19GE5021R0014-.pdf

19GE5021R0014

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS

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

1. REQUISITION NUMBER

5. SOLICITATION NUMBER

19GE5021R0014

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

DATE

01/05/2021

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

X

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

PORTMCODE15. DELIVER TO

AMERICAN EMBASSY PORT MORESBY

DOUGLAS STREET, P.O. BOX 1492

ATTN: GSO

PORT MORESBY, PAPUA NEW GUINEA

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 PORT MORESBY

DOUGLAS STREET, P.O. BOX 1492

ATTN: GSO

PORT MORESBY, PAPUA NEW GUINEA

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 01/05/2021

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:

19GE5021R0014

Contract Number: Title: PP-Port Moresby Health and Life Insurance

Date of Solicitation:

01/05/2021

Line Item No.

Description Quantity Unit Unit Price Total Cost

001 BASE YEAR HEALTH INSURANCE

inclusive of the following Sub CLINs:

0001A Single Employees (Self Only); 0001B Employee+1; 0001C Family Plan (3 or more individuals) Type of Contract Pricing:

Doc Ref No:

Delivery Date FOB:

0.00 EA

002 BASE YEAR LIFE INSURANCE

Type of Contract Pricing:

Doc Ref No:

Delivery Date FOB:

0.00 EA

1001 OPTION YEAR 1 HEALTH INSURANCE

inclusive of the following Sub CLINs:

1001A Single Employees (Self Only); 1001B Employee +1; 1001C Family Plan (3 or more individuals) Type of Contract Pricing:

Doc Ref No:

Delivery Date FOB:

0.00 EA

1002 OPTION YEAR 1 LIFE INSURANCE

Type of Contract Pricing:

Doc Ref No:

Delivery Date FOB:

0.00 EA

2001 OPTION YEAR 2 HEALTH INSURANCE

inclusive of the following Sub CLINs:

2001A Single Employees (Self Only); 2001B Employee +1; 2001C Family Plan (3 or more individuals) Type of Contract Pricing:

Doc Ref No:

Delivery Date FOB:

0.00 EA

2002 OPTION YEAR 2 LIFE INSURANCE

Type of Contract Pricing:

Doc Ref No:

Delivery Date FOB:

0.00 EA

3001 OPTION YEAR 3 HEALTH INSURANCE

inclusive of the following Sub CLINs:

3001A Single Employees (Self Only); 3001B Employee +1;

3001C Family Plan (3 or more individuals) Type of Contract Pricing:

Doc Ref No:

Delivery Date FOB:

0.00 EA

3002 OPTION YEAR 3 LIFE INSURANCE

Type of Contract Pricing:

Doc Ref No:

Delivery Date FOB:

0.00 EA

4001 OPTION YEAR 4 HEALTH INSURANCE

inclusive of the following Sub CLINs:

4001A Single Employees (Self Only); 4001B Employee +1;

4001C Family Plan (3 or more individuals) Type of Contract Pricing:

Doc Ref No:

Delivery Date FOB:

0.00 EA

4002 OPTION YEAR 4 LIFE INSURANCE

Type of Contract Pricing:

Doc Ref No:

0.00 EA

Line Item Summary

Solicitation Number:

19GE5021R0014

Contract Number: Title: PP-Port Moresby Health and Life Insurance

Date of Solicitation:

01/05/2021

Line Item No.

Description Quantity Unit Unit Price Total Cost

Delivery Date FOB:

5000 VAT (if appplicable) Type of Contract Pricing:

Doc Ref No:

Delivery Date FOB:

0.00 EA

19GE5021R0014 Port Moresby, Papua New Guinea Health & Life Insurance for LES Page 4 of 87

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

• Exhibit A – Employee Statistics

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 87

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 (USG) requires Health and Life Insurance for its Locally Engaged Staff (LES) and their dependents in Papua New Guinea. In Solomon Islands, the USG, requires Health Insurance for LES and their dependents only, with no Life Insurance coverage for Solom Islands.

The Contractor shall provide the Health Insurance services to employees of the Government of the United States of America in Papua New Guinea and Solomons Islands, as described in Section 1.IV.A and the Exhibits attached. The groups of employees who shall be provided this insurance are listed in Section 1.IV.A.2.

The Contractor shall provide the Life Insurance services to employees of the Government of the United States of America in Papua New Guinea as described in Section 1.IV.B and the Exhibits attached. The groups of employees who shall be provided this insurance are listed in Section 1.IV.B.2

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 and B are listed in Section1.III.C

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 $1,000,000.00.

Health & Life Insurance for LES Page 6 of 87

II ACRONYMS AND ABBREVIATIONS

Acronym Definition

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

Employer The United States Government = USG

Employee Staff member of the US Embassy Praia 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.

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

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

Health & Life Insurance for LES Page 7 of 87 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 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

Health & Life Insurance for LES Page 8 of 87 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.

B. VAT – if applicable, the contractor shall be responsible for paying to the appropriate authority the applicable rate of Value Added Tax (VAT). Offerors shall identify the VAT as a separate line item. The VAT shall also be a separate cost item on all invoices submitted against task orders under the resulting contract. The contractor will be reimbursed for VAT only up to the amount listed in each task order and upon presentation of proof that VAT has been paid to the host country government. If the contractor receives a VAT refund from the host government he shall re-pay the refund amount to the US Government.

C. Offeror, insert the currency of prices offered __________________

The fixed prices / premium rates for the health insurance services as specified in Section IV are as follows:

Health & Life Insurance for LES Page 9 of 87

Number of employees is an estimate only, based on the current situation and subject to change

BASE YEAR

Sub-CLIN Description

Number of

Employees

Rate per month Rate per Year Subtotal

0001A Health Insurance Single Employees (Self Only) 13 0 -

0001B Health Insurance Employee + 1 11 0 -

0001C Health Insurance Family Plan (three or more individuals) 76 0 -

0002 Life Insurance 100

TOTAL BASE YEAR

OPTION YEAR 1

Sub-CLIN Description

Number of

Employees

Rate per month Rate per Year Subtotal

1001A Health Insurance Single Employees (Self Only) 13 0 -

1001B Health Insurance Employee + 1 11 0 -

1001C Health Insurance Family Plan (three or more individuals) 76 0 -

1002 Life Insurance 100

TOTAL OPTION YEAR 1

OPTION YEAR 2

Sub-CLIN Description

Number of

Employees

Rate per month Rate per Year Subtotal

2001A Health Insurance Single Employees (Self Only) 13 0 -

2001B Health Insurance Employee + 1 11 0 -

2001C Health Insurance Family Plan (three or more individuals) 76 0 -

2002 Life Insurance 100

TOTAL OPTION YEAR 2

OPTION YEAR 3

Sub-CLIN Description

Number of

Employees

Rate per month Rate per Year Subtotal

3001A Health Insurance Single Employees (Self Only) 13 0 -

3001B Health Insurance Employee + 1 11 0 -

3001C Health Insurance Family Plan (three or more individuals) 76 0 -

3002 Life Insurance 100

TOTAL OPTION YEAR 3

OPTION YEAR 4

Sub-CLIN Description

Number of

Employees

Rate per month Rate per Year Subtotal

4001A Health Insurance Single Employees (Self Only) 13 0 -

4001B Health Insurance Employee + 1 11 0 -

4001C Health Insurance Family Plan (three or more individuals) 76 0 -

4002 Life Insurance 100

TOTAL OPTION YEAR 4

Sub Total -

VAT (if applicable)percentage: ______

TOTAL ESTIMATED CONTRACT AMOUNT-

CURRENCY:

Health & Life Insurance for LES Page 10 of 87

CONTINUATION TO SF-1449

SCHEDULE OF SUPPLIES / SERVICES, BLOCK 20

DESCRIPTION / SPECIFICATIONS / WORK STATEMENT

IV SPECIFICATIONS / STATEMENT OF WORK

A Part I – HEALTH INSURANCE

A.1 The U.S. Embassy, Papua New Guinea and the Consular Agency, Solomon Islands requires Health Insurance coverage for its locally employed staff (LES). This benefit is only for all the current active employees of the USG. The US Government will pay 100% of the premiums of the LES to the contractor.

The Official Residence staff (ORE) at the Chief of Mission (COM) and Deputy Chief of Mission Residences (DCM) shall be covered under a rider to the contract. The COM and DCM, not the United States Government (USG), employ official Residence staff. The employer, COM and DCM is responsible for the employer's share of the premium costs for an ORE employee. The U.S. Embassy American Employee Association (AEA) employees will be covered under a rider too, in this contract. The AEA, not the USG, is responsible for the employer's share of the premium costs for an AEA employee. The COM, DCM and AEA will pay 100% of the premiums of their employees to the contractor.

(See also Sub Section V.10.4 Riders)

The specific health benefit coverage will be as per the Global Medical Coverage (GMC) agreed benefits by U.S. Embassy Port Moresby and GMT/OE. Medical insurance premiums under GMC shall be based on the number of individuals covered: - Self-Only, Self Plus One (two individuals) and Family (three or more individuals).

A.2 Eligibility

To be eligible to participate in the GMC medical plan, LE Staff must be:

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

a. Under a non-temporary direct hire appointment, personal services agreement

(PSA), or personal services contract (PSC); or

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

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

- 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.

Health & Life Insurance for LES Page 11 of 87

Note: 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.

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

Ineligible employees for post Health Insurance

a. LE Staff working under temporary appointments.

b. Staff working under a PSA or PSC that is time limited to less than one year.

c. Staff with a When Actually Employed (WAE) workweek schedule.

d. Non-personal services contract personnel and their employees, supplied by an independent contractor licensed to do business in the Papua New Guinea and Solomon Island who provide services to other local organizations as well as to the U.S. Mission.

e. Employees of USAID institutional contractors; and Peace Corps personal services contractors as indicated in MS 743.

The annual maximum limit per member is Papua New Guinea Kina (PGK) 65,000 or Solomon Island dollar (SBD) $156,796.95. The maximum annual reimbursement per covered member during the contract year, not including expenses covered under HIV/AIDS benefits or defined under Exclusions and Limitations, is PGK 65,000 or SBD$156,796.95. This amount is denominated in the currency of the Local Compensation Plan (LCP).

Post requests, a performance period of one (1) base year with four (4) options years.

A.3 Mandatory Health Benefits under GMC:

For employer provided benefits listed below, the percentages refer to minimum coverage levels.

1) Hospitalization services; The employer will pay 100% of the bill - Services and supplies provided during hospitalization, including services provided by a licensed healthcare provider, bed and board (semi-private accommodations), operating room, recovery room, intensive care, imaging and diagnostic testing, 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

2) Emergency Services (trips to emergency room); The employer will pay 100% of the bill. Services provided for conditions that could lead to serious disability or death if not immediately treated, such as accidents or sudden illness.

Health & Life Insurance for LES Page 12 of 87

3) Ambulance Services; The employer will pay 80% of the bill and the employee 20%.

The requirement is to get a 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.

4) Professional Services; Under Outpatient Services, the employer will pay 80% of the bill and the employee 20%. Services provided by a licensed healthcare provider on an ambulatory or outpatient basis (without being admitted to a hospital), including surgeon’s fees and other medical services that may be provided at a hospital, clinic, doctor’s office, medical facility, etc. Examples include, but are not limited to:

- Annual physical examinations

- Specialist consultations and treatment, including second surgical opinion

- Minor surgical interventions

- Chemotherapy and radiation treatments

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

Organization

- Diagnostic tests and diagnostic imaging.

5) a) The inpatient and outpatient services in this CLIN 5a) i to ii; the employer will pay 50% of the bill and the employee 50%

i) Physical Therapy Under Rehabilitative and Habilitative Services and Devices

ii) Psychiatric Therapy Under Mental Health and Substance Abuse care

b) The Inpatient services listed in this CLIN 5b) i) to iii); the employer will pay 100% of the bill and for outpatient services in this CLIN 5b i) to iii) the employer will pay 80% of the bill and the employee 20%

i) Obstetric/Newborn 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 inpatient care. All other treatments will be considered outpatient.

ii) Pediatric Services 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

iii) Prescription Drugs Medications prescribed by a licensed health care provider that are medically necessary. Examples include, but are not limited to: prescription antibiotics to treat an infection; medication used to treat an ongoing condition, such as high cholesterol; prophylaxis; or contraceptive medication.

Health & Life Insurance for LES Page 13 of 87

6) Preventative and Wellness and Chronic Disease Management Counseling or preventative 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. The employer will pay 80% and the employee 20%.

7) Hearing Aids Hearing aid apparatus and related examinations and treatment. Limited to one apparatus per ear up to a maximum of USD1500 per covered individual per three-year period - The employer will pay 80% of the bill and the employee 20%.

8) Optical Care Eye examination, treatment, and prescription lenses and frames, or contact lenses up to a maximum of USD150 per covered individual per contract year - The employer will pay 80% of the bill and the employee 20%.

9) Dental Care Dentist’s fees, x-rays, examinations and treatment, cleanings, fillings, extractions, false teeth, crowns, and bridges per covered individual up to a maximum of USD460 per contract year. Orthodontia treatment is covered only if treatment begins before age 18, or if required as the result of an accident. A maximum of four years of orthodontia treatment will be covered per covered individual up to a maximum of USD2400 lifetime limit - The employer will pay 80% of the bill and the employee 20%.

10) Reproductive Health 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) - The employer will pay 80% of the bill and the employee 20%.

11) Mental Health and Substance Abuse Care Inpatient and outpatient care provided to evaluate, diagnose and treat a mental health condition or substance abuse disorder.

This includes behavioral health treatment, counseling, and psychotherapy. Services must be provided by a licensed psychiatrist, psychoanalyst, psychologist, or psychiatric social worker. Inpatient care for alcohol and substance abuse must be carried out at a facility licensed for detoxification and rehabilitation - The employer will pay 50% of the bill and the employee 50%.

12) Rehabilitative and Habilitative Services and Devices Rehabilitative services (e.g., recovering skills, such as speech therapy after a stroke or physical therapy after an accident) and habilitative services (e.g., developing skills, such as speech therapy for children) that help develop skills needed for everyday life. Devices to help gain or recover mental or physical skills lost due to injury, disability or a chronic condition, and devices needed for habilitative reasons - The employer will pay 50% of the bill and the employee 50%.

13) HIV/AIDS the employer will pay 100% of the bill up to USD 10,000 per coverage year per covered individual. If local medical benefit plans do not provide HIV/AIDS treatment coverage at the minimum level defined below, or is prohibitively expensive, this category of benefits will be mandatory.

Health & Life Insurance for LES Page 14 of 87

Medications to suppress opportunistic infections (such as tuberculosis or toxoplasmosis for covered individuals who have HIV/AIDS). Brief courses of anti-retroviral drugs during childbirth to prevent the transmission of HIV/AIDS to the child. Generally excludes medication for the long-term suppression of HIV/AIDS through the combination of anti-retroviral drugs in locations with inadequate local healthcare infrastructures. This will be invoiced separately and patients identified by numbering or codes by the provider, Post Human Resources office, Finance and procurement.

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, micro surgical 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.

B. PART II – GROUP LIFE INSURANCE

B.1 The Government of the United States of America requires group life insurance coverage for its locally employed staff in the US Embassy, Papua New Guinea. This benefit is only for all the current active LES employees of the USG.The US Government will pay 100% of the premium to the contractor.

The Official Residence staff (ORE) at the Chief of Mission (COM) and Deputy Chief of Mission Residences (DCM) shall be covered under a rider to the contract. The COM and DCM, not the United States Government (USG), employ official Residence staff. The employer, COM and DCM is responsible for the employer's share of the premium costs for an ORE employee. The U.S. Embassy American Employee Association (AEA) employees shall also be covered under a rider to the contract. The AEA, not the USG, is responsible for the employer's share of the premium costs for an AEA employee. The COM, DCM and AEA will pay 100% of the premium to the contractor.

(See also Sub Section V.10.4 Riders)

B.2 Eligibility

Eligible Employees

Eligible employees are Locally Employed (LE) Staff who are (1) working on a full-time or part-time basis under non-temporary direct-hire appointments and under personal services

Health & Life Insurance for LES Page 15 of 87 agreements/contracts that are not time limited to less than one year and (2) paid under the terms of the Local Compensation Plan. Dependents are not covered. Retirees are not covered.

Ineligible Employees for Life Insurance;

a. LE Staff working under temporary appointments.

b. Staff working under a PSA or PSC that is time limited to less than one year.

c. Staff with a When Actually Employed (WAE) workweek schedule.

d. Non-personal services contract personnel and their employees, supplied by an independent contractor licensed to do business in the Papua New Guinea who provide services to other local organizations as well as to the U.S. Mission.

e. Employees of USAID institutional contractors; and Peace Corps personal services contractors as indicated in MS 743.

B.3 Benefits:

I. Premium Costs: The USG will pay 100% of the premium costs.

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

(1) Natural Death: 12 times the monthly basic salary

(2) Accidental Death: 12 times the monthly basic salary

III. Disability Benefit: Post does not provide disability benefits.

IV. Funeral Benefit: Post does not provide funeral benefits.

V. i. Definitions:

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

VI. Currency: Premiums and benefits will be paid in local currency VII. 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 no-declared war of any martial operations or invasion, hostile acts of foreign powers, rebellion, riot, civil war, uprising, mutiny, operations by military or usurpatory authorities, martial law or state of siege or any other similar event or reason for declaring martial law or war. A terrorist attack shall not be considered war.

No benefit shall be payable under this contract if the employee’s bodily injuries have been caused directly or indirectly and totally or partially by:

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.

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V CONTRACT ADMINISTATIVE REQUIREMENTS AND PROCEDURES

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.

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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.

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 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 10 (ten) 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.

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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.

(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 Port Moresby ATTN: Human Resources Officer

TBA

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 1

Additional copies

For review 30 days after contract award

After review by the COR

Within 10 calendar days of the COR’s request

COR

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

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Basic supply

Additional copies

30 days after contract award

Within 10 calendar days of the COR’s request

COR

mail, hard copy 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

e-mail, pdf document para V.7 Final version of Management Plan

1 ea 15 calendar days after receipt of contract award

COR

e-mail, pdf document

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.

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

(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.

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V.6 Physical and Information Security Requirements

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 prior authorization from the USG.

V.6.4 Those receiving any type of proposed and / or actual contract documents shall be responsible for these materials while in their possession, or that of any of their subcontractors. They shall return all documents, including all copies, promptly upon demand by the USG.

V.7 Contractor Management Plan

Offerors shall submit a draft version of their management plan as part of their proposal. The contractor shall submit the final version no later than 15 calendar days after receipt of a contract award.

V.7.1 The contractor’s management plan shall:

• describe the organization of the work force,

• specify the names and responsibilities of the principal manager and the supervisors under this project,

• indicate the manner in which the contractor assures quality documents and service,

• state the frequency of inspections and the use of operational records

• include organizational and functional charts reflecting the line of management responsibility

V.7.2 Inspection System – The contractor’s management plan shall establish an inspection system covering all services stated in Section 1, The Schedule. The inspection system shall:

a. specify areas to be inspected on a scheduled basis;

b. include a method of identifying deficiencies in the quality of supplies (reports) and

/ or services before the level of performance becomes unacceptable;

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c. include a filing system for all inspections conducted by the contractor and the corrective action taken.

This documentation shall be made available to the USG during the term of the contract.

The contractor shall obtain the COR’s approval prior to making any changes in its management plan. If directed by the COR, the contractor shall submit said changes in writing as a proposal for Government review and approval / disapproval.

V.8 Laws And Regulations

V.8.1 Compliance Required – If the contractor has or will establish a local office, he shall, without additional expense to the USG, be responsible for complying with all laws, codes, ordinances, and regulations applicable to the performance of the work, including those of the host country, and with the lawful orders of any governmental authority having jurisdiction.

V.8.2 Labor, Health and Safety Laws and Customs – If the contractor has or will establish a local office, he shall comply with all local labor laws, regulations, customs and practices pertaining to labor, safety, and similar matters, to the extent that such compliance is not inconsistent with the requirements of this contract.

V.8.3 A contract with the USG 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 USG employees. Registration of this contract with the host country 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 USG of the amounts thereof.

V.8.4 The only items that the USG will consider for price adjustments are those that are mandated e.g. changes in the VAT rate (if applicable) or minimum hourly wage rate.

V.9 Contract Administration Data

V.9.1 Authority of the Contracting Officer – All work shall be performed under the general direction of the Contracting Officer, who alone shall have the power to bind the Government and to exercise the rights, responsibilities, authorities and functions vested by the contract, except that the Contracting Officer and the Procurement Executive shall have the right to designate authorized representatives to act for the Contracting Officer, as specifically provided in the designation of that individual, such as the COR.

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V.9.2 Government Personnel

Contracting Officer: Eric N. Moore

Contract Administrator: Wencke Jacobsen E-mail address: JacobsenW@state.gov

Contracting Officer's Representative (COR): TBA HRO, Port Moresby, Papua New Guinea

V.9.3 Invoices, Review and Payment

Invoices shall be issued monthly. Value Added Tax (VAT), if applicable, shall be a separate line item on each invoice.

Each invoice shall include the items listed in Section 2, FAR 52.212-4 g.1.

Payment shall be made in the currency the contractor specified in Section1.III.C Prices.

V.9.4 Advance Payment shall not be authorized under this contract.

V.9.5 Changes In Ownership – The contractor shall furnish the COR advance notification (90 calendar days prior to the effective date) of any disposition or the change in ownership or terms of lease of any facilities utilized by him for performance of any service under this contract.

V.10 Funding / Task Orders / Procedures

V.10.1 The contract remains unfunded; funding will be provided by issuing annual task orders with possible modification for staffing changes. Each task order will contain the following information:

• Name of contractor

• Contract number

• Date of purchase

• Task order number

• Name of person placing the order

• Quantity, unit price, and total price of each service / insurance rate

• VAT or other taxes as a separate item, if applicable

• COR and post points of contact, including e-mail addresses

• applicable contract clauses, either in reference or in full text if necessary

V.10.2 Only an RPSO Contracting Officer may place a written order.

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V.10.3 Ordering Procedures – The Government shall issue annual funded task orders to cover all eligible employees and their dependents. No task order shall include any names or PII (personally identifiable information). The COR informs the contracting officer if any additions or deletions are required throughout the year and the Contracting Officer will issue funded modifications as required.

V.10.4 Riders - The ORE staff and AEA employees under separate riders are not included under the task orders issued by…