19PK3324R7000_Solicitation MP Health Insurance.pdf

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

PREVIOUS EDITION NOT USABLE Prescribed by GSA

SOLICITATION, OFFER AND AWARD

1. THIS CONTRACT IS A RATED ORDER

UNDER DPAS (15 CFR 350)

RATING PAGE OF PAGES

1 | 85

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

3. SOLICITATION NO.

19PK3324-R-7000

4. TYPE OF SOLICITATION

[ ] SEALED BID (IFB)

[x] NEGOTIATED (RFP)

5. DATE ISSUED

July 02, 2024

6. REQUISITION/PURCHASE NO.

XXXXXXXX

7. ISSUED BY

CODE

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

U.S. Embassy, Diplomatic Enclave, Ramna 5 Islamabad, Pakistan

Phone: +92 51-2015464 Fax:

Submit proposal electronically to: Islamabad-GSO-Contracting@state.gov

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

SOLICITATION

9. Sealed offers in original and 0 copies for furnishing the supplies or services in the Schedule will be received at the place specified, in the depository located in N/A until September 06, 2024 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

Latricia A. Hall

B. TELEPHONE (NO COLLECT

CALLS)

AREA CODE NUMBER EXT

+92-51-2015464

C. E-MAIL ADDRESS

Islamabad-GSO- Contracting@state.gov and

ShahzadK2@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 1 X I CONTRACT CLAUSES 30

X B SUPPLIES OR SERVICE AND PRICES/COSTS 2 PART III - LIST OF DOCUMENTS, EXHIBITS, AND OTHER ATTACH.

X C DESCRIPTION/SPECS/WORK STATEMENT 12 X J LIST OF ATTACHMENTS 50

X D PACKAGING AND MARKETING 21 PART IV - REPRESENTATIONS AND INSTRUCTIONS

X E INSPECTION AND ACCEPTANCE 22 X K REPRESENTATIONS, CERTIFICATIONS, AND 52

X F DELIVERIES OR PERFORMANCE 24 OTHER STATEMENTS OF OFFERORS

X G CONTRACT ADMINISTRATION 25 X L INSTRS., COND., AND NOTICES TO OFFERORS 71

X H SPECIAL CONTRACT REQUIREMENTS 27 X M EVALUATION FACTORS FOR AWARD 78

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 DDRESS

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

G.4

24. ADMINISTRATION BY (If other than Item 7)

CODE

25. PAYMENT WILL BE MADE BY

CODE

26. NAME OF CONTRACTING OFFICER (Type or print)

Latricia A. Hall

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:Islamabad-GSO-Contracting@state.gov mailto:Islamabad-GSO-Contracting@state.gov mailto:ShahzadK2@state.gov

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 Pakistan and their eligible dependents as described in Section C. This insurance shall be provided in accordance with Section C.

B.1.1. Official Residence Expense (ORE) Staff and Mission Pakistan Employee Association Staff are included under this contract only as a rider; the Contractor shall bill the Chief of Mission, Deputy Chief of Mission, and Consul Generals (for ORE Staff), 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

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 will obtain a tax exemption certificate from 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:

B.2.2.1. Note for offerors.

Note: Offerors are required to provide prices for all three caps for reimbursement (PKR two (2) million, PKR. Three (3) million and PKR four (4) million). Providing prices for all three caps will not obligate US

Government to procure insurance coverage for all caps. US Government reserves the right to choose any of the caps prior to award or may modify the contract in order to shift to any reimbursement cap any time during life of the contract.

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.

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

B.2.3 Base Year of the Contract – Maximum Reimbursement PKR 2,000,000.

Bi-Weekly Rates Per Employee

Category Estimated Number of

Employees*

Bi-weekly Rate per Employee

(PKR)

Total Bi-Weekly Amount

(PKR)

a. Self 114

b. Self Plus One 270

c. Family (3 or more individuals)

d. Subtotal 1451

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

*Estimated number of employees does not include any Riders (B.1.1)

**does not include any premiums for Riders.

B.2.4 First Option Year of the Contract – Maximum Reimbursement PKR 2,000,000.

Bi-Weekly Rates Per Premium

Employees*

Bi-weekly Rate per Employee

(PKR)

Total Bi-Weekly Amount

(PKR)

a. Self 114

b. Self Plus One 270

c. Family (3 or

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

*Estimated number of employee does not include any Riders (B.1.1)

B.2.5 Second Option Year of the Contract – Maximum Reimbursement PKR 2,000,000.

Employees*

Bi-weekly Rate per

Employee (PKR)

Total Bi-Weekly

Amount (PKR)

a. Self 114

b. Self Plus One 270

c. Family (3 or

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

B.2.6 Third Option Year of the Contract – Maximum Reimbursement PKR 2,000,000.

Employees*

Bi-weekly Rate per

Employee (PKR)

Total Bi-Weekly

Amount (PKR)

a. Self 114

b. Self Plus One 270

c. Family (3 or

Total Price for Third Option Year (d x 26)**

*Estimated number of Employees does not include any Riders (B.1.1)

B.2.7 Fourth Option Year of the Contract – Maximum Reimbursement PKR 2,000,000.

Employees*

Bi-weekly Rate per

Employee (PKR)

Total Bi-Weekly

Amount (PKR)

a. Self 114

b. Self Plus One 270

c. Family (3 or

Total Price for Fourth Option Year (d x 26)**

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

B.2.8 Grand Total: Base + All Option Years - Maximum reimbursement PKR 2 Million

B.2.8 Grand Total: Base + All Option Years - Maximum reimbursement PKR 2 Million

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

OPTIONS YEARS

B.2.3.a. Base Year of the Contract – Maximum Reimbursement PKR 3,000,000.

Employees*

Bi-weekly Rate per Employee

(PKR)

Total Bi-Weekly Amount

(PKR)

a. Self 114

b. Self Plus One 270

c. Family (3 or

B.2.4.a. First Option Year of the Contract – Maximum Reimbursement PKR 3,000,000.

Employees*

Bi-weekly Rate per Employee

(PKR)

Total Bi-Weekly Amount

(PKR)

a. Self 114

b. Self Plus One 270

c. Family (3 or

B.2.5.a. Second Option Year of the Contract – Maximum Reimbursement PKR 3,000,000.

Employees*

Bi-weekly Rate per Employee

(PKR)

Total Bi-Weekly Amount

(PKR)

a. Self 114

b. Self Plus One 270

c. Family (3 or

B.2.6.a. Third Option Year of the Contract – Maximum Reimbursement PKR 3,000,000.

Employees*

Bi-weekly Rate per Employee

(PKR)

Total Bi-Weekly Amount

(PKR)

a. Self 114

b. Self Plus One 270

c. Family (3 or

B.2.7.a. Fourth Option Year of the Contract – Maximum Reimbursement PKR 3,000,000.

Employees*

Bi-weekly Rate per Employee

(PKR)

Total Bi-Weekly Amount

(PKR)

a. Self 114

b. Self Plus One 270

c. Family (3 or

B.2.8.a Grand Total: Base + All Option Years - Maximum reimbursement PKR 3 Million

B.2.8.a Grand Total: Base + All Option Years - Maximum reimbursement PKR 3 Million

Second Option Year Total

B.2.3.b. Base Year of the Contract – Maximum Reimbursement PKR 4,000,000

Employees*

Bi-weekly Rate per Employee

(PKR)

Total Bi-Weekly Amount

(PKR)

a. Self 114

b. Self Plus One 270

c. Family (3 or

B.2.4.b. First Option Year of the Contract – Maximum Reimbursement PKR 4,000,000

Category Estimated Number of

Employees*

Bi-weekly Rate per Employee

(PKR)

Total Bi-Weekly Amount

(PKR)

a. Self 114

b. Self Plus One 270

c. Family (3 or

B.2.5.b. Second Option Year of the Contract – Maximum Reimbursement PKR 4,000,000

Category Estimated Number of

Employees*

Bi-weekly Rate per Employee

(PKR)

Total Bi-Weekly Amount

(PKR)

a. Self 114

b. Self Plus One 270

c. Family (3 or

B.2.6.b. Third Option Year of the Contract – Maximum Reimbursement PKR 4,000,000

Category Estimated Number of

Employees*

Bi-weekly Rate per Employee

(PKR)

Total Bi-Weekly Amount

(PKR)

a. Self 114

b. Self Plus One 270

c. Family (3 or

B.2.7.b. Fourth Option Year of the Contract – Maximum Reimbursement PKR 4,000,000

Category Estimated Number of

Employees*

Bi-weekly Rate per Employee

(PKR)

Total Bi-Weekly Amount

(PKR)

a. Self 114

b. Self Plus One 270

c. Family (3 or

B.2.8.b Grand Total: Base + All Option Years - Maximum reimbursement PKR 4 Million B.2.8 Grand Total: Base + All Option Years - Maximum reimbursement PKR 4 Million

Second Option Year Total

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 five hundred thousand only

(500,000). 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 five (5) million. 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 (Self)

Employee’s Spouse

(Self plus one)

Family (3 or more

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

SECTION C

DESCRIPTION/SPECIFICATION/WORK STATEMENT

C.1. HEALTH INSURANCE SERVICES

The Government of the United States of America requires Health Insurance coverage for its Locally

Employed (LE) Staff as further described in C.1.1.4 in Pakistan. Health insurance protection will be representative of locally prevailing practice.

The Contractor shall insure that health care under this contract does not exclude HIV/AIDS care.

C.1.1 Employee and Dependent Health Service Benefits

Contactor is encouraged to provide the off the shelf plan for each benefit level below.

C.1.1.1 Hospitalization (Treatment in the Hospital for Inpatient Care): Minimum coverage –

100%

Services and supplies provided during hospitalization, including services provided by a licensed healthcare provider, bed, and board (Semi-private accommodations), operating room, recovery room, intensive care, imaging and diagnostic testing, general hospital nursing care, physical therapy, medically necessary optical surgery (non-cosmetic) care, and treatments, as well as drugs and medicines administered while in-patient. When private accommodations are provided, coverage will be limited to the cost of the semi-private room unless otherwise covered in an off the shelf plan.

See Mental Health and Substance Abuse Care (below) for details concerning inpatient psychiatric care

(C.1.1.13).

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

C.1.1.2 Emergency Services (Trips to Emergency Room): Minimum Coverage – 100%

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

C1.1.3 Ambulance: Minimum Coverage – 80%

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

C.1.1.4 Outpatient Services/Professional Services & Treatment: Minimum Coverage

100%

Services provided by a licensed healthcare provider on an ambulatory or outpatient basis (without being admitted to a hospital), including surgeon’s fees and other medical services that may be provided in a hospital, clinic, doctor’s office, medical facility, etc. Coverage shall include all medically necessary services and treatments. Examples include, but are not limited to:

- Annual physical examinations and inoculations.

- Specialist consultations and treatment, including second surgical opinion.

- Minor surgical interventions

- Chemotherapy and radiation treatments

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

- Diagnostic tests and diagnostic imaging

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

See Mental Health and Substance Abuse Care (below) for details concerning psychiatric therapy.

C.1.1.5 Obstetric and Newborn Care: Minimum Coverage – Inpatient 100% / Out patient 100%

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

C.1.1.6 Pediatric Services: Minimum Coverage Inpatient 100% / Outpatient 100%

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

C.1.1.7 Prescription Drugs: Minimum Coverage - Inpatient 100% /Outpatient 100%

Medications prescribed by a licensed health care provider that are medically required. Examples include, but are not limited to prescription antibiotics to treat an infection, medication used to treat an ongoing condition, such as high cholesterol, prophylaxis, contraceptive medication.

C.1.1.8 Preventive and Wellness Services and Chronic Disease Management:

Minimum Coverage: 100%

Counseling or preventive care designed to prevent or detect medical conditions and care for chronic conditions such as asthma and diabetes. Examples include, but are not limited to: physicals, immunizations, and cancer screenings.

C.1.1.9 Hearing Aids:

Examinations and Treatment: 80% Minimum Coverage

Hearing Aid Apparatus: Limited to one apparatus per ear up to a maximum of PKR equivalent of USD

800 per covered individual per three-year period. 80% Minimum Coverage: with applicable cap.

C.1.1.10 Optical Care:

Examinations and Treatment: 80% Minimum Coverage

Prescription lenses and frames or contact lenses: Covered up to a maximum of PKR equivalent of USD

300 per covered individual every two years. 80% Minimum Coverage; with applicable cap.

Also refer to section C.1.1.1 for additional benefits.

C.1.1.11 Dental Care:

Examinations and Treatment: Expenses for dental services including but not limited to dentist’s fees, x-rays, examinations and treatment, cleanings, fillings, extractions, false teeth, crowns, and bridges up to a maximum of PKR equivalent of USD 2,000 per covered individual per contract year. 80% Minimum

Coverage; with annual cap.

Orthodontia: Treatment is covered only if treatment begins before age 18, or if required as the result of an accident. A maximum of four years of orthodontia treatment will be covered per covered individual up to a maximum of PKR equivalent of USD 1,800 lifetime limit. 80% Minimum Coverage; with contract lifetime cap.

C.1.1.12 Reproductive Health: Minimum Coverage – 80%

Prescribed contraceptive devices, preventive care and routine examinations, voluntary sterilization, and diagnosis and treatment of conditions which may cause infertility.

Assisted reproductive technology (ART), fertility treatments, and reversal of sterilization are not covered (see Exclusions to Coverage).

C.1.1.13 Mental Health and Substance Abuse Care: Minimum Coverage – 50%

Inpatient and outpatient care provided to evaluate, diagnose, and treat a mental health condition or substance abuse disorder. This includes behavioral health treatment, counseling, and psychotherapy.

Services must be provided by a licensed psychiatrist, psychoanalyst, psychologist, or psychiatric social worker. Inpatient care for alcohol and substance abuse must be provided at a facility licensed for detoxification and rehabilitation.

C.1.1.14 Rehabilitative and Habilitative Services and Devices: Minimum Coverage 50%

Rehabilitative services (e.g., recovering skills, such as speech therapy after a stroke or physical therapy after an accident) and habilitative services (e.g., developing skills, such as speech therapy for children, etc.) that help develop skills needed for everyday life. Devices to help gain or recover mental or physical skills lost due to injury, disability or a chronic condition, and devices needed for habilitative reasons.

C.1.1.15 HIV/AIDS:

Minimum Coverage: 100% 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.

*C.1.1.16 Catastrophic Coverage

Additional coverage equal to PKR 2,000,000 per covered individual per contract year. Catastrophic conditions shall be defined as major medical conditions occurring as a result of a single/illness/accident or closely related set of major illnesses (or conditions relating to a single accident) that exceed the standard maximum coverage limit.

*C.1.1.17 RESERVED

*C.1.1.18 RESERVED

C.1.1.19 180 Days Coverage for Dependents After Employee’s Death

At the time of a covered employee’s death, his/her eligible dependents covered under post’s medical plan are eligible to continue receiving the same level of medical coverage for up to 180 days. This optional benefit is subject to availability of funds at post and no extensions are permitted. The USG covers the full premium.

C.1.1.20 RESERVED

C.1.1.21 RESERVED

C.1.2 Annual Maximum Limit –

The maximum annual reimbursement per covered individual per contract year, not including expenses covered under C.1.1.15, HIV/AIDS, is equivalent to PKR 2,000,000.

C.1.3 Exclusions and Limitations

There is no coverage for elective cosmetic surgery; spa cures; rejuvenation cures; massage; exercise therapy; long-term rehabilitative therapy; non-medical hospital charges (e.g., telephone, television, etc.); home help, family help, or similar household assistance; fees of persons who are not certified health care providers; advanced reproductive technology (e.g., in-vitro fertilization, intra-cellular sperm injection, artificial insemination, microsurgical epididymal sperm aspiration, testicular sperm extraction, cryopreservation, etc.); or services or supplies which have not been prescribed or approved by a certified health care provider. Exclusions to coverage may be amended if provided in an off the shelf plan and is the lowest-cost and technically acceptable. Removal of any exclusions require prior authorization.

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

Staff workers’ compensation program.

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

C.1.4 ELIGIBLE PARTICIPANTS

C.1.4.1 Identification of Eligible Employees and Dependents: U.S. Mission Pakistan will provide a list of all eligible employees and dependents with relationship to employee (self/spouse/child) and DOB for each. Updates will be provided to add or remove individuals on a bi-weekly/monthly basis.

C.1.4.1.1 Definition of Dependents

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

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.1.4.1.1.2 Children: a child is defined as the LE Staff’s natural, adopted, stepchild, or foster child.

The child must be unmarried and financially dependent upon the LE Staff. A child will be covered until the end of the contract year in which s/he reaches age 26. An unmarried child determined to be incapable of self-support due to a physical or mental condition will continue to be eligible to participate in the medical plan as long as the condition persists, the child remains unmarried, and the LE Staff maintains coverage. 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.1.4.2 Location of Employment: The eligible employees covered by C.1.4.1 must be employed within the geographic boundaries of Pakistan

C.1.4.3 Participants Covered Under a Rider

a. Official Residence Expense (ORE) and Employee Association (EA) employees may be covered under a rider to the contract. The employing officer/EA, not the U.S. Government, is responsible for the employer's share of the premium costs for an ORE/EA employee.

C.1.5 ELIGIBILITY

C.1.5.1 Term of Eligibility and Effective Date

Each current active eligible employee and their eligible dependents are enrolled for health benefits under this contract upon award and thereafter during the performance period of this contract. Each new eligible employee and eligible dependents will be enrolled upon entering on duty with the United States

Government. An employee is considered active ("on the rolls") whenever such employee is on approved leave, whether paid or unpaid.

C.1.5.2 Individuals Not Eligible for Coverage

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 Pakistan who provides services to other local organizations as well as to the U.S. Mission; employees with an intermittent, seasonal, or WAE

(when actually employed) schedule; employees of USAID institutional contractors; Peace Corps personal services contractors as indicated in MS 743; and Recreation Association employees. There is no coverage for retired employees.

C.1.5.3 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.1.6 Brochure Requirement and Proof of Coverage

C.1.6.1 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.1.6.2 The Contractor shall provide the document described in C.1.6.1 to the COR not later than

30 days after date of contract award. The Contractor shall provide additional brochures for new employees within ten (10) business days of the COR’s request.

C.1.6.3 The Contractor assumes full responsibility for ensuring that the document described in

C.1.6.1 accurately reflects the requirements, coverage, and contract terms of the contract, as implemented by the Contractor’s technical proposal. In all cases, the contract shall take precedence.

Should the COR discover that the document contains inaccuracies, the Contractor will be notified in writing; however, failure on the part of the U.S. Government to notice any inaccuracies shall in no way limit, revise or otherwise affect the requirement under this contract for the Contractor to fully comply with all contract terms.

C.1.6.4. The contractor shall provide two insurance cards 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.1.7 Pre-Existing Condition Clarification:

Coverage of pre-existing conditions will be extended to all covered individuals.

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 (Embassy Islamabad and Consulates Karachi, Lahore, Peshawar).

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 to discuss.

C.1.9.7. Optional Additional Coverage or Other Insurance Plans

The Contractor shall provide, at no additional cost to the U.S. Government, an option for covered employees to purchase additional insurance coverage or other available insurance products (Example:

Insurance policy for parents). 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.

Paragraph C.2 is RESERVED

C.3.0 DEFINITIONS

FMO The Financial Management Officer (FMO) or the paying office for all U.S.

Government Agencies, except U.S. AID.

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

Customary and

Reasonable Treatment

A diagnostic test or medical treatment which is usually performed in the community where the individual is being treated.

Dependent 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, 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.

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.

This may also include ORE and Provident Fund Office Staff, if this category of individual is listed as participating under a rider in C.1.3.3.

Employer The United States Government or in case of ORE and PF employees, the chief of Mission/Deputy Chief of Mission, respective Principal Officer, and

Provident Fund Office respectively.

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

Hospital An institution established and operated for the care and treatment of sick and injured persons. It provides 24-hours nursing care and has diagnostic, laboratory, treatment, and surgical facilities. Any instruction 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 a treatment for a disease or an injury.

Maximum Benefit The total amount that will be pa id to any one covered individual for covered medical expenses.

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.

Plastic Surgery A specially dedicated to reconstruction of facial and body defects due to birth disorders, trauma, buns, and disease. Plastic surgery is intended to correct dysfunctional areas of the body.

Cosmetic Procedure Treatments whose primary purpose is to improve the physical appearance of a recipient but may also have medical benefits.

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.1.9.7

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.

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 two (2) 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 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)

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

If the Federal Acquisition Regulation (FAR) is not available at the location indicated above, use the

Internet “search engine” (for example, Google, Yahoo or Excite) to obtain the latest location of the most

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 January 1, 2025 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, Islamabad, Pakistan https://gov.ecfr.io/cgi-bin/text-idx?SID=d9a7851186785ba2b1896db79b1b6b29&mc=true&tpl=/ecfrbrowse/Title48/48tab_02.tpl

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 the Human Resources Officer 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 three (3) copies to the following address (designated billing office only for the purpose of submitting invoices):

Financial Management Officer, U.S Embassy, Diplomatic Enclave, Ramna-5, Sector G-5, Islamabad Invoices can also be sent through email at: Islamabadfmc-invoices@state.gov mailto:Islamabadfmc-invoices@state.gov

ALTERNATE A – Payments at End of Covered Period

G.4.2. Frequency of Payments. All funds under this contract for non-rider coverage 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 period covered. Invoices may be submitted after conclusion of period covered under each task order.

G.4.3. U.S. Government Employees. The Government shall make payments directly to the Contractor for all Government employees, whether or not the employee is contributing to the basic premium amount.

G.4.4 Riders:

a. ORE. The Chief of Mission and/or Deputy Chief of Mission, and/or Consul General 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.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

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 will obtain a tax exemption certificate from 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. Riders are not included under the task orders issued by the Contracting Officer. Because their coverage is under a rider, either their employer or themselves are responsible for directly interacting with the Contractor to order any coverage. When contacted, the Contractor shall advise the person of the paperwork and payment that will be necessary to order coverage for the identified individuals. The

Contractor may be contacted by more than one individual.

H.4. CONTRACTOR RESPONSIBILITY IN CLAIMS AND REIMBURSEMENT TO

CLAIMANTS

General.

The Contractor shall be responsible for all planning, estimating, programming, project management, scheduling, dispatching, supervision, and inspection of work.