19GE5024R0067 0001.pdf

19GE5024R0067

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

1. CONTRACT ID CODE RATING

2. AMENDMENT/MODIFICATION NO.

3. EFFECTIVE DATE

06/24/2024

4. REQUISITION/PURCHASE REQ. NO. 5. PROJECT NO. (If applicable)

FRANKCODE

AMERICAN CONSULATE GENERAL FRANKFURT

GIESSENER STRASSE 30

ATTN: RPSO

60435, FRANKFURT

GERMANY

Katy Fischer

NAME

TEL.

FischerK1@state.gov

EMAIL

6. ISSUED BY OPEAQMCODE

RPSO Frankfurt OPE/AQM/IP/RPSO Frankfurt Office of Acquisition (AQM) Frankfurt

7. ADMINISTERED BY (If other than Item 6)

9A. AMENDMENT OF SOLICITATION NO.

19GE5024R0067

CONTACT: UEI:

CODE FACILITY CODE

8. NAME AND ADDRESS OF CONTRACTOR (No., street, country, state and ZIP Code) (X)

X 9B. DATED (SEE ITEM 11)

05/21/2024

10A. MODIFICATION OF CONTRACT/ORDER NO.

10B. DATED (SEE ITEM 13)

11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS

X XThe above numbered solicitation is amended as set forth in item 14. The hour and date specified for receipt of Offers is extended, is not extended, Offers must acknowledge receipt of this amendment prior to the hour and date specified in the solicitation or as amended, by one of the following methods: (a) By completing items 8 and 15, and returning __1__copies of the amendment;(b)By acknowledging receipt of this amendment on each copy of the offer submitted; or (c) By separate letter or telegram which includes a reference to the solicitation and amendment numbers. FAILURE OF YOUR ACKNOWLEDGMENT TO BE RECEIVED AT THE PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY RESULT IN REJECTION OF YOUR OFFER. If by virtue of this amendment you desire to change an offer already submitted, such change may be made by telegram or letter, provided each telegram or letter makes reference to the solicitation and this amendment, and is received prior to the opening hour and date specified.

12. ACCOUNTING AND APPROPRIATION DATA (If required)

13. THIS ITEM ONLY APPLIES TO MODIFICATION OF CONTRACTS/ORDERS. IT MODIFIES THE CONTRACT/ORDER NO. AS DESCRIBED IN ITEM 14.

CHECK ONE A. THIS CHANGE ORDER IS ISSUED PURSUANT TO: (Specify authority) THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE CONTRACT ORDER NO. IN ITEM 10A.

B. THE ABOVE NUMBERED CONTRACT/ORDER IS MODIFIED TO REFLECT THE ADMINISTRATIVE CHANGES (such as changes in paying office, appropriation date, etc.) SET FORTH IN ITEM 14, PURSUANT TO THE AUTHORITY OF FAR 43.103(b).

C. THIS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO AUTHORITY OF:

D. OTHER (Specify type of modification and authority)

E. IMPORTANT: Contractor is not, is required to sign this document and return copies to the issuing office.

14. DESCRIPTION OF AMENDMENT/MODIFICATION (Organized by UCF section headings, including solicitation/contract subject matter where feasible.)

This solicitation is herewith amended incorporate the following changes:

1. Incorporate solicitation questions and answers 1 through 4;

2. Add Attachment 6 Claims History ORE Staff (U.S. Embassy);

3. Update the clause at FAR 52.212-5 to comply with incorporation of FAR 52.226-8; and

4. Extend the proposals due date from June 24, 2024 to July 1, 2024. The submission hours remain unchanged.

Except as provided herein, all terms and conditions of the document referenced in Item 9A or 10A, as heretofore changed, remains unchanged and in full force and effect.

15A. NAME AND TITLE OF SIGNER (Type or print) 16A. NAME AND TITLE OF CONTRACTING OFFICER (Type or print)

Nicolas Wilhelm

(Signature of person authorized to sign)

15B. CONTRACTOR/OFFEROR 15C. DATE SIGNED

By (Signature of Contracting Officer)

16B. UNITED STATES OF AMERICA 16C. DATE SIGNED

06/24/2024

NSN 7540-01-152-8070

Previous edition unusable

STANDARD FORM 30 (REV. 10-83)

Prescribed by GSA FAR (48 CFR) 53.243

CGFS // CGFS

X

Line Item Summary

Solicitation Number:

19GE5024R0067

Contract Number: Title: Health Insurance (LES) - Paramaribo, Suriname

Date of Solicitation:

06/24/2024

Line Item No.

Description Quantity Unit Unit Price Total Cost

001 BASE YEAR - LES Health Insurance (estimate) inclusive of the following Sub CLINs:

0001 Single Employee (Self Only) 0002 Employee + 1 0003 Family Plan 0004 Retiree Only 0005 Retiree + 1 0006 Retiree Family Plan Type of Contract Pricing: FFP

Doc Ref No:

Delivery Date FOB:

0.00 0.00 0.00

EA $0.00

$0.00

$0.00

$0.00 $0.00

$0.00

002 OPTION YEAR ONE - LES Health Insurance (estimate) inclusive of the following Sub CLINs:

1001 Single Employee (Self Only) 1002 Employee + 1 1003 Family Plan 1004 Retiree Only 1005 Retiree + 1 1006 Retiree Family Plan Type of Contract Pricing: FFP

Doc Ref No:

Delivery Date FOB:

0.00 0.00 0.00

EA $0.00

$0.00

$0.00

$0.00 $0.00

$0.00

003 OPTION YEAR TWO - LES Health Insurance (estimate) inclusive of the following Sub CLINs:

2001 Single Employee (Self Only) 2002 Employee + 1 2003 Family Plan 2004 Retiree Only 2005 Retiree + 1 2006 Retiree Family Plan Type of Contract Pricing: FFP

Doc Ref No:

Delivery Date FOB:

0.00 0.00 0.00

EA $0.00

$0.00

$0.00

$0.00 $0.00

$0.00

004 OPTION YEAR THREE - LES Health Insurance (estimate) inclusive of the following Sub CLINs:

3001 Single Employee (Self Only) 3002 Employee + 1 3003 Family Plan 3004 Retiree Only 3005 Retiree + 1 3006 Retiree Family Plan Type of Contract Pricing: FFP

Doc Ref No:

Delivery Date FOB:

0.00 0.00 0.00

EA $0.00

$0.00

$0.00

$0.00 $0.00

$0.00

005 OPTION YEAR FOUR - LES Health Insurance (estimate) inclusive of the following Sub CLINs:

4001 Single Employee (Self Only) 4002 Employee + 1 4003 Family Plan 4004 Retiree Only 4005 Retiree + 1

0.00 0.00 0.00

EA $0.00

$0.00

$0.00

$0.00 $0.00

$0.00

Line Item Summary

Solicitation Number:

19GE5024R0067

Contract Number: Title: Health Insurance (LES) - Paramaribo, Suriname

Date of Solicitation:

06/24/2024

Line Item No.

Description Quantity Unit Unit Price Total Cost

4006 Retiree Family Plan Type of Contract Pricing: FFP

Doc Ref No:

Delivery Date FOB:

Section A - Solicitation/Contract Form Identifier Title Date Number of

Pages 1 RQS 19GE5024R0067.pdf 05/21/2024

Section A - Solicitation/Contract Form

Q&A - QUESTIONS & ANSWERS

Question #001: Please provide claims data for Health Insurance for the last 5 years – 2023, 2022, 2021, 2020 & 2019. It is standard practice in the insurance industry (and in other Department of State insurance solicitations) to provide this information to ensure equal/fair opportunity for all offerors in an open solicitation.

Answer #001: Please refer to Attachment 6 Claims History ORE Staff (U.S. Embassy).

Question #002: Please confirm if the claims data includes claims from ORE employees.

Answer #002: Confirmed. Please refer to Attachment 6 Claims History ORE Staff (U.S. Embassy).

Question #003: Please provide retirees claims data for the last 5 years – 2023, 2022, 2021, 2020 & 2019.

Answer #003: The government does not have any retirees claims data for Paramaribo at this moment.

Question #004: Please provide average insured member counts for Health Insurance for the last 5 years – 2023, 2022, 2021, 2020 & 2019. It is standard practice in the insurance industry (and in other Department of State insurance solicitations) to provide this information to ensure equal/fair opportunity for all offerors in an open solicitation.

Answer #004: Post Paramaribo does have an average of 100 insured member counts for the last 5 years. This includes family members, ORE, retirees. (an average of 88 employees and average of 10 retirees).

SECTION I - THE SCHEDULE

CONTINUATION TO SF-1449

RFP NUMBER 19GE5024R0067

PRICES, BLOCK 23

I. BACKGROUND / SCOPE OF SERVICES

A. The Government of the United States of America (USG) requires Health Insurance for its Locally Employed Staff (LES) and their dependents at US Embassy Paramaribo, Suriname. The Contractor shall provide the Health Insurance services, as described in Section

1. Specifications / Satememt of Work. The groups of employees who shall be provided this insurance are listed in Section 1.4.

B. This is a fixed price with economic price adjustment requirements type contract under which annual firm, fixed-price task orders will be issued. The contract shall remain unfunded. The fixed prices / premium rates for the health insurance services as specified in Section 1. Specifications / Satememt of Work are listed in Section II. Prices. The quantities set forth in the pricing section are estimates for evaluation purposes only; the Government does not guarantee that such quantities will be ordered. The contract will be for a one-year period from the date of the contract award, with four (4) one-year options.

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

During the term of this contract, the Government shall order, as a minimum, services in an amount of $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 value during the entire life of this contract is $1,500,000.00.

D. 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.

E. Official Residence Expense (ORE) Staff are included under this contract only as a rider; the Contractor shall bill the Chief of Mission and Deputy Chief of Mission (for ORE Staff at the rates specified below.

F. The general liability policy required of the Contractor shall name “the United States of America” as additional insured. The general liability insurance shall be as required by law or as ordinarily obtained in the location of the work. The limit of such insurance shall be as provided by law or sufficient to meet normal and customary claims.

The Contractor agrees that the Government shall not be responsible for personal injuries or for damages to Government’s property in Contractor’s custody, any property of the Contractor, its officers, agents, servants, and employees, or any other person, arising from, and incident to, the Contractor's performance of the work detailed herein.

The Contractor shall hold harmless and indemnify the Government from any and all claims arising therefrom, except in the instance of gross negligence on the part of the Government. The Contractor shall submit evidence of general liability insurance within 10 calendar days after award.

G. Acquisition Method. This is a commercial acquisition as defined in Federal Acquisition Regulation (FAR) 2.101, Definitions, and as describe in FAR part 12, Acquisition of Commercial Products and Commercial Services. Pursuant to FAR 12.102(b), the policies in FAR part 12 are used in conjunction with the policies and procedures for solicitation, evaluation and award prescribed in FAR part 13, Simplified Acquisition Procedures.

H. Value Added Tax (VAT). Value Added Tax (VAT) is not applicable to this contract and shall not be included in the contract line item numbers (CLINs) rates or invoices because the U.S. Embassy has a tax exemption certificate from the host government.

I. James Zadroga 9/11 Victims Health and Compensation Act of 2010 Notice: Unless a waiver or exception applies, payments subsequent to this procurement are subject to an excise tax of 2% pursuant to 26 U.S.C. 5000C.

J. ADMINISTRATIVE RETENTION AMOUNTS.

(a) If the Contractor requests a price adjustment under Section K (a) below, the Contractor shall present cost experience data that includes the retention amount. For purposes of any economic price adjustment, this retention amount is a fixed amount that is a part of the premium amounts Attachment 3, Price Proposal Breakdown. This retention amount will not be adjusted for any reason.

(b) The retention amount is part of the premium and may include, but not be limited to, such costs as overhead and general and administrative costs. It will also include any profit. Essentially, it includes all costs except the actual portion of the premium intended to fund claims paid to the health care provider/claimant. J (c) sets forth the retention amounts per premium paid for each category of premium and for each period of performance.

(c) Monthly Retention Amounts per separate premium paid per self only, per self plus one and per family plan.

The offeror shall complete the fixed monthly retention amounts for each performance period and premium category. Ensure these amounts are expressed in the currency proposed for the premium. Note that the fixed retention amount should not be indicated as a percentage of the premium.

Period of Performance

Employee Only Employee Plus One

Family Retiree Retiree Plus One

Retiree Family

Base Year First Option Year Second Option Year Third Option Year Fourth Option Year

K. ECONOMIC PRICE ADJUSTMENT-HEALTH INSURANCE PREMIUMS.

(a) 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 U.S. Government 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 U.S. Government 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. EPA adjustments will only be made to the contract line item rate amount for each type of premium, and cannot be collected as a lump sum adjustment based on the annual projected price.

The U.S. Government 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.

(b) 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.

(c) 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.

II. PRICING

BASE YEAR

A B C D E F CLIN Description Unit Quantity * Month Rate per

Premium Amount [D x E x F]

0001 Employee Only Coverage EA 16 12 0002 Employee Plus One Coverage EA 25 12 0003 Family Coverage EA 47 12

BASE YEAR

A B C D E F CLIN Description Unit Quantity * Month Rate per

Premium Amount [D x E x F]

0004 Retiree Only Coverage EA 4 12 0005 Retiree Plus One Coverage EA 8 12 0006 Retiree Family Coverage EA 2 12 Total Cost (CLINs 0001-0006)

FIRST OPTION YEAR

A B C D E F CLIN Description Unit Quantity * Month Rate per

Premium Amount [D x E x F]

1001 Employee Only Coverage EA 16 12 1002 Employee Plus One Coverage EA 25 12 1003 Family Coverage EA 47 12 1004 Retiree Only Coverage EA 4 12 1005 Retiree Plus One Coverage EA 8 12 1006 Retiree Family Coverage EA 2 12 Total Cost (CLINs 1001-1006)

SECOND OPTION YEAR

CLIN Description Unit Quantity * Month Rate per Premium Amount

[D x E x F] 2001 Employee Only Coverage EA 16 12 2002 Employee Plus One Coverage EA 25 12 2003 Family Coverage EA 47 12 2004 Retiree Only Coverage EA 4 12 2005 Retiree Plus One Coverage EA 8 12 2006 Retiree Family Coverage EA 2 12 Total Cost (CLINs 2001-2006)

THIRD OPTION YEAR

CLIN Description Unit Quantity * Month Rate per

Premium Amount [D x E x F]

3001 Employee Only Coverage EA 16 12 3002 Employee Plus One Coverage EA 25 12 3003 Family Coverage EA 47 12 3004 Retiree Only Coverage EA 4 12 3005 Retiree Plus One Coverage EA 8 12 3006 Retiree Family Coverage EA 2 12 Total Cost (CLINs 3001-3006)

FOURTH OPTION YEAR

A B C D E F CLIN Description Unit Quantity * Month Rate per Premium Amount

[D x E x F] 4001 Employee Only Coverage EA 16 12 4002 Employee Plus One Coverage EA 25 12 4003 Family Coverage EA 47 12 4004 Retiree Only Coverage EA 4 12 4005 Retiree Plus One Coverage EA 8 12 4006 Retiree Family Coverage EA 2 12

Total Cost (CLINs 4001-4006)

*Estimated quantity for evaluation purposes only. Actual number may be lower or higher than the estimates in the solicitation/ contract.

STATE CURRENCY: __________________________________

TOTAL CONTRACT PRICE

Total Base Year Total First Option Year Total Second Option Year Total Second Option Year Total Second Option Year Grand Total

The fixed prices / premium rates for the health insurance services as specified in Section 1. below are as follows:

Attachment 1 Pricing Table will be inserted here with contract award

1. SPECIFICATIONS / STATEMENT OF WORK

1.1 HEALTH INSURANCE SERVICES

The Government of the United States of America requires Health Insurance coverage for its employees as described herein.

(a) 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.

Not eligible are those working under temporary appointments; those working under a PSC or PSA that is time limited to less than one year; non-personal services contract personnel and their employees, supplied by an independent contractor licensed to do business in Suriname who provides services to other local organizations as well as to the U.S. Mission; employees working on an intermittent or When Actually Employed (WAE) schedule; employees of USAID institutional contractors; Peace Corps personal services contractors as indicated in MS 743; and Recreation Association employees.

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.

(b) Retiree Coverage: Current retirees and current employees are grandfathered and eligible to continue retiree coverage for themselves and their dependents. USG pays 70% and Retiree pays 30% of the premium costs. Participation by retired or retiring employees is voluntary. Employees hired after the effective date of the new contract will not be eligible for retiree coverage.

(c) Periods 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 Leave Without Pay (LWOP) or unpaid leave beyond one pay period, 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 they prefer not to pay the premium.

1.1.1 Dependents:

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

Legal spouse: one legal spouse as defined by local law may be covered. LE Staff with more than one legal spouse must select only one spouse for coverage.

In cases where LE Staff and their legal spouse both work for the mission and both are eligible to participate in the medical plan, one will be designated as the lead for purposes of the medical plan, and the other will be considered a legal spouse.

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.

1.1.1.1 Premium:

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)

1.1.1.2 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 $50,000 USD.

1.2 MANDATORY/REQUIRED BENEFITS:

1.2.1 Hospitalization (treatment in the hospital for inpatient care):

Services and supplies provided during hospitalization, including services provided by a licensed healthcare provider, bed & board (first class care levels), 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 Health and Substance Abuse care (below) for details concerning inpatient psychiatric care.

See Outpatient Services (1.2.6) for details concerning professional services.

1.2.2 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

1.2.3 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

1.2.4 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 (1.2.16) for details concerning psychiatric therapy.

1.2.5 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 covered as Hospitalization (treatment in the hospital for inpatient care). All other treatments will be considered Outpatient Services.

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

1.2.6 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

1.2.7 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

1.2.8 Preventive and Wellness and Chronic Disease Management:

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

1.2.9 Hearing Aids:

Examinations and Treatment: 80% Minimum Coverage

Hearing Aid Apparatus: Limited to one apparatus per ear. The maximum coverage is USD 1,500 per covered individual per three-year period. 80% Minimum Coverage; with applicable cap

1.2.10 Optical:

Examinations and Treatment: 80% Minimum Coverage

Prescription lenses and frames, or contact lenses: The maximum coverage is USD 300 per covered individual every two years.

80% Minimum Coverage; with applicable cap

1.2.11 Dental:

Examinations and Treatment: Dentist’s fees, x-rays, examinations and treatment, cleanings, fillings, extractions, false teeth, crowns, and bridges. The maximum coverage is USD 3,200 per covered individual per contract year. 80% Minimum Coverage; with annual cap

1.2.12 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. The maximum coverage is USD 2,400 lifetime limit. 80% Minimum Coverage; with contract lifetime cap

1.2.13 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

1.2.14 Mental Health and Substance Abuse Care:

Inpatient and outpatient care provided to evaluate, diagnose and treat a mental health condition or substance abuse disorder.

This includes behavioral health treatment, counseling, and psychotherapy. Services must be provided by a licensed psychiatrist, psychoanalyst, psychologist, or psychiatric social worker. Inpatient care for alcohol and substance abuse must be carried out at a facility licensed for detoxification and rehabilitation.

50% Minimum Coverage

1.2.15 Rehabilitative and Habilitative Services and Devices:

Rehabilitative services (e.g., recovering skills, such as speech therapy after a stroke or physical therapy after an accident) and habilitative services (e.g., developing skills, such as speech therapy for children) that help develop skills needed for everyday life.

Devices to help gain or recover mental or physical skills lost due to injury, disability or a chronic condition, and devices needed for habilitative reasons.

50% Minimum Coverage

1.2.16 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. 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.

Note to Contracting Officer: Post should consider electing this option if HIV/AIDS treatment is not covered as prevailing practice by local medical insurance providers or is prohibitively expensive.

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

1.2.17 Excess Coverage:

Additional coverage equal to $50,000 per covered individual per contract year. This excess coverage will be offered as an optional benefit to LE Staff. LE Staff must pay 100% of the premium if they elect Excess Coverage.

1.2.18 Out-of-Country Medical Treatment:

Medical expenses incurred out-of-country will be covered, but coverage will be the same and subject to the same total maximum annual limit as for medical expenses incurred in-country.

1.2.19 Out-of-Country Medical Travel:

Transportation for out-of-country medical treatment will be a covered expense for LE Staff 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. 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. 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.

1.2.20 Exclusions to Coverage:

There is no reimbursement for elective cosmetic surgery; spa cures; rejuvenation cures; massage; exercise therapy; long-term rehabilitative therapy; non-medical hospital charges (e.g., telephone, television, etc.); home help, family help, or similar household assistance; fees of persons who are not certified health care providers; advanced reproductive technology (e.g., in-vitro fertilization, intra-cellular sperm injection, artificial insemination, microsurgical epididymal sperm aspiration, testicular sperm extraction, cryopreservation, etc.); or services or supplies which have not been prescribed or approved by a certified health care provider.

Exclusions to coverage may be amended if provided in an off the shelf plan and is the lowest-cost and technically acceptable.

Removal of any exclusions require prior authorization.

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

1.3 BROCHURE REQUIREMENT

1.3.1 The Contractor shall provide a document (brochure/pamphlet/other written document) in 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.

1.3.2 The Contractor shall provide the document described in Section 1.3.1 to the COR not later than 10 (ten) days after date of contract award. The Contractor shall provide additionalbrochures for new employees within ten (10) days of the COR’s request.

1.3.3 The Contractor assumes full responsibility for ensuring that the document described in Sction.1.2.1 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.

1.3.4 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.).

1.4. DEFINITIONS

CLIN Contract Line Item Number

CO Contracting Officer

COR Contracting Officer’s Representative

FMO Financial Management Office

PII Personal Identifiable Information

QA Quality Assurance

QC Quality Control

QCP Quality Control Plan

USG The United State Government

2. CONTRACT ADMINISTATIVE REQUIREMENTS AND PROCEDURES

2.1. 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 Services:

Performs all services set forth in the scope of work.

All required services are performed and no more than three (3) customer complaint are received per month.

Timely payment of benefits (within 14 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 three (3) 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 inreceipt 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.

2.2 DELIVERABLES

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

U.S EMBASSY PARAMARIBO

Attn: HR

(Contact details to be provided in contract document)

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.

No. Description Quantity Submission Date Deliver to:

1 Management Plan 1 15 calendar days after contract award.

COR

2 Brochures As instructed by the COR Additional copies

15 calendar days after contract award.

COR

Within 10 calendar days if the COR’s request.

3 Employee Claims Report

1 Monthly - no later than the 10th of the following month.

COR

4 Provide a Trafficking in Persons compliance plan (FAR 52.222-50 and

FAR 52.222-56)

1 Within 30 calendar days after award.

CO and COR

2.3 Contractor Responsibility in Claims and Reimbursement to Claim

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

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

a. Administrative Records

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

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

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

(4) The contractor shall send employee claim reimbursement checks to employees not later than two weeks after a claim is 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.

(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 (2) 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 EFT payment 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.

2.4 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.

Licenses and Local Laws: The Contractor shall possess all permits, licenses, and any other appointments required for the prosecution of work under this contract, all at no additional cost to the Government. The Contractor shall perform this contract in accordance with local laws.

Report Requirements: The contractor shall provide the following monthly report. The report shall be received by the COR no later than the 10th day of each month. The report shall report on the previous month's activities.

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

2.5 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.

2.6 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.

2.7 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.

• 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.

2.8 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.

This contract will be administered as follows:

Contracting Officer:

Nicolas A. Wilhelm, Contracting Officer Deputy Director, Regional Procurement Support Office (RPSO)

Contract Administrator:

Katy Fischer, Contract Specialist Email: FischerK1@state.gov Phone number: +49-69-7535-3317

Contracting Officer's Representative (COR):

* to be designated on award

2.9 Invoices, Review and Payment

The contractor shall submit monthly invoices to the Contracting Officer Representative and the designated billing office (to be determined on award).

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 each summary invoice and should include the cost breakdown by each membership fee line according to the pricing schedule

• 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 Sub-Section II Prices.

• Advance Payment shall not be authorized under this contract.

• Payment will be made via EFT.

2.10 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.

2.11 Funding / Task Orders / Procedure

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

• 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 - As stated in Section 1.4 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.

Therefore, any ORE and EA staff are are not included under the task orders issued by the Contracting Officer. As 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).

2.12 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 any and all disputes that may arise under the Disputes clause of this contract.

2.13 Start / Period of Performance

Contract performance is estimated to start in the third quarter of calendar year 2024.

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 II, FAR 52.217-9, Option to Extend the Term of the Contract.

The Government may exercise the option set forth at Section II, "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.

2.14 List Of Attachments

• Attachment 1: Price Proposal Breakdown

• Attachment 2: Form W-14

• Attachment 3: W-14 Instructions

• Attachment 4: Employee Statistic 2024

• Attachment 5: Past Performance and Experience

• Attachment 6: Claims History ORE Staff and U.S. Embassy staff

SECTION II - CONTRACT CLAUSES

52.212-5 - Contract Terms and Conditions Required To Implement Statutes or Executive Orders-Commercial Products and Commercial Services (May 2024)

(a) The Contractor shall comply…