19GT5025R0005 - Health and life insurance services for LE Staff.docx

Guatemala, September 11, 2025

Dear Prospective Offeror:

Subject: Request for Proposals number 19GT5025R0005 – Health and life insurance services for LE Staff

The Embassy of the United States of America invites you to submit a proposal for locally employed staff health and/or life insurance coverage. The Embassy encourages prospective offerors to offer off-the- shelf plans that meet at least the minimum benefit levels required in this solicitation.

The U.S. Government intends to award an indefinite delivery/indefinite quantity (IDIQ) contract to the responsible company submitting an acceptable offer at the lowest price. We intend to award a IDIQ based on initial proposals, without holding discussions, although we may hold discussions with companies in the competitive range if there is a need to do so.

The Embassy intends to conduct a pre-proposal conference at the site. The pre-proposal conference will be held on October 1, 2025, at 9:00 AM (local Guatemala time) at the U.S. Embassy Guatemala compound, Boulevard Austriaco 11-51, Zona 16 at 9:00 AM. Prospective offerors should contact Lorena Galdamez at GaldamezAL@state.gov for additional information or to arrange entry to the building, not later than September 24, 2025.

Proposals are due by October 24, 2025, by COB 17:00 hours. No proposals will be accepted after this time. Proposals must be in English and incomplete proposals will not be accepted.

Your proposal must be submitted electronically to GuatemalaBids@state.gov. It is important to make sure the submission is made in specific size and format; in MS-Word 2007/2010 or MS-Excel 2007/2010 or Adobe Acrobat (pdf) file format. The file size must not exceed 30MB. If the file size should exceed the 30MB, the submission must be made in separate files and attached to separate emails with less than 30MB each.

In order for a quotation to be considered, you must also complete and submit the following: 1. SF-33

2. Section B, Pricing Schedule.

3. Section B, Retention Amounts in B.3 and B.7.

4. Section K, Representations and Certifications; and

5. Additional information as required in Section L.

6. The Offeror should submit a completed IRS Form W-14, found at www.irs.gov/w14, to ensure compliance with FAR 52.229-11;”

7. Proof of SAM Registration

Offerors shall be registered in the SAM (System for Award Management) database at https://www.sam.gov prior to submittal of their offer/proposal as prescribed under FAR 4.1102. Failure to be registered at the time of proposal submission may deem the offeror’s proposal to be considered non-responsive to the solicitation instruction and requirements and no further consideration will be given. Therefore, offerors are highly encouraged to register immediately if they are interested in submitting a response to this requirement.

Sincerely, Beau P. Garrett Contracting Officer

Enclosure:

UNDER DPAS (15 CFR 700)

PAGE OF PAGES

7. ISSUED BY CODE

AMERICAN EMBASSY GUATEMALA CITY

GUATEMALA

Boulevard Austriaco 11-51, Zona 16, ATTN: GSO -

PROCUREMENT SECTION

Guatemala GUATEMALA

NOTE: In sealed bid solicitations "offer" and "offeror" mean "bid" and "bidder".

SOLICITATION

CAUTION - LATE Submissions, Modifications, and Withdrawals: See Section L, Provision No. 52.214-7 or 52.215-1. All offers are subject to all terms and conditions contained in this solicitation.

10. FOR INFORMATION

CALL:

A. NAME

Lorena Galdamez

+502 52058011

EXTENSION

11. TABLE OF CONTENTS

OFFER (Must be fully completed by offeror) NOTE: Item 12 does not apply if the solicitation includes the provisions at 52.214-16, Minimum Bid Acceptance Period.

12. In compliance with the above, the undersigned agrees, if this offer is accepted within calendar days (60 calendar days unless a different period is inserted by the offeror) from the date for receipt of offers specified above, to furnish any or all items upon which prices are offered at the set opposite each item, delivered at the designated point(s), within the time specified in the schedule.

13. DISCOUNT FOR PROMPT PAYMENT

(See Section I, Clause No. 52.232-8)

14. ACKNOWLEDGMENT OF AMENDMENTS

(The offeror acknowledges receipt of amendments to the SOLICITATION for offerors and related documents numbered and dated):

15A. NAME AND ADDRESS OF OFFER- OR

CODE

FACILITY

16. NAME AND THE TITLE OF PERSON AUTHORIZED TO SIGN OFFER

(Type or print)

AWARD (To be completed by Government)

(4 copies unless otherwise specified)

AMERICAN EMBASSY GUATEMALA CITY

Boulevard Austriaco 11-51 Zona 16, ATTN: GSO GUATEMALA CITY

GUATEMALA

(Signature of Contracting Officer)

28. AWARD DATE

IMPORTANT - Award will be made on this Form, or on Standard Form 26, or by other authorized official written notice. AUTHORIZED FOR LOCAL REPRODUCTION Previous edition is unusable

STANDARD FORM 33 (REV. 6/2014)

Prescribed by GSA - FAR (48 CFR) 53.214 (c)

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 and Peace Corps Personal Service Contracts (PSC) 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 Peace Corps 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.

VAT is NOT included in the price chart under Section B. Instead it shall be included on the Invoice submitted for payment. 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 CLIN 0001 Base Year

Quetzales

Bi-Weekly Rates Per Premium

Premiums* Rate per Premium Extended Bi-Weekly Total

c. Family (3 or more individual)

d. Subtotal (a+b+c)

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

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

C.1.1.21 Excess Coverage

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

B.2.4 First Option Year of Contract

CLIN 1001 First Option Year

Quetzales

Bi-Weekly Rates Per

Premiums*

Total

c. Family (3 or more

d. Subtotal (a+b+c)

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

C.1.1.21 Excess Coverage

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

B.2.5 Second Option Year of Contract

CLIN 2001 Second Option Year

Quetzales

Bi-Weekly Rates Per

Premiums*

Total

c. Family (3 or more

d. Subtotal (a+b+c)

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

C.1.1.21 Excess Coverage

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

B.2.6 Third Option Year of Contract

CLIN 3001 Third Option Year

Quetzales

Bi-Weekly Rates Per

Premiums*

Total

c. Family (3 or more

d. Subtotal (a+b+c)

e. Total Price for Third

C.1.1.21 Excess Coverage

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

B.2.7 Fourth Option Year of Contract

CLIN 4001 Fourth Option Year

Quetzales

Bi-Weekly Rates Per

Premiums*

Total

c. Family (3 or more

d. Subtotal (a+b+c)

e. Total Price for Fourth

C.1.1.21 Excess Coverage

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

FAR 52.217-8 – Option to Extend Services (6-months)

The U.S. Embassy of Guatemala requires prices in this 6-month period of performance in case the FAR Clause 52.217-8 option to extend services is executed. Please note, the purpose of this pricing information is only for the evaluation of the total price including all options and will not be included in the grand total amount of the award.

B.2.8 Option to Extend Services

CLIN 5001 Option to Extend Services

Quetzales

Bi-Weekly Rates Per

Premiums*

Total

c. Family (3 or more

d. Subtotal (a+b+c)

e. Total Price for Option to Extend Services Period (d x 13)**

CLIN 5002 Option to Extend Services - Rider Category*** Biweekly Rate per Premium

C.1.1.21 Excess Coverage

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

B.2.9 Grand Total of Base plus all option years and Option to Extend Services (Quetzales)

Base Year total (CLINS 0001 & 0002)

First Option Year total (CLINS 1001 & 1002)

Second Option Year total (CLINS 2001 & 2002)

Third Option Year total (CLINS 3001 & 3002)

Fourth Option Year total (CLINS 4001 & 4002)

FAR 52.217-8 - Option to Extend Services (6-months) (CLINS 5001 & 5002)

Grand Total of Base plus all Option Years and Option to Extend Services

MINIMUM AND MAXIMUM AMOUNTS

During the Base Year of the contract, and during the option year that might be exercised, the United States Government (USG) shall place orders totaling a minimum of USD 10,000.00. This reflects the contract minimum guarantee for each period of performance. The amount of all orders, for base and all option years shall not exceed TBD. This reflects the contract maximum.”

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 the 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

Self

Self plus one

Family

Base Period

First Option Year

Second Option Year

Third Option Year

Fourth Option Year

FAR 52.217-8 - Option to Extend Services (6- months)

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 with 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. 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 the 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.

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 with 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 Peace Corps Personal Service Contracts (PSC) 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), the Embassy Association (for EAEs) separately, at the rates specified below. See Section G for billing procedures.

B.6. GROUP LIFE INSURANCE RATES

This is a fixed price with an 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:

Estimated payroll for the Mission is Q5,750,284.00 bi-weekly.

B.6.1. Base Year of Contract CLIN 0002 – Base Year

Bi-Weekly Rates per Employee

Thousand) Bi-Weekly Total (Quetzales)

a. Basic Life

b. Accidental Death & Dismemberment

c. Partial & Total Disability Coverage

d. Subtotal (a+b+c)

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

B.6.2. First Option Year of Contract

CLIN 1002

Bi-Weekly Rates per Employee

Thousand) Bi-Weekly Total (Quetzales)

a. Basic Life

b. Accidental Death &

c. Partial & Total Disability

d. Subtotal (a+b+c)

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

B.6.3. Second Option Year of Contract

CLIN 2002

Bi-Weekly Rates per Employee

Thousand) Bi-Weekly Total (Quetzales)

a. Basic Life

b. Accidental Death &

c. Partial & Total Disability

d. Subtotal (a+b+c)

e. Total Price for Second

B.6.4. Third Option Year of Contract

CLIN 3002

Bi-Weekly Rates per Employee

Thousand) Bi-Weekly Total (Quetzales)

a. Basic Life

b. Accidental Death &

c. Partial & Total Disability

d. Subtotal (a+b+c)

e. Total Price for Third

B.6.5. Fourth Option Year of Contract

CLIN 4002

Bi-Weekly Rates per Employee

Thousand) Bi-Weekly Total (Quetzales)

a. Basic Life

b. Accidental Death &

c. Partial & Total Disability

d. Subtotal (a+b+c)

e. Total Price for Fourth

FAR 52.217-8 – Option to Extend Services (6-months)

The U.S. Embassy of Guatemala requires prices in this 6-month period of performance in case the FAR Clause 52.217-8 option to extend services is executed. Please note, the purpose of this pricing information is only for the evaluation of the total price including all options and will not be included in the grand total amount of the award.

B.6.6 Option to Extend Services

CLIN 5002

Bi-Weekly Rates per Employee

Thousand) Bi-Weekly Total (Quetzales)

a. Basic Life

b. Accidental Death &

c. Partial & Total Disability

d. Subtotal (a+b+c)

e. Total Price for Option to Extend Services period (d x 13)

B.6.7 Grand Total of Base plus all option years and Option to Extend Services (Quetzales)

Base Year total (CLIN 0002)

First Option Year total (CLIN 1002)

Second Option Year total (CLIN 2002)

Third Option Year total (CLIN 3002)

Fourth Option Year total (CLIN 4002)

FAR 52.217-8 - Option to Extend Services (6-months) (CLIN 5002)

Grand Total of Base plus all Option Years and Option to Extend Services

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 the purpose 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.

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

First Option Year

Second Option Year

Third Option Year

Fourth Option Year

FAR 52.217-8 - Option to Extend Services (6-months)

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, . 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 with 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 by every 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 the 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.

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 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 offers 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.

The Contractor accepts the U.S. Embassy – Guatemala employees’ group with all the pre-existing medical conditions and guarantee coverage of all current treatments.

C.1.1 Employee and Dependent Health Service Benefits

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 accommodation is 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 (C.1.1.13 below) for details concerning inpatient psychiatric care.

See Outpatient Services (C.1.1.4 below) for details concerning professional services.

C.1.1.2 Emergency Services (trips to emergency room): Minimum Coverage - 100% with a co-pay of Q1,000 per visit

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

C.1.1.3 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

· Immunizations recommended by local authorities and/or the World Health Organization

· Diagnostic tests and diagnostic imaging

See Rehabilitative and Habilitative Services and Devices (C.1.1.14 below) for details concerning physical therapy.

See Mental Health and Substance Abuse Care (C.1.1.13 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 covered 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%, Outpatient: 80%

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%, Outpatient: 80%

Medications prescribed by a certified health care provider that are medically required. 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 is designed to prevent or detect medical conditions and care for chronic conditions such as asthma and diabetes. Examples include, but are not limited to physical, 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. The maximum coverage is Q12,000.00 per covered individual per three-year period. 80% Minimum Coverage; with applicable 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 Q3,000.00 per covered individual every two years. 80% Minimum Coverage; with applicable cap.

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. The maximum coverage is Q25,600.00 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. The maximum coverage is Q19,200 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 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 provided 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 chronic condition, and devices needed for habilitative reasons.

C.1.1.15 HIV/AIDS: 100% up to Q80,000.00 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 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.1.1.17 Out-of-Country Medical Travel: 80% Reimbursement

Transportation for out-of-country medical treatment will be a covered expense for LE Staff and eligible family members. To be considered a covered expense, the attending certified health care provider must certify in advance that the treatment is medically necessary and unavailable locally. 80% of covered individual’s transportation expenses by the least expensive, appropriate means of transportation to the nearest city with adequate medical facilities will be covered. 80% of the transportation expenses of an attendant will also be covered, but only if the covered individual's attending certified health care provider certifies that an attendant for the patient is necessary, (e.g., a parent in the case of a patient who is a minor, or a family member, to make medical decisions in the case of a patient who is unwell or unconscious). All coverage for transportation for out-of-country medical treatment is subject to the total maximum annual limit. Transportation to a neighboring country without the attending certified health care provider certifying that the treatment is medically necessary and unavailable locally will not be covered.

C.1.1.18 Excess Coverage:

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

Additional coverage equal to Q1,000,000.00 per covered individual per the lifetime of the contract. This excess coverage will be offered as an optional benefit to LE Staff. LE Staff must pay 100% of the premium if they choose Excess Coverage.

The premium for this additional coverage is a rider to be paid by the employee to the vendor directly and USG will not be responsible for collecting these premium payments.

C.1.2 Maximum Coverage Limit - The maximum coverage reimbursement per covered individual per the lifetime of the contract is Q1,800,000.00. This limit does not include 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.

C.1.3 Exclusions and Limitations

There is no coverage 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. Mission 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 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 institutional contractors; and Recreation Association employees.

Official Residence Expense (ORE), Retired Employees and Peace Corps PSCs 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

C1.4.1.1.1 Legal Spouse: a limit of one legal spouse or domestic partner, to include same-sex domestic partners, as certified by COM: one legal spouse as defined by local law or one domestic partner per employee will be covered. LE Staff with more than one legal spouse or domestic partner must select only one individual for coverage. In cases where LE Staff and their legal spouse or domestic partner 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 or domestic partner. In these specific cases, both the lead and the spouse shall be eligible to participate in the life insurance coverage plan. The employees will decide who is registered as the principal and who is registered as the dependent.

C.1.4.1.1.2 Dependent Children: a child is defined as the LE Staff’s natural, adopted, stepchild, or foster child. Any child of a recognized domestic partner shall be deemed a stepchild of the employee. 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 are 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.

b. All retired employees of the 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. Peace Corps personal services contractors. All costs for coverage of Peace Corps staff are the responsibility of Peace Corps, 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.1.6 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 15 business days after date of contract award. The Contractor shall provide additional brochures for new employees within ten (10) business days of the COR’s request.

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.

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 and that the cost of such insurance protection is usually borne by the employer. The USG will pay 100% of the premium cost of the life insurance benefit. Therefore, the Government desires to adopt such locally prevailing practice as part of its compensation plan for its employees as further described in C.2.2. 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 life insurance that is equal to 24 times their 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 monthly basic salary, in addition to the life insurance benefit in C.2.1.1, in the event the employee is killed in an accident.

C.2.1.3 Partial and Total Disability Coverage

The employee will receive an amount equal to 19 times his/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 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.

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 Peace Corps 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 B). All costs for ORE employees are the responsibility of the employing officer, not the U.S. Government.

C.2.3.3.2 Peace Corps personal service contractors. All costs for Peace Corps employees are the responsibility of the employing officer, not the U.S. Government.

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.

C.2.4.2 Individuals not eligible for coverage under this contract are nonpersonal services contract personnel; employees working on a temporary basis; employees with an intermittent, seasonal, or WAE (when actually employed) schedule; 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 dependent 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 dependent.

C.2.4.4 Retirees are not covered under this plan.

C.2.5 Eligibility and Effective Date

C.2.5.1. 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.2.5.2. Period of Ineligibility

Employees are not entitled to life insurance and disability benefits here under 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.2.6. BROCHURE REQUIREMENT

C.2.6.1. The Contractor shall provide a document (brochure/pamphlet/other written document) in Spanish 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 brochures to the COR, who will ensure that appropriate distribution is made.

C.2.6.2. The document described in C.2.6.1 shall be provided to the COR not later than 15 business days after the date of the contract award. The Contractor shall provide additional brochures for new employees within ten (10) days of the COR’s request.

C.2.6.3. The Contractor assumes full responsibility for ensuring that the document described in C.2.6.1 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.3 DELIVERABLES

The following items shall be delivered under this contract:

H.5 Report Requirement (a) Employee Claims Report

COR

Every month on the first 10 days

H.5 Report Requirement (b) Quarterly Report

COR

Every quarter on the first 10 days of the quarter

H.6.2. Licenses and Local Laws

COR

Date of award

C.3.0 DEFINITIONS

C.3.0 DEFINITIONS

all U.S. Government Agencies, except U.S. AID.

Resources Officer (HRO) at post.

premium.

treated.

reaches age 26.

The employees will…