RFP 19GT5020R0005 - Amendment 0001 - Health and Life Insurance services for LE Staff for U.S. Embassy in Guatemala.pdf

PAGE OF PAGESAMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT 1. CONTRACT ID CODE

1 69

2. AMENDMENT/MODIFICATION NO.

3. EFFECTIVE DATE

12/03/2020

4. REQUISITION/PURCHASE REQ. NO.

PR9399980-0001

5. PROJECT NO. (If applicable)

6. ISSUED BY CODE GT500 7. ADMINISTERED BY (If other than Item 6) CODE

AMERICAN EMBASSY GUATEMALA CITY

Avenida Reforma 7-01, Zona 10, ATTN: GSO - PROCUREMENT SECTION Guatemala

GUATEMALA

AMERICAN EMBASSY GUATEMALA CITY

Avenida Reforma 7-01, Zona 10, ATTN: GSO - PROCUREMENT SECTION Guatemala

GUATEMALA

(X) 9A. AMENDMENT OF SOLICITATION

NO.

19GT5020R0005

x

9B. DATED (SEE ITEM 11)

09/21/2020

10A. MODIFICATION OF CONTRACT/ORDER NO.

8. NAME AND ADDRESS OF CONTRACTOR (No., street, county, State and ZIP Code)

CODE FACILITY CODE

10B. DATED (SEE ITEM 13)

11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS

x The above numbered solicitation is amended as set forth in Item 14. The hour and date specified for receipt of Offers x is extended, is not extended.

Offers must acknowledge receipt of this amendment prior to the hour and date specified in the solicitation or as amended, by one of the following methods:

(a) By completing items 8 and 15, and returning 1 copies of the amendment; (b) By acknowledging receipt of this amendment on each copy of the offer submitted;

or (c) By separate letter or telegram which includes a reference to the solicitation and amendment numbers. FAILURE OF YOUR ACKNOWLEDGMENT TO BE RECEIVED AT THE PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY RESULT IN REJECTION OF YOUR OFFER. If by virtue of this amendment your desire to change an offer already submitted, such change may be made by telegram or letter, provided each telegram or letter makes reference to the solicitation and this amendment, and is received prior to the opening hour and date specified.

12. ACCOUNTING AND APPROPRIATION DATA (If required)

13. THIS ITEM ONLY APPLIES TO MODIFICATION OF CONTRACTS/ORDERS.

IT MODIFIES THE CONTRACT/ORDER NO. AS DESCRIBED IN ITEM 14.

CHECK ONE A. THIS CHANGE ORDER IS ISSUED PURSUANT TO: (Specify authority) THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE CONTRACT ORDER

NO. IN ITEM 10A.

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

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

D. OTHER (Specify type of modification and authority)

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

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

The purpose of this amendment is to:

1) Extend due date of offers to December 21, 2020 by COB 17:00 hours.

2) Edit Section C.1.4.1.1 and C.2.4.3 as detailed in the attached scope of work.

3) Add H.4. CONTRACTOR RESPONSIBILITY IN CLAIMS AND REIMBURSEMENT TO CLAIMANTS, (c) Life Insurance Claims as detailed in the attached scope of work.

All other terms and conditions remain the same.

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)

15B. CONTRACTOR/OFFEROR

(Signature of person authorized to sign)

15C. DATE SIGNED 16B. UNITED STATES OF AMERICA

(Signature of Contracting Officer)

16C. DATE SIGNED

NSN 7540-01-152-8070

Previous edition unusable

STANDARD FORM 30 (REV. 10-83)

Prescribed by GSA FAR (48 CFR) 53.243

Juan G. Ortiz x 1

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SECTION B - PRICE

B.1. HEALTH INSURANCE SERVICES

The Contractor shall provide the Health Insurance services to employees of the Government of the United States of America in Guatemala and their eligible dependents as described in

Section C. This insurance shall be provided in accordance with Section C.

B.1.1. Official Residence Expense (ORE) Staff are included under this contract only as a rider;

the Contractor shall bill the Chief of Mission and Deputy Chief of Mission (for ORE Staff), at the rates specified below. 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.

B.2. PRICES

B.2.1 VALUE ADDED TAX.

The Contractor shall include VAT as a separate line item in the pricing chart in Section B and shall include VAT in the Invoice. A VAT form will be provided for 12% tax of VAT.

B.2.2 This is a fixed price with economic price adjustment requirements type contract under which will be issued firm, fixed-price task orders. The fixed prices/premium rates for the health insurance services as specified in Section C are as follows:

B.2.3 Base Year of

Contract

Bi-Weekly Rates Per

Premium

Category Estimated Number of

Premiums*

Rate per

Premium

Extended Bi-Weekly Total

a. Single Employee

(self only)

b. Self plus one (Two individuals)

c. Family (three or more individuals)

d. Subtotal (a + b + c)

e. 12% VAT

f. Total (d + e)

g. Total Price for Base

Year (f x 26)**

*estimated number of premiums does not include any Riders (B.1.1)

**does not include any premiums for Riders.

Rider Category*** Biweekly Rate per Premium

C.1.1.21 Excess Coverage

***not included in the Total Price for Base Year Calculation

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B.2.4 First Option Year of Contract

Rate per

Premium

Extended Bi-Weekly Total

a. Single Employee

(self only)

b. Self plus one (Two individuals)

c. Family (three or more individuals)

d. Subtotal (a + b + c)

e. 12% VAT

f. Total (d + e)

***not included in the Total Price for First Option Year Calculation

B.2.5 Second Option

Year of Contract

Rate per

Premium

Extended Bi-Weekly Total

a. Single Employee

(self only)

b. Self plus one (Two individuals)

c. Family (three or more individuals)

d. Subtotal (a + b + c)

e. 12% VAT

f. Total (d + e)

***not included in the Total Price for Second Option Year Calculation

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B.2.6 Third Option

Rate per

Premium

Extended Bi-Weekly Total

a. Single Employee

(self only)

b. Self plus one (Two individuals)

c. Family (three or more individuals)

d. Subtotal (a + b + c)

e. 12% VAT

f. Total (d + e)

***not included in the Total Price for Third Option Year Calculation

B.2.7 Fourth Option

Rate per

Premium

Extended Bi-Weekly Total

a. Single Employee

(self only)

b. Self plus one (Two individuals)

c. Family (three or more individuals)

d. Subtotal (a + b + c)

e. 12% VAT

f. Total (d + e)

***not included in the Total Price for Fourth Option Year Calculation

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B.2.8. Grand Total of Base plus All Option Years

Base Year Total

First Option Year Total

Second Option Year Total

Third Option Year Total

Fourth Option Year Total

Grand Total of Base plus All Option Years

B.3 ADMINISTRATIVE RETENTION AMOUNTS

B.3.1 If the Contractor requests a price adjustment under B.4 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 in B.2. This retention amount will not be adjusted for any reason.

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. B.3.2 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 bi-weekly 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.

B.3.2 Bi-Weekly Retention Amounts per separate premium paid per single employee and per family plan.

Period of Performance Single Employee (self only)

Family Plan

Base Period

First Option Year

Second Option Year

Third Option Year

Fourth Option Year

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B.4. ECONOMIC PRICE ADJUSTMENT-HEALTH INSURANCE PREMIUMS

B.4.1. 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.1.1. 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. 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.

B.4.2. 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.

B.4.2.1 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.

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PART II: PRICE - GROUP LIFE INSURANCE

B.5. GROUP LIFE INSURANCE SERVICES

The Contractor shall provide the Group Life Insurance services described herein to employees of the Government of the United States of America in Guatemala. The groups of employees who shall be provided this insurance are listed in C.2.3. This insurance shall be provided in accordance with Section C and the Exhibits in Section J.

B.5.1. Official Residence Expense (ORE) Staff and Retirees are included under this contract only as a rider; the Contractor shall bill the Chief of Mission and Deputy Chief of Mission (for ORE

Staff), and the retirees separately, at the rates specified below. See Section G for billing procedures.

B.6. GROUP LIFE INSURANCE RATES

This is a fixed-price with economic-price- adjustment-requirements type contract under which the Government will issue firm-fixed price task orders. The fixed prices/premium rates per one thousand of salary to provide life insurance, accidental death and dismemberment and partial and total disability coverage are as follows:

Type of Insurance

(per 1,000 of Salary)

Estimated Payroll

(Bi-Weekly in USD

Thousands) Bi-Weekly Total

a. Basic Life $384,868

b. Accidental Death & Dismemberment $384,868

c. Partial & Total Disability Coverage $384,868

Bi-Weekly Rates per Employee

B.6.1. Base Year of Contract

d. Subtotal (a + b + c)

e. Total Price for Base Year (d x 26)

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(per 1,000 of Salary)

Estimated Payroll

(Bi-Weekly in USD

Thousands) Bi-Weekly Total

a. Basic Life $396,415

b. Accidental Death & Dismemberment $396,415

c. Partial & Total Disability Coverage $396,415

Bi-Weekly Rates per Employee

B.6.2. Option Year 1 of Contract

d. Subtotal (a + b + c)

e. Total Price for Option Year 1 (d x 26)

Type of Insurance

Premium

(per 1,000 of Salary)

Estimated Payroll

(Bi-Weekly in USD

Thousands) Bi-Weekly Total

a. Basic Life $408,307

b. Accidental Death & Dismemberment $408,307

c. Partial & Total Disability Coverage $408,307

Bi-Weekly Rates per Employee

B.6.3. Option Year 2 of Contract

d. Subtotal (a + b + c)

e. Total Price for Option Year 2 (d x 26)

Type of Insurance

Premium

(per 1,000 of Salary)

Estimated Payroll

(Bi-Weekly in USD

Thousands) Bi-Weekly Total

a. Basic Life $420,556

b. Accidental Death & Dismemberment $420,556

c. Partial & Total Disability Coverage $420,556

Bi-Weekly Rates per Employee

B.6.4. Option Year 3 of Contract

d. Subtotal (a + b + c)

e. Total Price for Option Year 3 (d x 26)

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B.7 ADMINISTRATIVE RETENTION AMOUNTS

B.7.1 If the Contractor requests a price adjustment under B.8 below, the Contractor must 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 in B.6. This retention amount will not be adjusted for any reason.

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 claimant.

B.7.2 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 retention amounts for each period of performance and for each category of premium. This fixed amount must 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.

(per 1,000 of Salary)

Estimated Payroll

(Bi-Weekly in USD

Thousands) Bi-Weekly Total

a. Basic Life $433,173

b. Accidental Death & Dismemberment $433,173

c. Partial & Total Disability Coverage $433,173

Bi-Weekly Rates per Employee

B.6.5. Option Year 4 of Contract

d. Subtotal (a + b + c)

e. Total Price for Option Year 4 (d x 26)

B.6.6. Grand Total of Base plus All Option Years

Base Year Total

Option Year 1 Total

Option Year 2 Total

Option Year 3 Total

Option Year 4 Total

Grand Total of Base plus All Option Years

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B.7.2 Retention Amounts per Separate Premium Paid per Employee:

Period of Performance Basic Life

Accidental Death and

Dismemberment

Partial and Total

Disability Coverage

Base Period

Option Year 1

Option Year 2

Option Year 3

Option Year 4

B.8 ECONOMIC PRICE ADJUSTMENT (EPA)-LIFE INSURANCE PREMIUMS

B.8.1. Premium Adjustment Based on Experience: For life insurance, prices may be adjusted upward or downward based on the experience rating of the Mission(s) covered by this contract. 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. The information shall be provided per type of premium, i.e. per line item. The retention amount is not subject to adjustment. The Government reserves the right to select an independent third party to 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.

B.8.2. Premium Adjustment Based on Law: 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 rate contracted for herein. 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.

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SECTION C - DESCRIPTION/SPECIFICATION/WORK STATEMENT

C.1. HEALTH INSURANCE SERVICES

The Government of the United States of America requires Health Insurance coverage for its employees in Guatemala as described herein. The U. S. Government pays 90% and the employee pays 10% of the Premium costs. The specific health benefit coverage under this contract is set forth in Section C and the Exhibits in Section J.

The Contractor must offer options for both “in-network” and “out-of-network” medical providers within the stated benefit levels below. In-Network providers must work directly with the

Contractor to receive payment. The Contractor may require employees to pay upfront for services with Out-of-Network medical providers and subsequently seek reimbursement from the

Contractor.

C.1.1 Employee and Dependent Health Service Benefits

Deductible of $103.89 (Q800 based on an exchange rate of Q7.7=$1) per person/per year.

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

Minimum Coverage - 100%

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, and 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.

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

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

C.1.1.2 Emergency Services (Trips to Emergency Room): Minimum Coverage - 100%

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

C1.1.3 Ambulance: Minimum Coverage - 80%

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: Minimum Coverage - 80%

Services provided by a licensed healthcare provider on an ambulatory or outpatient basis (without being admitted to a hospital), including surgeon’s fees and other medical services provided at 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

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- Immunizations recommended by local authorities and/or the World Health

Organization

- Diagnostic tests and diagnostic imaging

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: Minimum Coverage - Inpatient/Emergency: 100%;

Outpatient: 80%

Care and services that women receive during pregnancy (prenatal care), throughout labor, 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: Minimum Coverage - Inpatient/Emergency: 100%, Primary and preventive routine care services for covered dependent children, including, but not limited to: physical examinations, developmental assessments, laboratory tests, and immunizations recommended by local authorities and/or the World Health

Organization.

C.1.1.7 Prescription Drugs: Minimum Coverage -Inpatient/Emergency: 100%, 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:

Minimum Coverage - 80%

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, immunizations, and cancer screenings.

C.1.1.9 Hearing Aids: Minimum Coverage – 80%

Examinations and Treatment: 80% Minimum Coverage

Hearing Aid Apparatus: Limited to one apparatus per ear up to a maximum of USD

1,500.00 per covered individual per three-year period. 80% Minimum Coverage; with annual cap.

C.1.1.10 Optical Care: Minimum Coverage – 80%

Examinations and Treatment: 80% Minimum Coverage

Prescription lenses and frames, or contact lenses: Covered up to a maximum of

USD300.00 per covered individual every two years. 80% Minimum Coverage; with annual cap.

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C.1.1.11 Dental Care: Minimum Coverage – 80%

Examinations and Treatment: Dentist’s fees, x-rays, examinations and treatment, cleanings, fillings, extractions, false teeth, crowns, and bridges up to a maximum of

USD3,200.00 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 covered individual up to a maximum of USD 2,400.00 lifetime limit. 80%

Minimum Coverage; with contract lifetime cap.

C.1.1.12 Reproductive Health: Minimum Coverage - 80%

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: Minimum Coverage - 50%

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.

C.1.1.14 Rehabilitative and Habilitative Services and Devices: Minimum Coverage - 50%

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.

C.1.1.15 HIV/AIDS: 100% up to USD10,000.00 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 RESERVED

C.1.1.17 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.

C.1.1.18 Out-of-Country Medical Travel: 80% Reimbursement

Transportation for out-of-country medical treatment will be a covered expense for covered employees 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

14 | P a g e 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.

C.1.1.19 RESERVED

C.1.1.20 RESERVED

NOTE: Employee responsible for paying 100% of premium for Excess Coverage

Additional coverage equal to $129,870 (Q1,000,000.00 based on an exchange rate of

Q7.7=$1) per covered individual per the lifetime of the contract. This excess coverage will be offered as an optional benefit to LE Staff. This can be used for any covered individual for any covered expense that exceeds annual maximum. LE Staff must pay

100% of the premium if they elect Excess Coverage. The premium for this additional coverage is a rider to be paid by the employee to the vender directly and USG will not be responsible for collecting of these premium payments.

C.1.2 Maximum Coverage Limit - The maximum coverage reimbursement per covered individual per the lifetime of the contract, not including expenses defined under Exclusions and

Limitations (C.1.3) or those covered under C.1.1.15, HIV/AIDS, and C.1.1.21 Excess Coverage is equivalent to $129,870 (Q1,000,000.00 based on an exchange rate of Q7.7=$1)

C.1.3 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 is the lowest-cost and technically acceptable. Removal of any exclusions require prior authorization.

There is no coverage 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.1.4 Eligible Participants

C.1.4.1 Identification of Eligible Employees and Dependents: U.S. Embassy - Guatemala will provide a list of all eligible employees and dependents with relationship to employee

(self/spouse/child) and DOB for each. Updates will be provided to add or remove

15 | P a g e individuals on a bi-weekly/monthly basis. Eligible Employees are the LE Staff who are paid under the terms of the Local Compensation Plan (LCP); and under a non-temporary direct hire appointment, personal services agreement (PSA), or personal services contract (PSC); or under a temporary direct hire appointment or PSA Fixed Term of one year or more.

Not eligible are those working under temporary appointments; those working under a

PSC or PSA that is time limited to less than one year; non-personal services contract personnel and their employees, supplied by an independent contractor licensed to do business in Guatemala who provides services to other local organizations as well as to the U.S. Mission; employees working on an intermittent or When Actually Employed (WAE) schedule; employees of USAID institutional contractors; Peace Corps personal services contractors as indicated in MS 743; and Recreation Association employees.

Official Residence Expense (ORE) and Retired Employees are covered under a rider to the contract. The employing officer/Retired Employee, not the USG, is responsible for the share of the premium costs for such riders.

C.1.4.1.1 Definition of Dependents

C.1.4.1.1.1 Legal Spouse: one legal spouse as defined by local law per employee 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. In these specific cases, both the lead and the spouse shall be elegible to participate in the life insurance coverage plan. The employees will decide who is registered as the principal and who is registered as the dependant.

C.1.4.1.1.2 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.1.4.2 Location of Employment: The eligible employees covered by C.1.4.1 must be employed within the geographic boundaries of Guatemala by the United States

Government agencies under the Chief of Mission Authority.

C.1.4.3 Participants Covered Under a Rider

a. All current active ORE Staff personally employed by the Chief of Mission and the Deputy Chief of Mission and assigned to their respective official Government residences and paid under an ORE account. All costs for coverage of ORE Staff are the responsibility of the Chief of Mission and the Deputy Chief of Mission, not the U.S. Government.

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b. All retired employees of U. S. Embassy – Guatemala (see separate rider, Exhibit

B). All costs for retired employees are the employee’s responsibility, not the U. S.

Government.

C.1.5 Eligibility

C.1.5.1 Term of Eligibility and Effective Date

Each current active eligible employee and their eligible dependents are enrolled for health benefits under this contract upon award and thereafter during the performance period of this contract. Each new eligible employee and eligible dependents will be enrolled upon entering on duty with the United States Government. An employee is considered active ("on the rolls") whenever such employee is on approved leave, whether paid or unpaid.

C.1.5.2. 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 (LWP) 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 that employee prefers not to pay the premium.

C.1.6 Brochure Requirement

C.1.6.1 The Contractor shall provide a document (brochure/pamphlet/other written document) in Spanish 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.1.6.2 The Contractor shall provide the document described in C.1.6.1 to the COR not later than 20 calendar 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.

C.1.6.3 The Contractor assumes full responsibility for ensuring that the document described in C.1.6.1 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.

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PART II: GROUP LIFE INSURANCE

C.2. GROUP LIFE INSURANCE

The Government of the United States of America requires group life insurance coverage for its employees, as further described in C.2.2, in Guatemala. The Government has determined that the prevailing practice by employers in Guatemala is that group life insurance coverage is representative of locally prevailing compensation practice. The USG will pay 100% of the

Premium Costs of the life insurance benefit. The specific group insurance coverage under this contract is set forth in this part of Section C and the Attachments in Section J.

C.2.1. Group Life Insurance Coverage.

The amount of group life insurance coverage is as follows:

C.2.1.1 Amount of Employee Life Insurance.

The amount of life insurance coverage for each employee is based upon the monthly basic salary of the individual; each employee is eligible for a face amount of coverage that is equal to 24 times his or her monthly basic salary in the event the employee dies of natural causes.

C.2.1.2 Amount of Accidental Death and Dismemberment Coverage.

The employee's estate or employee will receive an amount equal to 40 times the amount of his or her monthly basic salary.

C.2.1.3 Partial and Total Disability Coverage

The employee will receive an amount equal to 19 times his or her monthly basic salary in the event of total disability.

C.2.2 Life Insurance Benefits Conditions and Limitations.

Conditions and limitations on the entitlement to life insurance benefits under this contract are as follows:

No benefits shall be payable if an employee’s death or other insurance event was caused directly or indirectly by war. War shall be defined as declared or non-declared war or any martial operations or invasion, hostile acts of foreign powers, rebellion, riot, civil war, uprising, mutiny, operations by military or usurpatory authorities, martial law or state of siege or any other similar event or reason for declaring martial law or war. A terrorist attack shall not be considered war. No benefit shall be payable under this contract if the employee’s bodily injuries have been caused directly or indirectly and totally or partially by:

1. Violating the law or in resisting detention or arrest;

2. Participation in competitions involving the use of wheeled vehicles, horses, boats or water skis;

3. An accident resulting from the employee being under the influence of alcohol, drugs or other toxic substance unless administered by a physician.

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Death as a result of a disease or physical or mental infirmities and medical or surgical treatment thereof (except pyogenic infection due to an accidental cut or wound) shall be considered a natural and not an accidental death. Suicide will not be covered.

C.2.3. Eligible Participants.

C.2.3.1 Eligible Employees. The employees eligible for the group life insurance coverage include the following:

C.2.3.1.1 All current active employees of the United States Government, employed within the geographic boundaries of Guatemala, paid under the Local

Compensation Plan, and certified by the Contracting Officer. Covered employees include:

C.2.3.1.2. Locally Employed Staff (LE Staff) employed under direct hire appointments, Personal Services Agreements (PSAs) and Personal Services Contracts

(PSCs);

C.2.3.1.3. Locally hired U.S. citizens employed under direct hire appointments, PSAs, and PSCs.

C.2.3.2 Location of Employment

C.2.3.2 The individuals covered by C.2.3.1 must be employed within the geographic boundaries of Guatemala by:

Department of State

Department of Defense

Department of Agriculture

Department of Commerce

Department of Health and Human Services

Department of Homeland Security

Department of Justice

Department of the Treasury

U.S. Agency for International Development

Any other United States Government Agency under Chief of Mission Authority

C.2.3.3 Participants Covered Under a Rider

C.2.3.3.1 All current active employees of the Chief of Mission and the

Deputy Chief of Mission assigned to their respective official Government residences and paid under an ORE account (see separate rider, Exhibit C). All costs for ORE employees are the responsibility of the employing officer, not the U.S. Government.

C.2.3.3.2 RESERVED.

C.2.4 Individuals Not Eligible for Coverage

C.2.4.1. New employees who have reached the age of sixty (60) years prior to entering on duty with the U.S. Government will not be eligible for life insurance coverage.

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C.2.4.2 Individuals not eligible for coverage under this contract are LE Staff working under temporary appointments; those working under a PSA or PSC that is time limited to less than one year; those with a When Actually Employed (WAE) workweek schedule; non-personal services contract personnel and their employees, supplied by an independent contractor licensed to do business in Guatemala who provide services to other local organizations as well as to the U. S. Mission; employees of USAID institutional contractors; and Peace Corps personal services contractors as indicated in MS 743 and any other individual not falling within one of the categories of employees described in this clause.

C.2.4.3 Employee’s dependents are not covered under this plan. The only exception is when the dependant spouse is a Locally Employed Staff (LE Staff) employed under direct hire appointments, Personal Services Agreements (PSAs) and Personal Services Contracts

(PSCs)employee of the U.S. Embassy – Guatemala. The employees will decide who is registered as the principal and who is registered as the dependant.

C.2.4.4 Retirees are not covered under this plan.

C.2.5. RESERVED

C.2.6 Eligibility and Effective Date

C.2.6.1. Term of Eligibility and Effective Date

Each current active eligible employee is enrolled for life insurance and disability benefits under this contract upon award and thereafter during the performance period of this contract. Each new eligible employee will be enrolled upon entering on duty with the United States Government. An employee is considered active ("on the rolls") whenever such employee is on approved leave, whether paid or unpaid.

During a period of Leave Without Pay (LWP) or unpaid leave that is one pay period or less, coverage under the insurance contract will continue. The USG will pay the total premium cost to the Contractor. The employee’s share of the premium will be collected through payroll deduction in that or the subsequent pay period.

C.2.6.2. Period of Ineligibility

Employees are not entitled to life insurance and disability benefits hereunder during any period of employment for which premiums are not paid.

During a period of extended (beyond one pay period) of Leave Without Pay

(LWP) or unpaid leave, the employee is responsible for the full cost of the insurance premiums. 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.

C.2.7. Brochure Requirement

C.2.7.1. The Contractor shall provide a document (brochure/pamphlet/other written document) in Spanish language that sets forth a complete listing of the life 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

20 | P a g e brochures to the COR, who will ensure that appropriate distribution is made. In addition, the written documentation must be made available in electronic (.pdf) format.

C.2.7.2. The document described in C.2.7.1 shall be provided to the COR not later than twenty (20) calendar days after date of contract award. The Contractor shall provide additional brochures for new employees within ten days of the COR’s request.

C.2.7.3. The Contractor assumes full responsibility for ensuring that the document described in C.2.7.1 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.

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SECTION D - PACKAGING AND MARKING

(RESERVED)

SECTION E - INSPECTION AND ACCEPTANCE

E.1. 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

This contract incorporates the following 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. In addition, the full text of a clause may be accessed electronically at

Acquisition.gov this address is subject to change.

If the Federal Acquisition Regulation (FAR) is not available at the location indicated above, use the Department of State Acquisition website at e-CFR to see the links to the FAR. You may also use an Internet “search engine” (for example, Google, Yahoo or Excite) to obtain the latest location of the most current FAR.

The following Federal Acquisition Regulation clause(s) is/are incorporated by reference:

CLAUSE TITLE AND DATE

52.246-4 INSPECTION OF SERVICES - FIXED PRICE (AUG 1996)

E.2. 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 Government, is responsible for management and quality control to meet the terms of the contract. The role of the Government is to conduct quality assurance to ensure that contract standards are achieved.

Performance Objective

PWS

Paragraph Performance Threshold

Services

Performs all the insurance services set forth in the Performance Work Statement (PWS)

C.1.0 thru

C.2.7

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

E.2.1 Surveillance. 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.

E.2.2 Standard. The performance standard is that the Government receives no more than three (3) customer complaint per month. The COR shall notify the Contracting Officer of the complaints so that the Contracting Officer may take appropriate action to enforce the inspection clause (FAR 52.246-4, Inspection of Services – Fixed Price (AUG 1996) or the appropriate Inspection of Services clause), if any of the services exceed the standard.

https://acquisition.gov/browse/index/far https://gov.ecfr.io/cgi-bin/text-idx?SID=d9a7851186785ba2b1896db79b1b6b29&mc=true&tpl=/ecfrbrowse/Title48/48tab_02.tpl

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E.2.3 Procedures

(a) If any Government personnel observe unacceptable services, either incomplete work or required services not being performed, they should 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, orally notify the Contractor of any valid complaints.

(f) If the Contractor disagrees with the complaint 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.

(g) The COR will consider complaints as resolved unless notified otherwise by the complaint.

(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.

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SECTION F - DELIVERIES OR PERFORMANCE

F.1. 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

available. Also, the full text of a clause may be accessed at: Acquisition.gov this address is subject to change.

The following Federal Acquisition Regulation clauses are incorporated by reference:

52.242-15 STOP WORK ORDER (AUG 1989)

52.242-17 GOVERNMENT DELAY OF WORK (APR 1984)

F.2 PERIOD OF PERFORMANCE. The performance period of this contract is one year beginning on specified pay period with four (4) one-year options to renew.

F.3 OPTIONS

(a) The Government may extend this contract in accordance with the option clause at Section I, clause I.2, FAR Clauses Incorporated by Full Text (FAR 52.217-9, Option to Extend the

Term of the Contract), which also specifies the total potential duration of the contract.

(b) The Government may exercise the option set forth at Section I, "FAR 52.217-8, Option to Extend Services".

F.4 REPORTS AND OTHER DELIVERABLES

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

EMBAJADA DE LOS ESTADOS UNIDOS

Attn: Human Resources Office

Avenida Reforma 7-01, Zona 10

Guatemala, Guatemala 01010 https://gov.ecfr.io/cgi-bin/text-idx?SID=d9a7851186785ba2b1896db79b1b6b29&mc=true&tpl=/ecfrbrowse/Title48/48tab_02.tpl

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SECTION G - CONTRACT ADMINISTRATION DATA

G.1. 652.242-70 CONTRACTING OFFICER’S REPRESENTATIVE (COR) (AUG 1999)

(a) The Contracting Officer may designate in writing one Government employee, by name or position title, to take action for the Contracting Officer under this contract. This designee shall be identified as a Contracting Officer’s Representative (COR). Such designation shall specify the scope and limitations of the authority so delegated; provided, that the designee shall not change the terms or conditions of the contract, unless the COR is a warranted Contracting Officer and this authority is delegated in the designation.

(b) The COR for this contract is the designated Human Resources Officer.

G.2 COR DUTIES

G.2.1 The COR is responsible for inspection and acceptance of services. These duties include review of Contractor invoices, including the supporting documentation required by the contract. The COR may provide technical advice, substantive guidance, inspections, invoice approval, and other purposes as deemed necessary under the contract.

G.2.2 In addition, the COR shall maintain updated list of employees and dependents insured, which will supersede the initial list provided under this contract and as reported to the insurer without prejudice to the ineligibility clause.

G.2.3. The COR has the additional responsibility of maintaining the eligible listing of employees and dependents for insurance coverage.

G.2.4 The COR may not change the terms and conditions of the contract. While the

COR is authorized to provide the Contractor with updated listings of eligible employees and dependents, only the Contracting Officer may modify existing task orders or issue new task orders, reflecting these changes, since only the Contracting Officer can obligate funding and commit the Government.

G.3. Payment shall be made in US Dollars or Quetzales, depending on the Contractor’s capacity to present an invoice in the selected currency.

G.4 SUBMISSION OF INVOICES AND PAYMENT

G.4.1. Invoices for U.S. Government employees shall be submitted in electronic version to the following address (designated billing office only for the purpose of submitting invoices):

GTMD…