19PA1024R0001 LT Health Insurance for LE Staff_April2024.pdf

SECTION A - MODEL CONTRACT

SOLICITATION, OFFER AND AWARD

1. THIS CONTRACT IS A RATED ORDER

UNDER DPAS (15 CFR 350)

RATING PAGE OF PAGES

1 | 57

2. CONTRACT (Proc. Inst. Ident.) NO.

3. SOLICITATION NO.

19PA1024R0001

4. TYPE OF SOLICITATION

[ ] SEALED BID (IFB)

[x] NEGOTIATED (RFP)

5. DATE ISSUED

04/18/2024

6. REQUISITION/PURCHASE NO.

7. ISSUED BY CODE 19PA10 8. ADDRESS OFFER TO (If other than item 7) American Embassy – Asunción

1776 Mariscal Lopez Avenue

Asunción - Paraguay

Phone: (595-21)213-715 Fax: (595-21)213-878

NOTE: In sealed bid solicitation "offer" and "offeror mean "bid" and "Bidder".

SOLICITATION

9. Digital offer for furnishing the services in the Schedule will be received at the place specified, in the depository located in

AsuncionContracting@state.gov until 17:00 local time May 20, 2024

(hour) (date)

CAUTION - LATE Submissions, Modifications, and Withdrawals: Provision No. 52.215-1 Deviation. All offers are subject to all terms and conditions contained in this solicitation.

10. FOR

INFORMATION

CALL:

A. NAME

Nicola Cullen

B. TELEPHONE NO.(NO COLLECT CALLS)

(Include AREA CODE) – NUMBER EXT.

+595-21-248-3000, x23180

C. E-MAIL ADDRESS

AsuncionContracting@state.gov

11. TABLE OF CONTENTS

(x) SEC. DESCRIPTION PAGE(S) (x) SEC. DESCRIPTION PAGE(S)

PART I - THE SCHEDULE PART II - CONTRACT CLAUSES

A SOLICITATION/CONTRACT FORM I CONTRACT CLAUSES

B SUPPLIES OR SERVICE AND PRICES/COSTS PART III - LIST OF DOCUMENTS, EXHIBITS, AND OTHER ATTACH.

C DESCRIPTION/SPECS/WORK STATEMENT J LIST OF ATTACHMENTS

D PACKAGING AND MARKETING PART IV - REPRESENTATIONS AND INSTRUCTIONS

E INSPECTION AND ACCEPTANCE K REPRESENTATIONS, CERTIFICATIONS, AND

F DELIVERIES OR PERFORMANCE OTHER STATEMENTS OF OFFERORS

G CONTRACT ADMINISTRATION L INSTRS., COND., AND NOTICES TO OFFERORS

H SPECIAL CONTRACT REQUIREMENTS M EVALUATION FACTORS FOR AWARD

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 120 calendar days (120 calendar days unless a different period is inserted by the offer) from the date for receipt of offers specified above, to furnish any or all items upon which prices are offered at the price set opposite each item, delivered at the designated point(s), within the time specified in the schedule.

13. DISCOUNT FOR PROMPT PAYMENT SEE 14

(See section I, Clause No 52.232-8)

10 CALENDAR

DAYS

20 CALENDAR DAYS

30 CALENDAR

DAYS

CALENDAR DAYS

14. ACKNOWLEDGMENT OF

AMENDMENTS

AMENDMENT NO. DATE AMENDMENT NO. DATE

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

15A. NAME CODE FACILITY 16. NAME AND TITLE OF PERSON AUTHORIZED

AND ADDRESS

OF OFFEROR

TO SIGN OFFER (Type or print)

15B. TELEPHONE NO. (Include area code)

15C. CHECK IF REMITTANCE

ADDRESS [ ] IS DIFFERENT FROM

ABOVE - ENTER SUCH ADDRESS

17. SIGNATURE 18. OFFER DATE

AWARD (To be completed by Government)

19. ACCEPTED AS TO ITEM NUMBERED

20. AMOUNT 21. ACCOUNTING AND APPROPRIATION

22. AUTHORITY FOR USING OTHER THAN FULL AND OPEN COMPETITION:

[ ] 10 U.S.C. 2304(c)( ) [ ] 41 U.S.C. 253(c)( )

23. SUBMIT INVOICES TO ADDRESS SHOWN IN

(4 copies unless otherwise specified)

ITEM

24. ADMINISTRATION BY (If other than Item 7) CODE 25. PAYMENT WILL BE MADE BY CODE

Financial Management Office (FMO)

Am-Embassy – 1776 Mariscal Lopez Avenue – Asunción, Paraguay

26. NAME OF CONTRACTING OFFICER (Type of print)

27. UNITED STATES OF AMERICA

(Signature of Contracting Officer)

28. AWARD DATE

IMPORTANT - Award will be made on this form, or on the Standard Form 26, or by other authorized official written notice.

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 Paraguay and their eligible dependents as described in Section

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

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

the Contractor shall bill the Chief of Mission and Deputy Chief of Mission directly for ORE

Staff at the rates specified below. Retirees are included under this contract only as riders; the

Contractor shall bill the individual covered at the rates specified below. Excess coverage for

Extended Family (C.2.4.1.1.4) is included under this contract only as rider benefits; the

Contractor shall bill the individual covered at the rates specified below. See Section G for billing procedures. Note that USG is not responsible, nor liable, for any riders.

B.2. PRICES

B.2.1 Value Added Tax

The Government will not reimburse the Contractor for VAT under this contract. The Contractor shall not include a line for VAT on Invoices as the U.S. Embassy has a tax exemption certificate with the host government.

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:

PRICES FOR PLAN 1

B.2.3 Base Year of

Contract

Bi-Weekly Rates Per

Premium

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.

Category Estimated Number of

Premiums*

Rate per

Premium

Extended Bi-Weekly Total

a. Self 20

b. Self Plus One 5

c. Family (3 or more individual)

d. Subtotal

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.

Rider Category*** Biweekly Rate per Premium

C.2.4.1.1.4 Excess Coverage

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

B.2.4 First Option

Year of Contract

Rate per

Premium

Extended Bi-Weekly Total

a. Self 20

b. Self Plus One 5

c. Family (3 or more individual)

d. Subtotal

Total Price for First

Option Year (d x

26)**

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

B.2.5 Second Option

Rate per

Extended Bi-Weekly Total

a. Self 20

b. Self Plus One 5

c. Family (3 or more individuals)

d. Subtotal

Total Price for

Second Option Year

(d x 26)**

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

B.2.6 Third Option

Rate per

Premium

Extended Bi-Weekly Total

a. Self 20

b. Self Plus One 5

c. Family (3 or more individuals)

d. Subtotal

Total Price for Third

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

B.2.7 Fourth Option

Rate per

Extended Bi-Weekly Total

a. Self 20

b. Self Plus One 5

c. Family (3 or more individuals)

d. Subtotal

Total Price for Fourth

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

PRICES FOR PLAN 2

B.2.3 Base Year of

Contract

Rate per

Premium

Extended Bi-Weekly Total

e. Self 10

f. Self Plus One 5

g. Family (3 or more individual)

h. Subtotal

Total Price for Base

Year (d x 26)**

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

B.2.4 First Option

Rate per

Premium

Extended Bi-Weekly Total

e. Self 10

f. Self Plus One 5

g. Family (3 or more individual)

h. Subtotal

Total Price for First

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

B.2.5 Second Option

Rate per

Premium

Extended Bi-Weekly Total

e. Self 10

f. Self Plus One 5

g. Family (3 or more individuals)

h. Subtotal

Total Price for

Second Option Year

(d x 26)**

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

B.2.6 Third Option

Rate per

Premium

Extended Bi-Weekly Total

e. Self 10

f. Self Plus One 5

g. Family (3 or more individuals)

h. Subtotal

Total Price for Third

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

B.2.7 Fourth Option

Rate per

Premium

Extended Bi-Weekly Total

e. Self 10

f. Self Plus One 5

g. Family (3 or more individuals)

h. Subtotal

Total Price for Fourth

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

MINIMUM AND MAXIMUM AMOUNTS

During the Base Year of the contract, and during the option years that might be exercised, the

United States Government (USG) shall place orders totaling a minimum of USD 100. 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 USD 8,000,000. 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

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

Base Year Total (Plan 1 + Plan 2)

First Option Year Total (Plan 1 + Plan 2)

Second Option Year Total (Plan 1 + Plan 2)

Third Option Year Total (Plan 1 + Plan 2)

Fourth Option Year Total (Plan 1 + Plan 2)

Grand Total of Base plus All Option Years

Third Option Year

Fourth Option Year

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

(PLAN 1, Section C.1 - Current Employees Only)

C.1. HEALTH INSURANCE SERVICES – PLAN 1 (Current Employees Only)

The Government of the United States of America requires Health Insurance coverage for its employees as described herein. The Government has determined that the prevailing practice by employers in Paraguay is to provide for their employees’ health insurance protection and that the cost of such insurance protection is usually borne by both the employee (15%) and the employer

(85%).

The specific health benefit coverage under this contract is set forth in Plan 1, Section C.1. This is a standard package that must be provided to all current employees at U.S. Mission Paraguay who do not elect to participate in Plan 2, Section C.2 set forth below. New employees hired after the health insurance contract’s effective date do not qualify for the benefit levels in this Plan 1, Section C.1 (see Plan 2, Section C.2 below).

The Contractor shall insure that health care under this contract does not exclude HIV/AIDS care, unless exclusion has been authorized by GTM/OE/CM.

C.1.1. Employee and Dependent Health Service Benefits

The insurance company will cover 100% of reasonable and customary costs of benefits and services received and referenced below subject to any stated limits or applicable maximums as noted below. The medical treatment must be prescribed or provided by a physician or nurse licensed in Paraguay, the United States, or in the country in which the treatment or prescription is received. Payment will be made in local currency.

C.1.1.1. Deductible: None

C.1.1.2. Hospitalization: 100% coverage of room and board for a standard ward room, semi-private room, or private room; disposable/expendable medical supplies, medicines and utilitarian materials. 100% coverage of hospital medical expenses including laboratory tests, x-rays, nursing care, operating room costs, intensive care, and prescription medicines.

C.1.1.3. Surgery - 100% coverage of all types of major or minor surgical operations, anesthesia, blood transfusions, medicines, disposable/expendable medical supplies, utilitarian materials.

C.1.1.4. Doctor Visits – 100% coverage of hospital and office calls and medical appointments; and professional services of general clinic specialists; excluding home visits. Use of physicians and professionals not included on the Contractor’s list of preferred providers would result in coverage in the amount the physicians of the Contractor's staff would receive.

C.1.1.5. Hospital Outpatient Services – 100% coverage of all outpatient services, including, but not limited to: ambulatory services, studies, treatments, simple and specialized laboratory analysis, and diagnostic studies.

C.1.1.6. Prescription Drugs and medicines: – 100% coverage of the cost of medicines and drugs while hospitalized for which a prescription is legally required. Expenses incurred for medicines in ambulatory prescriptions, vitamins, cold remedies, etc., that are available over the counter without a prescription will not be reimbursed even if prescribed by a physician.

C.1.1.7. Obstetrical Care - 100% coverage when hospitalized for obstetrical medical care to include post-natal care and newborn care.

C.1.1.8. Family Planning: Not covered.

C.1.1.9. Ambulance Service - 100% coverage (extended to the entire territory of

Paraguay).

C.1.1.10. Expenses Incurred Out-of-Country – Not covered.

C.1.1.11. HIV/AIDS Treatment Coverage: 100% coverage for medications to suppress opportunistic infections, such as tuberculosis and toxoplasmosis for employees who have

HIV/AIDS; as well as brief courses of antiretroviral drugs during childbirth to prevent the transmission of HIV to the employee's child. This expanded coverage generally excludes medications for the long-term suppression of AIDS through the combination of antiretroviral drugs at those posts with inadequate local healthcare infrastructures. A separate maximum limit per year of USD 10,000 per employee applies to this coverage.

C.1.1.12. Emergencies: 100% coverage of treatment, procedures and medicines received as the result of urgencies and emergencies.

C.1.1.13 Intensive Care: 100% coverage of intensive therapy and/or poly-trauma services, therapies, medicines, supplies and materials. Adults and children covered.

C.1.1.14 Specialized Cases: 100% coverage for treatment in specialized medical centers for burn cases or contagious diseases.

C.1.1.15. Laboratory, analysis and diagnosis: 100% coverage of analyses and test ordered by an approved physician, radiology and scans, x-rays, etc. Medicines not covered.

C.1.1.16. Preventative Care: 100% coverage for annual preventative service to include:

physical examination, general analysis, x-ray and electrocardiogram. For females this includes a pap smear, bone densitometry and mammography, etc.

C.1.1.17. Physical Therapy - 100% coverage for services prescribed by a physician.

C.1.1.18. Psychiatric Treatment – Reserved (special fee).

C.1.1.19. Dental Service - 100% coverage of basic dental treatments.

C.1.1.20. Optical Service – 100% coverage of examinations and eye surgery.

Prescriptions, frames and lenses are not covered.

C.1.1.21. Hearing Aids - Not covered.

C.1.1.22. NOTE: Procedures and disposable/expendable and materials/supplies for blood transfusions are covered at 100%, however, the provision of blood is not covered.

C.1.1.23. CONTRACTOR AND CONTRACTOR’S PERSONNEL KNOWLEDGE AND

EXPERIENCE IN THE WORK.

C.1.1.23.1. The Contractor shall have a minimum of two (2) years progressively responsible prior work experience in this business.

C.1.1.23.2. The Contractor shall have an office settled in the City of Asuncion properly registered under the laws of the republic of Paraguay.

C.1.1.23.3. The Contractor shall provide sufficient personnel possessing the skill, knowledge, education, training, etc. to perform the task described herein. Moreover, the Contractor shall assure that any required local licenses, permits, medical board certification etc. are obtained prior the Contractor personnel performing these services. The Contractor shall not hire off duty

Government employees who serve as inspector or Contracting Officer’s Representative (COR) in their Government position, or any other persons whose employment would result in conflict of interest.

C.1.1.24. Exclusions or limitations: No coverage will be made for elective cosmetic surgery; spa cures; rejuvenation cures; massage; exercise therapy; long term rehabilitative therapy; non-medical hospital charges such as telephones or television, home help, family help, or similar household assistance; fees of persons who are not licensed physicians or nurses; or services or supplies which have not been prescribed or approved by a physician or nurse.

No coverage will be made for expenses that will be reimbursed or paid directly under a host country medical program, the U.S. workers' compensation program, or any Paraguayan workers' compensation program.

No coverage will be made for expenses related to an illness or injury that is a result of an unlawful action on the part of the patient; the practice of a dangerous sport; excessive or illegal use of alcohol or drugs; drug addiction; a self-inflicted wound; or service in the armed forces of any country.

Any exclusion, exception or limitation to the services provided by the Contractor under the

Contractor shall be clearly spelled out by the Contractor and provided to the Government and the

Beneficiaries. Services not properly listed as called under this clause shall be considered as covered under the Contractor and must be covered by Contractor.

C.1.2. Health Benefits Conditions and Limitations

With the exception of expenses incurred under paragraph C.1.11 above, the insurance company shall cover expenses up to a limit of USD 120,000 per individual, per event, per contract year.

The insurance company shall cover expenses described under paragraph C.1.1.11 of the plan up to a separate limit of USD 10,000 per employee per contract year.

No coverage for elective cosmetic surgery; spa cures; rejuvenation cures; massage; exercise therapy; long term rehabilitative therapy; non-medical hospital charges such as telephones or television; home help, family help, or similar household assistance; fees of persons who are not licensed physicians or nurses; or services or supplies which have not been prescribed or approved by a physician or nurse.

No coverage for expenses that will be covered or paid directly under a host country medical program, the U.S. workers’ compensation program, or a post's LE Staff workers' compensation program.

No coverage for expenses related to an illness or injury that is a result of an unlawful action on the part of the patient; the practice of a dangerous sport; excessive or illegal use of alcohol or drugs; a self-inflicted wound; or service in the armed forces of any country. There is no reimbursement for medical expenses incurred outside of Paraguay. There is no reimbursement for round trip transportation expenses to travel out of country for medical treatment.

C.1.3 Eligible Participants

C.1.3.1 Eligible Employees.

The employees eligible for the health insurance services include the following:

C.1.3.1.1 All current active employees of the United States Government, employed within the geographic boundaries of Paraguay paid under the Local Compensation Plan, and certified by the Contracting Officer. Eligible employees are Locally Employed Staff who are (1) working on a full time or part time basis under non-temporary direct hire appointments or under personal services agreements/contracts that are not time limited to less than one year and (2) paid under the terms of the Local Compensation Plan. Participation is mandatory.

C.1.3.2. Location of Employment.

The individuals covered by C.1.3.1 must be employed within the geographic boundaries of

Paraguay by:

U.S. Department of State, U.S. Agency for International Development (USAID), Drug Enforcement Administration (DEA), Defense Attaché Office (DAO), Office of Defense Cooperation (ODC), Open Source Center (OSC) former Foreign Broadcast Information Service

(FBIS),

Peace Corps (PC), Department of Justice, Department of Treasury, Federal Bureau of Investigation, or

Any other USG Agency as certified by the CO.

C.1.3.3 RESERVED

C.1.4 Individuals Not Eligible for Coverage

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

PSC that is time limited to less than one year; non-personal services Contractor personnel and their employees, supplied by an independent Contractor licensed to do business in Paraguay who provides services to other local organizations as well as to the U.S. Mission; employees of

USAID institutional Contractors; and Peace Corps personal services Contractors as indicated in

MS 743.

C.1.5. Other Eligible Participants.

The following additional categories of persons are covered by this insurance:

C.1.5.1. Dependent Coverage: Expenses incurred by an enrolled employee's eligible dependents are covered under this plan. For the purposes of this plan, an employee's dependents are defined as the employee's legal spouse (limit one), economically dependent parents, and each unmarried, economically dependent child who primarily resides with the employee unless away at school. Child is defined as the employee's natural child, adopted child, foster child, or stepchild. An eligible child will be covered until the end of the calendar year in which the child turns age 21. There is no age limit for an eligible child who is physically or mentally handicapped so as to be unable to live independently. There is no limit on the number of children covered per employee.

C.1.5.2. Special agreements between the Contractor and covered employee may be established to cover the following dependents based on an additional premium which will be paid in each case by the employee without charge to the U.S. Government.

a. Parents of the covered employee, who are not economically dependent.

b. Dependent children of the covered employee over twenty-one (21) years old, single or married; no coverage for spouses.

c. Parents-in-law of the covered employee.

d. Brothers and sisters of the covered employee only, single and/or married.

e. Grandchildren of the beneficiary employee only, single and/or married.

C.1.5.3 Retired U.S. Government Employees: USG retirees shall have the option, upon a written request addressed to Contractor and cleared by the COR to be covered by the Contractor, at any time, by virtue of a private agreement signed between the Contractor and the retiree. All

Retired employees covered by this clause must pay the total amount of the premium to the

Contractor; the Government shall not contribute to these premium payments. Retirees covered under this clause shall have all rights and benefits conceded to USG employees including coverage for spouses and the options stipulated above at same prices set for employees/beneficiary coverage.

C.1.6. Eligibility

C.1.6.1. Term of Eligibility and Effective Date

Each current active eligible employee is enrolled for health benefits under this contract upon award and thereafter during the performance period of this contract. An employee is considered active ("on the rolls") whenever such employee is on approved leave, whether paid or unpaid.

C.1.6.2. Period of Ineligibility.

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

Additionally, employee's dependents are not entitled to health benefits during any period of employment during which the employee was not eligible to participate.

During a period of Leave Without Pay 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.

During a period of extended (beyond one pay period) of Leave Without Pay or unpaid leave, the employee is responsible for the full cost of the insurance premiums (employee’s and the

Government’s share) for self and dependents. The Mission will pay the premiums directly to the contractor, and will collect the full cost from the employee.

C.1.7. Brochure Requirement.

C.1.7.1. The contractor shall provide a document (brochure/pamphlet/other written document) in Spanish language 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.1.7.2. The contractor shall provide the document described in C.1.7.1 to the COR not later than thirty (30) days after date of contract award. The Contractor shall provide additional brochures for new employees within ten (10) days of the COR’s request.

C.1.7.3. The contractor assumes full responsibility for ensuring that the document described in C.1.7.1 accurately reflects the requirements of the contract, as implemented by the contractor’s technical proposal. In all cases, the contract shall take precedence. Should the COR discover that the brochure contains inaccuracies, the contractor will be notified in writing;

however, failure on the part of the Government to notice any inaccuracies shall in no way limit, revise or otherwise affect the requirement under this contract for the contractor to fully comply with all contract terms.

C.2.0. This section C2 is RESERVED

C.3.0 Definitions

FMO: The Financial Management Officer or the paying office for all U.S. Government Agencies except AID and Peace Corps.

COR: Contracting Officer's Representative (COR) is the Human Resources Officer (HRO) at post.

Contributory Insurance: Insurance for which the employee contributes toward the premium.

Dependent: The spouse, children under the age of twenty one (21) years old, if they are not married and are economically dependent (child is defined as the employee’s natural child, adopted child, stepchild, or foster child), as well as the parents of the employee, if economically dependent and/or living at the employee’s house.

Disability: Total and Permanent: A physical or mental impairment which precludes the individual from performing ordinary motor or bodily functions and which requires separation from employment. If the impairment is the result of a previous impairment, it shall be considered a continuation of the prior impairment.

Employee: An individual employed by the U.S. Government, under a direct-hire appointment, personal services contract (PSC), or personal services agreement (PSA), as further defined in

Section C.1.3 for health insurance.

Employer: The United States Government.

GSO: General Services Officer in charge of the General Services Office at post. This officer is usually the Contracting Officer for this contract.

Hospital: An institution established and operated for the care and treatment of sick and injured persons. It provides 24-hour nursing care and has diagnostic, laboratory, treatment, and surgical facilities. Any institution which does not meet this definition is not considered a hospital.

Hospital Patient: An individual who has been admitted to a hospital, is assigned a bed, and is given diagnostic tests or receives treatment for a disease or an injury.

Maximum Benefit: The total amount that will be covered/paid to any one covered individual for covered medical expenses.

Customary and Reasonable Treatment: A diagnostic test or medical treatment which is usually performed in the community where the individual is being treated.

Physician An individual who has graduated from an accredited medical school and is licensed to practice medicine in the jurisdiction in which the contract is to be performed. If the individual is a medical specialist, then he or she is Board Certified in that specialty.

Surgical procedure: Any invasive medical procedure by manual or instrument operation undertaken for diagnosis or treatment of a diseased patient.

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.

PLAN 2, SECTION C.2 - CURRENT EMPLOYEES AND NEW EMPLOYEES –

ADDITIONAL PLAN

C.2 HEALTH INSURANCE SERVICES – PLAN 2 (Current Employees and New

Employees)

The Government of the United States of America requires Health Insurance coverage for its employees as described herein. The benefit levels listed in Plan 2, Section C.2 are a standard package that must be provided to all new employees hired at U.S. Embassy Paraguay after the new health insurance contract’s effective date and current employees who enroll in Plan 2, Section C.2, during an initial enrollment period or during Annual Open Season. Current employees may select Plan 2, Section C.2, during an initial enrollment period or during

Annual Open Season. Once Plan 2. Section C.2 is selected, current employees cannot opt back into Plan 1, Section C.1.

C.2.1 Employee and Dependent Health Service Benefits

C.2.1.1 Hospitalization (treatment in the hospital for inpatient care): 100% Coverage

Services and supplies provided during hospitalization, including services provided by a licensed healthcare provider, bed & board (semi-private accommodations), operating room, recovery room, intensive care, imaging and diagnostic testing, general hospital nursing care, physical therapy, as well as drugs and medicines administered while in-patient. 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 Outpatient Services (below) for details concerning professional services.

C.2.1.2 Emergency Services (trips to emergency room): 100% Coverage

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

C.2.1.3 Ambulance: 100% Coverage

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

C.2.1.4 Outpatient Services: 100% Coverage

Services provided by a certified healthcare provider on an ambulatory or outpatient basis

(without being admitted to a hospital), including surgeon’s fees and other medical services that may be provided in a hospital, clinic, doctor’s office, medical facility, etc. Examples include, but are not limited to:

-- Annual physical examinations

-- Specialist consultations and treatment, including second surgical opinion

-- Minor surgical interventions

-- Chemotherapy and radiation treatments

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

-- Diagnostic tests and diagnostic imaging

C.2.1.5 Obstetric and Newborn Care: Inpatient: 100% Coverage; Outpatient: 100%

Coverage

Care and services that women receive during pregnancy (prenatal care), throughout labor and delivery, and post-delivery, and outpatient care for newborn babies. Hospitalization during pregnancy and/or delivery will be covered as Hospitalization (treatment in the hospital for inpatient care). All other treatments will be considered Outpatient Services.

C.2.1.6 Pediatric Services: Inpatient: 100% Coverage; Outpatient: 100% Coverage

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

C.2.1.7 Prescription Drugs: Inpatient: 100% Coverage; Outpatient: No Coverage

Medications prescribed by a certified health care provider that are medically necessary.

Examples include but are not limited to: prescription antibiotics to treat an infection; medication used to treat an ongoing condition, such as high cholesterol; prophylaxis; or contraceptive medication.

C.2.1.8 Preventive and Wellness and Chronic Disease Management: 100% Coverage

Counseling or preventive care designed to prevent or detect medical conditions and care for chronic conditions such as asthma and diabetes. Examples include, but not limited to: physicals, immunization, hearing tests for diagnostic and preventative purposes, and cancer screenings.

C.2.1.9 Hearing Aids: No Coverage

C.2.1.10 Optical:

Examinations and Treatment: 100% Coverage

Prescription lenses and frames, or contact lenses: No Coverage

C.2.1.11 Dental:

Basic dental treatments: 100% Coverage

Examples include, but are not limited to: dentist’s fees, x-rays, examinations and treatment, cleanings, fillings, extractions, false teeth, crowns, and bridges.

Orthodontia: No Coverage

C.2.1.12 Reproductive Health: No Coverage

C.2.1.13 Mental Health and Substance Abuse Care: No Coverage

C.2.1.14 Rehabilitative and Habilitative Services and Devices:

Physical Therapy: For services prescribed by a physician. 100% Coverage

C.2.1.15 HIV/AIDS: 100% up to USD 10,000 per contract year per covered individual

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

Note to Contracting Officer: Post should consider electing this option if HIV/AIDS treatment is not covered as prevailing practice by local medical insurance providers, or is prohibitively expensive.

*C.2.1.16 RESERVED

*C.2.1.17 RESERVED

*C.2.1.18 RESERVED

*C.2.1.19 RESERVED

*C.2.1.20 RESERVED

*C.2.1.21 RESERVED

C.2.2 Annual Maximum Limit:

The maximum annual coverage per covered individual per contract year, not including expenses covered under HIV/AIDS benefits if selected by post, is USD 120,000.

C.2.3 Exclusions to Coverage:

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

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

Removal of any exclusions require prior authorization.

There is no reimbursement for expenses that will be reimbursed or paid directly under a host country medical program or workers' compensation program, the U.S. workers’ compensation program, or post’s LE Staff workers’ compensation program.

There is no coverage for medical expenses incurred out-of-country. There is no reimbursement for out-of-country treatment.

C.2.4 ELIGIBLE PARTICIPANTS

C.2.4.1 Identification of Eligible Employees and Dependents: U.S. Embassy Paraguay 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.

To be eligible to participate in the medical plan, LE Staff must be 1) Paid under the terms of the

Local Compensation Plan (LCP); and 2) Under a non-temporary direct hire appointment, personal services agreement (PSA), or Personal services contract (PSC); or 3) 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 Paraguay who provides services to other local organizations as well as to the U.S. Mission; employees working on an intermittent or When Actually Employed (WAE) schedule; employees of USAID institutional contractors; Peace Corps personal services contractors as indicated in MS 743; and

Recreation Association employees.

C.2.4.1.1. Definition of Dependents

LE Staff who are eligible to participate in the medical plan automatically confer coverage to eligible family members who meet the following criteria:

C.2.4.1.1.1 Legal spouse: one legal spouse as defined by local law may be covered. LE Staff with more than one legal spouse must select only one spouse for coverage.

In cases where LE Staff and their legal spouse both work for the mission and both are eligible to participate in the medical plan, one will be designated as the lead for purposes of the medical plan, and the other will be considered a legal spouse.

C.2.4.1.1.2 Dependent children: a child is defined as the LE Staff’s natural, adopted, stepchild, or foster child. The child must be unmarried and financially dependent upon the LE

Staff. A child will be covered until the end of the contract year in which s/he reaches age 21. 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.2.4.1.1.3 Dependent Parents: Economically dependent parents may be covered.

C.2.4.1.1.4 Extended Family: A special agreement between the Contractor and covered employee may be established to cover the following dependents based on an additional premium which will be paid in each case by the employee without charge to the U.S. Government.

a. Parents of the covered employee, who are not economically dependent.

b. Dependent children of the covered employee over twenty one (21) years old, single or married; no coverage for spouses.

c. Parents-in-law of the covered employee.

d. Brothers and sisters of the covered employee only, single and/or married.

e. Grandchildren of the beneficiary employee only, single and/or married.

C.2.4.2 Location of Employment: The eligible employees covered by C.1.4.1 must be employed within the geographic boundaries of Paraguay by:

U.S. Department of State, U.S. Agency for International Development (USAID), Drug Enforcement Administration (DEA), Defense Attaché Office (DAO), Office of Defense Cooperation (ODC), Open Source Center (OSC) former Foreign Broadcast Information Service (FBIS), Peace Corps (PC), Department of Justice, Department of Treasury, Federal Bureau of Investigation, or

Any other USG Agency as certified by the CO.

C.2.4.3 Participants Covered Under a Rider

Official Residence Expense (ORE) and Employee Association (EA) 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 employee.

Retiree Coverage: Retirees have the option to participate in this plan under a rider for continued coverage for themselves and eligible covered dependents. All health benefits and limitations outlined apply to the retired employee and covered dependents. The retired employee will be responsible for paying 100% of the premium costs for the coverage of themselves and their dependents.

C.2.5 ELIGIBILITY

C.2.5.1 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.2.5.2 Periods of Ineligibility:

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

Additionally, employee's dependents are not entitled to health benefits during any period of employment during which the employee was not eligible to participate.

During a period of extended Leave Without Pay (LWOP) or unpaid leave beyond one pay period, the employee is responsible for the full cost of the insurance premiums for self and dependents. The Mission will pay the premiums directly to the Contractor, and will collect the full cost from the employee on a quarterly basis. Alternatively, the employee may elect to have coverage cease if they prefer not to pay the premium.

C.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 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.2.6.2 The Contractor shall provide the document described in C.1.6.1 to the COR not later than thirty (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.2.6.3 The Contractor assumes full responsibility for ensuring that the document described in C.2.6.1 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.3.0 Definitions

FMO: The Financial Management Officer or the paying office for all U.S. Government

Agencies except AID and Peace Corps.

COR: Contracting Officer's Representative (COR) is the Human Resources Officer (HRO) at post.

Contributory Insurance: Insurance for which the employee contributes toward the premium.

Dependent: The spouse, children under the age of twenty one (21) years old, if they are not married and are economically dependent (child is defined as the employee’s natural child, adopted child, stepchild, or foster child), as well as the parents of the employee, if economically dependent and/or living at the employee’s house.

Disability-Total and Permanent: A physical or mental impairment which precludes the individual from performing ordinary motor or bodily functions and which requires separation from employment. If the impairment is the result of a previous impairment, it shall be considered a continuation of the prior impairment.

Employee: An individual employed by the U.S. Government, under a direct-hire appointment, personal services contract (PSC), or personal services agreement (PSA), as further defined in Section C.1.3 for health insurance.

Employer: The United States Government.

GSO: General Services Officer in charge of the General Services Office at post. This officer is usually the Contracting Officer for this contract.

Hospital: An institution established and operated for the care and treatment of sick and injured persons. It provides 24-hour nursing care and has diagnostic, laboratory, treatment, and surgical facilities. Any institution which does not meet this definition is not considered a hospital.

Hospital Patient: An individual who has been admitted to a hospital, is assigned a bed, and is given diagnostic tests or receives treatment for a disease or an injury.

Maximum Benefit: The total amount that will be covered/paid to any one covered individual for covered medical expenses.

Customary and Reasonable Treatment: A diagnostic test or medical treatment which is usually performed in the community where the individual is being treated.

Physician: An individual who has graduated from an accredited medical school and is licensed to practice medicine in the jurisdiction in which the contract is to be performed. If the individual is a medical specialist, then he or she is Board Certified in that specialty.

Surgical procedure: Any invasive medical procedure by manual or instrument operation undertaken for diagnosis or treatment of a diseased patient.

Annual Open Season: Time of the year to enroll, update, or cancel health insurance coverage.

SECTION D

PACKAGING AND MARKING

(RESERVED)

SECTION E

INSPECTION AND ACCEPTANCE

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

This contract incorporates 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.

Performance Objective

PWS

Paragraph Performance Threshold

Services

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

C.1.0 thru

C.1.7 and

C.2.0 thru

C.2.6

All required services are performed and no more than five

(5) 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.

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

E.2.2 Standard. The performance standard is that the Government receives no more than five

(5) 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

(a) If any Government personnel observe unacceptable services, either incomplete work or required services not being performed, they should immediately contact the COR.

(b) The COR…