19GE5025R0025 BW Health solicitation.pdf

19GE5025R0025

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS

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

1. REQUISITION NUMBER

5. SOLICITATION NUMBER

19GE5025R0025

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

DATE

03/11/2025

7. FOR SOLICITATION

INFORMATION CALL:

a. NAME

Anthony K. Walker

b. TELEPHONE NUMBER (No collect calls)

c. EMAIL walkerak@state.gov

8. OFFER DUE DATE / LOCAL

TIME

04/03/2025 15:00

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

GABORCODE15. DELIVER TO

AMERICAN EMBASSY GABORONE

GOVERNMENT ENCLAVE, EMBASSY DRIVE

ATTN: GSO/PROCUREMENT

GABORONE, BOTSWANA

CODE OPEAQM16. ADMINISTERED BY

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

FACILITY

CODE

CODE

Contact UEI:

Telephone No.

17a. CONTRACTOR/

OFFEROR

OPEAQMCODE18a. PAYMENT WILL BE MADE BY

AMERICAN EMBASSY GABORONE

P O BOX 90

ATTN: FMC

GABORONE, BOTSWANA

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)

27a. SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1, 52.212-4. FAR 52.212-3 AND 52.212-5 ARE ATTACHED. ADDENDA 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

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN ____ 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) Daniel J Jackson

31c. DATE SIGNED 03/11/2025

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

19.

ITEM NO.

20.

SCHEDULE OF SUPPLIES/SERVICES

21.

QUANTITY

22.

UNIT

23.

UNIT PRICE

24.

AMOUNT

32a. QUANTITY IN COLUMN 21 HAS BEEN

RECEIVED INSPECTED ACCEPTED, AND CONFORMS TO THE CONTRACT, EXCEPT AS NOTED: _________________________________

32b. SIGNATURE OF AUTHORIZED GOVERNMENT

REPRESENTATIVE

32c. DATE 32d. PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT

REPRESENTATIVE

32e. MAILING ADDRESS OF AUTHORIZED GOVERNMENT REPRESENTATIVE 32f. TELEPHONE NUMBER OF AUTHORIZED GOVERNMENT

REPRESENTATIVE

32g. E-MAIL OF AUTHORIZED GOVERNMENT REPRESENTATIVE

PARTIAL FINAL

33. SHIP NUMBER 34. VOUCHER NUMBER 35. AMOUNT VERIFIED

CORRECT FOR

COMPLETE PARTIAL FINAL

36. PAYMENT 37. CHECK NUMBER

38. S/R ACCOUNT NUMBER 39. S/R VOUCHER NUMBER 40. PAID BY

41a. I CERTIFY THIS ACCOUNT IS CORRECT AND PROPER FOR PAYMENT 42a. RECEIVED BY (Print)

41b. SIGNATURE AND TITLE OF CERTIFYING OFFICER 41c. DATE

42b. RECEIVED AT (Location)

42c. DATE REC'D (YY/MM/DD) 42d. TOTAL CONTAINERS

STANDARD FORM 1449 (REV. 02/2012) BACK

Line Item Summary

Solicitation Number:

19GE5025R0025

Contract Number: Title: Botswana Health Insurance Date of Solicitation:

03/11/2025

Line Item No.

Description Quantity Unit Unit Price Total Cost

001 Base Year

CLIN 0001- 0004

Health Insurance services for the base year period as detailed in Attachment I - Price Proposal Type of Contract Pricing: FFP

Doc Ref No:

Delivery Date FOB:

1.00 EA $0.00 $0.00

002 First Option Year

CLIN 1001- 1004

Health Insurance services for the base year period as detailed in Attachment I - Price Proposal Type of Contract Pricing: FFP

Doc Ref No:

Delivery Date FOB:

1.00 EA $0.00 $0.00

003 Second Option Year

CLIN 2001- 2004

Health Insurance services for the base year period as detailed in Attachment I - Price Proposal Type of Contract Pricing: FFP

Doc Ref No:

Delivery Date FOB:

1.00 EA $0.00 $0.00

004 Third Option Year

CLIN 3001- 3004

Health Insurance services for the base year period as detailed in Attachment I - Price Proposal Type of Contract Pricing: FFP

Doc Ref No:

Delivery Date FOB:

1.00 EA $0.00 $0.00

005 Fourth Option Year

CLIN 4001- 4004

Health Insurance services for the base year period as detailed in Attachment I - Price Proposal Type of Contract Pricing: FFP

Doc Ref No:

Delivery Date FOB:

1.00 EA $0.00 $0.00

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

Pages 1 RQS 19GE5025R0025.pdf 03/11/2025

52.252-2 - Clauses Incorporated by Reference (Feb 1998)

This contract incorporates one or more clauses by reference, with the same force and effect as if they were given in full text. Upon request, the Contracting Officer will make their full text available. Also, the full text of a clause may be accessed electronically at this/ these address(es):

https://acquisition.gov

[Insert one or more Internet addresses] (End of clause) Clause Title Fill-ins

52.203-3 Gratuities (Apr 1984)

52.203-12 Limitation On Payments to Influence Certain Federal Transactions (Jun 2020)

52.204-13 System for Award Management Maintenance (Oct 2018)

52.204-21 Basic Safeguarding of Covered Contractor Information Systems (Nov 2021)

52.204-7 System for Award Management (Nov 2024)

52.204-16 Commercial and Government Entity Code Reporting (Aug 2020)

52.204-18 Commercial and Government Entity Code Maintenance (Aug 2020)

52.204-22 Alternative Line Item Proposal (Jan 2017)

52.212-1 Instructions to Offerors-Commercial Products and Commercial Services (Sep

2023)

52.217-5 Evaluation of Options (July 1990)

0.01 - 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 PROCENT PERSUANT TO 26 U.S.C. 5000C.

1. - SERVICES AND PRICES

B.1. GENERAL INFORMATION

B.1.1. The Contractor shall provide health insurance services to locally employed staff of the Government of the United States of America in Botswana and their eligible dependents as described in Section C- Statement of Work.

B1.2. Acronyms and definitions

CLIN: Contract Line Item Number Contractor: Insurance Company and/or Health Care Center CO: Contracting Officer COR: Contracting Officer Representative (Human Resources Supervisor of the US Embassy Gaborone) Dependent: Dependents are defined as the covered employee’s legal spouse (limit one) and each unmarried, economically dependent child who primarily resides with employee unless away at school. Child is defined as the employee’s natural child, adopted child, stepchild or foster child. An eligible child will be covered until the end of the contract year in which the child turns age 18, or in the case of a child who is a full-time student, until the end of the contract year in which the child turns age 26. There is no age limit for an eligible child who is physically or mentally handicapped so as to be unable to live independently. There is no limit on the number of children covered per employee. Parents, grandparents, siblings, and other relatives are not eligible dependents.

Employer: The United States Government (USG) Employee: Staff member of the US Embassy Gaborone FMO: Financial Management Officer

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

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

LE Staff: Local Employed Staff LS: Lump Sum PII: Personally Identifiable Information Physician: An individual who has graduated from an accredited medical school and is licensed to practice medicine in the jurisdiction in which the contract is to be performed. If the individual is a medical specialist, then he or she is Board Certified in that specialty.

QA: Quality Assurance 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

B.1.3. The contractor shall complete all work, including furnishing all labor, material, equipment and services, unless otherwise specified herein, required under this contract for the 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).

B.1.4. 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.

B.1.5. Official Residence Expense (ORE) Staff and Employe Association (EA) employees may be covered under this contract only as a rider; the Contractor shall bill the Chief of Mission and Deputy Chief of Mission (for ORE Staff), and the Employe Association (EA) at the rates specified below. Retirees are included under this contract only as riders; the Contractor shall bill the individual covered at the rates specified below. Excess Coverage (C.1.1.19) is included under this contract only as rider benefits; the Contractor shall bill the individual covered at the rates specified below. See Section G for billing procedures. Note that USG is not responsible, nor liable, for any riders.

1.2. TYPE OF CONTRACT

This is a requirement type contract with fixed priced units with economic price adjustment under which will be issued fixed-price orders.

The fixed prices/premium rates for the health insurance services as specified in Section C are detailed in Attachment 1 – Price schedule.

1.3. PERIOD OF PERFORMANCE

The period of performance of this contract is for one base year with four (4) one-year options.

1.4 CONTRACT PRICE

The Contractor shall complete all work (including furnishing all labor, material, equipment, and services) as required in the orders issued under this contract for the following fixed-price units and within the time specified herein. The unit prices shall include all labor, services, materials, equipment, overhead, costs for insurance, costs of obtaining Irrevocable Letters of Credit if required, profit, travel, DBA Insurance, and any other costs required to perform and complete all services, in accordance with the Statement of Work (SOW), specifications, and all other contract terms and conditions stated within the contract.

The Contractor shall complete the Attachment 1 - Price Proposal and ensure that the total amount matches that of the total fixed-price units proposal in the offeror’s price proposal in Section 1.4.1

1.4.1 TOTAL CONTRACT PRICE

This is a is a requirements type contract with fixed priced units with economic price adjustment under which will be issued fixed-price orders. The fixed prices/premium rates for the health insurance services as specified in Section C are as follows:

ESTIMATED BASE YEAR TOTAL

ESTIMATED FIRST OPTION YEAR TOTAL

ESTIMATED SECOND OPTION YEAR TOTAL

ESTIMATED THIRD OPTION YEAR TOTAL

ESTIMATED FOURTH OPTION YEAR TOTAL

GRAND TOTAL (ESTIMATED BASE + OPTION YEARS)

CURRENCY: _____________________________ (please enter).

The offeror shall clearly identify and state the currency for all costs in their price proposal. After award, the Contractor shall invoice in and payment will be made according to the currency identified in the offerror's proposal, unless otherwise specified by the Contracting Officer.

1.5. ADMINISTRATIVE RETENTION AMOUNTS

1.5.1 If the Contractor requests a price adjustment under 1.6 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 I – Price schedule. This retention amount will not be adjusted for any reason.

1.5.2. 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. 1.5.3 sets forth the retention amounts per premium paid for each category of premium and for each period of performance.

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

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

Period of Performance Single Employees (Self only) Self Plus One (two individuals) Family

(three or more individuals) Base Period First Option Period Second Option Period Third Option Period Fourth Option Period

1.6. ECONOMIC PRICE ADJUSTMENT-HEALTH INSURANCE PREMIUMS

1.6.1. Premium Adjustment Based on Experience - For health insurance, prices may be adjusted upward or downward based on the experience rating of the Mission(s) covered by this contract, and it specifically excludes all riders in B.1. No adjustment will be allowed during the first twelve months. After such time, the Contractor or the Government may request an adjustment in premiums on an annual basis. Adjustments are not retroactive to previous contract terms. Before any such adjustment is made, the Contractor agrees to provide the Government a balance sheet showing three main components for the time period: (1) receipts (premiums received) minus the retention amount, (2) number of insurance plans and (3) claims paid. This information shall be provided per type of premium, ie 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 retention amount is not subject to adjustment. The 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. Mutually agreed to adjustments shall be effective thirty days after complete information is received by the Government.

Any failure to reach agreement under this clause shall be subject to the procedures in the Disputes clause.

1.6.2. 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. The Contractor agrees to provide all documentation necessary to support any requested adjustment.

1.6.2.1 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 shall include in its proposal for adjustment, details setting forth how the pool impacts the request for equitable adjustment.

1.7 - VALUE ADDED TAX (VAT)

Where applicable, the Contractor shall be responsible for paying to the appropriate authority, the applicable rate of Value Added Tax (VAT). Offerors shall identify Value Added Tax (VAT) as a separate line item. The VAT shall also be reflected as a separate cost item on all invoices submitted under the resulting contract.

Local law dictates the portion of the contract price that is subject to VAT; this percentage is multiplied only against that portion. It is reflected for each performance period. Please indicate if you’re VAT exempt.

2. - STATEMENT OF WORK

C.1. HEALTH INSURANCE SERVICES

The Contractor shall provide health insurance services to locally employed staff of the Government of the United States of America in Botswana and their eligible, as further described in this section.

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

MANDATORY/REQUIRED BENEFITS

Hospitalization (treatment in the hospital for inpatient care):

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

100% Coverage

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

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

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

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.

100% Minimum Coverage (the final bid may be higher)

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 (the final bid may be higher) 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.

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 (the final bid may be higher)

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 (the final bid may be higher)

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 (the final bid may be higher)

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 (the final bid may be higher)

Hearing Aids:

Examinations and Treatment:

100% Minimum Coverage (the final bid may be higher)

Hearing Aid Apparatus: Limited to one apparatus per ear up to a maximum of $1,500 USD per covered individual per three-year period.

100% Minimum Coverage (the final bid may be higher); with annual cap.

Optical:

Examinations and Treatment:

80% Minimum Coverage (the final bid may be higher)

Prescription lenses and frames or contact lenses: Covered up to a maximum of $300 USD per covered individual every two years.

80% Minimum Coverage (the final bid may be higher); with annual cap

Dental:

Examinations and Treatment: Dentist’s fees, x-rays, examinations and treatment, cleanings, fillings, extractions, false teeth, crowns, and bridges up to a maximum of $3,200 USD per covered individual per contract year.

80% Minimum Coverage (the final bid may be higher); 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 $2,400 USD lifetime limit.

80% Minimum Coverage (the minimum bid may be higher); with contract lifetime cap

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 (the final bid may be higher)

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.

100% Minimum Coverage

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 (the final bid may be higher)

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.

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

Catastrophic Coverage:

Additional coverage equal to BWP 574,000 per covered individual per contract year. Catastrophic conditions shall be defined as major medical conditions occurring because of a single/illness/accident or closely related set of major illnesses (or conditions relating to a single accident) that exceed the standard maximum coverage limit.

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.

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.

Excess Coverage: (NOTE: Employee is responsible for paying 100% premium) Additional coverage equal to BWP 574,000 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.

180 Day 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 180 days. This optional benefit is subject to availability of funds at post and no extensions are permitted.

Employee Assistance Program (EAP):

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

Post does not elect any optional benefits.

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.

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.

Employees that are 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 Botswana 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 Employee Recreation Association (ERA) employees.

Official Residence Expense (ORE) and ERA’s employees may be covered under a rider to the contract. The employing officer/EA, not the U.S. Government, is responsible for the employee’s share of the premium costs for an ORE/EA employee.

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.

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.

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)

All LE Staff covered under post’s medical benefit plan will pay a 10% share of the premium.

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 BWP 574,000.00

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.

Brochure Requirement The Contractor shall provide a document (brochure/pamphlet/other written document) in Polish 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.

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

The Contractor assumes full responsibility for ensuring that the document described above accurately reflects the requirements, coverage, and contract terms 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 document contains inaccuracies, the Contractor will be notified in writing;

however, failure on the part of the U.S. 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.

Lawful Operation, Permits and Indemnification

Bonds. The Government imposes no bonding requirement on this contract. The Contractor shall provide any official bonds required, pay any fees or costs involved or related to the authorization for the equipping of any employees engaged in providing services specified under this contract if such bonds or payments are legally required by the local government or local practice.

Employee Salary Benefits. The Contractor shall be responsible for payment of all employee wages and benefits required by host country law or agreements with its employees. The Government, its agencies, agents, and employees shall not be part of any legal action or obligation regarding these benefits which may subsequently arise. Where local law requires bonuses, specific minimum wage levels, and premium pay for holidays, payments for social security, pensions, sick or health benefits, severance payments, child care or any other benefit, the Contractor is responsible for payments of these costs and must include them in the fixed prices in this contract.

Personal Injury, Property Loss or Damage (Liability). The Contractor assumes absolute responsibility and liability for any and all personal injuries or death and property damage or losses suffered due to negligence of the Contractor's personnel in the performance of this contract. The Contractor's assumption of absolute liability is independent of any insurance policies.

Amount of Insurance. The Contractor is required to provide whatever insurance is legally necessary. The Contractor shall, at its own expense, provide and maintain during the entire performance period the following insurance amounts:

The Contractor shall hold harmless and indemnify the Government from any and all claims arising, except in the instance of gross negligence on the part of the Government.

Permits. Without additional cost to the Government, the Contractor shall obtain all permits, licenses, and appointments required for the prosecution of work under this contract. The Contractor shall obtain these permits, licenses, and appointments in compliance with applicable host country laws. Application, justification, fees, and certifications for any licenses required by the host government are entirely the responsibility of the Contractor.

Workers' Compensation. The contractor shall provide for Worker's Compensation as required by local law. See also FAR 228-3 Defense Base Act Insurance Employer's Liability. As required by host country law.

Key Personnel

The Project Manager must be able to converse in English. The Contractor shall assign to this contract the following key persons:

POSITION/FUNCTION NAME

Project Manager _________________________________

Project Manager Alternate ____________________________

The Contractor shall notify US Embassy of the names of the Accounting Manager (and his/her alternate), no later than 10 days after the contract award. Should any of the above professionals change during the period of this contract, the new names shall be notified to the COR no later than three (3) working days after such a change.

During the first 90 days of performance, the Contractor shall make no substitutions of key personnel unless the substitution is required due to illness, death, or termination of employment. The Contractor shall notify the COR within 15 calendar days after the occurrence of any of these events and provide the information required below to the COR at least 15 days before making any permanent substitutions.

After the first 90 days of performance, the Contractor may substitute a key person if the Contractor determines that it is necessary. The Contractor shall notify the COR of the proposed action immediately. Prior to making the substitution, the Contractor will provide the information required below to the COR.

The Contractor shall provide a detailed explanation of the circumstances requiring the proposed substitution, a complete resume for the proposed substitute. The proposed substitute shall possess qualifications comparable to the original key person. The COR will notify the Contractor of its approval or disapproval of the substitution within 15 calendar days after receiving the required information.

Permits

Without additional cost, the Contractor shall obtain all permits, licenses, and appointments required for the work under this contract. The Contractor shall obtain these permits, licenses, and appointments in compliance with applicable local country laws.

Disclosure of Information

Any information made available to the Contractor by the Government shall be used only for the purpose of carrying out the provisions of this contract and shall not be divulged or made known in any manner to any person except as may be necessary in the performance of the contract.

Quality Assurance and Surveillance Plan (QASP) This plan provides an effective method to promote satisfactory Contractor performance. The QASP provides a method for the Contracting Officer's Representative (COR) and GTM to monitor Contractor performance, advise the Contractor of unsatisfactory performance, and notify the Contracting Officer of continued unsatisfactory performance. The Contractor, not the Government, is responsible for management and quality control to meet the terms of the contract. The role of the Government is to monitor quality to ensure that contract standards are achieved. The Contractor will provide to the COR and GTM, on a monthly basis, performance metrics based on the Performance Objectives set below.

Failure to comply with the performance thresholds indicated below will be grounds for terminating this contract. The Contracting Officer may, at his or her option, require the Contractor to take corrective action prior to determining that the contract will be terminated.

Performance Objective Scope of Work Performance Threshold

Services Performs all services set forth in the scope of work.

All All required services are performed and no more than one (1) customer complaints are reported to contractor per month by the COR and/or GTM.

Support Resolution of reported service issues

All Contractor will resolve 98 percent of reported issues within 48 hours of service ticket number assignment.

This is calculated on a monthly basis

The COR will receive and document all complaints from Government personnel regarding the services provided. If appropriate, the COR will send the complaints to the Contractor for corrective action.

The performance standard is that the Government 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)), if any of the services exceed the standard.

If any Government personnel observe unacceptable services, either incomplete work or required services not being performed they should immediately contact the COR.

The COR will complete appropriate documentation to record the complaint.

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.

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.

The COR shall, as a minimum, orally notify the Contractor of any valid complaints.

If the Contractor disagrees with the complaint after investigation of the site and challenges the validity of the complaint, the Contractor will notify the COR. The COR will review the matter to determine the validity of the complaint.

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

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.

3. - Deliverables

D. CONTRACT ADMINISTATIVE REQUIREMENTS AND PROCEDURES

All reports and other deliverables required under this contract shall be delivered by email to the COR and mailed to the following address: (to be provided at time of award) NOTE: Any and all costs for the preparation, handling, mailing and submission of progress reports or any other required reports and documentation shall be included in the total price of each delivery order.

Description Quantity Submission Date Delivery:

Brochures 1 For review 30 days after contract award

COR

Brochures 346 After review by the COR Hard Copy Brochures Additional Copies Within 10 calendar days of the COR’s request Hard Copy

Employee claims report 1 each No later than the 30th calendar day of each month

COR, email pdf document

Invoice 1 Monthly COR, Payment Office

Insurance Card (Optional – this requirement shall be discussed with the COR after contract award)

An ID card shall be provided for each insured person (preferably with photo).

If the ID card is lost or stolen the contractor shall provide a replacement at no cost.

CONTRACTOR RESPONSIBILITY IN CLAIMS AND REIMBURSEMENT TO CLAIMS

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

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

a. Administrative Records 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.

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.

The contractor shall use the English spelling of the employees' names in all transactions The contractor shall provide claim reimbursement via EFT to the employees no later than two weeks after the claim has been submitted.

No upfront payment by the employee: Individual employees insured under this contract shall not be invoiced directly for covered medical services. All financial settlements for covered medical services shall be made between the contractor and the medical service provider. In the event that an invoice is issued, the employee shall not be required to pay at time of service but shall be required only to submit said invoice to the contractor, and the contractor shall settle the invoice with the medical provider.

Medical service providers: No claims to be submitted. If the contractor is a direct medical services provider, there will be no claims for reimbursement.

Medical service providers: Should the contractor be a medical service provider, the contractor shall not invoice the insured employee for covered medical services, and there shall be no claim for reimbursement.

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, including the name of the employee, 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.

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.

ERRONEOUS PAYMENT

If the U.S. Government 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 U.S. Government, whichever the U.S. Government prefers. The Contractor shall refund any refunds not complete or discovered after the completion date of this contract.

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 U.S. Government will be the sole property of the U.S. Government. The Contractor shall not release any documents to anyone unless authorized by the U.S. Government. The following considerations shall be followed by the Contractor:

All documents received or generated under the contract are the property of the U.S. Government.

All documents shall be controlled and disseminated on a need-to-know basis. Reproduction and distribution are prohibited without express approval of the U.S. Government.

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 U.S. Government.

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 U.S. Government.

LAWS AND REGULATIONS

Compliance Required: If the Contractor has or will establish a local office, he shall without additional expense to the U.S.

Government, 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.

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

INVOICES, REVIEW AND PAYMENT

The Contractor shall submit monthly invoices to the Contracting Officer Representative and the designated billing office at: *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…