVICES

A. The Government of the United States of America requires Health and Life Insurance for its Locally Engaged Staff and their dependents at the US Embassy Cairo, Egypt.

The Contractor shall provide the Health Insurance services and Life Insurance coverage to employees of the Government of the United States of America in Egypt as described in Section C.1 and the Exhibits attached. This insurance shall be provided in accordance with Section C.1 and the Exhibits attached.

A.1.1 Official Residence Expense (ORE) Staff and the American Employees Cooperative and Welfare Association (AECWA) employees are included under this contract only as a rider; the Contractor shall bill the Chief of Mission and Deputy Chief of Mission (for ORE Staff), and the AECWA employees at the rates specified below.

(See Section V.10.4 Riders).

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

B. This is a fixed price with economic price adjustment requirements type contract under which annual firm, fixed-price task orders will be issued. The contract shall remain unfunded. The fixed prices / premium rates for the health insurance services as specified in Section 1.IV. A are listed in Section1.III.D.

C MINIMUM (Reference Section I, Clause 52.216-22(b))

During the term of this contract, the Government shall order, as a minimum, services in an amount of at least $5,000.00 or equivalent in local currency.

The Government makes no guarantee as to the number of orders or actual amount of services that will be requested above the guaranteed minimum of $5,000.00 or equivalent in local currency.

The maximum dollar value during the entire life of this contract is $50,000,000.00.

Health & Life Insurance for LES Page 6 of 103

II ACRONYMS AND ABBREVIATIONS

Acronym Definition

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

CLIN Contract Line Item Number

Contractor Insurance Company

CO

Contracting Officer

COR

Contracting Officer Representative

Dependent Dependents are defined as the covered employee’s legal spouse as defined by law (limit one) and children (natural, adopted, stepchild, or foster children). 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.

Parents, grandparents, siblings, and other relatives are not eligible dependents

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.

Employer

The United States Government = USG

Employee Staff member of the US Embassy Cairo

FMO Financial Management Officer

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.

Health & Life Insurance for LES Page 7 of 103

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.

LS

Lump Sum

Maximum Benefit

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

PII

Personally Identifiable Information

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

QA

Quality Assurance

QC

Quality Control

QCP

Quality Control Plan

QTY

Quantity

SOW

Statement of Work

Surgical Procedure

Any invasive medical procedure by manual or instrument operation undertaken for diagnosis or treatment of a diseased patient.

TBD

To be determined

USG

U.S. Government

III PRICES

A.1 The contractor shall complete all work, including furnishing all labor, material, equipment and services, unless otherwise specified herein, required under this contract for the firm fixed unit prices indicated below and within the time specified herein. These individual prices shall include all labor, materials, profit, and, if applicable, value added tax (VAT).

Any costs not separately priced will be considered to be included in the individual prices as overhead or other indirect cost. No additional sums will be payable on account of any escalation in the cost of materials, equipment or labor, or because of the contractor's failure to properly estimate or accurately predict the cost or

Health & Life Insurance for LES Page 8 of 103 difficulty of achieving the results required by this contract. Nor will the contract price be adjusted on account of fluctuations in the currency exchange rates.

A.2 The currency shall be fixed and cannot be changed by modification to the contract.

A.3.1 Economic Price Adjustment, Premium Adjustment Based on Experience – For health insurance, prices may be adjusted upward or downward based on the experience rating of the Mission covered by this contract, and it specifically excludes all riders.

No adjustment will be allowed during the first twelve months.

After such time, the contractor or the USG may request an adjustment in premiums on an annual basis to be effective per contract year. Adjustments are not retroactive to previous contract terms. Before any such adjustment is made, the contractor agrees to provide the USG a balance sheet showing three main components for the previous time period:

(1) receipts (premiums received),

(2) number of insurance policies and

(3) claims paid.

This information shall be provided per type of premium, i.e. per line item.

The USG 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 effective for the following option year. Any failure to reach agreement under this clause shall be subject to the procedures in the Disputes clause.

A.3.2.1 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(s). The contractor agrees to provide all documentation necessary to support any requested adjustment.

A.3.2.2 Employee Pool – This clause is only in effect if the contractor included details in its offer regarding a pooling arrangement, of which this contract is a part.

Before any adjustment is made under this price adjustment clause, the contractor must include in its proposal for adjustment details setting forth how the pool impacts the request for equitable adjustment.

Health & Life Insurance for LES Page 9 of 103

B. VAT – The Government will not reimburse the Contractor for VAT under this contract.

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

C. Offerors shall quote in Egyptian Pounds (EGP)

Health & Life Insurance for LES Page 10 of 103

D. Prices

D.1 Pricing Health Insurance

D.1.1 Base Year

D.1.2 Option Year One

D.1.3 Option Year Two

D.1.4 Option Year Three

Bi-Weekly Rates per Employee

Category Estimated Number of Employees

Rate per

Employee Bi-Weekly Total

a. Single Employees (Self Only) 400

b. Family Plan 1100

c. Subtotal (a + b)

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

Category Estimated Number of Employees

Rate per

Employee Bi-Weekly Total

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

Category Estimated Number of Employees

Rate per

Employee Bi-Weekly Total

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

Category Estimated Number of Employees

Rate per

Employee Bi-Weekly Total

Health & Life Insurance for LES Page 11 of 103

D.1.5 Option Year Four

D.1.6 Grand Total of Base Plus All Option Years

D.2 Pricing for Health Insurance for Riders

The firm fixed price/premium rates in for the Rider CLINS are as follows and are to be paid 100% by the enrollee; these Rider CLINS will NOT be evaluated as part of the overall price evaluation. Riders will not be covered under the annual task orders (see also Sub Section V.10.4 for procedures).

D.2.1 Base Year Riders

No. Category Bi-Weekly Rates per Employee

1 ORE Staff, AECWA Staff, and their Dependents

D.2.2 Option Year One Riders

D.2.3 Option Year Two Riders

D.2.4 Option Year Three Riders

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

Category Estimated Number of Employees

Rate per

Employee Bi-Weekly Total

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

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

Health & Life Insurance for LES Page 12 of 103

D.2.5 Option Year Four Riders

D.3 Retention Amounts Health Insurance

D.3.1 If the Contractor requests a price adjustment under A.3.1 above, 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 D.1. 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. D.3.2 sets forth the retention amounts per premium paid for each category of premium and for each period of performance.

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

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

Period of Performance Single Employees (Self Only) Family Plan

Base Period

First Option Year

Second Option Year

Third Option Year

Fourth Option Year

Health & Life Insurance for LES Page 13 of 103

D.4 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 to provide life insurance, accidental death and dismemberment and partial and total disability coverage are as follows:

D.4.1 Base year

Type of Insurance Premium (per

1,000 of Salary)

Estimated Average

Payroll (Bi-Weekly in

Thousands)

Bi-Weekly Total

a. Basic Life EGP 5,279

b. Accidental Death & Dismemberment

EGP 5,279

c. Partial & Total Disability

Coverage

EGP 5,279

d. Subtotal (a + b + c)

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

D.4.2 Option Year One

Type of Insurance Premium (per

1,000 of Salary)

Estimated Average

Payroll (Bi-Weekly in

Thousands)

Bi-Weekly Total

a. Basic Life EGP 6,388

b. Accidental Death & Dismemberment

EGP 6,388

c. Partial & Total Disability

EGP 6,388

Health & Life Insurance for LES Page 14 of 103

D.4.3 Option Year Two

Type of Insurance Premium (per

1,000 of Salary)

Estimated Average

Payroll (Bi-Weekly in

Thousands)

Bi-Weekly Total

a. Basic Life EGP 6,388

b. Accidental Death &

Dismemberment

EGP 6,388

c. Partial & Total Disability

EGP 6,388

D.4.4 Option Year Three

Type of Insurance Premium (per

1,000 of Salary)

Estimated Average

Payroll (Bi-Weekly in

Thousands)

Bi-Weekly Total

a. Basic Life EGP 7,026

b. Accidental Death &

Dismemberment

EGP 7,026

c. Partial & Total Disability

EGP 7,026

D.4.5 Option Year Four

Type of Insurance Premium (per

1,000 of Salary)

Estimated Average

Payroll (Bi-Weekly in

Thousands)

Bi-Weekly Total

a. Basic Life EGP 7,729

b. Accidental Death &

Dismemberment

EGP 7,729

c. Partial & Total Disability

EGP 7,729

Health & Life Insurance for LES Page 15 of 103

D.4.6 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 Year Plus All Option Years

D.5 Group Life Insurance Rates Riders

The firm fixed price/premium rates in Egyptian Pounds for the Rider CLINS are as follows and are to be paid 100% by the enrollee; these Rider CLINS will NOT be evaluated as part of the overall price evaluation. Riders will not be covered under the annual task orders (see also Sub Section V.10.4 for procedures).

D.5.1 Base Year

D.5.2 Option Year One

D.5.3 Option Year Two

D.5.4 Option Year Three

D.5.5 Option Year Four

Health & Life Insurance for LES Page 16 of 103

CONTINUATION TO SF-1449

SCHEDULE OF SUPPLIES / SERVICES, BLOCK 20

DESCRIPTION / SPECIFICATIONS / WORK STATEMENT

IV SPECIFICATIONS / STATEMENT OF WORK

PART I

A.1 MEDICAL INSURANCE SERVICES

The Government of the United States of America requires Medical Insurance coverage for its employees as described in Section A.1.1 below and the Exhibits attached.

A.1.1 Employee and Dependent Health Services Benefits

A.1.1.1 Hospitalization (treatment in the hospital for inpatient care): 100% Coverage

Services and supplies provided during hospitalization, including services provided by a licensed healthcare provider, bed & board (semi-private accommodations), operating room, recovery room, intensive care, imaging and diagnostic testing, general hospital nursing care, physical therapy, as well as drugs and medicines administered while in-patient . When private accommodations are provided, coverage will be limited to the cost of a semi-private room unless otherwise covered in an off the shelf plan.

See Outpatient Services (below) for details concerning professional services.

A.1.1.2 Emergency Services (trips to emergency room): 100% Coverage Services provided for conditions that could lead to serious disability or death if not immediately treated, such as accidents or sudden illness.

A.1.1.3 Ambulance: 80% Minimum Coverage 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.

A.1.1.4 Outpatient Services: 80% Minimum Coverage

Services provided by a certified healthcare provider on an ambulatory or outpatient basis (without being admitted to a hospital), including surgeon’s fees and other medical services that may be provided in a hospital, clinic, doctor’s office, medical facility, etc. Examples include, but are not limited to:

- Annual physical examinations

- Specialist consultations and treatment, including second surgical opinion

- Minor surgical interventions

- Chemotherapy and radiation treatments

- Immunizations recommended by local authorities and/or the World Health Organization

- Diagnostic tests and diagnostic imaging

Health & Life Insurance for LES Page 17 of 103

See Rehabilitative and Habilitative Services and Devices (below) for details concerning physical therapy.

A.1.1.5 Obstetric and Newborn Care:

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

Inpatient: 100% Coverage;

Outpatient: 80% Minimum Coverage; Up to:

- EGP 25,000 for Normal Delivery

- EGP 30,000 for C-Section

A.1.1.6 Pediatric Services:

Inpatient: 100% Coverage;

Outpatient: 80% Minimum Coverage

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

A.1.1.7 Prescription Drugs:

Inpatient:100% Coverage;

Outpatient: 80% Minimum Coverage

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

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

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

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

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

A.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 EGP 20,000 per covered individual per two-year period. 80% Minimum Coverage; with annual cap.

Health & Life Insurance for LES Page 18 of 103

A.1.1.10. Optical:

Examinations and Treatment: 80% Minimum Coverage

Prescription lenses and frames, or contact lenses: Covered up to a maximum of EGP 2,500 per covered individual every two years. 80% Minimum Coverage; with annual cap

A.1.1.11 Dental:

A.1.1.11.1 Examinations and Treatment: 80% Minimum Coverage; with annual cap EGP 3,800

Dentist’s fees, x-rays, examinations and treatment, cleanings, fillings, extractions, false teeth, crowns, and bridges up to a maximum of EGP 3,800 per covered individual per contract year.

A.1.1.11.2 Orthodontia: 80% Minimum Coverage; with contract lifetime cap EGP 15,000

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 EGP 15,000 lifetime limit.

A.1.1.12 Reproductive Health: 80% Minimum Coverage Up to EGP 50,000

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).

A.1.1.13 Rehabilitative and Habilitative Services and Devices: 50% Minimum Coverage

Rehabilitative services (e.g., recovering skills, such as speech therapy after a stroke or physical therapy after an accident). Devices to help gain or recover mental or physical skills lost due to injury, disability or a chronic condition

A.1.1.14 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.

A.1.2 Annual Maximum Limit:

A.1.2.1 Normal Annual Limit:

Health & Life Insurance for LES Page 19 of 103

The maximum annual reimbursement per covered individual per contract year is EGP 400,000.

A.1.2.2 Catastrophic Coverage:

Additional coverage equal to EGP 400,000 per covered individual per contract year.

Catastrophic conditions shall be defined as major medical conditions occurring as a result of a single/illness/accident or closely related set of major illnesses (or conditions relating to a single accident) that exceed the standard maximum coverage limit.

A.1.3 Exclusions to Coverage:

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

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

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

A.1.4 Eligible Participants:

A.1.4.1 LE Staff:

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 Egypt 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.

A.1.4.2 Official Residence Expense (ORE) Staff and the American Employees Cooperative and Welfare Association (AECWA) employees:

Health & Life Insurance for LES Page 20 of 103

ORE and AECWA employees may be covered under a rider to the contract. The employing officer/AECWA, not the USG, is responsible for the employer's share of the premium costs for an ORE/AECWA employee.

A.1.5 Location of Employment

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

A.1.6 Participants and Benefits Covered Under a Rider

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

A.1.6.2 All current active employees of the AECWA (see separate rider, Exhibit C). All costs for AECWA employees are the responsibility of the AECWA, not the U.S. Government.

A.1.7 Other Eligible Participants

A.1.7.1 Dependents:

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

A.1.7.1.2 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.

A.1.7.1.2 Dependent children:

A child is defined as the LE Staff’s natural, adopted, stepchild, or foster child. The ch ild 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.

PART II GROUP LIFE INSURANCE

A.2. GROUP LIFE INSURANCE

Health & Life Insurance for LES Page 21 of 103

The Government of the United States of America requires group life insurance coverage for its employees, as further described in A.2.2, in Egypt. The Government has determined that the prevailing practice by employers in Egypt is to provide life insurance coverage as described below and that such group life insurance protection is representative of locally prevailing compensation practice. Therefore, the Government desires to adopt such locally prevailing practice as part of its compensation plan for its employees as further described in A.2.2.

The specific group life insurance coverage under this contract is set forth in this part of Section A and the Exhibits attached.

A.2.1. Group Life Insurance Coverage

The amount of group life insurance coverage is as follows:

A.2.1.1 Amount of Employee Life Insurance.

The amount of life insurance coverage for each employee is based upon basic salary of the individual. Each employee is eligible for a face amount of coverage that is equal to a number of months times his or her last reported basic salary as described below.

In the event of the natural death of an eligible employee, the Contractor shall pay to the employee’s estate a lump-sum benefit equal to 24 months of employee’s last reported basic salary.

A.2.1.2 Amount of Accidental Death and Dismemberment Coverage.

The employee's estate or employee will receive an amount equal to 48 times the amount of monthly basic salary, inclusive of the life insurance benefit in C.2.1.1, in the event the employee is killed in an accident

A.2.1.3 Total Permanent Disability Coverage

In the event of an eligible employee becoming completely and permanently disable due to bodily injury, work or non-work-related diseases, the Contractor shall pay a lump sum benefit to the employee equal to 48 months of the employee’s last reported salary.

Partial Permanent Disability benefit will be a percentage of the total permanent disability benefit in accordance with the offeror’s standard schedule listing various types of Partial Disabilities along with the amount paid, expressed as a percentage of the total disability benefits. Payment of Partial Permanent Disparity shall range from 20% up to 50% of the total disability benefit.

A.2.2 Life Insurance Benefits Conditions and Limitation

Health & Life Insurance for LES Page 22 of 103

A.2.2.1 Schedule of payment under Partial Permanent Disability

Loss of arm between shoulder and wrist 50% Loss of hand below wrist 50% Losses of four fingers and thumb 40% Loss of four fingers 35% Loss of whole thumb 25% Loss of whole index finger 20% Loss of whole middle finger 20% Loss of Whole ring finger 20% Loss of whole little finger 20% Los of leg at tip 50% Loss of leg between knee and hip 50% Loss of leg below knee 35% Loss of one toe 20% Loss of an additional toe (each) 20% Loss of one eye 50% Deafness of both ears 50% Deafness of one ear 20%

A.2.3. Eligible Participants.

A.2.3.1 Eligible Employees.

A.2.3.1.1 To be eligible to participate in the medical plan, LE Staff must be:

- Paid under the terms of the Local Compensation Plan (LCP); and –

- Under a non-temporary direct hire appointment, personal services agreement (PSA), or personal services contract (PSC); or

- Under a temporary direct hire appointment or PSA Fixed Term of one year or more.

C.2.3.1.2 Official Residence Expense (ORE) and Employee Association (EA) employees may be covered under a rider to the contract. The employing officer/EA, not the USG, is responsible for the employer's share of the premium costs for an ORE employeeC.2.3.2

A.2.3.2 Location of Employment

Individuals covered by C.2.3 must be employed within the geographic boundaries of Egypt.

A.2.3.3 Participants Covered Under a Rider:

A.2.3.3.1 All current active employees of the Chief of Mission and the Deputy Chief of Mission assigned to their respective official Government residences and paid under an ORE account (see separate rider, Exhibit B). All costs for ORE employees are the responsibility of the employing officer, not the U.S. Government.

Health & Life Insurance for LES Page 23 of 103

A.2.3.3.2 All current active employees of the AECWA at U.S. Embassy Cairo are the responsibility of the AECWA, not the U.S. Government.

A.2.4 Individuals Not Eligible for Coverage

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 Egypt 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.

A.2.5. Other Eligible Participants

Reserved

A.2.6 Eligibility and Effective Date

A.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 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.

A.2.6.2 Period of Ineligibility

During a period of extended (beyond one pay period) of Leave Without Pay 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.

A.2.7 Conditions and Limitations:

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.

Health & Life Insurance for LES Page 24 of 103

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:

(1) Violating the law or in resisting detention or arrest.

(2) Participation in competitions involving the use of wheeled vehicles, horses, boats or water skis.

(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. Suicide will not be covered.

V CONTRACT ADMINISTATIVE REQUIREMENTS AND PROCEDURES

Health & Life Insurance for LES Page 25 of 103

V.1 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 USG, is responsible for management and quality control to meet the terms of the contract. The role of the USG is to conduct quality assurance to ensure that contract standards are achieved.

Performance Objective Performance Threshold

Timely payment of benefits (within 21 calendar days)

No more than one (1) customer complaint is received per month.

No incorrectly denied claims

No more than one (1) customer complaint is received per month.

V.1.1 Surveillance – The COR will receive and document all complaints from USG personnel regarding the services provided. If found valid, the COR will send the complaints to the contractor for corrective action.

V.1.2 Standard – The performance standard is that the USG 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.

V.1.3 Complaint Procedures

a. If USG personnel observe unacceptable services such as but not limited to lack of coordination during medical evacuation, extended referral periods, delays in receipt of payment, etc., they will immediately contact the COR.

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

c. If the COR determines the complaint is invalid, the COR will advise the complainant. The COR will retain the annotated copy of the written complaint for his / her files.

d. If the COR determines the complaint is valid, the COR will inform the contractor and give the contractor additional time to correct the defect, if additional time is available. The COR shall determine how much time is reasonable.

Health & Life Insurance for LES Page 26 of 103

e. The COR shall, as a minimum, provide e-mail notification informing the contractor of any valid complaints.

f. If the contractor disagrees with the complaint and challenges the validity of the complaint, the contractor shall notify the COR by e-mail. The COR will review the matter to determine the validity of the complaint.

g. The COR will consider complaints as resolved unless notified otherwise by the complainant.

h. Repeat customer complaints are not permitted for any services. If a repeat customer complaint is received for the same deficiency during the service period, the COR will contact the Contracting Officer for appropriate action under the Inspection clause.

V.1.4 Employee Claims Report

The contractor shall provide a monthly Employee Claims Report. The report shall be received by the COR no later than the 10th calendar day of each month.

The report shall list all claims paid by the contractor to a claimant, including the name of the claimant, date claim is received by the contractor, and the amount claimed. This report shall also include all outstanding claims and a brief description of why claim has not been paid.

V.2 REPORTS AND OTHER DELIVERABLES

V2.1 The Contractor shall provide a document (brochure/pamphlet/other written document) in English and Arabic that sets forth a complete listing of the health and 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.

The Contractor shall provide the document to the COR not later than sixty (60) days after date of contract award. The Contractor shall provide additional brochures for new employees within ten (10) days of the COR’s request.

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

V2.2 The Contractor shall provide the following summary reports monthly. All reports must be received by the COR no later than the 10th day of each month. These reports shall report on the previous month's activities. No PII information will be included in the report.

Health & Life Insurance for LES Page 27 of 103

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

(b) Demographic Information Report to include employee age distribution, dependent distribution, member movement, and distribution of benefits.

(c) Benefits utilization information to include hospital benefit statistics, chronic illness statistics, claims expenditure distribution, and health promotion utilization.

All reports and other deliverables required under this contract shall be delivered by email to the COR and mailed to the following address:

US Embassy Cairo

ATTN: Human Resources Office TBA at time of award

NOTE: Any and all costs for the preparation, handling, mailing and submission of progress reports or any other required reports and documentation shall be included in the total price of each delivery order.

Description QTY Submission Date Deliver to and how:

Reference para V.2.1 Brochures

Additional copies

For review 30 days after contract award

After review by the COR

Within 10 calendar days of the COR’s request hard copy para V.2.2 Employee claims report 1 ea No later than the 10th calendar day of each month

COR

e-mail, pdf document para V.3 Claim forms for each type of benefit that can be claimed under the contract

Basic supply

30 days after contract award mail, hard copy

Health & Life Insurance for LES Page 28 of 103

Additional copies

Within 10 calendar days of the COR’s request para V.3 Employee claim reimbursement checks or

VIA EFT

each Within 21 calendar days of the submission of the claim

COR

mail, hard copy para V.7 Draft version of Management Plan

1 ea As part of the offer

CO

para V.7 Final version of Management Plan

1 ea 15 calendar days after receipt of contract award

COR

V.3 Contractor Responsibility in Claims and Reimbursement to Claims

General – The contractor shall be responsible for all planning, estimating, programming, project management, scheduling, dispatching, supervision, and inspection of work. The contractor shall maintain his own reference library of technical reference works and local laws and regulations, including current tariffs and registries. The contractor shall treat the information provided by the Embassy concerning employees' personal data, medical information, and salaries as highly sensitive and not divulge any employee information to unauthorized persons.

The contractor shall establish procedures for handling medical insurance claims as follows:

a. Administrative Records

(1) The contractor shall maintain medical insurance files for each eligible employee including receipts and proof of paid claims, requests for claim reimbursements, and accounting of paid benefits with balances of amounts remaining in the annual per employee per year reimbursement ceiling.

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

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

Health & Life Insurance for LES Page 29 of 103

(4) The contractor shall provide employee claim reimbursement checks to the COR for disbursement to the employee not later than the Tuesday, which is two weeks after the claim has been submitted.

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

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

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

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

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

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

V.4 Miscellaneous Contractor Requirements

A contract with the U.S. Government conveys no special privileges or immunities to the contractor. The contractor is an independent commercial concern and not a part of the U.S. mission. The contractor's employees are not U.S. Government employees. Registration of this contract with the local government, if required by law, will be the sole responsibility of the contractor, and any fees, taxes, or other duties shall be payable by the contractor without recourse to the Government of the amounts thereof.

V.5 Erroneous Payment

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

V.6 Physical and Information Security Requirements

Health & Life Insurance for LES Page 30 of 103

The contractor shall be responsible for safeguarding all government information provided for contractor use. All material / documentation produced for the USG will be the sole property of the USG. The contractor shall not release any documents to anyone unless authorized by the USG. The following considerations shall be followed by the contractor and/or shall be incorporated into the design documents / shop drawings.

V.6.1 All documents received or generated under the contract are the property of the

USG.

V.6.2 All documents shall be controlled and disseminated on a need-to-know basis.

Reproduction and distribution is prohibited without express approval of the USG.

All design documents generated shall be annotated as follows:

V.6.3 All documents shall be marked and handled in strict accordance with all applicable requirements and regulations. Proposed and actual contract documents shall only be disseminated on a strict need-to-know basis, and shall not be further disseminated without…