Health Insurance Solicitation 19KE5025R0001 SF30 Amendment A00001.pdf

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

1. CONTRACT ID CODE

PAGE 1 OF PAGES

2. AMENDMENT/MODIFICATION NO.

A00001

3. EFFECTIVE DATE

May 27, 2025

4. REQUISITION/PURCHASE REQ.

NO.

PR15113907

5. PROJECT NO. (If applicable)

6. ISSUED BY CODE

7. ADMINISTERED BY (If other than Item 6)

CODE

U.S. Embassy Nairobi, UN Avenue, Nairobi, Kenya

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

9a. AMENDMENT OF SOLICITATION NO.

19KE5025R0001

9b. DATED (SEE ITEM 11)

April 07, 2025 10a. MODIFICATION OF

CONTRACT/ORDER NO.

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© 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 you 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 APPLIES ONLY TO MODIFICATIONS OF CONTRACTS/ORDERS,

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

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, [ X] is required to sign this document and return __1_ copy to the issuing office.

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

A. The solicitation is amended to correct the pricing tables B. 2.3 Base Year, B. 2.4 First Option Year, B 2.5 Second Option Year, B 2.6 Third Option Year, B

2.7 Fourth Option Year and B2.8 Extension Options per attached documents as follows;

i. Respective family category numbers have been edited to reflect family units instead of lives.

ii. Tables updated to include currency unit Kenya Shillings (KES)

B. Section J. has been edited to provide a breakdown of the family category sizes.

C. Section J- Exhibit F has been updated with claims estimate for past 3 years .

D. Section C.1.4. Eligibility is edited to remove mention of USAID as an eligible agency.

E. Section C.1.1.16 is edited to adjust XOL Group Limit.

F. Solicitation due date is extended to June 9 at 9 a.m. East Africa time Per A,B,C,D,E above, replace the pages below with the previous ones in the solicitation.

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 OF CONTRACTING OFFICER

Leslie Marks

15B. NAME OF CONTRACTOR/OFFEROR

BY

(Signature of person authorized to sign)

15C.DATE

SIGNED

16B. UNITED STATES OF AMERICA

BY

(Signature of Contracting Officer)

16C.DATE

SIGNED

May 27, 2025 https://ilmsariba.state.sbu/Buyer/Main/aw?awh=r&awssk=qars&awrdt=1

SECTION B - PRICES

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 Kenya 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 American Employees Association (AEA). 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 AEAs) and U.S Peace Corps Kenya PSC Contractors and

Dependents 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 Government will not reimburse the Contractor for Value Added Tax (VAT) under this contract. All taxable supplies (goods and services) to the United States Embassy in Kenya are exempt from Value Added Tax. See the VAT Act, 2013, 2nd Schedule, Part B ‘Zero Rates Supplies to Public Bodies, Privileged persons and

Institutions’, para (3). Vendors are therefore required to present invoices without a tax element, i.e., indicate 0%

VAT on all invoices. The Purchase Orders or Contracts issued by the United States Embassy will serve as the basis for Zero Rating when vendors are accounting for VAT with the Kenya Revenue Authority.

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:

JAMES ZADROGA 9/11 VICTIMS HEALTH AND COMPENSATION ACT OF 2010

NOTICE: UNLESS A WAIVER OR EXCEPTION APPLIES, PAYMENTS

SUBSEQUENT TO THIS PROCUREMENT ARE SUBJECT TO AN EXCISE TAX OF

2% PERSUANT TO 26 U.S.C. 5000C.

B.2.3 Base Year of

Contract

Bi-Weekly Rates Per Employee

Category *** Estimated Number of

Families per

Category*

Rate (Premium) per Category

Kes

Extended Bi-Weekly

Premium Total KES

a. Self 71

b. Self Plus One 74

c. Family (3 to 6 individuals)

d. Family (7 or more individuals)

e. Subtotal 676

Total Price (KES)for

Base Year (e x 26)**

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

**does not include any premiums for Riders.

*** Family Size breakdown see tables in section J

B.2.4 First Option

Year of Contract

Bi-Weekly Rates Per Employee

Category *** Estimated Number of

Families per

Category*

Rate (Premium) per Category Kes

Extended Bi-Weekly

Premium Total KES

a. Self 71

b. Self Plus

One

c. Family (3 to 6 individuals)

d. Family (7 or more individuals)

e. Subtotal 676

Total Price (KES) for First Option

Year (e x 26)**

*** Family Size breakdown see tables in section J

B.2.5 Second Option

Bi-Weekly Rates Per Employee

Category *** Estimated Number of

Families per

Category s*

Rate (Premium) Per

Category Kes

Extended Bi-Weekly

Premium Total KES

a. Self 71

b. Self Plus One 74

c. Family (3 to 6 individuals)

d. Family (7 or more individuals)

e. Subtotal 676

Total Price (KES) for

Second Option Year

(e x 26)**

*** Family Size breakdown see tables in section J.

B.2.6 Third Option

Bi-Weekly Rates Per Employee

Category *** Estimated Number of

Families Per

Category*

Rate (Premium) Per

Category Kes

Extended Bi-Weekly

Premium Total KES

a. Self 71

b. Self Plus One 74

c. Family (3 to 6 individuals)

d. Family (7 or more individuals)

e. Subtotal 676

Total Price (KES) for

Third Option Year (e x 26)**

B.2.7 Fourth Option

Bi-Weekly Rates Per Employee

Category *** Estimated Number of

Families per

Category*

Rate (Premium) per

Category Kes

Extended Bi-Weekly

Premium Total KES

a. Self 71

b. Self Plus One 74

c. Family (3 to 6 individuals)

d. Family (7 or more individuals)

e. Subtotal 676

Total Price (KES) for

Fourth Option Year (e x 26)**

B.2.8 Optional

Extension up to 6 months of the

Contract

Bi-Weekly Rates Per Employee

Category *** Estimated Number of

Families per

Category*

Rate (Premium) per

Category Kes

Extended Bi-Weekly

Premium Total KES

a. Self 71

b. Self Plus One 74

c. Family (3 to 6 individuals)

d. Family (7 or more individuals)

e. Subtotal 676

Total Price (KES) for

6 months extension period (e x 13)**

B.2.9 Grand Total of Base plus All Options KES

Base Year Total

First Option Year Total

Second Option Year Total

Third Option Year Total

Fourth Option Year Total

Optional Extension up to 6 months of the

Contract

Grand Total Of Base Plus All Option

Years (KES)

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 Kes 646,750. 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 until award for each 12-month period of performance. 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 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

Employee

Employee’s Spouse Employee’s Dependent

Child

Base Period

First Option Year

Second Option Year

Third Option Year

Fourth Option Year

Extension Period up to 6 months

C.1.1.13 Mental Health and Substance Abuse Care: Coverage - 100%

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 provided at a facility licensed for detoxification and rehabilitation.

C.1.1.14 Rehabilitative and Habilitative Services and Devices:

Coverage - 100%

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, etc.) 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% - part of annual maximum limit cover

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.

*C.1.1.16 Group Excess of Loss (XOL)

In the event that individual family member(s) exceed the designated family maximum coverage limit for inpatient medical services, the eligible family member(s) can access coverage from claims arising from all hospitalization costs subject to a maximum limit of KES 3,500,000 per individual per contract year. The aggregate liability of the insurer for all claims arising under XOL policy shall not exceed KES 40,000,000 for the group per contract year.

*C.1.1.17 Out-of-Country Medical Treatment:

Medical expenses incurred out-of-country will be covered at the same benefit levels 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: Reserved

C.1.1.19 90-Day Coverage for Dependents After Employee’s Death

At the time of a covered employee’s death, his/her eligible dependents covered under post’s medical plan are eligible to continue receiving the same level of medical coverage for up to 90 days. This optional benefit is subject to availability of funds at post and no extensions are permitted.

C.1.1.20 Employee Assistance Program (EAP): Reserved

C.1.2 Annual Maximum Limit - The maximum annual reimbursement per covered individual per contract year, not including expenses defined under Exclusions and Limitations (C.1.3) and Group Excess of Loss

(C.1.1.16), is equivalent to the annual maximum limit per family category in C.1, including outpatient services coverage up to KES 800,000 per year per individual.

C.1.3 Exclusions and Limitations

There is no coverage for elective cosmetic surgery; spa cures; rejuvenation cures; massage; exercise 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 ELIGIBILITY

To be eligible to participate in the medical plan, LE Staff must be:

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 Kenya 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; Peace Corps personal services contractors as indicated in MS 743; and Recreation Association employees.

Official Residence Expense (ORE), U.S. Peace Corps Kenya Contractors and American Employee Association

(AEA) employees may be covered under a rider to the contract. The employing officer/EA, not the USG, is responsible for the employer's share of the premium costs for an ORE/EA employee. 1998 Embassy Bombing

Victims and Victim’s Family Members.

SECTION J

LIST OF EXHIBITS/ATTACHMENTS

EXHIBIT A – EMPLOYEE STATISTICS (PROJECTED ESTIMATES, NOT EXACT FIGURES)

1. EMBASSY EMPLOYEES BY SEX WITHIN AGE RANGES

FEMALE MALE

Age (years) Number Age (years) Number

20-34 22 20-34 40

35-45 83 35-45 152

46-55 93 46-55 161

56-65 30 56-65 95

TOTAL 228 TOTAL 448

2. EMBASSY EMPLOYEE SPOUSES BY SEXWITHIN AGE RANGES

20-34 66 20-34 3

35-45 173 35-45 34

46-55 130 46-55 48

56-65 30 56-65 36

66+ 66+ 6

TOTAL 399 TOTAL 127

3. DEPENDENT CHILDREN BY SEX WITHIN AGE RANGES

0-10 292 0-10 263

11-18 268 11-18 237

19-26

(if full-time student)

214 19-26

(if full-time student)

Eligible Above 26 2 Eligible Above 26 2

TOTAL 776 TOTAL 692

4. DEPENDENTS WITH RESPECT TO PRINCIPAL MEMBERS

EMBASSY & OTHER

AGENCIES

N0. OF

FAMILIES BY

CATEGORY

NO. OF

CHILDREN

NO. OF

SPOUSES

GRAND

TOTAL

Self- Count 71 0 0 71

Self Plus One- Count 74 36 38 148

Family (3 to 6 individuals)- Count 500 1256 457 2213

Family (7 or more individuals) 31 176 31 238

TOTALS 676 1468 526 2670

EXHIBIT B - ORE EMPLOYEES RIDER

1. ORE EMPLOYEES BY SEX WITHIN AGE RANGES (PROJECTED ESTIMATES, NOT EXACT

FIGURES)

Category Estimated Number of Families per

Category*

No. Of

Children

No. Of

Spouses

Grand Total

a. Self 0 0 0 0

b. Self Plus One 1 1 0 2

c. Family (3 to 6 individuals)

5 13 4 22

d. Family (7 or more individuals)

0 0 0 0

e. Subtotal 6 14 4 24

20-34 0 20-34 0

35-45 1 35-45 1

46-55 2 46-55 1

56-65 0 56-65 1

TOTAL 3 TOTAL 3

2. ORE EMPLOYEE SPOUSES BY SEX WITHIN AGE RANGES

20-34 0 20-34 1

35-45 1 35-45 0

46-55 2 46-55 0

56-65 0 56-65 0

66+ 66+ 0

TOTAL 3 TOTAL 1

0-10 1 0-10 2

11-18 4 11-18 1

19-26

(if full-time student)

2 19-26

(if full-time student)

Eligible Above 26 0 Eligible Above 26 0

TOTAL 7 TOTAL 7

EXHIBIT C – AMERICAN EMPLOYEE ASSOCIATION (AEA) RIDER (PROJECTED ESTIMATES,

NOT EXACT FIGURES)

Category Estimated Number of Families per

Category*

No. Of

Children

No. Of

Spouses

Grand Total

a. Self 2 0 0 2

b. Self Plus One 0 0 0 0

c. Family (3 to 6 individuals)

2 5 1 8

d. Family (7 or more individuals)

e. Subtotal 4 5 1 10

1. AEA EMPLOYEES BY SEX WITHIN AGE RANGES

20-34 0 20-34 1

35-45 1 35-45 0

46-55 0 46-55 2

56-65 0 56-65 0

TOTAL 1 TOTAL 3

2. AEA EMPLOYEE SPOUSES BY SEX WITHIN AGE RANGES

20-34 0 20-34 0

35-45 1 35-45 0

46-55 0 46-55 0

56-65 0 56-65 0

TOTAL 1 TOTAL 0

0-10 3 0-10 2

11-18 1 11-18 0

19-26

(if full-time student)

0 19-26

(if full-time student)

TOTAL 3 TOTAL 2

EXHIBIT D – 1998 EMBASSY BOMBING VICTIMS AND VICTIMS FAMILY MEMBERS RIDER

(PROJECTED ESTIMATES, NOT EXACT FIGURES)

Category*

No. Of

Children

No. Of

Spouses

Grand Total

a. Self 23 0 0 23

b. Self Plus One 1 0 1 2

c. Family (3 to 6 individuals)

0 0 0 0

d. Family (7 or more individuals)

e. Subtotal 24 0 1 25

1998 FORMER EMPLOYEES BY SEX WITHIN AGE RANGES

20-34 0 20-34 0

35-45 0 35-45 0

46-55 0 46-55 0

56-60+ 1 56-60+ 1

TOTAL 1 TOTAL 1

2. 1998 EMPLOYEE SPOUSES BY SEX WITHIN AGE RANGES

20-34 0 20-34 0

35-45 0 35-45 0

46-55 4 46-55 0

56-65 7 56-65 0

66+ 10 66+ 2

TOTAL 21 TOTAL 2

0-10 0 0-10 0

11-18 0 11-18 0

19-26

(if full-time student)

0 19-26

(if full-time student)

TOTAL 0 TOTAL 0

EXHIBIT E – U.S. PEACE CORPS CONTRACTORS AND DEPENDENTS (PROJECTED ESTIMATES,

NOT EXACT FIGURES)

Category*

No. Of

Children

No. Of

Spouses

Grand Total

a. Self 3 0 0 3

b. Self Plus One 1 1 0 2

c. Family (3 to 6 individuals)

29 73 27 129

d. Family (7 or more individuals)

e. Subtotal 33 74 27 134

U.S. PEACECORPS EMPLOYEES BY SEX WITHIN AGE RANGES

20-34 2 20-34 1

35-45 5 35-45 10

46-55 6 46-55 6

56-65 1 56-65 2

66+ 0 66+ 0

TOTAL 14 TOTAL 19

2. U.S. PEACECORPS EMPLOYEE SPOUSES BY SEX WITHIN AGE RANGES

20-34 5 20-34 2

35-45 8 35-45 3

46-55 4 46-55 3

56-65 1 56-65 1

66+ 0 66+ 0

TOTAL 18 TOTAL 9

Age (years) Number Age (years) Number

0-10 12 0-10 24

11-18 8 11-18 14

19-26

(if full-time student)

9 19-26

(if full-time student)

TOTAL 29 TOTAL 45

EXHIBIT F – CLAIMS PAID OUT FOR THE PAST 3 YEARS.

YEAR TOTAL KES TOTAL USD

6/20/2021 -

06/19/2022

151,278,814 1,170,435.70

06/20/2022 -

06/19/2023

165,174,474 1,277,945.64

06/20/2023 TO

06/19/2024

161,460,763 1,249,212.87

NOTE TO OFFERORS:

The claims paid by the incumbent contractor are provided for informational purposes only and under no circumstances shall it be construed to change any terms or conditions or requirements within the solicitation. Under no circumstances shall the U.S. Government be liable for this data or shall it become the basis for a request to adjust the premium rates after contract award. Offerors are advised any adjustments to contract premium rates shall be in accordance with the B.4.