19GE5021R0052.Maputo.pdf

19GE5021R0052

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS

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

1. REQUISITION NUMBER

5. SOLICITATION NUMBER

19GE5021R0052

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

DATE

03/31/2021

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

MAPUTCODE15. DELIVER TO

AMERICAN EMBASSY MAPUTO

AV. KENNETH KAUNDA 193, PO BOX 783

ATTN: GSO

MAPUTO, MOZAMBIQUE

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 MAPUTO

AV. KENNETH KAUNDA, 193

ATTN: FINANCIAL MANAGEMENT OFFICE

MAPUTO, MOZAMBIQUE

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 03/31/2021

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

19GE5021R0052

Line Item Summary

Solicitation Number:

19GE5021R0052

Contract Number: Title: MO - Maputo LES Health insurance

Date of Solicitation:

03/31/2021

Line Item No.

Description Quantity Unit Unit Price Total Cost

001 BASE YEAR

LES Health Insurance as per attached Pricing Schedule Type of Contract Pricing:

Doc Ref No:

Delivery Date FOB:

0.00 EA

1001 OPTION YEAR 1

LES Health Insurance as per attached Pricing Schedule Type of Contract Pricing:

Doc Ref No:

Delivery Date FOB:

0.00 EA

2001 OPTION YEAR 2

LES Health Insurance as per attached Pricing Schedule Type of Contract Pricing:

Doc Ref No:

Delivery Date FOB:

0.00 EA

3001 OPTION YEAR 3

LES Health Insurance as per attached Pricing Schedule Type of Contract Pricing:

Doc Ref No:

Delivery Date FOB:

0.00 EA

4001 OPTION YEAR 4

LES Health Insurance as per attached Pricing Schedule Type of Contract Pricing:

Doc Ref No:

Delivery Date FOB:

0.00 EA

19GE5021R0052 Maputo, Mozambique Health Insurance for LES Page 3 of 84

Table of Contents

SECTION 1 – THE SCHEDULE

I BACKGROUND / SCOPE OF SERVICES

II ACRONYMS AND ABBREVIATIONS

III PRICES

IV SPECIFICATIONS / STATEMENT OF WORK

V CONTRACT ADMINISTATIVE REQUIREMENTS AND

PROCEDURES

SECTION 2 – CONTRACT CLAUSES

52.212-4 Contract Terms and Conditions-Commercial

Items (Oct 2018)

52.212-5 – CONTRACT TERMS AND CONDITIONS REQUIRED

TO IMPLEMENT STATUTES OR EXECUTIVE ORDERS –

COMMERCIAL ITEMS (JAN 2021)

52.252-2 – CLAUSES INCORPORATED BY REFERENCE (FEB

1998)

52.204-25 Prohibition on Contracting for Certain

Telecommunications and Video Surveillance

Services or Equipment (Aug 2020)

52.216-4 – ECONOMIC PRICE ADJUSTMENT – LABOR AND

MATERIAL (JAN 2017)

52.216-18 – ORDERING (AUG 2020)

52.216-19 – ORDER LIMITATIONS (OCT 1995)

52.216-21 – REQUIREMENTS (OCT 1995)

52.216-22 – INDEFINITE QUANTITY (OCT 1995)

52.217-5 –EVALUATION OF OPTIONS (JULY 1990)

52.217-8 – OPTION TO EXTEND SERVICES (NOV 1999)

52.217-9 – OPTION TO EXTEND THE TERM OF THE

CONTRACT (MAR 2000)

52.229-12 Tax on Certain Foreign Procurements

(FEB 2021)

652.242-70 – CONTRACTING OFFICER'S REPRESENTATIVE

(COR) AUG 1999)

652.242-73 – AUTHORIZATION AND PERFORMANCE (AUG

1999)

652.243-70 – NOTICES (AUG 1999)

SECTION 3 – SOLICITATION PROVISIONS

52.212-1 INSTRUCTIONS TO OFFERORS – COMMERCIAL

ITEMS (JUN 2020)

B. INFORMATION DEMONSTRATING THE OFFEROR’S

ABILITY TO PERFORM, INCLUDING:

52.216-1 – TYPE OF CONTRACT (APR 1984)

52.252-1 – SOLICITATION PROVISIONS INCORPORATED

BY REFERENCE (FEB 1998)

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652.206-70 – ADVOCATE FOR COMPETITION / OMBUDSMAN

(FEB 2015)

SECTION 4 – EVALUATION FACTORS

52.217-5 – EVALUATION OF OPTIONS (JUL 1990)

52.225-17 – EVALUATION OF FOREIGN CURRENCY OFFERS

(FEB 2000)

SECTION 5 – REPRESENTATIONS AND CERTIFICATIONS

52.212-3 Offeror Representations and

Certifications – Commercial Items (FEB 2021) .. 60

52.204-19- INCORPORATION BY REFERENCE OF

REPRESENTATIONS AND CERTIFICATIONS (DEC

2014)

52.209-11 – REPRESENTATION BY CORPORATONS

REGARDING AN UNPAID TAX LIABILITY OR A

FELONY CRIMINAL CONVITION UNDER ANY FEDERAL

LAW (FEB 2016)

52.222-56 – CERTIFICATION REGARDING TRAFFICKING

IN PERSONS COMPLIANCE PLAN (OCT 2020)

52.204-24 REPRESENTATION REGARDING CERTAIN

TELECOMMUNICATIONS AND VIDEO SURVEILLANCE

SERVICES OR EQUIPMENT (OCT 2020)

52.229-11 Tax on Certain Foreign Procurements—

Notice and Representation (Jun 2020)

652.225-70 – ARAB LEAGUE BOYCOTT OF ISRAEL (AUG

1999)

Attachments:

• Attachment 1 – Pricing

• Attachment 2 – Pricing, Past Performance

• Attachment 3 - IRS Form W-14

• Exhibit A – Employee and Dependent Statistics

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SECTION 1 – THE SCHEDULE

CONTINUATION TO SF-1449

PRICES – BLOCK 23

I BACKGROUND / SCOPE OF SERVICES

The Government of the United States of America (USG) requires Health Insurance for its Locally Employed Staff (LES) and their dependents in Maputo, Mozambique.

The Contractor shall provide the Health Insurance services to employees of the Government of the United States of America in Maputo, as described in Section 1.IV.A and B and the Exhibits attached. The groups of employees who shall be provided this insurance are listed in Section 1.IV.C

A. 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.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 $20,000,000.00.

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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 Maputo 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 performed. If the individual is a medical specialist, then he or she is Board Certified in that specialty

QA

Quality Assurance

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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 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

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(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.

B. 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:

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Attachment 1 Pricing Table will be inserted here with contract award

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CONTINUATION TO SF-1449

SCHEDULE OF SUPPLIES / SERVICES, BLOCK 20

DESCRIPTION / SPECIFICATIONS / WORK STATEMENT

IV SPECIFICATIONS / STATEMENT OF WORK

A. Health Insurance Services

The Government of the United States of America requires Health Insurance coverage for its employees in Maputo, as further described in this Section.

The insurance company will reimburse covered medical expenses incurred, subject to the stated limits. Payment will be made for reasonable and customary costs of covered benefits.

The medical treatment must be prescribed or provided by a physician or nurse licensed in Mozambique, South Africa or in the country in which the treatment or prescription is received.

Coverage of expenses will be made in the local currency, Metical.

The specific health benefit coverage under this contract is set forth in Sub Sections B.1.1 through B.1.22

B. Benefits

B.1. Mandatory / Required Benefits

B.1.1. Hospitalization (treatment in the hospital for inpatient care)

Services and supplies provided during hospitalization, including but not limited to services provided by a licensed healthcare provider, bed & board, 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. 100% Coverage

See Mental, Nervous and Substance Abuse care (below) for details concerning inpatient psychiatric care.

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

B.1.2. Emergency Services (trips to emergency room)

Services provided for conditions that could lead to serious disability or death if not immediately treated, such as accidents or sudden illness.100% Coverage

B.1.3. Ambulance

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. 80% Minimum Coverage

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B.1.4. Outpatient Services:

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 80% Minimum Coverage

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

See Mental Health and Substance Abuse Care (below) for details concerning psychiatric therapy.

B.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).

Inpatient: 100% Coverage; Outpatient: 80% Minimum Coverage

B.1.6. 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.

Inpatient: 100% Coverage; Outpatient: 80% Minimum Coverage

B.1.7. Prescription Drugs

Medications prescribed by a certified 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.

Inpatient: 100% Coverage; Outpatient: 80% Minimum Coverage

B.1.8. Preventive and Wellness and Chronic Disease Management

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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. 80% Minimum Coverage

B.1.9. Hearing Aids

Examinations and Treatment: 80% Minimum Coverage Hearing Aid Apparatus: Minimum of one apparatus per ear up to a minimum of USD 1,500 per covered individual per three-year period. 80% Minimum Coverage

B.1.10. Optical

Examinations and Treatment: 80% Minimum Coverage

Prescription lenses and frames, or contact lenses: Covered up to a minimum of USD 300 per covered individual every two years. 80% Minimum Coverage

B.1.11. Dental

Examination and Treatment: Including but not limited to dentist’s fees, x-rays, examinations and treatment, cleanings, fillings, extractions, false teeth, crowns, and bridges up to a minimum of USD 3,200 per covered individual per contract year. 80% Minimum Coverage

Orthodontia treatment: 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 minimum of USD 2,400 lifetime limit. 80% Minimum Coverage

B.1.12. 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). 80% Minimum Coverage

B.1.13. 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, but is not limited to, 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 50% Minimum Coverage

B.1.14. 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.

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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.

50% Minimum Coverage per beneficiary per year

B.1.15. HIV/AIDS

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. 100% Coverage up to USD 10,000 per contract year per covered individual

B.1.16. Excess Coverage

Additional coverage equal to 40,525 USD to be applied to any covered individual to any covered benefit. Staff must pay 100% of the premium if they elect Excess Coverage. Not applicable to direct reimbursement posts. This can be used for any individual coverage for any covered expense that exceed annual maximum.

B.1.17. Catastrophic Coverage

Additional coverage equal to 40,525 USD per person 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.

B.1.18. 60 Day Extended Dependent Coverage After Employee’s Death

At the time of a covered employee’s death, his/her eligible dependents covered under post’s medical plan as designated in the official personnel file and eligible to temporarily continue receiving the same level of medical coverage for up to 60 days.

B.1.19. Out-country Medical Treatment

Medical expenses incurred out-of-country will be covered at the same benefit levels and subject to the same total maximum annual limit as medical expenses incurred in-country.

B.1.20. Out-country Medical Travel

Transportation for out-of-country medical treatment will be a covered expense for covered employees and eligible family members. To be considered a covered expense, the attending certified health care provider must certify in advance that the treatment is medically necessary and unavailable locally.

Minimum 80% of covered individual’s transportation expenses by the least expensive, appropriate means of transportation to the nearest city with adequate medical facilities will be covered.

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Minimum 80% of the transportation expenses of an attendant will also be covered, but only if the covered individual's attending certified health care provider certifies that an attendant for the patient is necessary, (e.g., a parent in the case of a patient who is a minor, or a family member to make medical decisions in the case of a patient who is unwell or unconscious).

All coverage for transportation for out-of-country medical treatment is subject to the total maximum annual limit. Transportation to a neighboring country without the attending certified health care provider certifying that the treatment is medically necessary and unavailable locally will not be covered.

B.1.21. Employee Assistance Program (EAP)

An Employee Assistance Program (EAP) is a voluntary, work-based program that offers free and confidential assessments, short-term counseling, referrals, and follow-up services to employees who have personal and/or work-related problems.

B.1.22. Annual Limit

The maximum annual coverage per covered individual per contract year, not including expenses covered under HIV/AIDS benefits if selected by post, is 6,600,000 meticais*.

*The official US Department of State Rate of Exchange effective in the solicitation submission date, shall be used to calculate to USD equivalent (ROE and USD amount will be inserted here on the solicitation issuance date)

C. Eligible Participants

C.1. Eligibility

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.

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 employee.

C.2. Dependents

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.

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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.

[Embassy Maputo recognizes civil marriages and municipality recognized common law marriages.]

Dependent Children: 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.

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.

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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.

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.2 REPORTS AND OTHER DELIVERABLES

V.2.1. Brochure

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

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The Contractor assumes full responsibility for ensuring that the document described in V.2.1 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.

V.2.2. 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 Maputo ATTN: Human Resources Office

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

For review 30 days after contract award

After review by the COR

Within 10 calendar days of

COR

hard copy

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Additional copies the COR’s request 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

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

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

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(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.

(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

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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

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, Health Insurance for LES Page 21 of 84

• 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;

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

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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

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): named at time of award US Embassy Maputo, Mozambique

V.9.3 Invoices, Review and Payment

The Contractor shall submit monthly invoices to the Contracting Officer Representative.

A proper invoice must include the following information:

• Contractor's name and bank account information for payments by wire transfers

• Invoice Date

• Contract Number

• Embassy Tax Registration Number (NUIT)

• A summary showing a listing of each member with total monthly price in USD currency for that line. A detailed invoice for each Agency has to be attached to each summary invoice and should include the cost breakdown by each membership fee line according to the pricing schedule

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

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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.

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 the Contracting Officer. Because their coverage is under a rider, their employer is responsible for directly interacting with the Contractor to order any coverage for their employees. When contacted by the employer, the Contractor shall advise the employer of the paperwork and payment that will be necessary to order coverage for the identified individuals.

Because more than one employer may have ORE staff, the Contractor may be contacted by more than one employer (typically the Chief of Mission and Deputy Chief of Mission).

V.11 Choice of Law

This contract shall be construed and interpreted in accordance with the substantive laws of the United States of America. By the execution of this contract, the contractor expressly agrees to waive any rights to invoke the jurisdiction of local national courts where this contract is performed and agrees to accept the exclusive jurisdiction of the United States Civilian Board of Contract Appeals and the United States Court of Federal Claims for hearing and determination of any and all disputes that may arise under the Disputes clause of this contract.

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V.12 Start / Period of Performance

Contract performance is estimated to start in January 2022.

The period of performance is one year, with four possible annual option years.

Option years, if exercised, shall be for twelve (12) months each, commencing at the expiration of the previous period of performance.

The Government may extend this contract in accordance with the option clause in Section 2, FAR 52.217-9, Option to Extend the Term of the Contract - Deviation, which also specifies the total duration of this contract.

The Government may exercise the option set forth at Section 2, "FAR 52.217-8, Option to Extend Services", within the currently ongoing period of performance.

Notwithstanding the expressed contract expiration date, this contract shall remain in full force and effect until the last items or services ordered hereunder have been delivered and accepted by the Government.

V.13 List Of Attachments

Exhibit A Employee Statistic

Attachment 1 Pricing

Attachment 2 Experience / Past Performance

Attachment 3 Form W-14

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SECTION 2 – CONTRACT CLAUSES

52.212-4 Contract Terms and Conditions-Commercial Items (Oct 2018)

(a) Inspection/Acceptance. The Contractor shall only tender for acceptance those items that conform to the requirements of this contract. The Government reserves the right to inspect or test any supplies or services that have been tendered for acceptance. The Government may require repair or replacement of nonconforming supplies or reperformance of nonconforming services at no increase in contract price. If repair/replacement or reperformance will not correct the defects or is not possible, the Government may seek an equitable price reduction or adequate consideration for acceptance of nonconforming supplies or services. The Government must exercise its post-acceptance rights-

(1) Within a reasonable time after the defect was discovered or should have been discovered;

and

(2) Before any substantial change occurs in the condition of the item, unless the change is due to the defect in the item.

(b) Assignment. The Contractor or its assignee may assign its rights to receive payment due as a result of performance of this contract to a bank, trust company, or other financing institution, including any Federal lending agency in accordance with the Assignment of Claims Act (31 U.S.C. 3727). However, when a third party makes payment (e.g.,use of the Governmentwide commercial purchase card), the Contractor may not assign its rights to receive payment under this contract.

(c) Changes. Changes in the terms and conditions of this contract may be made only by written agreement of the parties.

(d) Disputes. This contract is subject to 41 U.S.C. chapter 71, Contract Disputes. Failure of the parties to this contract to reach agreement on any request for equitable adjustment, claim, appeal or action arising under or relating to this contract shall be a dispute to be resolved in accordance with the clause at FAR 52.233-1, Disputes, which is incorporated herein by reference. The Contractor shall proceed diligently with performance of this contract, pending final resolution of any dispute arising under the contract.

(e) Definitions. The clause at FAR 52.202-1, Definitions, is incorporated herein by reference.

(f) Excusable delays. The Contractor shall be liable for default unless nonperformance is caused by an occurrence beyond the reasonable control of the Contractor and without its fault or negligence such as, acts of God or the public enemy, acts of the Government in either its sovereign or contractual capacity, fires, floods, epidemics, quarantine restrictions, strikes, unusually severe weather, and delays of common carriers. The

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Contractor shall notify the Contracting Officer in writing as soon as it is reasonably possible after the commencement of any excusable delay, setting forth the full particulars in connection therewith, shall remedy such occurrence with all reasonable dispatch, and shall promptly give written notice to the Contracting Officer of the cessation of such occurrence.

(g) Invoice.

(1) The Contractor shall submit an original invoice and three copies (or electronic invoice, if authorized) to the address designated in the contract to receive invoices. An invoice must include-

(i) Name and address of the Contractor;

(ii) Invoice date and number;

(iii) Contract number, line item number and, if applicable, the order number;

(iv) Description, quantity, unit of measure, unit price and extended price of the items delivered;

(v) Shipping number and date of shipment, including the bill of lading number and weight of shipment if shipped on Government bill of lading;

(vi) Terms of any discount for prompt payment offered;

(vii) Name and address of official to whom payment is to be sent;

(viii) Name, title, and phone number of person to notify in event of defective invoice; and

(ix) Taxpayer Identification Number (TIN). The Contractor shall include its TIN on the invoice only if required elsewhere in this contract.

(x) Electronic funds transfer (EFT) banking information.

(A) The Contractor shall include EFT…