19GE5022R0048.pdf

19GE5022R0048

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS

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

1. REQUISITION NUMBER

5. SOLICITATION NUMBER

19GE5022R0048

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

DATE

03/10/2022

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

ANKARCODE15. DELIVER TO

AMERICAN EMBASSY ANKARA

110 ATATURK BLVD

ATTN: AMERICAN EMBASSY ANKARA

ANKARA, TURKEY 06100

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 ANKARA

110 ATATURK BLVD

ATTN: FMC

ANKARA, TURKEY 06100

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 03/10/2022

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

19GE5022R0048

Line Item Summary

Solicitation Number:

19GE5022R0048

Contract Number: Title: TU - Ankara LES Health Insurance

Date of Solicitation:

03/10/2022

Line Item No.

Description Quantity Unit Unit Price Total Cost

001 BASE YEAR

LES Health Insurance inclusive if Sub CLINs 001A Single Employee (Self Only) 001B Employee plus one (two individuals) 001C Family (three or more individuals) Type of Contract Pricing:

Doc Ref No:

Delivery Date FOB:

0.00 EA

1001 OPTION YEAR ONE

LES Health Insurance inclusive if Sub CLINs 1001A Single Employee (Self Only) 1001B Employee plus one (two individuals) 1001C Family (three or more individuals) Type of Contract Pricing:

Doc Ref No:

Delivery Date FOB:

0.00 EA

2001 OPTION YEAR TWO

LES Health Insurance inclusive if Sub CLINs 2001A Single Employee (Self Only) 2001B Employee plus one (two individuals) 2001C Family (three or more individuals) Type of Contract Pricing:

Doc Ref No:

Delivery Date FOB:

0.00 EA

19GE5021R0048 Ankara, Turkey Health Insurance for LES Page 3 of 83

Table of Contents

SECTION I – THE SCHEDULE

A. BACKGROUND / SCOPE OF SERVICES

B. PRICES

C. SPECIFICATIONS / STATEMENT OF WORK

C.1. HEALTH INSURANCE SERVICES

MANDATORY BENEFITS:

OPTIONAL BENEFITS WITH SEPARATE ANNUAL MAXIMUM LIMITS: .. 12

C.2 OVERALL ANNUAL MAXIMUM LIMIT:

C.3 HEALTH BENEFITS EXCLUSIONS and LIMITATIONS

C.4 ELIGIBLE PARTICIPANTS

C.5 Individuals Not Eligible for Coverage C.6 Dependents:

C.7. Eligibility

C.8. BROCHURE REQUIREMENT

C.9 ACCRONYMS AND ABBREVIATIONS

D. CONTRACT ADMINISTATIVE REQUIREMENTS AND

PROCEDURES

SECTION II – CONTRACT CLAUSES

52.212-4 Contract Terms and Conditions-Commercial

Items (NOV 2021)

52.212-5 – CONTRACT TERMS AND CONDITIONS REQUIRED

TO IMPLEMENT STATUTES OR EXECUTIVE ORDERS –

COMMERCIAL ITEMS (JAN 2022)

52.252-2 – CLAUSES INCORPORATED BY REFERENCE (FEB

1998) 52.204-25 Prohibition on Contracting for Certain

Telecommunications and Video Surveillance

Services or Equipment (Nov 2021)

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)

52.223-99 Ensuring Adequate COVID-19 Safety

Protocols for Federal Contractors (OCT 2021)

(DEVIATION)

52.229-12 Tax on Certain Foreign Procurements

(FEB 2021)

Health Insurance for LES Page 4 of 83

652.232-70 Payment Schedule and Invoice

Submission (Fixed-Price) (AUG 1999)

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 III– SOLICITATION PROVISIONS

52.212-1 INSTRUCTIONS TO OFFERORS – COMMERCIAL

ITEMS (NOV 2021)

INSTRUCTIONS TO OFFERORS

Submission of questions Proposal Due Date Pre-Proposal Conference

52.216-1 – TYPE OF CONTRACT (APR 1984)

52.252-1 – SOLICITATION PROVISIONS INCORPORATED

BY REFERENCE (FEB 1998)

652.206-70 – ADVOCATE FOR COMPETITION / OMBUDSMAN

(FEB 2015)

SECTION IV – EVALUATION FACTORS

52.212-2 Evaluation—Commercial Products and

Commercial Services (Nov 2021)

52.217-5 – EVALUATION OF OPTIONS (JUL 1990)

52.225-17 – EVALUATION OF FOREIGN CURRENCY OFFERS

(FEB 2000)

SECTION V – REPRESENTATIONS AND CERTIFICATIONS

52.212-3 Offeror Representations and

Certifications – Commercial Items (NOV 2021) .. 64

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 (NOV 2021)

52.229-11 Tax on Certain Foreign Procurements—

Notice and Representation (Jun 2020)

652.225-70 – ARAB LEAGUE BOYCOTT OF ISRAEL (AUG

1999)

Health Insurance for LES Page 5 of 83

Attachments:

• Attachment 1 – Pricing

• Attachment 2 – Pricing, Past Performance

• Attachment 3 - IRS Form W-14

• Exhibit A – Employee Statistics

Health Insurance for LES Page 6 of 83

SECTION I – THE SCHEDULE

CONTINUATION TO SF-1449

PRICES – BLOCK 23

A. BACKGROUND / SCOPE OF SERVICES

1. The Government of the United States of America (USG) requires Health

Insurance for its Locally Employed Staff (LES) and their dependents at US Mission Turkey. The Contractor shall provide the Health Insurance services, as described in Section I.C. Specifications / Satememt of Work. The groups of employees who shall be provided this insurance are listed in Section I.C.4 Eligible Participants

2. 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 I.C. Specifications / Satememt of Work are listed in Section I.B. Prices.

3. 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 100 enrollees.

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 100 enrollees.

The maximum value during the entire life of this contract is 3,500 enrollees.

B. PRICES

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.

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

Health Insurance for LES Page 7 of 83

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

No adjustment will be allowed during the first twelve months.

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

(1) receipts (premiums received),

(2) number of insurance policies and

(3) claims paid.

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

The USG reserves the right to have an independent third party review the balance sheet and claims and make recommendations regarding the appropriateness of the requested adjustment. Any adjustment shall be subject to mutual agreement of the parties and shall result in a written modification to the contract effective for the following option year. Any failure to reach agreement under this clause shall be subject to the procedures in the Disputes clause.

3. 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.

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.

4. VAT – Value Added Tax Is not applicable, as Embassy Ankara holds a VAT exemption certificate.

5. The contract will be issued in Turkish Lira. Offerors shall quote their prices in Turkish Lira.

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

Health Insurance for LES Page 8 of 83

Attachment 1 Pricing Table will be inserted here with contract award

Health Insurance for LES Page 9 of 83

CONTINUATION TO SF-1449

SCHEDULE OF SUPPLIES / SERVICES, BLOCK 20

DESCRIPTION / SPECIFICATIONS / WORK STATEMENT

C. SPECIFICATIONS / STATEMENT OF WORK

C.1. HEALTH INSURANCE SERVICES

The Government of the United States of America (USG) requires Health Insurance coverage for its employees as further described in in this section.

Retired employees are 100% responsible for the premium costs for themselves and their dependents. (See C.4.3 Participants and Benefits Covered Under a Rider)

The premium costs for any optional benefits, if elected, are 100% the responsibility of the employee or retiree. (See C.4.3 Participants and Benefits Covered Under a Rider)

Medical insurance premiums will be based on the number of individuals covered:

- Self-Only (1 covered individual)

- Self Plus One (two individuals)

- Family (three or more individuals)

During a period of Leave Without Pay (LWOP) or unpaid leave that is one pay period or less, coverage under the insurance contract will continue. During a period of extended (beyond one pay period) Leave Without Pay (LWOP) or unpaid leave, the employee is responsible for the full cost of the insurance premiums for self and dependents. The Mission will pay the premiums directly to the Contractor and will collect the full cost from the employee. Alternatively, the employee may elect to have coverage cease if the employee prefers not to pay the premium.

The Contractor shall ensure that health care under this contract does not exclude HIV/AIDS care.

C.1.1 EMPLOYEE and DEPENDENT HEALTH SERVICES BENEFIT

MANDATORY BENEFITS:

C.1.1.1. Hospitalization (Treatment in the Hospital for Inpatient Care):

Reimbursement Rate for Inpatient /Emergency - 100%

Services and supplies provided during hospitalization, including services provided by a licensed healthcare provider, bed & board (semi-private accommodations), operating room, recovery room, intensive care, imaging and diagnostic testing, general hospital nursing care, physical therapy, as well as drugs and medicines administered while in-patient. When private

Health Insurance for LES Page 10 of 83 accommodations are provided, coverage will be limited to the cost of a semi-private room unless otherwise covered in an off the shelf plan.

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

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

C.1.1.2 Emergency Services (Trips to Emergency Room):

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

C.1.1.3. Ambulance:

Reimbursement Rate - 80% 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.

C.1.1.4 Outpatient Services:

Reimbursement Rate - 80% 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 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

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.

C.1.1.5 Obstetric and Newborn Care:

Reimbursement Rate for Inpatient Emergency/Inpatient - 100%; for Outpatient - 80% Care and services that women receive during pregnancy (prenatal care), throughout labor, delivery, and post-delivery, and outpatient care for newborn babies. Hospitalization during pregnancy and/or delivery will be covered as Hospitalization (treatment in the hospital for inpatient care). All other treatments will be considered outpatient services and reimbursed as such.

C.1.1.6 Pediatric Services:

Reimbursement Rate for Inpatient /Emergency - 100%; for Outpatient - 80%

Health Insurance for LES Page 11 of 83

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.

C.1.1.7 Prescription Drugs:

Reimbursement Rate for Inpatient /Emergency - 100%; for Outpatient - 80% 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, and contraceptive medication.

C.1.1.8 Preventive and Wellness Services and Chronic Disease Management:

Reimbursement Rate -80% Counseling or preventive care designed to prevent or detect medical conditions and care for chronic conditions such as asthma and diabetes. Examples include, but are not limited to:

physicals, immunizations, and cancer screenings.

C.1.1.9 Hearing Aids:

Reimbursement Rate - 80% Hearing Aid Apparatus: Limited to one apparatus per ear up to a maximum of USD 1,500 per covered individual per three-year period. 80% Minimum Coverage; with annual cap

C.1.1.10 Optical Care:

Reimbursement Rate - 80% Eye examination, treatment: 80% Prescription lenses and frames or contact lenses: Covered up to a maximum of USD 300 per covered individual very two years. 80% Minimum Coverage; with annual cap

C.1.1.11 Dental Care:

Reimbursement Rate - 80% Examinations and Treatment: Dentist’s fees, x-rays, examinations and treatment, cleanings, fillings, extractions, false teeth, crowns, and bridges up to a maximum of USD 900 per covered individual per contract year. 80% Minimum Coverage; with annual cap 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 USD 900 lifetime limit. 80% Minimum Coverage; with contract lifetime cap.

[Note: C.1.1.9, C.1.1.10, C.1.1.11, C.1.1.15, C.1.1.17 will be converted to local currency using the DOS exchange rate for the date of solicitation posting.]

C.1.1.12 Reproductive Health:

Reimbursement Rate - 80% 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).

Health Insurance for LES Page 12 of 83

C.1.1.13 Mental Health and Substance Abuse Care:

Reimbursement Rate - 50% 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.

C.1.1.14 Rehabilitative and Habilitative Services and Devices:

Reimbursement Rate - 50% 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.

C.1.1.15 HIV/AIDS:

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

OPTIONAL BENEFITS WITH SEPARATE ANNUAL MAXIMUM LIMITS:

Employees have the option of electing the benefits outlined under 1.1.17 at the beginning of the contract and may then subsequently opt in/out at the time of each extension.

C.1.1.17 Excess Coverage:

NOTE: Employee responsible for paying 100% of premium for Excess Coverage

Additional coverage equal to USD 28,000 per covered individual per contract year. This excess coverage will be offered as an optional benefit to LE Staff. This can be used for any covered individual for any covered expense that exceeds annual maximum. LE Staff must pay 100% of the premium if they elect Excess Coverage.

[This shall be priced separately in the pricing sheet tab B.Rider and Optional services]

C.1.1.18 90 Day Extended Coverage for Dependents After Employee’s Death

At the time of a covered employee’s death, his/her eligible dependents covered under post’s medical plan are eligible to continue receiving the same level of medical coverage for up to 90 days. This optional benefit is subject to availability of funds at post (Agency) and no extensions are permitted. If the Option year ends within these 90 days, the dependents' policy will be ceased and will not be renewed in the next option year.

Health Insurance for LES Page 13 of 83

C.2 OVERALL ANNUAL MAXIMUM LIMIT:

The maximum annual coverage per covered individual per contract year, not including expenses covered under HIV/AIDS benefits if selected by post, is USD 28,000. Basic Rates are denominated in USD and paid in Turkish Lira. The overall maximum annual reimbursement limit will be converted to TL and the rate of exchange will be used from the Department of State (DOS) exchange rate for the date of solicitation posting.

[Note: C.2, Overall Annual Maximum Limit Will be converted to local currency using the DOS exchange rate for the date of solicitation posting.]

C.3 HEALTH BENEFITS EXCLUSIONS and LIMITATIONS

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

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

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

There is no coverage for medical expenses incurred out-of-country. There is no reimbursement for out-of-country treatment.

C.4 ELIGIBLE PARTICIPANTS

C.4.1 Eligible Employees The employees eligible for te health insurance services include the following:

C.4.1.1 Current active Locally Employed (LE) Staff of the United States Government, employed within the geographic boundaries of Turkey paid under the Local Compensation Plan, and certified by the Contracting Officer. To be eligible, LE Staff must work a regular tour of duty (either full or part-time) under:

C.4.1.1.1 a non-temporary direct hire appointment, Personal Services Agreement (PSA), or Personal Services Contract (PSC); or

C.4.1.1.2 a temporary direct hire appointment or PSA fixed term of one year or more.

Health Insurance for LES Page 14 of 83

C.4.2 Location of Employment The individuals covered by C.1.4.1 must be employed within the geographic boundaries of Turkey by: Department of State and U.S. Government agencies named DEA, DAO, DHS/ICE, DHS/CBP, DOJ, FAS, FBI, FCS, FCS/BIS, PRM, EXBS, agencies under START, ODC and AFOSI and any other USG agency operating within the boundaries of Turkey.

C.4.3 Participants and Benefits Covered Under a Rider

C.4.3.1 All current active employees of the Chief of Mission and the Deputy Chief of Mission assigned to their respective official Government residences and paid under an ORE account.

The employing officer/EA, not the USG, is responsible for the employer's share of the premium costs for an ORE employee.

C.4.3.2 Retirees covered under the medical insurance plan at the time the new contract goes into effect are grandfathered to continue coverage, for themselves and dependents, under a rider to the contract. The retiree, not the USG, is responsible for 100% of the premium costs associated with the plan. The retiree and insurance provider are responsible for the administration of the plan.

C.4.3.4 Optional excess coverage per above item C.1.1.17. If elected, all costs for excess coverage are the responsibility of the employee, not the U.S. Government.

C.4.3.5 The U.S. Government requires that an enrollee has the right to extend their enrollment during the open season for each option year; and under any circumstances, the contractor will not conduct any risk assessment and will not apply pre-existing conditions.

C.5 Individuals Not Eligible for Coverage

Individuals not eligible for coverage under this contract are those working under temporary direct hire appointments or PSAs/PSCs that are time limited to less than one year; those working on an intermittent or When Actually Employed (WAE) schedules; non-personal services contract personnel and their employees, supplied by an independent contractor licensed to do business in Turkey who provides services to other local organizations as well as to the U.S.

Mission; employees of USAID institutional contractors; and Peace Corps personal services contractors as indicated in MS 743; and Recreation Association employees.

C.6 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.

Health Insurance for LES Page 15 of 83

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: 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.

C.7. Eligibility

C.7.1. Term of Eligibility and Effective Date

C.7.1.1 Each current active eligible employee is enrolled for health benefits under this contract upon award and thereafter during the performance period of this contract. Each new eligible employee will have the option to enroll upon entering on duty with the United States Government.

C.7.1.2 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. Children will be covered under either of the parents’ coverage.

C.7.1.3 Retirees covered under the medical insurance plan at the time the new contract goes into effect are grandfathered to continue coverage with no age limitations, for themselves and dependents, under a rider to the contract. All costs for retired employees and their dependents are the responsibility of the concerning retired employee. In case of a retired personnel’s death, the spouse may continue to be enrolled if he/she desires. If a retired employee dies, his/her eligible family member(s) will be entitled to continue enrollment, if they elect to do so, at their own expense.

C.7.1.4 During a period of Leave Without Pay (LWOP) or unpaid leave that is one pay period or less, coverage under the insurance contract will continue. The employee will pay the total cost of the coverage for the duration of LWOP exceeding one pay period. The USG will pay the total premium cost to the Contractor.

C.7.1.5: In the event of death of an insured person, he/she shall be removed from the insurance as of the date of death. The Insurer may, at its own discretion, keep the dependent persons of a deceased insured person insured with the same level of medical coverage hereunder for up to 90 days This optional benefit is subject to availability of funds at post (Agency) and no extensions are permitted. If the Option year ends within these 90 days, the dependents' policy will be ceased and will not be renewed in the next option year.

C.7.1.6: Open Season will be executed one (1) month prior to the beginning of each option year.

The HR office will make a management announcement that will open for at least 2 weeks and will collect the enrollment and exit requests from the employees.

Health Insurance for LES Page 16 of 83

C.7.2. Period of Ineligibility

Employees and their dependents are not entitled to health benefits during any period of employment for which premiums are not paid.

Additionally, employee's dependents are not entitled to health benefits during any period of employment during which the employee was not eligible to participate.

During a period of extended (beyond one pay period) of Leave Without Pay (LWOP) or unpaid leave, the employee is responsible for the full cost of the insurance premiums for self and dependents. The Mission will pay the premiums directly to the Contractor and will collect the full cost from the employee on a quarterly basis. Alternatively, the employee may elect to have coverage cease if that employee prefers not to pay the premium.

C.7.3. Withdrawal from Insurance Coverage

C.7.3.1 If the U.S. Mission decides that there is a valid reason to permit an employee to withdraw from the ongoing insurance coverage, he/she will be permitted, and payment of premiums will cease with reference to the date of withdrawal.

C.7.3.2 If the U.S. Mission decides that there is a valid reason to permit an employee to withdraw from the ongoing insurance coverage after the said employee has been paid any claims, the said employee has to reimburse the Contractor for claims previously paid by the Contractor which could have been elective/scheduled in advance for a period of six months prior to withdrawal.

C.7.3.3 At the time of employment termination and/or death, subsequent claims should be disregarded. The insured will be responsible for payment of his/her share of the cost of insurance coverage up to the date of separation from duty.

C.8. BROCHURE REQUIREMENT

C.8.1. The Contractor shall provide a document (brochure/pamphlet/other written document) in Turkish and English 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.

C.8.2. The Contractor shall provide the document described in C.8.1 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.

C.8.3. The Contractor assumes full responsibility for ensuring that the document described in C.8.1 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

Health Insurance for LES Page 17 of 83 otherwise affect the requirement under this contract for the Contractor to fully comply with all contract terms.

C.8.4 During the contract period, any changes regarding the information in the submitted documents/brochures will be updated and re-submitted as revised documents/brochures (i.e.

changes to the list of approved institutes, etc.).

C.9 ACCRONYMS AND ABBREVIATIONS

Acronym Definition

CLIN Contract Line-Item Number

Contractor Insurance Company

CO

Contracting Officer

COR

Contracting Officer Representative

Customary and Reasonable Treatment

A diagnostic test or medical treatment which is usually performed in the community where the individual is being treated

Dependent An eligible spouse and/or child of the employee as further defined in C.6.1

Disability- Total and Permanent

A physical or mental impairment which precludes the individual from performing ordinary motor or bodily functions and which requires separation from employment. If the impairment is the result of a previous impairment, it shall be considered a continuation of the prior impairment.

Employer

The United States Government = USG

Employee An individual employed by the US Government, under a direct-hire appointment, personal service contract (PSC), or personal services agreement (PSA), as further defined in Section C.4. This may also include ORE staff, EAE and Peace Corps PSCs, if this category of individuals is listed as participating under a rider in C.4.3

Employee plus one Any eligible spouse or child of the Employee

FMO Financial Management Officer

GSO General Services Officer in charge of the General Services Office at post

Hospital An institution established and operated for the care and treatment of sick and injured persons. It provides 24-hour nursing care and has diagnostic, laboratory, treatment, and surgical facilities. Any institution which does not meet this definition is not considered a hospital.

Health Insurance for LES Page 18 of 83

Hospital Patient An individual who has been admitted to a hospital, is assigned a bed, and is given diagnostic tests or receives treatment for a disease or an injury.

LS

Lump Sum

Maximum Benefit The total amount that will be paid to any one covered individual for covered medical expenses

PII

Personally Identifiable Information

Physician An individual who has graduated from an accredited medical school and is licensed to practice medicine in the jurisdiction in which the contract is to be performed. If the individual is a medical specialist, then he or she is Board Certified in that specialty

QA

Quality Assurance

QC

Quality Control

QCP

Quality Control Plan

QTY

Quantity

SOW

Statement of Work

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

TBD

To be determined

USG

U.S. Government

D. CONTRACT ADMINISTATIVE REQUIREMENTS AND PROCEDURES

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.

Health Insurance for LES Page 19 of 83

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.

• 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.

• 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.

• 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.

Health Insurance for LES Page 20 of 83

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.

2. DELIVERABLES

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

American Embassy in Ankara Attn: HR Cukurambar Mah. 1478 Cad., No:24 Cukurambar, Ankara, Turkey

(Please note that this address might change with a permanent ‘official’ address as we approach the opening of the New Embassy Compound).

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

C.8 Brochures

As instructed by COR

Additional copies

10 days after contract award

Within 10 calendar days of the COR’s request

COR

hard copy

D.9 Invoice 1 monthly COR / Designated Billing Office

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

Health Insurance for LES Page 21 of 83

Embassy concerning employees' personal data, medical information, and salaries as highly sensitive and not divulge any employee information to unauthorized persons.

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

a. Administrative Records

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

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

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

(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.

Health Insurance for LES Page 22 of 83

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.

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.

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.

• All documents received or generated under the contract are the property of the USG.

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

Reproductionand distribution are prohibited without express approval of the USG. All design documents generated shall be annotated as follows:

• 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.

• 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.

7. Laws And Regulations

• Compliance Required - If the contractor has or will establish a local office, he shallwithoutadditional expense to theUSG, 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.

Health Insurance for LES Page 23 of 83

• 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.

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.

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.

8. Contract Administration Data

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

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 Ankara, HR

9. 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

• A summary showing a listing of each member with total monthly price the currency the contract has been issued in. A detailed invoice for each Agency has to be attached to mailto:JacobsenW@state.gov

Health Insurance for LES Page 24 of 83 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 Section I.B Prices.

• Advance Payment shall not be authorized under this contract.

10. 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.

11. Funding / Task Orders / Procedures

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 premium

• 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

Only an RPSO Contracting Officer may place a written order.

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.

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.

Health Insurance for LES Page 25 of 83

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).

12. 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…