19GE5026Q0035-Attachment-3-Pricing-Schedule.xlsx

This is a Pricing Schedule template for a health insurance services solicitation issued by the Department of State Regional Procurement Support Office Frankfurt for locally employed staff (LES) and eligible dependents at the U.S. Embassy in Lisbon, Portugal. The pricing schedule is structured as a firm-fixed-price Indefinite Delivery/Indefinite Quantity (IDIQ) contract with a base year and four optional one-year periods, with services commencing no later than January 1, 2027.

The pricing template requires offerors to submit bi-weekly rates for three coverage categories: Single Employees (Self Only) covering 31 members, Employee + 1 covering 56 members, and Family Plan covering 122 members. Rates must be provided for the Base Year, Year 1, Year 2, Year 3, and Year 4, with offerors calculating the annual rate (bi-weekly rate multiplied by 26 pay periods) and subtotals (annual rate multiplied by number of members) for each category and performance period. The template also includes a section for Monthly Retention Amounts across all contract periods. All pricing cells are highlighted for completion by the offeror, with a note that estimated quantities are for evaluation purposes only and actual member numbers may vary. The currency for pricing submission must be specified by the offeror.