RFP_19PK33-19-R-5897_LES_Health_Insurance.pdf

November 29, 2018

SUBJECT: Solicitation Number 19PK33-19-R-5897 - Health Insurance Services for LE Staff, U. S. Mission, Pakistan.

Dear Prospective Offeror:

The Embassy of the United States of America invites you to submit a proposal for customized

Group Health Insurance coverage for employees of the United States Embassy, Islamabad, Consulates of Karachi, Lahore, and Peshawar. Offerors shall submit their price proposals in the format shown in section B.2, based on maximum annual reimbursement limit stated in C.1.1.13 and a second set of prices based on maximum annual reimbursement limit of PKR one million.

The Embassy intends to conduct a pre-proposal conference, and all prospective offerors who have received a solicitation package are invited to attend. See Section L of the attached Request for

Proposals (RFP).

Your proposal must be submitted in a sealed envelope marked "Proposal Enclosed" to Jamison

Pixley, Contracting Officer, U. S. Embassy, Diplomatic Enclave, Ramna- 5, Islamabad on or before

1500 hrs, January 14, 2019. No proposal will be accepted after this time.

In order for a proposal to be considered, you must also complete and submit the following:

1. SF-33

2. Section B, Pricing Schedule

3. Section B, Retention Amounts in B.3

4. Section K, Representations and Certifications;

5. Additional information as required in Section L.

Direct any questions regarding this solicitation to Jamison F. Pixley by letter or by telephone 051-

201-5221during regular business hours.

Please note: Proposals that contain more benefits (even if there is no increase in cost) or fewer benefits than those stated in the solicitation may be deemed technically unacceptable.

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

Sincerely, Jamison F. Pixley

Contracting Officer

NSN 7540-01-152-8064 STANDARD FORM 33 (REV 9-97)

SOLICITATION, OFFER AND AWARD

1. THIS CONTRACT IS A RATED ORDER

UNDER DPAS (15 CFR 350)

RATING PAGE OF PAGES

1 | 63

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

3. SOLICITATION NO.

19PK33-19-R-5897

4. TYPE OF SOLICITATION

[ ] SEALED BID (IFB)

[x] NEGOTIATED (RFP)

5. DATE ISSUED

November 29,

6. REQUISITION/PURCHASE NO.

7. ISSUED BY

CODE

8. ADDRESS OFFER TO (If other than item 7)

U.S. Embassy, Diplomatic Enclave, Ramna 5

Islamabad, Pakistan

Phone: 051-2015221 Fax:

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

SOLICITATION

9. Sealed offers in original and 3 copies for furnishing the supplies or services in the Schedule will be received at the place specified, in the depository located in until January 14, 2018 local time 1500 hours PST.

(hour) (date)

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

10. FOR

INFORMATION

CALL:

A. NAME

Jamison F. Pixley

B. TELEPHONE (NO COLLECT

CALLS)

AREA CODE NUMBER EXT

+92-51-2015221

C. E-MAIL ADDRESS

PixleyJF@state.gov and Latifm@state.gov

11. TABLE OF CONTENTS

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

PART I - THE SCHEDULE PART II - CONTRACT CLAUSES

X A SOLICITATION/CONTRACT FORM 01 X I CONTRACT CLAUSES 26

X B SUPPLIES OR SERVICE AND PRICES/COSTS 02 PART III - LIST OF DOCUMENTS, EXHIBITS, AND OTHER ATTACH.

X C DESCRIPTION/SPECS/WORK STATEMENT 11 X J LIST OF ATTACHMENTS 36

D PACKAGING AND MARKING PART IV - REPRESENTATIONS AND INSTRUCTIONS

X E INSPECTION AND ACCEPTANCE 18 X K REPRESENTATIONS, CERTIFICATIONS, AND 44

X F DELIVERIES OR PERFORMANCE 20 OTHER STATEMENTS OF OFFERORS

X G CONTRACT ADMINISTRATION 21 X L INSTRS., COND., AND NOTICES TO OFFERORS 54

X H SPECIAL CONTRACT REQUIREMENTS 23 X M EVALUATION FACTORS FOR AWARD 61

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 150 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

(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 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

26. NAME OF CONTRACTING OFFICER (Type or 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.

mailto:PixleyJF@state.gov

PREVIOUS EDITION NOT USABLE Prescribed by GSA

SECTION B

PART I: PRICE - HEALTH INSURANCE

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 Pakistan as described in Section C and the Exhibits in Section J. The groups of employees who shall be provided this insurance are listed in C.1.3. This insurance shall be provided in accordance with Section C and the Exhibits in Section J.

B.1.1. Official Residence Expense (ORE) and Provident Fund (PF) Office Staff are included under this contract only as a rider; the Contractor shall bill the Chief of Mission, Deputy Chief of Mission, respective Principal Officers (for ORE Staff), and the Embassy Provident Fund Office (for PF staff) at the rates specified below. See Section G for billing procedures.

B.2. PRICES

The Offeror shall include Defense Base Act (DBA) insurance premium costs covering employees. The offeror may obtain DBA insurance directly from any Department of Labor approved providers at the DOL website at http://www.dol.gov/owcp/dlhwc/lscarrier.htm

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:

http://www.dol.gov/owcp/dlhwc/lscarrier.htm

Category

Estimated

Number of

Employees

Rate per

Employee

(PKR)

Bi-Weekly Total

(PKR)

a. Single Employees ( Self Only) 141

b. Family Plan (Married Employees) 1,362

Bi-Weekly Rates per Employee

B.2.3. Base Year of Contract - Maximum Reimbursement PRK 600,000

c. Subtotal (a + b)

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

Category

Estimated

Number of

Employees

Rate per

Employee

(PKR)

Bi-Weekly Total

(PKR)

a. Single Employees ( Self Only) 141

b. Family Plan (Married Employees) 1,362

Bi-Weekly Rates per Employee

B.2.4. 1st Option Year - Maximum Reimbursement PRK 600,000

c. Subtotal (a + b)

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

Category

Estimated

Number of

Employees

Rate per

Employee (PKR)

Bi-Weekly Total

(PKR)

a. Single Employees ( Self Only) 141

b. Family Plan (Married Employees) 1,362

Bi-Weekly Rates per Employee

B.2.6. 3 rd

Option Year of Contract - Maximum Reimbursement PKR 600,000

c. Subtotal (a + b)

d. Total Price for Third Option Year (c x 26)

Category

Estimated

Number of

Employees

Rate per

Employee (PKR)

Bi-Weekly Total

(PKR)

a. Single Employees ( Self Only) 141

b. Family Plan (Married Employees) 1,362

Bi-Weekly Rates per Employee

B.2.5. 2nd Option Year - Maximum Reimbursement PRK 600,000

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

B.2.8 Grand Total: Base+All Option Years - Maximum Reimbursement PKR 600,000

Base Year Total

First Option Year Total

Second Option Year Total

Third Option Year Total

Fourth Option Year Total

Grand Total of Base plus All Option Years

Category

Estimated

Number of

Employees

Rate per

Employee (PKR)

Bi-Weekly Total

(PKR)

a. Single Employees ( Self Only) 141

b. Family Plan (Married Employees) 1,362

Bi-Weekly Rates per Employee

B.2.7. 4 th

Option Year of Contract - Maximum Reimbursement PRK 600,000

d. Total Price for Fourth Option Year (c x 26)

Offerors are required to provide prices for both caps for reimbursement (PKR 600,000 and PKR

One million). Providing both prices will not obligate US Government to procure insurance coverage for both caps. For the contract base year the reimbursement cap level will be PKR 600,000.00.

However the US Government reserves the right to modify the contract in order to shift to reimbursement cap of PKR one million any time after completion of base year.

B.2.3.a. Base Year of the Contract - Maximum Reimbursement PKR 1 Million

Category Estimated Number of

Employees

Rate per

Employee

Total

a. Single Employees

(Self only)

b. Family Plan

(Married Employees)

c. Subtotal (a+b)

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

B.2.4.a. 1st Option Year - Maximum reimbursement PKR 1 Million

Rate per

Employee

Total

b. Family Plan

(Married Employees)

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

B.2.5.a. 2nd Option Year - Maximum reimbursement PKR 1 Million

Rate per

Employee

Total

b. Family Plan (Married

Employees)

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

B.2.6.a. 3rd Option Year of the Contract - Maximum Reimbursement PKR 1 Million

Rate per

Employee

Total

d. Total Price for Third Option Year (c x 26)

B.2.7.a. 4th Option Year - Maximum reimbursement PKR 1 Million

Rate per

Employee

Total

d. Total Price for Fourth Option Year (c x 26)

B.2.8.a Grand Total: Base + All Option Years - Maximum reimbursement PKR 1 Million

Total Price for Base Year: ____________________

Total Price for First Option Year: ____________________

Total Price for Second Option Year: ____________________

Total Price for Third Option Year: ____________________

Total Price for Fourth Option Year: ____________________

GRAND TOTAL BASE+ALL OPTION YEARS: ____________________

B.3 ADMINISTRATIVE RETENTION AMOUNTS

B.3.1 If the Contractor requests a price adjustment under B.4 below, the Contractor must present cost experience data that includes the retention amount. For purposes of any economic price adjustment, this retention amount is a fixed amount that is a part of the premium amounts in B.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 must be expressed in the currency in which the premium amount is proposed. The fixed retention amount shall NOT be expressed in terms of a percentage of the premium.

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

Period of Performance Single Employees (Self Only) Family Plan

Base Period

First Option Year

Second Option Year

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 must include in its proposal for adjustment, details setting forth how the pool impacts the request for equitable adjustment.

B.5 to B.8 Reserved

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 further described in C.1.2 in Pakistan. The Government has determined that the prevailing practice by employers in Pakistan is to provide for their employees health insurance protection and that the cost of such insurance protection is usually borne by the employer on a

100% basis. Health insurance protection will be representative of locally prevailing compensation practice as further described in C.1.2. The specific health benefit coverage under this contract is set forth in Section C and the Exhibits in Section J.

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

C.1.1 Employee and Dependent Health Services Benefits

The health benefits under this contract are as follows. Reimbursements or payments shall be made for the following covered benefits, subject to reasonable and customary costs in the locality where treatment was provided. (Note: Appendix A provides clarification and additional information.)

C.1.1.1. Hospitalization: 100% reimbursement of room and board for a ward room or semi-private room. 100% reimbursement of room and board for a private room if no ward or semi-private room option is available. 100% reimbursement of all hospital medical expenses including but not limited to: doctors’ and surgeons’ fees, laboratory tests and x-rays, diagnostic testing (such as CT scan and MRI), nursing care, operating room costs, intensive care/critical care (ICU/CCU), prescription medicines, and physical therapy. 60% reimbursement of ambulance service.

C.1.1.2. Professional Services and Treatment: 100% reimbursement of doctors’ and surgeons’ fees incurred while hospitalized, at a hospital on an out-patient basis, at a clinic or doctor’s office, or at home. 100% reimbursement for medical services and expenses when not hospitalized including but not limited to: laboratory tests and x-rays, prescription medicines, physical therapy, routine annual physical examination, and inoculations. Coverage shall include all medically necessary services and treatments

C.1.1.3. Prescription Drugs and Medicines: 100% reimbursement when hospitalized for all prescribed drugs and medicines. 100% reimbursement when not hospitalized, of the cost of medicines and drugs for which a prescription is provided.

C.1.1.4 For Employees Only: 100% reimbursement for medications to suppress opportunistic infections, such as tuberculosis and toxoplasmosis for employees who have

HIV/AIDS. For employee and employee's covered spouse/partner: 100% reimbursement for brief courses of anti-retroviral 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 anti-retroviral drugs at those posts with inadequate local healthcare infrastructures.

The maximum limit for expenses reimbursed under section C.1.1.4 is USD 10,000 per patient per contract year, or the equivalent in Pakistani Rupees (PKR).

C.1.1.5 Obstetrical Care: 100% reimbursement of obstetrical medical care including prenatal and postnatal care.

C.1.1.6 Family Planning: No reimbursement for family planning procedures, treatments, medications, devices, or products.

C.1.1.7 Hearing Aids: No reimbursement of the cost of a hearing aid apparatus and anything related to it.

C.1.1.8 Optical Care: 50% reimbursement for eye examination and treatment and prescription eyeglass or contact lenses. Limited to two lenses per patient every two years. No reimbursement for eyeglass frames, nonprescription lenses, or tinting. 100% reimbursement for medically necessary optical surgery (non-cosmetic), care, and treatments per C.1.1.1 and C.1.1.2.

C.1.1.9 Dental Care: 60% of expenses for dental services including but not limited to: dentists’ fees, x-rays, examination and treatment, cleaning, fillings, extractions, false teeth, crowns, and bridges. Orthodontia treatment is covered only if treatment begins before age 15, unless required as the result of an accident. A maximum of four years of orthodontia treatment will be covered per patient.

C.1.1.10 Psychiatric Treatment: 50% reimbursement.

C.1.1.11 Medical Expenses Incurred Out of Country: Medical expenses incurred out of country will not be covered.

C.1.1.12 Transportation for Out of Country Treatment: Transportation for out of country treatment is not a covered expense.

C.1.1.13 Annual Maximum Limit: The maximum annual reimbursement per employee (to include covered dependents) per contract year, not including expenses covered under

C.1.1.4, is PKR 600,000. In the event husband and wife both are employees, their maximum annual reimbursement per contract year is PKR 1.2 million, not including expenses covered under

C.1.1.4.

C.1.2 Health Benefits Conditions and Limitations.

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

exercise therapy; long term rehabilitative therapy; eyeglass frames; 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.

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 LES workers’ compensation program.

There is no reimbursement 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 Pakistan. There is no reimbursement for round trip transportation expenses to travel out of Pakistan 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 by U.S. Mission Pakistan, within the geographic boundaries of Pakistan, paid under the Local Compensation Plan, and certified by the Contracting Officer. Covered employees include

C.1.3.1.2. Foreign Service Nationals (FSNs) and Third-Country Nationals

(TCNs) employed under direct hire appointments, Personal Services Agreements (PSAs), and Personal Services Contracts (PSCs);

C.1.3.1.3. Locally hired U.S. citizens employed under direct hire appointments, PSAs, and PSCs.

C.1.3.2 Location of Employment

The individuals covered by C.1.3.1 must be employed within the geographic boundaries of Pakistan by: U.S. Mission Pakistan.

C.1.3.3 Participants Covered Under a Rider

C.1.3.3.1 All current active employees of the Chief of Mission and the Deputy

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

C.1.3.3.2 All current active employees of the U.S. Mission Pakistan Provident

Fund who are paid from the fund. (see separate rider, Exhibit B). All costs for Provident

Fund employees are the responsibility of the fund, not the U.S. Government.

C.1.4 Individuals Not Eligible for Coverage

Individuals not eligible for coverage under this contract are non-personal services contract personnel; employees working on a temporary basis; employees with an intermittent, seasonal, or

WAE (when actually employed) schedule; and any other individual not falling within one of the categories of employees described in this clause.

C.1.5 Other Eligible Participants

Covered dependents include the participating employee’s spouse and children. A limit of one spouse per employee is covered. An eligible child is defined as the employee’s natural child, adopted child, stepchild, or foster child. The child must be unmarried, economically dependent upon the employee, and reside with the employee unless away at school. An eligible child will be covered until the end of the contract year in which he/she reaches age 18, or age 23 if a full time student. There is no age limit for a 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.1.6. 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. Each new eligible employee will be enrolled upon entering on duty with the United States Government. An employee is considered active ("on the rolls") whenever such employee is on approved leave, whether paid or unpaid. Coverage under the plan will terminate when an employee retires or otherwise separates from service with the U.S. Government.

During a period of Leave Without Pay (LWOP) 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.

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

C.1.7. Brochure Requirement and Proof of Coverage

C.1.7.1. The Contractor shall provide a document (brochure/pamphlet/other written document) in English and Urdu 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 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.1.7.4. The contractor shall provide an insurance card to each covered employee as documentary proof of enrollment and coverage under the plan. This card should be good for the duration of the contract for use by the employee and eligible dependents. The card shall also provide customer service contact information.

C.1.8 Panel Facilities

C.1.8.1. The Contractor shall provide a network of panel facilities that provide all services, to include prescription medications, listed under C.1.1 to employees and beneficiaries on credit/without out of pocket payments. These facilities shall accept direct payment of bills from the

Contractor in lieu of payment by covered employees and beneficiaries. These facilities must provide inpatient, outpatient, radiological, laboratory, and pharmacy services. The network of panel facilities shall provide adequate geographic coverage for the metropolitan areas of

Islamabad/Rawalpindi, Karachi, Lahore, and Peshawar.

C.1.8.2. Covered employees and dependents shall not be responsible for verifying

PMDC status of treating physicians in any recognized medical facilities.

C.1.8.3. The Contractor must inform the U.S. Mission of any intent to alter the list of panel facilities and provide written justification for the change. This includes the addition or removal of a medical facility from panel status. The Contractor shall inform the U.S. Mission and covered employees any time the list of panel facilities changes.

C.1.9 Customer Service, Validity of Claims, and Privacy of Medical Records

C.1.9.1. The contractor shall provide customer service support for covered employees

24 hours per day, seven days per week.

C.1.9.2. Customer service representatives shall be well versed in the policy and able to provide assistance to employees and beneficiaries on all issues related to coverage as well as be able to speak with health care facilities (including non-panel facilities) about health services benefits provided under this contract. Representatives shall also provide information on pending claims and assist in the submission of claims as required. Representatives shall also be able to verify coverage of a claimant to a healthcare facility in the case of emergency or loss of insurance card. The Contractor may, with agreement from the COR, have customer service representatives present on U.S. Mission Pakistan premises.

C.1.9.3. For employees and dependents who use a non-panel health care facility and pay for services out of pocket, the Contractor shall reimburse the costs for covered services within two weeks from receipt of a completed insurance claim. The Contractor shall have the capability to reimburse claimants via electronic funds transfer (EFT).

C.1.9.4. The contractor shall provide an online portal for employees to access files related to their insurance claims. This portal shall also provide a current status on all pending claims. The contractor shall also provide billing and payment information for panel services at panel facilities through the online portal and will post this information within two weeks of payment.

C.1.9.5. The Contractor shall pay or reimburse valid claims from the contract year in which the service or treatment was provided. Such claims shall also count against the annual benefit cap for the year in which the service is provided. For example, if an employee receives treatment near the end of a covered year, but is unable to submit a claim until a new contracting year, or after expiration of the final contract year, the Contractor shall count the payment against the benefit cap from the prior contracting year.

C.1.9.6. Medical records are considered protected, personally identifiable information. The Contractor shall not require medical records to pay panel facilities or reimburse covered employees. Bills for services and receipts showing payment shall be sufficient in most circumstances. In cases where bills or receipts are not considered accurate for the payment of claims, the Contractor shall contact the COR.

C.1.10 Optional Additional Coverage

The Contractor shall provide, at no additional cost to the U.S. Government, an option for covered employees to purchase additional insurance coverage. This additional coverage, paid for by the employee and not the U.S. Government, should provide the same benefits and terms as listed above in section C.1.

C.1.11 Partial-Year Benefit Levels

C.1.11.1 In the event of an extension of contract services under Federal Acquisition

Regulation (FAR) 52.217-8, the full annual maximum limit of C.1.1.13 shall be available to all covered employees and their covered dependents.

C.1.11.2 In the event of an employee leaving the service of U.S. Mission Pakistan before the end of a contract year, the U.S. Government will cease paying the departed employee’s premium effective the date of his/her departure, regardless of the level of benefits used by that employee for that contract year.

Paragraph C.2 is RESERVED

SECTION E

INSPECTION AND ACCEPTANCE

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

This contract incorporates the following clauses by reference, with the same force and effect as if they were given in full text. Upon request, the Contracting Officer will make their full text available. Also, the full text of a clause may be accessed electronically at this address:

http://www.acquisition.gov/far/ or http://farsite.hill.af.mil/vffara.htm

These addresses are subject to change. If the Federal Acquisition Regulation (FAR) is not available at the locations indicated above, use the Department of State Acquisition website at http://www.statebuy.state.gov/ to see the links to the FAR. You may also use an internet “search engine” (for example, Google, Yahoo, 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.3.0

All required services are performed and no more than two

(2) customer complaint is received per month.

E.2.1 Surveillance. The COR will receive and document all complaints from Government personnel regarding the services provided. If appropriate, the COR will send the complaints to the

Contractor for corrective action.

E.2.2 Standard. The performance standard is that the Government receives no more than two (2) customer complaint per month. The COR shall notify the Contracting Officer of the complaints so that the Contracting Officer may take appropriate action to enforce the inspection clause (FAR

52.246-4, Inspection of Services – Fixed Price (AUG 1996) or the appropriate Inspection of

Services clause), if any of the services exceed the standard.

http://www.acquisition.gov/far/ http://farsite.hill.af.mil/vffara.htm http://www.statebuy.state.gov/

E.2.3 Procedures

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

(b) The COR will complete appropriate documentation to record the complaint.

(c) If the COR determines the complaint is invalid, the COR will advise the complainant. The COR will retain the annotated copy of the written complaint for his/her files.

(d) If the COR determines the complaint is valid, the COR will inform the Contractor and give the Contractor additional time to correct the defect, if additional time is available. The

COR shall determine how much time is reasonable.

(e) The COR shall, as a minimum, orally notify the Contractor of any valid complaints.

(f) If the Contractor disagrees with the complaint and challenges the validity of the complaint, the Contractor will notify the COR. The COR will review the matter to determine the validity of the complaint.

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

(h) Repeat customer complaints are not permitted for any services. If a repeat customer complaint is received for the same deficiency during the service period, the COR will contact the

Contracting Officer for appropriate action under the Inspection clause.

SECTION F

DELIVERIES OR PERFORMANCE

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

http://www.statebuy.state.gov/ to see the links to the FAR. You may also use an internet “search engine” (for example, Google, Yahoo, Excite) to obtain the latest location of the most current FAR.

The following Federal Acquisition Regulation clauses are incorporated by reference:

52.242-15 STOP WORK ORDER (AUG 1989)

52.242-17 GOVERNMENT DELAY OF WORK (APR 1984)

F.2 PERIOD OF PERFORMANCE. The performance period of this contract is one year beginning on June 1, 2019 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:

Human Resource Officer (HRO)

U.S. Embassy, Diplomatic Enclave, Ramna – 5 http://www.statebuy.state.gov/

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 will be either the HRO or an HR Assistant.

G.2 COR DUTIES

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

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

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

G.2.4 The COR may not change the terms and conditions of the contract. While the COR is authorized to provide the Contractor with updated listings of eligible employees and dependents, only the Contracting Officer may modify existing task orders or issue new task orders, reflecting these changes, since only the Contracting Officer can obligate funding and commit the

Government.

G.3. Payment shall be made in the currency identified in the section B pricing, or US dollars for

US vendors.

G.4 SUBMISSION OF INVOICES AND PAYMENT

G.4.1. Invoices for U.S. Government employees shall be submitted in an original and two

(2) copies to the following address (designated billing office only for the purpose of submitting invoices):

Financial Management Officer (FMO)____________________

U. S. Embassy

Diplomatic Enclave, Ramna - 5

ALTERNATE A – Payments at End of Covered Period

G.4.2. Frequency of Payments. All funds under this contract will be obligated by issuance of task orders, as described in H.3. 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. All payments under this contract will be made at the conclusion of the Quarterly period covered.

Invoices may be submitted monthly with payments being made monthly by the Government.

ALTERNATE B – Payments at Beginning of Covered Period

G.4.2. Frequency of Payments. All funds under this contract will be obligated by issuance of task orders, as described in H.3. 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. For payments, upon receipt of task order contractor may submit one invoice against each task order at the beginning of the period 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 premium amount.

G.4.4 ORE Staff. The Chief of Mission, Deputy Chief of Mission and/or respective

Principal Officer 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.

G.4.5. Provident Fund Staff. The Provident Fund Office will make payment directly to the

Contractor for the entire premium amount of the PF employee, whether or not the PF employee is contributing to the 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 the Contracting Officer requests a refund, the Contractor shall make that refund to the Government within ten calendar days of receipt of the request.

G.6 VALUE ADDED TAX

VALUE ADDED TAX (VAT). 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.

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.

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 new task order on a [ ] monthly, [X] quarterly basis. This new task order will include all changes made since the previous task order was issued and will include any increase or decrease in necessary funding. 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. The ORE staff and PF employees under separate 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 employer of the paperwork and payment that will be necessary to order coverage for the identified individuals. Because more than one employer may have ORE staff, the Contractor may be contacted by more than one employer (typically the Chief of Mission and Deputy Chief of

Mission).

H.4. CONTRACTOR RESPONSIBILITY IN CLAIMS AND REIMBURSEMENT TO

CLAIMANTS

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, and medical information, 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 employee reimbursement ceiling.

(2) The Contractor shall provide the COR with the necessary 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 English spelling of the employees' names in all transactions, including reimbursement checks.

(4) The Contractor shall send employee claim reimbursement checks to employees not later than two weeks after a claim is submitted. Contractor shall electronically transfer (EFT) the amount of reimbursement claim to employee’s account directly not later than two weeks after a claim is submitted and provide a list of such reimbursements to the COR describing the name of employee, bank account number, amount and the date transferred. If EFT information is not furnished to the

Contractor, the Contractor shall provide employee claim reimbursement checks to the COR for disbursement to the employee not later than the Tuesday which is two weeks after the claim has been 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, through a drop box in the COR's office. The claims shall be picked up from the COR each Tuesday.

(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 claim is submitted to the Contractor.

(4) Settlement shall be by issuance of checks in the name of the employee for each claim submitted. Each check 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. If an employee or dependent choose to go to a non-contractor designated hospital, the contractor shall reimburse the expenses to employee in accordance with section C.

(c) Reserved

H.5. REPORT REQUIREMENTS. The Contractor shall provide the following reports monthly.

All reports must be received by the COR no later than the 10th day of each month. These reports shall report on the previous month's activities.

(a) Employee Claims Report. The report will list all claims paid by the Contractor to a claimant, including the name 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.

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 Pakistan 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 Pakistan 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.

SECTION I

CONTRACT CLAUSES

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

https://www.ecfr.gov/cgi-bin/text-idx?SID=2e978208d0d2aa44fb9502725ecac4e5&mc=true&tpl=/ecfrbrowse/Title48/48chapter6.tpl to see the links to the FAR. You may also use a network “search engine” (for example, Google, Yahoo, Excite) to obtain the latest location of the most current FAR.

The following Federal Acquisition Regulation clauses are incorporated by reference:

52.202-1 DEFINITIONS (NOV 2013)

52.203-3 GRATUITIES (APR 1984)

52.203-5 COVENANT AGAINST CONTINGENT FEES (MAY 2014)

52.203-6 RESTRICTIONS ON SUBCONTRACTOR SALES TO THE GOVERNMENT

(SEPT 2006)

52.203-7 ANTI-KICKBACK PROCEDURES (MAY 2014)

52.203-8 CANCELLATION, RESCISSION, AND RECOVERY OF FUNDS FOR ILLEGAL

OR IMPROPER ACTIVITY (MAY 2014)

52.203-10 PRICE OR FEE ADJUSTMENT FOR ILLEGAL OR IMPROPER ACTIVITY

(MAY 2014)

52.203-12 LIMITATION ON PAYMENTS TO INFLUENCE CERTAIN FEDERAL

TRANSACTIONS (OCT 2010)

52.203-13 CONTRACTOR CODE OF BUSINESS ETHICS (OCT 2015)

52.203-17 CONTRACTOR EMPLOYEE WHISTLEBLOWER RIGHTS AND

REQUIREMENT TO INFORM EMPLOYEES OF WHISTLEBLOWER

RIGHTS (APR 2014)

52.203-19 Prohibition on Requiring Certain Internal Confidentiality Agreements or Statements

(JAN 2017)

https://www.ecfr.gov/cgi-bin/text-idx?SID=2e978208d0d2aa44f…