19GE5026R0020 - Combined Synopsis.pdf

RFP No.19GE5026R0020 U.S. Embassy Valletta, Malta Health Insurance for LES Page 1 of 102

COMBINED SYNOPSIS & SOLICITATION

LES Health Insurance, U.S. Embassy Valletta, Malta

SOLICITATION NO. 19GE5026R0020

Issued by:

American Consulate General

Regional Procurement Support Office

Giessener Strasse 30

60435 Frankfurt am Main

Germany

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Contents

SECTION I – THE SCHEDULE

A. BACKGROUND

1. SYNOPSIS

2. CONTRACT TYPE

3. MINIMUM & MAXIMUM

B. PRICING

1. GENERAL

2. ECONOMIC PRICE ADJUSTMENT, PREMIUM

ADJUSTMENT BASED ON EXPERIENCE

3. PREMIUM ADJUSTMENT BASED ON LAWS

4. VAT – VALUE ADDED TAX

5. THE CURRENCY OF THIS CONTRACT IS

7. PRICING TABLE

C. SPECIFICATIONS / STATEMENT OF WORK

C.1 HEALTH INSURANCE SERVICES

C.1.1 EMPLOYEE AND DEPENDENT HEALTH SERVICES

BENEFIT - MANDATORY BENEFITS:

C.2 OVERALL ANNUAL MAXIMUM LIMIT:

C.3 HEALTH BENEFITS EXCLUSIONS AND LIMITATIONS

C.4 ELIGIBLE PARTICIPANTS

C.5 DEPENDENTS:

C.6 INDIVIDUALS NOT ELIGIBLE FOR COVERAGE

C.7 ELIGIBILITY

C.8 BROCHURE REQUIREMENT

C.9 ACCRONYMS AND ABBREVIATIONS

D. CONTRACT ADMINISTATIVE REQUIREMENTS AND

PROCEDURES

D.1 QUALITY ASSURANCE AND SURVEILLANCE PLAN

(QASP)

D.2 DELIVERABLES AND REPORTS REQUIREMENTS

D.3 CONTRACTOR RESPONSIBILITY IN CLAIMS AND

REIMBURSEMENT TO CLAIMS

D.4 KEY PERSONAL

D.5 MISCELLANEOUS CONTRACTOR REQUIREMENTS

D.6 PHYSICAL AND INFORMATION SECURITY

REQUIREMENTS

D.7 CHANGES IN OWNERSHIP

E. FUNDING / TASK ORDERS / PROCEDURES

F. LAWS AND REGULATIONS

G. CONTRACT ADMINISTRATION DATA

H. INVOICES, REVIEW AND PAYMENT

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H.1 INVOICES SUBMISSION

H.2 ADVANCE PAYMENT SHALL NOT BE AUTHORIZED

UNDER THIS CONTRACT

H.3 ERRONEOUS PAYMENT

I. LIST OF ATTACHMENTS

SECTION II – CONTRACT CLAUSES

FAR 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

FAR 52.212-4 CONTRACT TERMS AND CONDITIONS-COMMERCIAL

ITEMS (NOV 2023)

FAR 52.212-5 CONTRACT TERMS AND CONDITIONS REQUIRED TO

IMPLEMENT STATUTES OR EXECUTIVE ORDERS-COMMERCIAL

PRODUCTS AND COMMERCIAL SERVICES (OCT 2025)

FAR 52.204-25 PROHIBITION ON CONTRACTING FOR CERTAIN

TELECOMMUNICATIONS AND VIDEO SURVEILLANCE

SERVICES OR EQUIPMENT (NOV 2021)

FAR 52.216-18 - ORDERING (AUG 2020)

FAR 52.216-19 - ORDER LIMITATIONS (OCT 1995)

FAR 52.216-21 - REQUIREMENTS (OCT 1995)

FAR 52.216-22 - INDEFINITE QUANTITY (OCT 1995)

FAR 52.217-8 - OPTION TO EXTEND SERVICES (NOV 1999)

FAR 52.217-9 - OPTION TO EXTEND THE TERM OF THE CONTRACT

(MAR 2000)

FAR 52.229-12 - TAX ON CERTAIN FOREIGN PROCUREMENTS (FEB

2021)

DOSAR 652.232-70 PAYMENT SCHEDULE AND INVOICE SUBMISSION

(FIXED-PRICE) (AUG 1999)

DOSAR 652.242-70 – CONTRACTING OFFICER'S REPRESENTATIVE

(COR) AUG 1999)

DOSAR 652.242-73 – AUTHORIZATION AND PERFORMANCE (AUG 1999) .. 59

DOSAR 652.243-70 – NOTICES (AUG 1999)

DOSAR 652.232-72 LIMITATION OF FUNDS

SECTION III– SOLICITATION PROVISIONS

III.1 FAR 52.252-1 – SOLICITATION PROVISIONS INCORPORATED BY

REFERENCE (FEB 1998)

III.2 ADDENDUM TO 52.212-1 - INSTRUCTIONS TO OFFERORS:

III.2.1 QUALIFICATIONS OF OFFERORS

III.2.2 JOINT VENTURE AGREEMENTS:

III.3 PRE-PROPOSAL CONFERENCE

III.4 SUBMISSION OF QUESTIONS

III.5 PROPOSAL DUE DATE

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III.6 DOSAR 652.206-70 – ADVOCATE FOR COMPETITION /

OMBUDSMAN (FEB 2015) (Deviation)

SECTION IV – EVALUATION FACTORS

IV.1 EVALUATION PROCESS AND FACTORS

FAR 52.212-2 Evaluation – Commercial Products and Commercial Services (Nov

2021)

ADDENDUM TO 52.212-2 - EVALUATION – COMMERCIAL

PRODUCTS AND COMMERCIAL SERVICES:

IV.2 FAR 52.217-5 – EVALUATION OF OPTIONS (JUL 1990)

IV.3 FAR 52.225-17 – EVALUATION OF FOREIGN CURRENCY OFFERS

(FEB 2000)

SECTION V – REPRESENTATIONS AND CERTIFICATIONS

V.1 FAR 52.212-3 OFFEROR REPRESENTATIONS AND CERTIFICATIONS-

COMMERCIAL PRODUCTS AND COMMERCIAL SERVICES (OCT

2025)

V.2 FAR 52.209-5 CERTIFICATION REGARDING RESPONSIBILITY

MATTERS (AUG 2020)

V.3 FAR 52.209-11 – REPRESENTATION BY CORPORATONS

REGARDING AN UNPAID TAX LIABILITY OR A FELONY

CRIMINAL CONVITION UNDER ANY FEDERAL LAW (FEB 2016) ... 95

V.4 FAR 52.222-56 – CERTIFICATION REGARDING TRAFFICKING IN

PERSONS COMPLIANCE PLAN (OCT 2025)

V.5 FAR 52.204-24 REPRESENTATION REGARDING CERTAIN

TELECOMMUNICATIONS AND VIDEO SURVEILLANCE

SERVICES OR EQUIPMENT (NOV 2021)

V.6 FAR 52.229-11 TAX ON CERTAIN FOREIGN PROCUREMENTS—

NOTICE AND REPRESENTATION (JUN

2020)

V.7 DOSAR 652.225-70 – ARAB LEAGUE BOYCOTT OF ISRAEL (AUG

1999)

V.8 CERTIFICATION ON CONTRACTOR

EMPLOYEES

The remainder of this page is left intentionally blank

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Combined Synopsis and Solicitation

Solicitation Number 19GE5026R0020

SECTION I – THE SCHEDULE

The Regional Procurement Support Office (RPSO) Frankfurt hereby provides the following

Combined Synopsis and Solicitation for:

A. BACKGROUND

The Government of the United States of America (USG) requires Health Insurance for its

Locally Employed Staff (LES) and their dependents at US Valletta, Republic of Malta. The

Contractor shall provide the Health Insurance services, as described in Section I.C.

Specifications / Statement of Work. The groups of employees who shall be provided this insurance are listed in Section I.C.4 Eligible Participants and section I.C.5 Dependents.

1. SYNOPSIS

1.1 This is a combined synopsis/solicitation for commercial items prepared in accordance with the format in FAR Subpart 12.6, as supplemented with additional information included in this notice.

1.2 This announcement constitutes the only solicitation; offers are being requested, and a written solicitation will not be issued. The solicitation number is 19GE5026R0020 and is issued as a Request for Quotations (RFP), unless otherwise indicated herein.

1.3 The solicitation document and incorporated provisions and clauses are those in effect through Federal Acquisition Circular (FAC) 2025-06, effective October 1, 2025.

1.4 This solicitation is utilizing Simplified Acquisition Procedures at FAR 13. Competition is full and open.

1.5 Applicable NAICS and PSC Codes:

NAICS 524114: Direct Health and Medical Insurance Carriers

PSC Code G007: Social- Government Health Insurance Programs

1.6 Offers valuation: The evaluation of offers will be based on Comparative Evaluation in accordance with FAR 13.106-2(b)(3). – see section IV Evaluation Factors.

2. CONTRACT TYPE

2.1 The contract resulting from this solicitation shall be a firm fixed-price Indefinite

Delivery, Indefinite Quantity (IDIQ) type contract with economic price adjustment requirements type contract under which annual firm, fixed-price task orders will be issued. The required minimum purchase shall be obligated on a task order at the time the contract is executed.

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2.2 The fixed prices / premium rates for the health insurance services as specified in section

I.C. Specifications / Statement of Work are listed in section I.B. Prices. The quantities shown in the Pricing Schedule are estimates only and the Government is not obligated to order the estimated quantities shown in this section.

2.3 The contract will be for a one base year period starting from September 01, 2026, and four (4) one-year options periods, which may be exercised by modification to the contract. Including optional years in the contract does not obligate the Government to exercise one or all option years.

2.4 Payments will be made only to the extent specifically authorized in the task order.

3. MINIMUM & MAXIMUM

3.1 As per FAR 52.216-22, "INDEFINITE QUANTITY," the minimum and maximum amounts for this indefinite quantity contract shall be any quantity or combination of supplies and services equal to the amount (s) set forth below. The US Government (USG) makes no guarantee as to the number of orders or actual amount of services that may be requested above the guaranteed minimum value for the life of the contract

3.2 The minimum guaranteed order amount: The Government shall order, as a minimum, services in an amount of $7,000.00 or equivalent in local currency. During the term of this contract. 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 $7,000.00 or equivalent in local currency.

3.3 The maximum ordered amount during the entire life of this contract is $3,500,000.00.

3.4 The required minimum purchase shall be obligated on a task order at the time the contract is executed.

B. PRICING

1. GENERAL

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.

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2. ECONOMIC PRICE ADJUSTMENT, PREMIUM ADJUSTMENT BASED ON

EXPERIENCE

2.1. 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.

No adjustment will be allowed during the base year.

2.2 The Contractor or the Government may request an adjustment 60 days prior to the end of the base year or current option year, to take effect at the start of the following option year.

Adjustments are not retroactive to previous periods of performance, and Contractors may not seek to recover costs incurred during a prior period of performance through an Economic Price

Adjustment. Economic Price Adjustments only apply as an adjustment to the rates to be charged by the Contractor for the services identified as in the contract, and cannot be recovered as a lump sum adjustment paid to the Contractor.

2.3 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, i.e. per line item for the preceding 12 months. 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.

2.4 Mutually agreed to adjustments shall be effective thirty days after complete information is received by the Government and after the corresponding modification has been signed by the

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

3. PREMIUM ADJUSTMENT BASED ON LAWS

The rates may also be adjusted during the performance period of the contract as a result of laws enacted by the host government, if such change in the laws has a direct impact on the cost to the contractor to perform this contract at the contracted rate. In that event, the Contracting Officer may enter into negotiations with the contractor to modify the contract to adjust the premium rate(s). The contractor agrees to provide all documentation necessary to support any requested adjustment.

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Employee Pool – This clause is only in effect if the contractor included details in its offer regarding a pooling arrangement, of which this contract is a part.

Before any adjustment is made under this price adjustment clause, the contractor must include in its proposal for adjustment details setting forth how the pool impacts the request for equitable adjustment.

4. VAT – VALUE ADDED TAX

Health Insurance Services are VAT exempted in the Republic of Malta.

5. THE CURRENCY OF THIS CONTRACT IS

Offerors shall insert the currency offers are made.

6. Excise Tax: 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. The Contractor shall complete attached form W-14 to apply for an exemption of the Excise Tax, if applicable.

7. PRICING TABLE

A. Contract Pricing

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C. SPECIFICATIONS / STATEMENT OF WORK

C.1 HEALTH INSURANCE SERVICES

The Government of the United States of America requires Health Insurance coverage for its employees Valletta, Republic of Malta, as further described in this Section.

The specific health benefit coverage under this contract is set forth in Sub Sections B.1 through

B.4:

The premium costs for any optional benefits, if selected, are 100% the responsibility of the employee

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

• Employee (1 covered individual)

• Adult Dependent

• Child Dependent

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

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

Pre-existing conditions refer to any disease or health condition arising from injury, illness, congenital or genetic factors, disease caused by sexual transmission, and/or autoimmune conditions. Coverage of pre-existing conditions shall be extended to all covered employees.

C.1.1 EMPLOYEE AND DEPENDENT HEALTH SERVICES BENEFIT -

MANDATORY BENEFITS:

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

Reimbursement Rate for Inpatient and/or Emergency: 100% Coverage

Services and supplies provided during hospitalization, including services provided by a licensed healthcare provider, bed & board, 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.

• See Mental, Nervous and Substance Abuse care (below) for details concerning inpatient psychiatric care.

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

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

Reimbursement Rate - 100% Coverage

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

100% Coverage

C.1.1.3 Ambulance:

Reimbursement Rate – 80% minimum coverage

Professional ground transport to move a patient from the place where s/he is injured or becomes ill to the nearest hospital able to provide treatment or to move a patient from one medical facility to another.

C.1.1.4 Outpatient Services:

Reimbursement Rate - 80% minimum coverage

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

- Medical Professional fees

• See Rehabilitative and Habilitative Services and Devices (below) for details concerning physical therapy.

• See Mental Health and Substance Abuse Care (below) for details concerning psychiatric therapy.

C.1.1.5 Obstetric and Newborn Care:

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

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

C.1.1.6 Pediatric Services:

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Reimbursement Rate for Inpatient: 100% Coverage; Outpatient: 80% Minimum Coverage

Primary and preventive routine care services for covered dependent children, including, but not limited to: physical examination, developmental assessment, laboratory tests, and immunizations recommended by local authorities or the World Health Organization.

C.1.1.7 Prescription Drugs:

Reimbursement Rate for Inpatient: 100% Coverage; Outpatient: 80% Minimum Coverage

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.

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

Reimbursement Rate: 80% Minimum Coverage

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

C.1.1.9 Hearing Aids:

Examinations and Treatment: 80% Minimum Coverage

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

C.1.1.10 Optical Care:

Examinations and Treatment: 80% Minimum Coverage

Prescription lenses and frames, or contact lenses: Covered up to a maximum of USD 300 per covered individual per two-year period. 80% Minimum Coverage; with applicable cap

C.1.1.11 Dental Care:

Reimbursement Rate – 80% Minimum Coverage

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

Orthodontia: Treatment is covered only if treatment begins before age 18, or if required as the result of an accident. A maximum of four years of orthodontia treatment will be covered per

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with contract lifetime cap

[Note: C.1.1.9, C.1.1.10, C.1.1.11, C.1.1.15, will be converted to cost proposal currency using the DOS exchange rate for the date of contract award:

C.1.1.12 Reproductive Health:

Reimbursement Rate: 80% Minimum Coverage

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).

C.1.1.13 Mental Health and Substance Abuse Care:

Reimbursement Rate: 50% Minimum Coverage

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

C.1.1.14 Rehabilitative and Habilitative Services and Devices:

Reimbursement Rate: 50% Minimum Coverage

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 chronic condition, and devices needed for habilitative reasons.

C.1.1.15 HIV/AIDS:

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

Medications to suppress opportunistic infections (such as tuberculosis or toxoplasmosis for covered individuals who have HIV/AIDS). Brief courses of anti-retroviral drugs during childbirth to prevent the transmission of HIV/AIDS to the child. Generally, excludes medication for the long-term suppression of HIV/AIDS through the combination of anti-retroviral drugs in locations with inadequate local healthcare infrastructures.

C.1.1.16 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 medical expenses incurred in-country.

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C.1.1.17 Pre-existing condition

Pre-existing conditions refer to any disease or health condition arising from injury, illness, congenital or genetic factors, disease caused by sexual transmission, and/or autoimmune conditions. Coverage of pre-existing conditions will be extended to all covered employees

C.2 OVERALL ANNUAL MAXIMUM LIMIT:

The maximum annual coverage per covered individual per contract year is 47,657 Euros, not including expenses covered under HIV/AIDS.

*The coverage/maximum limit under this section C.2 is provided in euros and shall remain fixed for the length of the contract.

C.3 HEALTH BENEFITS EXCLUSIONS AND LIMITATIONS

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

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

IV. 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.

C.4 ELIGIBLE PARTICIPANTS

C.4.1 Eligible Employees

To be eligible to participate in the medical plan, LE Staff (both full time and part time) must be:

C.4.1.1 Paid under the Local Compensation Plan (LCP); and be-

C.4.1.1.1 Under a non-temporary direct hire appointment, personal services agreement (PSA), or personal services contract (PSC); or

C.4.1.1.2 Under a temporary direct hire appointment or PSA Fixed Term of one year or more.

C.4.1.1.3 Part-time employees who work more than 20 hours per week are eligible.

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C.4.2 Location of Employment

The individuals authorized by C.1 must be employed within the geographic boundaries of the

Republic of Malta.

C.4.3 Official Residence Expense (ORE) and Employee Association (EA) 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 U.S. Government, is responsible for the employer's share of the premium costs for an ORE/EA employee.

C.4.4 Participants and Benefits Covered Under a Rider

C.4.4.1 The U.S. Government requires that an enrollee has the right to extend their enrollment during the open season for each option year; and under any circumstances, the contractor will not conduct any risk assessment and will cover pre-existing conditions

C.5 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.

C.6 INDIVIDUALS NOT ELIGIBLE FOR COVERAGE

C.6.1 Individuals 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

Malta 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

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743; and Recreation Association employees.

C.6.2. Retirees are not eligible for medical coverage.

C.7 ELIGIBILITY

C.7.1 Term of Eligibility and Effective Date

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

Government.

C.7.1.2 In cases where LE Staff and their legal spouse both work for the mission and both are eligible to participate in the medical plan, one will be designated as the lead for purposes of the medical plan, and the other will be considered a legal spouse. Children will be covered under either of the parents’ coverage.

C.7.2 Period of Ineligibility

C.7.2.1 Employees and their dependents are not entitled to health benefits during any period of employment for which premiums are not paid.

C.7.2.2 Additionally, employees’ dependents are not entitled to health benefits during any period of employment during which the employee was not eligible to participate.

C.7.2.3 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.

C.7.3 Withdrawal from Insurance Coverage

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

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

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

C.8 BROCHURE REQUIREMENT

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

English that sets forth a complete listing of the health insurance benefits to be provided under this contract. This brochure shall be provided in sufficient quantities so that each covered employee receives a copy. The Contractor shall furnish all copies of the brochures to the COR, who will ensure that appropriate distribution is made.

C.8.2 The Contractor shall provide the document described in C.8.1 to the COR not later than 10

(ten) days after date of contract award. The Contractor shall provide additional brochures for new employees within ten (10) days of the COR’s request.

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

C.8.1 accurately reflects the requirements of the contract, as implemented by the Contractor’s technical proposal. In all cases, the contract shall take precedence. Should the COR discover that the brochure contains inaccuracies, the Contractor will be notified in writing; however, failure on the part of the Government to notice any inaccuracies shall in no way limit, revise or otherwise affect the requirement under this contract for the Contractor to fully comply with all contract terms.

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

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

C.9 ACCRONYMS AND ABBREVIATIONS

Acronym Definition

CLIN Contract Line Item Number

Contractor Insurance Company

CO Contracting Officer

COR Contracting Officer Representative

Dependent Dependents are defined as the covered employee’s legal spouse as defined by law (limit one) and children (natural, adopted, stepchild, or foster children).

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.

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Employer The United States Government = USG

Employee Staff member of the US Embassy Valletta, Republic of Malta

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.

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

USG U.S. Government

D. CONTRACT ADMINISTATIVE REQUIREMENTS AND PROCEDURES

D.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

Timely payment of benefits (within

21 calendar days)

No more than one (1) customer complaint is received per month.

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No incorrectly denied claims

No more than one (1) customer complaint is received per month.

• Surveillance – The COR will receive and document all complaints from USG personnel regarding the services provided. If found valid, the COR will send the complaints to the contractor for corrective action.

• Standard – The performance standard is that the USG receives no more than one (1) customer complaint per month. The COR shall notify the Contracting Officer of the complaints so that the Contracting Officer may take appropriate action to enforce the inspection clause (FAR 52.246-4, Inspection of Services – Fixed Price (AUG 1996) or the appropriate Inspection of Services clause), if any of the services exceed the standard.

• Complaint Procedures

a. If USG personnel observe unacceptable services such as but not limited to lack of coordination during medical evacuation, extended referral periods, delays in receipt of payment, etc., they will immediately contact the COR.

b. The COR will complete appropriate documentation to record the complaint.

c. If the COR determines the complaint is invalid, the COR will advise the complainant.

The COR will retain the annotated copy of the written complaint for his / her files.

d. If the COR determines the complaint is valid, the COR will inform the contractor and give the contractor additional time to correct the defect, if additional time is available.

The COR shall determine how much time is reasonable.

e. The COR shall, as a minimum, provide e-mail notification informing the contractor of any valid complaints.

f. If the contractor disagrees with the complaint and challenges the validity of the complaint, the contractor shall notify the COR by e-mail. The COR will review the matter to determine the validity of the complaint.

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

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.

D.2 DELIVERABLES AND REPORTS REQUIREMENTS

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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 Valletta

ATTN: Human Resources Officer

COR -TBA

Valletta, Republic of Malta

NOTE: Any and all costs for the preparation, handling, mailing and submission of progress reports or any other required reports and documentation shall be included in the total price of each delivery order.

Description QTY Submission Date Deliver to and how:

Reference

C.8 Brochures

As many copies as instructed by the COR

Additional copies

10 days after contract award

Within 10 calendar days of the COR’s request

COR

hard copy

H.1 Invoice 1 monthly COR &

Designated

Billing Office

ID Card Each/per person As per discussion with the COR

COR

Hard Copy

D.3 CONTRACTOR RESPONSIBILITY IN CLAIMS AND

REIMBURSEMENT TO CLAIMS

General – The contractor shall be responsible for all planning, estimating, programming, project management, scheduling, dispatching, supervision, and inspection of work. The contractor shall maintain his own reference library of technical reference works and local laws and regulations, including current tariffs and registries. The contractor shall treat the information provided by the

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

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

a) Administrative Records

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I. 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.

II. 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.

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

b) Medical Insurance Claims – Settlement of medical insurance shall be completed as follows:

I. All medical claims shall be submitted directly to the Contractor by employees, through a drop box in the COR's office. The claims shall be picked up from the COR every week.

II. 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).

III. The Contractor shall settle the claims no later than two weeks from the date the claim is submitted to the Contractor.

IV. Settlement/Reimbursement shall be made by EFT from the insurance company directly to the employee.

V. 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.

D.4 KEY PERSONAL

The US Government considers the contractors Project Manager as Key Personnel for this contract.

Project Manager Name: To be inserted by the Contracting Office at the time of award

During the entire performance period of this contract, the contractor shall make no substitutions of key personnel unless the substitution is necessitated by illness, death, or termination of employment.

The contractor shall notify the Contracting Officer Representative within 15 calendar days after the occurrence of any of these events. The proposed substitute shall possess qualifications

Health Insurance for LES Page 21 of 102 comparable to the original key person, as well as satisfying any minimum standards set forth elsewhere in the solicitation / contract. The Contracting Officer Representative will notify the contractor within 15 calendar days after receipt of all required information of the decision on the substitution.

D.5 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.

D.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.

Reproduction and 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.

D.7 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.

E. FUNDING / TASK ORDERS / PROCEDURES

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The required minimum purchase shall be obligated on a task order at the time the contract is executed. Funding will be provided by issuing annual task orders with possible modification for staffing changes. Each task order will contain the following information:

• Name of contractor

• Contract number

• Date of purchase

• Task order number

• Name of person placing the order

• Quantity, unit price, and total price of each service / insurance premium

• VAT or other taxes as a separate item, if applicable

• COR and post points of contact, including e-mail addresses

• applicable contract clauses, either in reference or in full text if necessary

Only an RPSO Contracting Officer may place a written order.

Ordering Procedures – The Government shall issue annual funded task orders to cover all eligible employees and their dependents. No task order shall include any names or PII

(personally identifiable information). The COR informs the contracting officer if any additions or deletions are required throughout the year and the Contracting Officer will issue funded modifications as required.

Riders - The ORE staff and AEA employees under separate riders are not included under the task orders issued by the Contracting Officer.

Because their coverage is under a rider, their employer is responsible for directly interacting with the Contractor to order any coverage for their employees. When contacted by the employer, the

Contractor shall advise the employer of the paperwork and payment that will be necessary to order coverage for the identified individuals.

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).

b) 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.

c) Start Period of Performance

Contract performance starts September 1, 2026.

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The period of performance is one year, with two 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 2, FAR 52.217-9, Option to Extend the Term of the Contract - Deviation, which also specifies the total duration of this contract.

The Government may exercise the option set forth at Section 2, "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.

F. LAWS AND REGULATIONS

• Compliance Required - If the contractor has or will establish a local office, he shall without additional expenses to the USG, 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.

G. 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

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Government Personnel

Contracting Officer: Travis C. Keon

Contract Administrator: Alexandra Perez Acevedo

E-mail address: PerezAcevedoA@state.gov

Contracting Officer's Representative (COR): TBD

US Embassy Valletta, Malta

Human Resources Assistant

E-mail address: TBD

H. INVOICES, REVIEW AND PAYMENT

H.1 INVOICES SUBMISSION

a) The Contractor shall submit monthly invoices to the Contracting Officer Representative.

b) 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 must be attached to each summary invoice and should include the breakdown cost by each membership fee line according to the pricing schedule

c) Each invoice shall include the items listed in Section 2, FAR 52.212-4 g.1.

d) Payment shall be made in the currency the contractor specified in Section I.B Prices.

H.2 ADVANCE PAYMENT SHALL NOT BE AUTHORIZED UNDER THIS

CONTRACT.

Advance Payment shall not be authorized under this contract.

H.3 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.

mailto:PerezAcevedoA@state.gov

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I. LIST OF ATTACHMENTS

I.1 Attachment 1 Pricing

I.2 Attachment 2 Past Performance (to be completed by contractor)

I.3 Attachment 3 Form W-14 (to be completed by contractor)

I.4 Exhibit A: Employee Statistic

I.5 W-14 Form Instructions

The remainder of this page is left intentionally blank

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SECTION II – CONTRACT CLAUSES

FAR 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 these address(es):

Referenced FAR provisions and clauses can be obtained from:

https://www.acquisition.gov/browse/index/far

Referenced DOSAR provisions and clauses can be obtained from:

http://www.statebuy.state.gov/dosar/fullscreen.asp?menu_id=40

(note: click on 652 – 653 sub-chapter, Click on 652 and then scroll down)

The following FAR and DOSAR clauses are incorporated by reference:

CLAUSE TITLE DATE

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

52.204-19 Incorporation by Reference of Representations and Certifications DEC 2014

52.225-14 Inconsistency between English Version and Translation of

Contract

FEB 2000

52.228-4 Workers' Compensation and War-Hazard Insurance Overseas APR 1984

52.228-5 Insurance-Work on a Government Installation JAN 1997

52.229-6 Taxes – Foreign Fixed-Price Contracts FEB 2013

52.232-17 Interest MAY 2014

52.232-19 Availability of Funds for next year APR 1984

52.232-24 Prohibition of Assignment of Claims MAY 2014

52.232-39 Unenforceability of Unauthorized Obligations JUN 2013

52.232-40 Providing Accelerated…