RFP No. 19MX53-20-R-0001 - Health Insurance Services.docx

RFP NO. 19MX53-20-R-0001

PART I: HEALTH INSURANCE

SECTION A

Cover page SF-33

SECTION B

PRICE

B.1. HEALTH INSURANCE SERVICES

The Contractor shall provide Health Insurance services described herein to employees of the Government of the United States of America in the Embassy and Consulates in Mexico and their eligible dependents as described in Section C. This insurance shall be provided in accordance with Section C and the Exhibits in Section J.

B.1.1. RIDERS

B.1.1.1. Official Residence Expense (ORE) are included under this contract only as rider; the Contractor shall bill Chief of Mission, Deputy Chief of Mission, and Management/Principal Officer (for ORE Staff) separately, at the rates specified below.

B.1.1.2. APHIS are included under this contract only as a rider; the Contractor shall bill APHIS separately, at the rates specified below.

B.1.1.3. Excess Coverage (C.1.1.21) is included under this contract only as rider benefits; the Contractor shall bill the individual covered separately, at the rates specified below.

See Section G for billing procedures. Note that USG is not responsible, nor liable, for any riders.

B.1.2. TYPE OF CONTRACT

This is a fixed-price with economic-price- adjustment-requirements type contract.

(a) Orders will be placed by firm-fixed task orders.

(b) Individual orders shall be documented with a task order, see Exhibit 6.

B.1.3. CURRENCY

B.1.3.1 Offers and Payment for U.S. Firms

U.S. firms are eligible to be paid in U.S. dollars. U.S. firms desiring to be paid in U.S. dollars should submit their offer in U.S. dollars. A U.S. firm is defined as a company which operates as a corporation incorporated under the laws of a state within the United States. Local companies are eligible to be paid in U.S. dollars provided that such company has a bank account in U.S. dollars at a Local Bank.

B.1.3.2. Offers and Payment in Pesos, Mexican Currency

Any firm that is not a U.S. firm is a foreign firm. Any local or foreign firm that does not meet the definition of a U.S. firm shall submit its prices and receive payment in local currency unless the foreign or local firm has a U.S. dollar bank account in Mexico.

B.1.3.3. Value Added Tax

Value Added Tax (VAT) for offers in Pesos, Mexican currency, is not included in line item rates. Instead, it will be priced as a separate amount in the contract and on the Invoices. Local law dictates the portion of the contract price that is subject to VAT; this percentage is multiplied only against that portion.

VAT shall not be included in the CLIN rates or Invoices for U.S. firms as this is not applicable to U.S. based vendors.

B.2. FIXED PREMIUM RATES

The fixed prices/premium rates for the health insurance services as specified in Section C are as follows:

B.2.1. BASE YEAR OF CONTRACT (12 MONTH)

As per paragraphs B.1.3. above, prices are in __________ [Insert Currency].

B.2.1.1. Yearly Rates per Premium

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

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

B.2.2. FIRST OPTION YEAR OF CONTRACT (12 MONTH)

As per paragraphs B.1.3. above, prices are in __________ [Insert Currency].

B.2.2.1. Yearly Rates per Premium

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

B.2.3. SECOND OPTION YEAR OF CONTRACT (12 MONTH)

As per paragraphs B.1.3. above, prices are in __________ [Insert Currency].

B.2.3.1. Yearly Rates per Premium

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

B.2.4. THIRD OPTION YEAR OF CONTRACT (12 MONTH)

B.2.4.1. Yearly Rates per Premium

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

B.2.5. FOURTH OPTION YEAR OF CONTRACT (12 MONTH)

B.2.5.1. Yearly Rates per Premium

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

B.2.6. GRAND TOTAL OF BASE PLUS ALL OPTION YEARS

NOTE TO OFFERORS: Do not include riders in the total price.

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.

B.3.2. Yearly Retention Amounts per Employee

As per paragraph B.1.3., above, the retention amounts are in _____________ [Insert Currency].

Yearly Retention Amounts per separate premium paid per single employee and per family plan and for each period of performance.

Base Period

First Option Year

Second Option Year

Third Option Year

Fourth Option Year

NOTE TO OFFEROR: Fill in the fixed yearly 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.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.

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, in the U.S. Embassy Mexico City, U.S. Consulates and other U.S. offices located in the Mexican territory. The specific health benefit coverage under this contract is set forth in Section C and Exhibits in Section J.

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 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 (C.1.1.13) 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

· 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 covered as 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, 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 are 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 $32,940.00 MXN Pesos ($1,500.00 U.S.D.) 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 $6,588.00 MXN Pesos ($300.00 U.S.D.) per covered individual every two years. 80% Minimum Coverage; with annual 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 up to a maximum of $70,272.00 MXN Pesos ($3,200.00 U.S.D.) 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 $52,704.00 MXN Pesos ($2,400.00 U.S.D.) 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 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, 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:

Minimum Coverage 100% Coverage

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. Coverage under this benefit is excluded from the annual maximum limit (C.1.2).

C.1.1.16. Catastrophic Coverage

Additional coverage equal to $50,000,000.00 MXN Pesos per covered individual, per event, per contract length. Catastrophic conditions shall be defined as major medical conditions occurring as a result of a single/illness/accident or closely related set of major illnesses (or conditions relating to a single accident) that exceed the standard maximum coverage limit.

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. However, this clause will be applicable to only those employees and dependents who are able to prove legal and daily physical residence within Mexican territory. Coverage while temporarily absent from Mexican territory and unexpected or emergency medical services should be covered by the provider. During official travel this coverage is not applicable. The Contracting Officer or the designated Contracting Officer Representative will be entitled to request proof of residence of the claimant whenever deemed necessary.

C.1.1.18. RESERVED.

C.1.1.19. RESERVED.

C.1.1.20. RESERVED.

C.1.1.21. Excess Coverage

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

Additional coverage equal to $50,000,000.00 MXN pesos per covered individual, per event, per contract length. 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 vendor directly and USG will not be responsible for collecting of these premium payments.

C.1.2. Maximum Insured Limit

The maximum coverage per covered individual per covered illness or accident for the life of the contract is $50,000,000 MXN Pesos per individual, per event, per contract length (i.e. 5 years).

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 Mexico 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.

C.1.4.1.1. Definition of Dependents

C1.4.1.1.1. Spouse: a limit of one legal spouse as defined by local law per employee will be covered.

C.1.4.1.1.2. 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 Mexico by:

Department of Agriculture (USDA) Department of Commerce (DOC) Department of Defense (DOD) Department of Health and Human Services (HHS) Department of Homeland Security (DHS) Department of the Interior (DOI) Department of Justice (DOJ) Department of State (DOS) Department of Treasury (DOT) Department of Energy (DOE) Department of Labor (DOL) Peace Corps Mexico (PC) United States Agency for International Development (USAID)

C.1.4.3 . Participants Covered Under a Rider

C.1.4.3.1. 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.

C.1.4.3.2. All current active APHIS Staff personally employed by APHIS. All costs for coverage of APHIS Staff are the responsibility of APHIS, 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. Quality and Language

The Contractor shall provide a document (brochure/pamphlet/other written document) in Spanish and English that sets forth a complete listing of the health insurance benefits to be provided under this contract. This brochure shall be provided in sufficient quantities so that each covered employee receives a copy and electronic version. The Contractor shall furnish all copies of the brochures to the COR, who will ensure that appropriate distribution is made.

C.1.6.2. Delivery

The Contractor shall provide the document described in C.1.6.1 to the COR not later than 30 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. Contents

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.

C.1.6.4 . Presentation

The Contractor shall perform annual presentations in English and Spanish to explain benefits, procedures, requirements and Q&A sessions.

C.2. DEFINITIONS

SECTION D

PACKAGING AND MARKING

(RESERVED)

SECTION E

INSPECTION AND ACCEPTANCE

E.1. 52.2522 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

This contract incorporates one or more clauses by reference, with the same force and effect as if they were given in full text. Upon request, the Contracting Officer will make their full text available. 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.

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

C.1.0 thru C.2.

All required services are performed and no more than three (3) customer complaints 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 complaints 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.

E.2.3. Procedures

E.3. QUALITY ASSURANCE TEAM (QAT)

The Contractor shall designate a Quality Assurance Team who shall be responsible for managing issues relating to section E.2. Upon receiving the complaints, the team shall take immediate corrective action to ensure effective operation. The team shall understand written and spoken English. The QAT shall provide an oral and written notice to the COR about the progress and solution of the complaint, setting 7 business days as maximum response time. The QAT designated under this Contract are:

Note to Offeror: Please provide name of each individual that are part of the QAT, telephone number, and group e-mail.

SECTION F

DELIVERIES OR PERFORMANCE

F.1. 52.2522 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

This contract incorporates one or more clauses by reference, with the same force and effect as if they were given in full text. Upon request, the Contracting Officer will make their full text available. 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 clauses are incorporated by reference:

CLAUSE TITLE AND DATE

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 after contract award 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:

Attn: Human Resources Office Paseo de la Reforma No. 305 06500 Mexico, D. F.

MexicoSegurosMV@state.gov

F.4.1. Deliverables

The Contractor shall deliver the following items under this contract:

· Within five (5) business days of receiving a new Task Order or a Task Order modification that revises the employees to be insured.

COR/GTM

Insurance Policies

COR

F.5. INSURANCE POLICIES

The Contractor shall provide individual insurance policies for all U.S. Government employees within (14) fourteen calendar days of receiving the corresponding Task Order. Insurance Policies shall be provided in electronic and paper format.

Insurance policies should end at 12:01 a.m. on Expiration Date, in other words, the insurance policies end at 12:01 a.m. on the date the period of the performance ends for the base or any option year.

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 Christian Alvarez-Maciel, Compensation and Legal Coordinator.

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. However, the COR is authorized to provide the Contractor with updated listings of eligible employees and dependents. Additionally, the COR, on behalf of the Contracting Officer, may modify existing task orders or issue new task orders, reflecting these changes.

G.3. PAYMENT CURRENCY

Please refer to section B.1.3.

G.4. SUBMISSION OF INVOICES AND PAYMENT

G.4.1.1. Electronic Invoices Requirements

To constitute a proper invoice, the invoice shall include all the items required by FAR 32.905, as well as the following minimum requirements:

1. Electronic Invoice;

1. Contractor’s name and complete legal address;

1. Contractor’s RFC;

1. Date issued;

1. Issue Invoice as follows:

Embajada de los Estados Unidos de América Paseo de la Reforma No. 305, Colonia Cuauhtemoc, Ciudad de México, C.P. 06500;

RFC: EEU930201289;

1. Period of performance being charged;

1. Contract number/Delivery Order Number;

1. List the items/services being provided by line item number as stated in the Contract or the Delivery Order

1. IVA broken down (if applicable);

1. Amounts shall be in numbers and spelled out;

If an invoice does not contain the above information, the United States Government reserves the right to reject the invoice as improper and return it to the Contractor within seven (7) calendar days. The Contractor must then submit a proper invoice.

G.4.1.2 . Invoice Submission Instructions

The Contractor shall submit invoices, at the beginning of covered or quarterly period, per task order with the total quarterly amount within ten (10) days of receiving a fully approved task order. All task orders delivered to the Contractor shall include the total yearly amount, however, the payments shall be made in quarterly basis.

G.4.1.3 . Adjustments

If applicable, the Contractor shall submit invoices, at the end of the covered period, per task order with the total amount of adjustments within ten (10 days) of receiving a fully approved task order.

G,4.1.4 . Address to Send Electronic Invoice

The Accounts Payable section of the U. S. Embassy Mexico City has a paperless Voucher processing system. As a result, invoices shall be submitted to the following electronic mails:

mexfmcinvoices@state.gov Cc: DelacruzFS@state.gov; MexicoSegurosMV@state.gov

G.4.2. Frequency of Payments

All funds under this contract will be obligated by issuance of task orders, as described in H.3 for all non-rider coverage. Each task order will fund a specific period of time and number of employees, and the task orders will be issued at the frequency described in H.3. Contractor may submit invoices quarterly for payment to be made at the beginning of the month for which insurance coverage is provided in accordance with FAR 32.404.

G.4.3. U.S. Government Employees

The Government shall make payments directly to the Contractor for all Government employees, whether or not the employee is contributing to the basic premium amount.

G.4.4. Riders

a. ORE. The Chief of Mission and/or Deputy Chief of Mission will make payment directly to the Contractor for the entire premium amount of the ORE staff, whether or not the ORE employee is contributing to the premium amount.

b. C.1.1.21, Excess Coverage. The employee will make payment directly to the Contractor for the entire premium amount.

G.5. REFUNDS TO THE GOVERNMENT

If at any time during performance of the contract the Government finds that the Contractor has been overpaid because the number of employees and/or dependents covered has decreased, the Contracting Officer may either allow that overpayment to be credited to the Government’s account or require that the Contractor refund the overpayment.

If FMC, on behalf of the Contracting Officer, requests a refund, the Contractor shall make that refund to the Government within ten (10) calendar days of receipt of the request. The COR/FMC shall submit to the Contractor the modified Task Order and the instructions to transfer the refund amounts. The Contractor will have thirty (30) calendar days to complete the refund upon reception of the modified Task Order and refund instructions. The Contractor shall be responsible for notifying FMC, Contracting Officer Representative and the Contracting Officer of the scheduled date of refund transfer so that the U.S. Government financial office is able to track the transfer.

G.6. VALUE ADDED TAX

Please refer to section B.1.3.3.

G.7. POST MANAGERIAL AND ADMINISTRATIVE SUPPORT

This Contract shall be managed by three (3) offices as outlined below:

G.8. CONTRACTOR’S MANAGERIAL AND ADMINISTRATIVE SUPPORT

The Contractor shall furnish all managerial and administrative support necessary to furnish the insurance under this contract.

G.8.1. Project Manager

The Contractor shall designate a Project Manager for the daily administration of this contract, as well as for any urgent requests. This Project Manager shall be the Contractor’s point of contact, shall have delegated authority to lead the project, and shall have close communication and meet with the Contracting Officer’s Representative (COR) as needed. The Project Manager shall be available at all times during the performance period of these services to receive and implement orders or special instructions from the Contracting Officer or Contracting Officer's Representative and ensure a smooth and effective operation.

In the event that the Project Manager is absent, an alternate shall serve as a replacement. The alternate shall be familiar with this contract and all cases in progress.

If there is a need to replace the Project Manager, the Contractor shall notify the COR at least five (5) business days prior to any transition. The Contractor’s Project Manager designated under this Contract is:

Project Manager:

Telephone Number(s):

E-mail Address:

G.8.2. Project Manager Requirements

The Project Manager shall have sufficient English language skills to be able to communicate with members of the U.S. Government staff and the administrative skills required to perform the administrative matters of this contract.

As evidence of English language skills, the Project Manager shall comply with the following level of English Proficiency:

SECTION H

SPECIAL CONTRACT REQUIREMENTS

H.1. SECURITY

On occasion, a Contractor employee may require entry into U.S. Government-owned or -operated facilities. If so, the Contractor should be prepared to provide the necessary identification to permit escorted access within that facility. If the Contractor employee will be making scheduled visits the required security forms and background checks are necessary to have unescorted access.

H.2. STANDARDS OF CONDUCT

The Contractor shall maintain satisfactory standards of employee competency, conduct, cleanliness, appearance, and integrity and shall be responsible for taking such disciplinary action with respect to employees as may be necessary. Each Contractor employee is to adhere to standards that reflect credit on themselves, their employer, and the United States Government.

H.3. ORDERING PROCEDURES

The Government will issue a task order as soon as possible after contract award to identify all employees to be covered by the insurance described in this contract and the coverage selected by each employee, including dependents to be covered. The COR will make subsequent additions or deletions to this list in writing and provide the revised list to the Contractor. All such revisions shall be consolidated, and a new or modified task order will be issued by the Contracting Officer. If any changes have been made to the coverage listing, the Government anticipates issuance of a modified task order on a yearly basis. The changes to the list of eligible individuals will supersede the initial list provided under prior task orders without prejudice to the ineligibility clause. Task orders will indicate the effective date of employment, for purposes of calculating the premium due.

H.3.1. Riders are not included under the task orders issued by the Contracting Officer. Because their coverage is under a rider, their employer is responsible for directly interacting with the Contractor to order any coverage for their employees. When contacted by the employer, the Contractor shall advise the person of the paperwork and payment that will be necessary to order coverage for the identified individuals. The Contractor may be contacted by more than one individual.

H.4. CONTRACTOR RESPONSIBILITY IN CLAIMS AND REIMBURSEMENT TO CLAIMANTS

H.4.1. General

The Contractor shall be responsible for all planning, estimating, programming, project management, scheduling, dispatching, supervision, and inspection of work. The Contractor shall maintain his own reference library of technical reference works and local laws and regulations, including current tariffs and registries. The Contractor shall treat the information provided by the Embassy concerning employee' personal data, medical information, and salaries as highly sensitive and not divulge any employee information to unauthorized persons. The Contractor shall establish procedures for handling medical insurance claims as follows:

(a) Administrative Records

(1) The Contractor shall maintain medical insurance files for each covered employee and each covered dependent including receipts and proof of paid claims, requests for claim reimbursements, and accounting of paid benefits with balances of amounts remaining in the annual per person reimbursement ceiling.

(2) The Contractor shall provide the COR with the necessary up-to-date claim forms for each type of benefit that can be claimed under the contract. These forms shall specify a list of documents required to be appended to each claim and otherwise provide instructions for claim filing.

(3) The Contractor shall use the employees'/dependents’ full names, per Birth Certificate or Identification card, in all transactions. The Contractor may be liable for any errors in the in the names.

(4) The Contractor shall send employee claim reimbursement checks to employees not later than two weeks after a claim is submitted.

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

(1) All medical claims shall be submitted directly to the Contractor by employees via electronic means or submitted personally to a Contractor’s representative that will be stationed at the U.S. Government facilities, as follows:

The above schedule is subject to change.

The contractor shall provide a representative twice a week at the following U.S. Consulates: Guadalajara, Ciudad Juarez, Monterrey, and Tijuana. The schedule for Consulates shall be provided upon award of the contract by the COR. Office space will be provided with a desk, chair and land line extension at each Consulate. The representatives will be at these locations for a period of 2 hours during regular business hours.

(2) The Contractor shall date stamp and screen all claims submitted on the day of receipt. If there are any missing documents or information thereby disallowing said claim to be payable, the Contractor shall notify the employee within two days, with a copy to the COR (if notification is written).

(3) The Contractor shall settle the claims no later than two weeks from the date the complete claim package is properly submitted to the Contractor to include all required documents.

(4) Settlement shall be made via electronic funds transfer (EFT) to the employees’ bank accounts or via check for each claim submitted. Each settlement shall be accompanied by a form providing details of the amount reimbursed with an explanation of deductions, if any.

(5) The Contractor shall accept the employee's or dependent's choice to go for surgery to hospitals designated by the Contractor in order that the Contractor will pay the expenses directly to the hospitals.

H.5. REPORT REQUIREMENTS

The Contractor shall provide the following quarterly report. The report shall be received by the COR no later than the 10th day of the month. The report shall report on the previous months’ activities.

(a) Employee Claims Report.

The report shall list all claims paid by the Contractor to a claimant, including the name, age, location (Embassy/Consulates), brief description of coverage claim of the claimant, date claim is received by the Contractor, and the amount claimed. This report shall also include all outstanding claims and a brief description of why claim has not been paid. The report shall not include any claims information for riders.

The Contractor shall provide the corresponding formats/documents for the employees/dependents to fill out to comply with Ley Federal de Protección de Datos Personales en Posesión de los Particulares, as amended.

H.6. MISCELLANEOUS CONTRACTOR REQUIREMENTS

H.6.1. General

The Contractor shall take all such steps as are necessary, and obtain and pay for all permits, taxes and fees as are required by the Mexican government to establish and/or operate a commercial venture locally. A contract with the U.S. Government conveys no special privileges or immunities to the Contractor. The Contractor is an independent commercial concern and not a part of the U.S. mission. The Contractor's employees are not U.S. Government employees. Registration of this contract with the Mexican government, if required by law, will be the sole responsibility of the Contractor, and any fees, taxes, or other duties shall be payable by the Contractor without recourse to the Government of the amounts thereof.

H.6.2. Licenses and Local Laws

The Contractor shall possess all permits, licenses, and any other appointments required for the prosecution of work under this contract, all at no additional cost to the Government. The Contractor shall perform this contract in accordance with local laws.

H.7. ERRONEOUS PAYMENTS

If the Government becomes eligible for a refund of payment because of erroneous overpayment or other cause, the Contractor shall refund the amounts or use them to offset future payments owed by the Government, whichever the Government prefers. The Contractor shall refund any refunds not complete or discovered after the completion date of this contract.

H.8. REQUIRING ACTIVITY

The requiring activity under this contract is the U.S. Embassy Mexico City.

H.9. AUTHORIZED ORDERING OFFICIALS

Those authorized to approve task orders under this contract are as follows:

· Any warranted Contracting Officer assigned to the General Services Office at the U.S. Embassy and Consulates in Mexico that they are permanently assigned to may sign the order(s) for their Post.

NOTE: All authority to change or modify the basic IDIQ contract, including the exercising of any options, remains with the Contracting Officer assigned to the General Services Office at the U.S. Embassy Mexico City.

H.10. SIGNATURE LIMITATIONS

Contracting Officers shall not sign commercial contracts, agreements, or any other terms and conditions that are contrary to this Contract, U.S. Department of State regulations, or any Federal law or policy.

Additionally, the Contracting Officer is not required to provide copies of any kind of identification documents neither in hardcopy nor in electronic format.

SECTION I

CONTRACT CLAUSES

I.1. 52.2522 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

This contract incorporates one or more clauses by reference, with the same force and effect as if they were given in full text. Upon request, the Contracting Officer will make their full text available. 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 clauses are incorporated by reference:

CLAUSE TITLE AND DATE

52.202-1…