19GE5025R0095-A0002.pdf

Document Number: 19GE5025R0095 Page 1 of 12

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

1. CONTRACT ID CODE RATING

2. AMENDMENT/MODIFICATION NUMBER

3. EFFECTIVE DATE

08/06/2025

4. REQUISITION/PURCHASE REQ. NUMBER 5. PROJECT NUMBER (If applicable)

FRANKCODE

AMERICAN CONSULATE GENERAL FRANKFURT

GIESSENER STRASSE 30

ATTN: RPSO

60435, FRANKFURT

DE

Jenina K (Frankfurt) Dosch

NAME

TEL.

doschjk@state.gov

EMAIL

6. ISSUED BY OPEAQMCODE

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

DE

7. ADMINISTERED BY (If other than Item 6)

9A. AMENDMENT OF SOLICITATION NUMBER

19GE5025R0095

CODE FACILITY CODE

8. NAME AND ADDRESS OF CONTRACTOR (Number, street, country, state and ZIP Code) (X)

X 9B. DATED (SEE ITEM 11)

06/30/2025

10A. MODIFICATION OF CONTRACT/ORDER

NUMBER

10B. DATED (SEE ITEM 11)

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 electronic communication 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 your desire to change an offer already submitted, such change may be made by letter or electronic communication, provided each letter or electronic communication 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 NUMBER 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 NUMBER 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 amendment reflects the following changes:

1. Proposal due date is extended from Wednesday, August 13, 2025 at 12:00 pm CET to Wednesday, August 20, 2025 at 12:00 pm CET.

2. Provide answers to vendor questions incorporated herewith.

3. Provide updated Attachment 1 - Price Proposal Breakdown and Attachment 5 - Exhibit A - Employee and Claims Statistic.

CLOSING DATE/TIME:

08/20/2025 - 12:00 Europe/Berlin

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)

Travis Keon

(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

08/06/2025

NSN 7540-01-152-8070

Previous edition unusable

STANDARD FORM 30 (REV.

11/2016) Prescribed by GSA FAR (48 CFR) 53.243

CGFS // CGFS

Document Number: 19GE5025R0095 Page 2 of 12

Section A - Solicitation/Contract Form

Line Item Summary

Solicitation Number:

19GE5025R0095

Contract Number: Title:

Skopje - LES Health Insurance

Date of Solicitation:

08/06/2025

19GE5025R0095

Number Supplies or Services Qty Unit Unit Price Total (Inc. disc., tax, and fees)

PSC: G007

PSC Description: SOCIAL- GOVERNMENT HEALTH

INSURANCE PROGRAMS

Type of Contract Pricing: Firm Fixed Price

Original: 1.0

Change: 0.0

Current: 1.0

LT Original: $0.00

Change: $0.00

Current: $0.00

Original: $0.00

Change: $0.00

Current: $0.00

Delivery Schedule:

Delivery Number Quantity FOB Point 1 0.000000 Destination

Description: BASE YEAR LES Health Insurance inclusive of Sub CLINs:

001A Self Only (one individual) 001B Self Plus One (two individuals) 001C Family (three or more individuals)

Number Supplies or Services Qty Unit Unit Price Total (Inc. disc., tax, and fees)

PSC: G007

PSC Description: SOCIAL- GOVERNMENT HEALTH

INSURANCE PROGRAMS

Type of Contract Pricing: Firm Fixed Price

Original: 1.0

Change: 0.0

Current: 1.0

LT Original: $0.00

Change: $0.00

Current: $0.00

Original: $0.00

Change: $0.00

Current: $0.00

Delivery Schedule:

Delivery Number Quantity FOB Point 1 0.000000 Destination

Description: OPTION YEAR 1 LES Health Insurance inclusive of Sub CLINs:

1001A Self Only (one individual) 1001B Self Plus One (two individuals) 1001C Family (three or more individuals)

Number Supplies or Services Qty Unit Unit Price Total (Inc. disc., tax, and fees)

PSC: G007

PSC Description: SOCIAL- GOVERNMENT HEALTH

INSURANCE PROGRAMS

Type of Contract Pricing: Firm Fixed Price

Original: 1.0

Change: 0.0

Current: 1.0

LT Original: $0.00

Change: $0.00

Current: $0.00

Original: $0.00

Change: $0.00

Current: $0.00

Delivery Schedule:

Delivery Number Quantity FOB Point 1 0.000000 Destination

Description: OPTION YEAR 2 LES Health Insurance inclusive of Sub CLINs:

2001A Self Only (one individual) 2001B Self Plus One (two individuals) 2001C Family (three or more individuals)

Number Supplies or Services Qty Unit Unit Price Total (Inc. disc., tax, and fees)

PSC: G007

PSC Description: SOCIAL- GOVERNMENT HEALTH

INSURANCE PROGRAMS

Type of Contract Pricing: Firm Fixed Price

Original: 1.0

Change: 0.0

Current: 1.0

LT Original: $0.00

Change: $0.00

Current: $0.00

Original: $0.00

Change: $0.00

Current: $0.00

Document Number: 19GE5025R0095 Page 3 of 12

Delivery Schedule:

Delivery Number Quantity FOB Point 1 0.000000 Destination

Description: OPTION YEAR 3 LES Health Insurance inclusive of Sub CLINs:

3001A Self Only (one individual) 3001B Self Plus One (two individuals) 3001C Family (three or more individuals)

Number Supplies or Services Qty Unit Unit Price Total (Inc. disc., tax, and fees)

PSC: G007

PSC Description: SOCIAL- GOVERNMENT HEALTH

INSURANCE PROGRAMS

Type of Contract Pricing: Firm Fixed Price

Original: 1.0

Change: 0.0

Current: 1.0

LT Original: $0.00

Change: $0.00

Current: $0.00

Original: $0.00

Change: $0.00

Current: $0.00

Delivery Schedule:

Delivery Number Quantity FOB Point 1 0.000000 Destination

Description: OPTION YEAR 4 LES Health Insurance inclusive of Sub CLINs:

4001A Self Only (one individual) 4001B Self Plus One (two individuals) 4001C Family (three or more individuals)

CLIN Funding: Cost:

Base Totals: Original: $0.00

Change: $0.00

Current: $0.00

Original: $0.00

Change: $0.00

Current: $0.00

Exercised Options Totals: Original: $0.00

Change: $0.00

Current: $0.00

Original: $0.00

Change: $0.00

Current: $0.00

Unexercised Options Totals: Original: $0.00

Change: $0.00

Current: $0.00

Original: $0.00

Change: $0.00

Current: $0.00

Base and Options Totals: Original: $0.00

Change: $0.00

Current: $0.00

Original: $0.00

Change: $0.00

Current: $0.00

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

Pages 4 RQS 19GE5025R0095.pdf 06/30/2025 5 19GE5025R0095_A0001-signed.pdf 07/25/2025

Section A - Solicitation/Contract Form

Document Number: 19GE5025R0095 Page 4 of 12

Amendment 0002 - Questions & Answers

Question 001: Hello I am writing to express my company's interest in bidding for this solicitation. Do you have the claims history data available when the solicitation is issued? We would love to gather as much information to better understand how we can help.

Answer 001: The claims history data is available in Attachment 5 – Exhibit A (Employee and Claims Statistics), included in the solicitation package on SAM.gov. This attachment has been updated to include data covering the period from February 1, 2020 to October 29, 2020.

YEAR TOTAL MKD TOTAL USD

02/01/2019 – 01/31/2020 MKD 16,449,297 USD 301,545

02/01/2020 – 10/29/2020 MKD 7,397,949 USD 135,618

10/30/2020 – 10/29/2021 MKD 21,020,465 USD 385,343

10/30/2021 – 10/29/2022 MKD 28,599,617 USD 524,283

10/30/2022 – 10/29/2023 MKD 27,491,723 USD 503,972

10/30/2023 – 10/29/2024 MKD 27,466,892 USD 503,517

Question 002: To proceed with the proposal, we will need a census that includes the following information for those requiring coverage:

• Date of Birth

• Gender

• Employee Tier

• Home Country

• Host Country

• If Life/LTD coverage is part of the RFP request, please also provide salary and occupation details—otherwise, no further information is needed.

Answer 002: The relevant data is available in Attachment 5 – Exhibit A (Employee and Claims Statistics) on SAM.gov as part of the solicitation documents. Life and long-term disability (LTD) coverage are not included in this RFP, and the same benefits apply to all employees, regardless of tier. In line with privacy requirements, we are not sharing personally identifiable information (PII) that is not relevant to premium calculations.

Question 003: To accurately develop our quotation, I kindly request the employee census, including:

• Number of covered individuals

• Age and gender breakdown

• Any specific classification (e.g., active staff vs. retirees)

• Claims history from current or prior provider

Answer 003: The requested information, including the number of covered individuals, age and gender breakdown, and claims history, is provided in Attachment 6 –

Exhibit A (Employee and Claims Statistics) on SAM.gov. Please note that retirees are not included in the coverage.

Question 004:

i. Census – template can be sent if necessary

ALL insurance-eligible employees and enrolled dependents need to be listed

First/Last names, DOB’s, genders, enrollment tiers, etc.

i. Carrier claims reports (last 1 to 2 or more years)

These come from the incumbent insurance carrier(s) and show the total claims amounts

Large claims reports (generally $10,000 or $25,000 or more) must be listed along with diagnoses & prognoses)

Document Number: 19GE5025R0095 Page 5 of 12

Answer 004, i and ii: The relevant data is available in Attachment 5 – Exhibit A (Employee and Claims Statistics) on SAM.gov as part of the solicitation documents. In line with privacy requirements, we are not sharing personally identifiable information (PII) that is not relevant to premium calculations.

i. Current insurance benefits

Shows in-force benefits and plans for all lines being marketed

i. Current pricing

Shows in-force pricing for all plans

Answer 004, iii and iv: The U.S. Government generally does not disclose line item pricing. Line item pricing is considered sensitive and proprietary, both under the

FAR and relevant USC sections. The required benefits can be found in the Solicitation under C.1 Health Insurance Services.

Question 005: What are the consequences for the Contractor who does not want to renew any of the Optional years Contracts?

Answer 005: Under FAR 52.217-9, option years are at the sole discretion of the Government. The contractor cannot be forced to continue performance beyond the base period unless the option is exercised and accepted.

• The Government is not obligated to exercise the option.

• Likewise, the contractor is not obligated to agree if they made clear up front they will not perform beyond the base.

Consequences for the Contractor:

• Declining option years may affect the contractor’s reputation and future award competitiveness.

• The Government may view the contractor as less reliable for long-term commitments.

• The contractor has no legal right or entitlement to an option year. If they decline and the Government finds another vendor, they cannot object.

• Impact on Past Performance Ratings: Their refusal to continue may be reflected in CPARS (Contractor Performance Assessment Reporting System) ratings, especially if their unwillingness was not clearly disclosed in advance.

As such, this could impact their ability to win future federal contracts.

Question 006: Could you please provide an explanation on the CLIN Funding table

What are the meanings of:

• Base Totals;

• Exercised Options Totals;

• Unexercised Options Totals and

• Base and Option Totals

Answer 006: These totals help distinguish between what is currently obligated (base and any exercised options) versus what is potential future work (unexercised options).

Note to Offerors: You are not required to submit these totals as part of your pricing proposal. These fields are automatically populated by the Government’s contract system as part of internal processing.

Question 007: Please note that I can not find a field where we can enter the % or amount of Retention?

Answer 007: Offerors shall specify the amount they consider as the retention portion of the premium in Attachment 1 - Price Proposal Breakdown (updated).

Question 008: Please provide the total number of insured individuals for the last five years, broken down into employees, spouses, children, and retirees (if any).

Contractual Year Employees Spouses Children Retiree Total

10/30/2020-10/29/2021

10/30/2021-10/29/2022

10/30/2022-10/29/2023

10/30/2023-10/29/2023

Document Number: 19GE5025R0095 Page 6 of 12

10/30/2023 – current

Answer 008: We are unable to provide the requested information. However, Attachment 5 includes statistics on the anticipated number of employees, spouses, partners, and children for the upcoming contract associated with this solicitation.

In addition to the data provided in Attachment 5, we can share the following information, which reflects the number of individuals covered for the month of July over the past five years. This data offers a comparable overview:

Insurance Month Employees Spouses and grandfathered domestic partners

Children Total

July 2021 247 197 331 775

July 2022 254 199 334 787

July 2023 252 193 325 770

July 2024 249 193 311 753

July 2025 239 182 293 714

Please note that retirees are not covered under this contract, and the figures above do not include information about riders.

Question 009: Please provide missing Claims data 02/01/2020 until 9/31/2020

Answer 009: The claims history data has now been amended to provide information for the period from 02/01/2020 to 10/29/2020.

YEAR TOTAL MKD TOTAL USD

02/01/2019 – 01/31/2020 MKD 16,449,297 USD 301,545

02/01/2020 – 10/29/2020 MKD 7,397,949 USD 135,618

10/30/2020 – 10/29/2021 MKD 21,020,465 USD 385,343

10/30/2021 – 10/29/2022 MKD 28,599,617 USD 524,283

10/30/2022 – 10/29/2023 MKD 27,491,723 USD 503,972

10/30/2023 – 10/29/2024 MKD 27,466,892 USD 503,517

Question 010: Please provide missing Claims data from 10/30/2024 until 5/31/2025

Answer 010: According to the data reported by the contractor in June 2025, the status of claims for the period 10/30/2024 until 05/31/2025 was 14,312,997 MKD.

Employees and dependents may submit claims retroactively in the upcoming period.

Question 011: Kindly confirm the retention amount per year and the total premiums paid to the insurer for each contractual year.

Answer 011: The U.S. Government does not disclose incumbent pricing information, including retention amounts or total premiums paid in prior years, in accordance with federal procurement policy. Offerors are advised to develop their pricing proposals based on the requirements and data provided in the solicitation.

Question 012: Are there any currently open or ongoing high-cost claims exceeding USD 10,000?

Answer 012: According to the claims report provided by the current contractor in June 2025, there is no case of a single claim of USD 10,000.

Question 013: Have there been any catastrophic claims (USD 10,000 annual cap) in the last three years? If yes, how many and in which categories?

Answer 013: We do not have this information available. However, according to the information provided by the contractor, in the period from October 2020 until

March 2025, only 17 persons have reached the annual limit of USD 10,000 in total claims. This amount was obtained using the dollar to denar exchange rate of 52.9.

Document Number: 19GE5025R0095 Page 7 of 12

Question 014: Exhibit A in Attachment 5 provides an overview of past claims. Could you please disaggregate the claims paid outside of North Macedonia, by year?

Answer 014: The location of medical services (i.e., whether provided inside or outside North Macedonia) is not a parameter tracked in the available claims data.

Therefore, we are unable to disaggregate claims by service location.

Question 015: Under Clause C.1.1.16, are there any pre-authorization requirements or geographic restrictions for out-of-country medical treatment?

Answer 015: There are no geographic restrictions for medical treatment received outside the country. Pre-authorization is not required, provided the medical treatment falls within the services covered under this contract.

Question 016: Does the U.S. Embassy contribute to the state social insurance system for Locally Employed Staff (LES), which provides general public healthcare coverage?

If so, are dependents also entitled to access this public healthcare coverage?

Answer 016: The Mission participates in North Macedonia's Local Social Security System (LSSS), which includes medical contributions. Dependents are covered in accordance with the local laws.

Question 017: Is enrollment in the LES health insurance plan mandatory or voluntary for eligible employees?

Answer 017: Enrollment in the state’s Local Social Security System is a mandatory obligation, while participation in the supplementary health insurance system allows for withdrawal. Please read the terms for withdrawal in C.7.3.

Answer 018: Are there any minimum participation requirements or guaranteed enrollment figures per year?

Answer 018: Please refer to the following parts of the solicitation:

• A.3 Minimum and Maximum and

• C.7.3 Withdrawal from Insurance Coverage.

Question 019: Is enrollment of eligible dependents (spouse/children) optional or mandatory?

Answer 019: The enrollment of eligible dependents is optional.

Question 020: Is direct billing mandatory for medical services within N. Macedonia?

Answer 020: Direct billing is not mandatory.

Question 021: Are there any minimum geographic coverage expectations or service level requirements for the network of providers within N. Macedonia?

Answer 021: The insured persons under this contract have the right to obtain coverage for the medical services included in the contract in medical facilities in North

Macedonia and outside of North Macedonia, without any geographical restrictions, under the terms of the contract. The Contractor may also provide a direct billing system, within a network of medical providers. Medical providers offering high-quality and specialized services are strongly encouraged to be included in the network.

Question 022: What are the expected timelines for premium payments and claims reimbursements?

Answer 022: Please refer to Section I. D.3 Contractor Responsibility in Claims and Reimbursement to Claims for expectations on claims reimbursements. For premium payments, see Section I. H. Invoices and Payment, which outlines the required invoice contents to ensure prompt processing. Invoices are processed monthly and paid promptly in accordance with FAR 52.212-4, assuming proper submission and documentation.

Document Number: 19GE5025R0095 Page 8 of 12

Question 023: Will the Embassy collect employee premium contributions and remit payment to the contractor, or is the contractor expected to collect from individuals directly?

Answer 023: All payments to the contractor will be made by the U.S. Government, as outlined in Section I. H – Invoices, Review and Payment. The contractor is not expected to collect any contributions directly from individual employees.

Answer 024: For the 180-day dependent coverage post-employee death (Ref: C.1.1.17), will the premiums be paid by the USG or the dependents?

Answer 024: The premiums will be paid by the USG.

Question 025: Please confirm that VAT is not applicable to health insurance services under this contract in North Macedonia (per B.3).

Answer 025: VAT is not applicable to Health Insurance services in North Macedonia (see Section I. B.4 VAT – Value Added Tax).

Question 026: Does the 2% excise tax under the Zadroga Act apply to insurance premiums under this contract? If so, will a W-13 exemption form suffice?

Answer 026: Yes, 2% Excise Tax is applicable. Form W-14 with instructions is provided in the solicitation attachments on SAM.gov.

Question 027: Is Defense Base Act (DBA) Insurance required under this solicitation?

Answer 027: No, DBA is not applicable to the solicitation.

Question 028: Point B.2.3 specifies that a retention amount is a mandatory factor for premium adjustment. However, Attachment 1 – Price Proposal

Breakdown does not include a section for indicating retention amounts. Could you please confirm whether an updated version of Attachment 1 – Price Proposal

Breakdown will be provided with a designated field for retention amounts?

Answer 028: Offerors shall specify the amount they consider as the retention portion of the premium in Attachment 1 - Price Proposal Breakdown (updated).

Question 029: Please confirm whether all currencies allowed to be used in the proposal! Will you convert any currency to USD on the date of validation, with

USD serving as the reference currency for evaluation.

Answer 029: Offerors may propose in any currency as specified in Section I. B.6 Pricing Table (Attachment 1 - Price Proposal Breakdown). Per FAR 52.225-17, if multiple currencies are offered, the Government will convert them to USD using the exchange rate used by the Embassy at the time of evaluation. Please refer to the clause for full details.

Question 030: What is the currency of payment for monthly premiums: USD, EUR, or MKD?

Answer 030: Payments shall be made in the currency the contractor specified in Section I. B. PRICING, B.6 Pricing Table (Attachment 1 - Price Proposal

Breakdown).

Question 031: What is the currency for the monthly payments to the insurer, USD, EUR, or MKD?

Answer 031: Payment shall be made in the currency the contractor specified in Section I. B. PRICING, B.6 Pricing Table (Attachment 1).

Question 032: Would it be possible to extend the due date if responses to questions or amendments are issued less than seven working days before the original deadline?

Answer 032: See SF-30 Amendment 0002 under Description for the extended offer due date.

Document Number: 19GE5025R0095 Page 9 of 12

Question 033: Please confirm that C.1.1.7 Prescription Drugs does not include Reimbursement for over-the-counter (OTC) drugs, supplements, and similar items, even when prescribed.

Answer 033: Over-the-counter (OTC) drugs, supplements, and similar items are generally not included under this clause. However, coverage may be determined as necessary for certain products that may not clearly fall into the categories of prescription or OTC medications, provided they are medically necessary and prescribed by a certified health care provider.

Question 034: Is the budget for all 1 (contract) + 4 (optional) years limited to US$ 3.850.000, and we shall not exceed this amount in our quotation for the whole contract period (1+4 years)?

Answer 034: The amount of USD 3,850,000 represents the maximum total ordering limit over the full contract period, including the base year and all four option years.

Offerors may propose pricing within this ceiling.

Question 035: Please indicate whether in attachment 1 the premiums for the basic and optional years may differ due to the expected medical inflation throughout the years.

Answer 035: Yes, Offerors may propose different premiums across contract years based on anticipated medical inflation, subject to evaluation.

Question 036: Should the offeror fulfilled the document Section A – solicitation /contract form page 2 and 3, or the offeror/insurer should submit only the attachment 1 in terms of the premiums /cost of insurance?

Answer 036: Pages 2–3 of the SF1449 (Section A) are completed by the Government, not the offeror, unless otherwise stated. Offerors must complete Attachment

1 – Price Proposal Breakdown. Please refer to FAR 52.212-1 and its Addendum (Section III. A. INSTRUCTIONS TO OFFERORS of the solicitation) for detailed submission instructions, including the required contents of Volume I (Technical) and Volume II (Price).

Question 037: In point B.2.3, a retention amount is specified. Does this amount imply all costs associated with the provision of the insurance service? Should this amount, expressed as a percentage of the collected premium, be indicated by the offerors in their proposals? Could the USG possibly have a defined amount or a maximum percentage up to which the retention amount may be set?

Answer 037: The U.S. Government does not prescribe a maximum percentage or fixed amount for retention, nor is it a factor in proposal evaluation. Offerors shall specify the amount they consider as the retention portion of the premium in Attachment 1 - Price Proposal Breakdown (updated).

Question 038: The agreement is set to be 1+4 years; the USG may, but is not obligated to, perform the agreement for the subsequent four optional years. But is the conduct of the agreement for the subsequent four optional years a mandatory obligation for the insurance company? Only the USG has the authority to decide on the execution of the optional years; the Insurer does not possess such a possibility?

Answer 038: See Answer 005.

Question 039: In section C.1.1.4, annual physical examinations are mentioned; does this refer to preventive examinations without medical indication? If so, does this mean that the insured individuals are entitled to one examination, or to a batch of preventive examinations once a year? In the context of this question, please specify how the annual physical examinations mentioned in section C.1.1.4 differ from the provisions outlined in section C.1.1.8.

Answer 039: Annual physical examinations referenced in Section C.1.1.4 are considered preventive care and typically include a routine health check-up without medical indication. Preventive examination per year per insured individual is expected and aligns with common practice in North Macedonia. These services fall under the maximum annual coverage cap of USD 10,000 per individual, per contract year, as outlined in Section C.1.1.

Preventive examinations under Section C.1.1.4 differ from medically indicated diagnostic procedures or specialist consultations referenced in Section C.1.1.8, which are provided based on medical need rather than on a preventive basis.

Question 040: Is there an annual sublimit for annual physical examinations or for the point C.1.1.8 ?

Document Number: 19GE5025R0095 Page 10 of 12

Answer 040: See Answer 039.

Question 041: Regarding C.1.1.10 Optical. Will we receive confirmation from the existing insurer/insured regarding the last time the insured utilized this benefit, or will the limit of 300 USD be considered to commence from the day the contract is signed?

Answer 041: The limit of USD 300 will take effect from the effective date of the contract subject to this solicitation.

Question 042: Regarding C.1.1.9 Hearing Aids. Will we receive confirmation from the existing insurer/insured regarding the last time the insured utilized this benefit, or will the limit of 1.500USD be considered to commence from the day the contract is signed?

Answer 042: The limit of USD 1,500 will take effect from the effective date of the contract subject to this solicitation.

Question 043: Regarding C.1.1.11 Dental, Is it permissible to apply a sublimit for certain dental procedures, such as crowns and bridges, for instance, up to

150 dollars per crown?

Answer 043: There is no price limitation for individual dental procedures.

Question 044: Regarding C.1.1.11 Dental , Should implants be included under the stipulated minimum coverage?

Answer 044: Implants are generally not included under this clause. However, coverage may be determined as appropriate on a case-by-case basis, if implants are deemed medically necessary and prescribed by a certified dental professional.

Question 045: Regarding C.1.1.7 Prescription drugs, should the OTC be covered by the insurance plan?

Answer 045: See Answer 033.

Question 046: C.1.1.16 Out of country medical treatment is set to be optional benefit. This means the coverage is not part of the minimum coverage the insurers needs to provide under this solicitation?

Answer 046: Out-of-country medical treatment is indeed part of the minimum coverage that must be provided by the selected contractor under this solicitation. It is marked as "optional" because the Embassy has the discretion to decide whether to include this benefit in the solicitation. In this case, the Embassy chose to include it, making it a required component of the coverage under the solicitation.

Question 047. Should this insurance plan provide travel assistance services in terms of medical cost occurred abroad?

Answer 047: Transport costs are covered under C.1.1.3: Ambulance: Professional ground transport to move a patient from the place where s/he is injured or becomes ill to the nearest hospital able to provide treatment or to move a patient from one medical facility to another.

Question 048. In D.1 in the provisions regarding Complaint procedures (page 22) , in paragraph (i) it is mentioned medical evacuation, please specify whether costs for medical evacuation need to be covered by the insurance plan? If medical evacuation needs to be covered, please specify which cost under medical evacuation should be covered?

Answer 048: Mandatory covered benefits are outlined in Section C.1.1 of the solicitation. Specifically, Clause C.1.1.3 addresses ambulance services, which refer to transportation costs. No additional costs of this nature are covered under this contract.

Question 049: Can you please clarify the manning of this provisions in the Volume 2 – Technical proposal: Provide detailed information regarding the pool that will apply to the employees under this contract. Offeror will describe the size of the pool, whether it is a mixture of commercial and government (if applicable), alternative pools that are available in the event the economic price adjustment clause becomes effective. It shall be stated if no pool applies.

Document Number: 19GE5025R0095 Page 11 of 12

Answer 049: A pool refers to the group of individuals or entities whose claims experience will influence pricing and risk calculations. In your proposal, you should:

• Indicate whether the insured U.S. Embassy employees will be part of a larger insurance pool (e.g., combined with other commercial clients, government clients, or a specific group plan);

• State the approximate size of that pool;

• Clarify whether alternative pools are available in case an economic price adjustment (e.g., due to high claims or inflation) becomes necessary during contract performance; and

• If no such risk pool applies, please state so.

This information helps the Government understand your risk model and assess the stability and fairness of pricing overtime.

SECTION I - B. PRICING

B.6 Pricing Table

B.6.1 Contract Pricing

Note to Offerors: Complete Attachment 1 – Price Proposal Breakdown by entering the monthly premium for each performance period and each premium category.

(Pricing table to be inserted at the time of award by the contracting office)

B.6.2 Administrative Retention Amount

If the Contractor requests a price adjustment under B.2, it shall submit cost experience data that includes the fixed retention amount. This retention amount, included in the premium prices under B.6.1, will not be subject to adjustment under this contract. It encompasses all non-claims-related costs, such as overhead, G&A, and profit.

Note to Offerors: Complete Attachment 1 – Price Proposal Breakdown by entering the monthly retention amount for each performance period and each premium category.

(Pricing table to be inserted at the time of award by the contracting office)

SECTION III - A. INSTRUCTIONS TO OFFERORS

A. PROPOSAL DUE DATE

Offers shall be submitted no later than 12:00 PM CET on Wednesday, August 20th, 2025, via email to Ms. Jenina Dosch, DoschJK@state.gov. The email subject line must read “Solicitation 19GE5025R0095”.

Delivery via a cloud file storage service (e.g. GoogleDrive, etc.) is not allowed.

If the proposal is sent in multiple emails, the email shall be labeled accordingly (e.g. file 1 of 2). Individual emails may not exceed 50MB and shall not include compressed files (.zip/.rar).

Late submissions shall not be considered.

All documents shall be submitted in the Microsoft word or the Adobe pdf format and shall be named / numbered to appear in the e-mail(s) in the correct sequence.

The only exception is Pricing Document which may be submitted in Microsoft Excel format. The limit per e-mail is 50MB. Zipped files (.zip or .rar) are not permitted. The Government shall not be responsible for an offeror being unable to successfully transmit emails due to due to any file size constraints of e-mail systems.

Contractors shall ensure that emails have been transmitted and that messages have not been returned “undeliverable”.

USE OF ELECTRONIC DEPOSITORIES IS NOT PERMITTED (for example “We transfer”, google drive etc.).

• Definition. “Electronic proposal,” as used in this provision, means a proposal, revision, or modification of a proposal, or withdrawal of a proposal that is transmitted to and received by the Government via electronic means.

• Offeror shall submit electronic proposals as responses to this solicitation.

Document Number: 19GE5025R0095 Page 12 of 12

• Individual file names shall include the offeror's name as well as a concise description of the file (e.g., "Company XYZ Technical Proposal"). If the proposal is sent in multiple emails, the email shall be labeled accordingly (e.g., File 1 of 2).