19RS5019R0002_Health_Ins_Emb_Moscow_FINAL.pdf

mailto:MukhinaY@state.gov

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 the Russian Federation 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) Staff and American Embassy Community Association Employees (AECA) are included under this contract only as a rider; the Contractor shall bill the Chief of Mission and Deputy Chief of Mission (for ORE Staff) and the American Embassy Community Association (for AECA employees) separately, at the rates specified below. See Section G for billing procedures.

B.2 Prices

B.2.1 VALUE ADDED TAX.

The Contractor shall include VAT as a separate charge on the Invoice and as a separate line item in Section B.

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.2.3 BASE YEAR OF CONTRACT COMMENCING FROM THE DATE OF AWARD

AND CONTINUING FOR A PERIOD OF 12 MONTHS.

(a) Health Insurance Services for locally employed staff of the U.S. Embassy Moscow and their eligible dependents:

Description

Estimated # of employees and eligible dependents

Annual fee per person (p/p), $/RUB

Total Annual Fee for all employees and eligible dependents, $/RUB

01. Outpatient Services:

Adult Annual Premium 243

Child (age 18-23) 30

Child (age 1-17) 48

Child (age below 1) 3

02. Inpatient Services

(for adults and children): 326

03. Pre-Employment Exam 10

04. Childbirth Services 10

SUBTOTAL,

$/RUB:

VAT, $/RUB:

TOTAL (a), including VAT, $/RUB: _______________

(b) Health Insurance Services for locally employed staff of the U.S. Consulate General in Vladivostok and their eligible dependents:

Description

Estimated # of employees and eligible dependents

Annual fee per person (p/p), $/RUB

Total Annual Fee for all employees and eligible dependents, $/RUB

01. Outpatient Services:

Adult Annual Premium 39

Child (age 18-23) 8

Child (age 1-17) 14

Child (age below 1) 1

(for adults and children) 62

03. Pre-Employment Exam 5

04. Childbirth Services 2

TOTAL (b), including VAT, $/RUB: _______________

(c) Health Insurance Services for locally employed staff of the U.S. Consulate General in Yekaterinburg and their eligible dependents:

employees and eligible dependents

Annual fee per person (p/p), $/RUB

Total Annual Fee for all employees and eligible dependents, $/RUB

01. Outpatient Services:

Adult Annual Premium 35

Child (age 18-23) 1

Child (age 1-17) 15

Child (age below 1) 1

(for adults and children) 52

TOTAL (c), including VAT, $/RUB: ______________

TOTAL ESTIMATED PRICE FOR BASE YEAR

((Totals (a) + (b) + (c))

B.2.4 PRICES FOR HEALTH INSURANCE SERVICES FOR OPTION YEAR ONE

COMMENCING FROM THE DAY AFTER EXPIRATION OF THE BASE YEAR

AND CONTINUING FOR A PERIOD OF 12 MONTHS.

(a) Health Insurance Services for locally employed staff of the U.S. Embassy Moscow and their eligible dependents employees and eligible dependents

Annual fee per person (p/p), $/RUB

Total Annual Fee for all employees and eligible dependents, $/RUB

01. Outpatient Services:

Adult Annual Premium 243

Child (age 18-23) 30

Child (age 1-17) 48

Child (age below 1) 3

02. Inpatient Services (for adults and children): 326

Vladivostok and their eligible dependents employees and eligible dependents

Annual fee per person (p/p), $/RUB

Total Annual Fee for all employees and eligible dependents, $/RUB

01. Outpatient Services:

Adult Annual Premium 39

Child (age 18-23) 8

Child (age 1-17) 14

Child (age below 1) 1

02. Inpatient Services (for adults and children): 62

Yekaterinburg and their eligible dependents employees and eligible dependents

Annual fee per person (p/p), $/RUB

Total Annual Fee for all employees and eligible dependents, $/RUB

01. Outpatient Services:

Adult Annual Premium 35

Child (age 18-23) 1

Child (age 1-17) 15

Child (age below 1) 1

02. Inpatient Services (for adults and children): 52

TOTAL ESTIMATED PRICE FOR OPTION YEAR ONE

B.2.5 PRICES FOR HEALTH INSURANCE SERVICES FOR OPTION YEAR TWO

COMMENCING FROM THE DAY AFTER EXPIRATION OF OPTION YEAR ONE AND

CONTINUING FOR A PERIOD OF 12 MONTHS.

their eligible dependents:

employees and eligible dependents

Annual fee per person (p/p), $/RUB

Total Annual Fee for all employees and eligible dependents, $/RUB

01. Outpatient Services:

Adult Annual Premium 243

Child (age 18-23) 30

Child (age 1-17) 48

Child (age below 1) 3

02. Inpatient Services (for adults and children): 326

Vladivostok and their eligible dependents employees and eligible dependents

Annual fee per person (p/p), $/RUB

Total Annual Fee for all employees and eligible dependents,$/RUB

01. Outpatient Services:

Adult Annual Premium 39

Child (age 18-23) 8

Child (age 1-17) 14

Child (age below 1) 1

02. Inpatient Services (for adults and children): 62 employees and eligible dependents

Annual fee per person (p/p), $/RUB

Total Annual Fee for all employees and eligible dependents,$/RUB

01. Outpatient Services:

Adult Annual Premium 35

Child (age 18-23) 1

Child (age 1-17) 15

Child (age below 1) 1

02. Inpatient Services (for adults and children): 52

TOTAL ESTIMATED PRICE FOR OPTION YEAR TWO

B.2.6 PRICES FOR HEALTH INSURANCE SERVICES FOR OPTION YEAR THREE

COMMENCING FROM THE DAY AFTER EXPIRATION OF OPTION YEAR TWO

AND CONTINUING FOR A PERIOD OF 12 MONTHS.

their eligible dependents:

employees and eligible dependents

Annual fee per person (p/p), $/RUB

Total Annual Fee for all employees and eligible dependents, $/RUB

01. Outpatient Services:

Adult Annual Premium 243

Child (age 18-23) 30

Child (age 1-17) 48

Child (age below 1) 3

02. Inpatient Services (for adults and children): 326 employees and eligible dependents

Annual fee per person (p/p), $/RUB

Total Annual Fee for all employees and eligible dependents, $/RUB

01. Outpatient Services:

Adult Annual Premium 39

Child (age 18-23) 8

Child (age 1-17) 14

Child (age below 1) 1

02. Inpatient Services (for adults and children): 62 employees and eligible dependents

Annual fee per person (p/p), $/RUB

Total Annual Fee for all employees and eligible dependents, $/RUB

01. Outpatient Services:

Adult Annual Premium 35

Child (age 18-23) 1

Child (age 1-17) 15

Child (age below 1) 1

02. Inpatient Services (for adults and children): 52

TOTAL ESTIMATED PRICE FOR OPTION YEAR THREE

B.2.7 PRICES FOR HEALTH INSURANCE SERVICES FOR OPTION YEAR FOUR

COMMENCING FROM THE DAY AFTER EXPIRATION OF OPTION YEAR FOUR

AND CONTINUING FOR A PERIOD OF 12 MONTHS.

(a) Health Insurance Services for locally employed staff of the U.S. Embassy Moscow and their eligible dependents:

Description

Estimated # of employees and eligible dependents

Annual fee per person (p/p), $/RUB

Total Annual Fee for all employees and eligible dependents, $/RUB

01. Outpatient Services:

Adult Annual Premium 243

Child (age 18-23) 30

Child (age 1-17) 48

Child (age below 1) 3

02. Inpatient Services (for adults and children): 326 employees and eligible dependents

Annual fee per person (p/p), $/RUB

Total Annual Fee for all employees and eligible dependents, $/RUB

01. Outpatient Services:

Adult Annual Premium 39

Child (age 18-23) 8

Child (age 1-17) 14

Child (age below 1) 1

02. Inpatient Services (for adults and children): 62 employees and eligible dependents

Annual fee per person (p/p), $

Total Annual Fee for all employees and eligible dependents, $

01. Outpatient Services:

Adult Annual Premium 35

Child (age 18-23) 1

Child (age 1-17) 15

Child (age below 1) 1

02. Inpatient Services (for adults and children): 52

TOTAL ESTIMATED PRICE FOR OPTION YEAR FOUR

B.2.8 Grand Total of Base and All Option Years Price, pre-VAT, RUB/$ VAT, RUB/$

Price, pre-VAT, RUB/$

Base Year Total

First Option Year Total

Second Option Year Total

Third Option Year Total

Fourth Option Year Total

Grand Total- Base and 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 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. Retention Amounts per separate premium paid per single employee, spouses and children, per location:

B.2.3.1 Retention Amounts for U.S. Embassy Moscow:

Type of service Period of performance Base Year

Total First Option Year Total

Second Option Year Total

Third Option Year Total

Fourth Option Year Total

Outpatient Services Adult Annual Premium Child (age 18-23) Child (age 1-17) Child (age below 1)

Inpatient Services

Pre-Employment Exam

Childbirth Services

B.2.3.2 Retention Amounts for U.S. Consulate General in Vladivostok:

Type of service Period of performance Base Year

Total First Option Year Total

Second Option Year Total

Third Option Year Total

Fourth Option Year Total

Outpatient Services Adult Annual Premium

Child (age 18-23) Child (age 1-17) Child (age below 1)

Inpatient Services

B.2.3.3 Retention Amounts for U.S. Consulate General in Yekaterinburg:

Type of service Period of performance Base Year

Total First Option Year Total

Second Option Year Total

Third Option Year Total

Fourth Option Year Total

Outpatient Services Adult Annual Premium Child (age 18-23) Child (age 1-17) Child (age below 1)

Inpatient Services

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.

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 the Russian Federation. The Government has determined that the prevailing practice by employers in the Russian Federation is to provide for their employees health insurance protection; that the cost of such insurance protection is usually borne by both the employee and the employer. The Government pays 90% and the employee pays 10% of the premium costs for both employee and eligible dependent coverage; however, for employees who are regularly scheduled to work less than 30 hours per week, there is no Government contribution for dependent coverage, and the employee will pay 100% of the premium cost for dependent coverage if s/he wishes to enroll his/her eligible dependents. Health insurance protection will be representative of locally prevailing compensation practice as further describe in C.1.2. The specific health benefit coverage under this contract is set forth in Section C and the Exhibits in Section J. In accordance with the local regulations and practice, the Contractor will provide insurance coverage to each eligible participant of the contract. Additionally, the Contractor shall arrange access to certain local medical facilities and secure professional medical assistance through these medical facilities. The list of acceptable medical facilities is provided herein (Exhibit D.) If the Contractor is unable to provide healthcare services in these clinics, or if the special treatment if required, the employees, upon the approval by the Contractor, may visit other medical facilities proposed by the Contractor for inspection.

Health Insurance services provided under this contract shall also be in compliance with the local regulations based upon the Voluntary Medical Insurance Act and Insurance Act of the Russian Federation, which are common for all Russian citizens. However, in the event of inconsistency between any terms of this contract and any terms of the Regulations, the contract terms shall prevail.

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

C.1.1.1. Hospitalization

Hospitalization shall include emergency and planned hospitalization, hospital accommodation in a two-person bedroom, surgeon’s and anesthetist’s fees, drug therapy, consultations of medical specialists, diagnosis lab, treatment procedures, surgery, dressings and other medical procedures and expenses deemed necessary for the patient. The Contractor shall pay for stents in life-threatening cases. Emergency and planned inpatient care for pregnancies (including complicates pregnancy at any stage) shall be provided. The list of acceptable hospitals is provided in Exhibit D.

C.1.1.2. Doctor Visits

This service shall include doctors and paramedic home visits on call basis. Calls for home visits may be placed by patients or their family members by telephone. This service shall be available for all eligible participants (regardless of their location at the time of illness) as long as it is within city limits and outside of cities within the distance of 50 km from the cities’ boundaries.

C.1.1.3. Prescription Drugs

All drugs that have been determined by doctors to be necessary for treatment shall be prescribed in writing. Those drugs that are not sold on open access, shall be prescribed on special forms, which contain name of a patient, drugs prescribed, doctor’s name and medical facility’s seal.

C.1.1.4. Childbirth and delivery services

C.1.1.4.(a) Fee for service

The Government is responsible for the first USD 2,000.00 per occurrence, which will be paid against separate invoices submitted by the Contractor. Should the cost of the services provided exceed USD 2,000.00, the insured person shall pay the difference directly to the Insurance Company.

C.1.1.4.(b) The Contractor shall provide childbirth and delivery services as follows:

(i) Consultations at a specialized medical facility starting from the 36th week of pregnancy, including ultrasound examination, cardio monitoring of the pre-natal condition of the fetus; lab tests based on medical indications.

(ii) Emergency transportation to a specialized medical facility by the ambulance service of the Insurance Company, within the 50-kilometer zone beyond the cities’ boundaries.

(iii) Accommodation in the best specialized hospitals in two-person bedroom, meals, drugs, dressings, brief courses of anti-retroviral drugs during childbirth to prevent the transmission of HIV to the employee’s child. Inpatient treatment from the time when the labor pains begin, as well as in cases of emergency hospitalization due to early discharge of waters or blood, includes:

a. obstetric aid based on medical indications;

b. after-natal observation of the mother and child for a period determined by medical indications.

A medical team providing aid to the woman in childbirth shall include an obstetrician, and anesthetist, a neonatologist, and a midwife, as deemed medically necessary.

The presence of a spouse at childbirth is possible by mutual agreement between the parents and if there are no contra-indications.

(iv) Cesarean sections shall be covered.

(v) In the event of suppuration and septic complications in the small pelvis area, occurring within 28-day period after childbirth, the following services shall be provided:

a. a consultation by an obstetrician, additional tests, or hospitalization (based on medical indications at the obstetrics unit of a specialized medical facility.)

C.1.1.4(c) Insurance Program for Pregnancy:

A complete package of outpatient services provided by the medical establishment specified in the contract for insurance:

- A complete package of polyclinic services, including dentist’s services and home visits;

- Specialized medical care required in the course of pre-natal observation, including:

regular observation by an obstetrician, from the moment when pregnancy is ascertained to childbirth;

examination by specialists;

ultrasound examination in each trimester of pregnancy;

laboratory and diagnostic examination including EKG, blood and urine tests, Hbs-antigen testing; RW, HIV, and vaginal flora tests;

additional lab tests, as needed.

C.1.1.5. Outpatient Care

The Contractor shall provide medical outpatient treatment at the best clinics available in each city covered by this contract. The list of acceptable clinics available for outpatient care is attached in Exhibit D.

Outpatient care shall include, but not be limited to the following, unless excluded under Section C.1.8.1:

C.1.1.5(1) Annual check-ups;

C.1.1.5(2) Vaccinations for children aged up to 3 years inclusive will be carried out in accordance with the national prophylactic immunization schedule approved by the Ministry of Public Health of the Russian Federation;

C.1.1.5(3) Home nursing of newborn children, if prescribed by a physician;

C.1.1.5(4) Visits to and consultations by specialists;

C.1.1.5(5) General physical therapy;

C.1.1.5(6) Pediatrics care;

C.1.1.5(7) Surgery, traumatology, and orthopedics procedures;

C.1.1.5(8) Proctologic procedures;

C.1.1.5(9) Urologic procedures;

C.1.1.5(10) Otolaryngological procedures;

C.1.1.5(11) Ophthalmologic procedures;

C.1.1.5(12) Gynecological procedures;

C.1.1.5(13) Allergology procedures;

C.1.1.5(14) Hematological procedures;

C.1.1.5(15) Pulmonary procedures;

C.1.1.5(16) Dermatology and venerology procedures;

C.1.1.5(17) Endoscopic procedures;

C.1.1.5(18) Diagnostic procedures;

C.1.1.5(19) Angiography;

C.1.1.5(20) Computer tomography;

C.1.1.5(21) Thermography;

C.1.1.5(22) Anesthetic procedures;

C.1.1.5(23) Non-cosmetic dentistry, including the following procedures: visits to and consultations by specialists; functional diagnosis; physiotherapy; anesthetic procedures (except general anesthesia); treatment of tooth decay; treatment of pulpits; treatment of periodontitis; treatment of illnesses of the mucous coat of the mouth and tongue; dental surgery; surgical methods of treating periodontal diseases; treatment of benign tumors in the maxillofacial region.

C.1.1.5 (24) Medical care for disabled individuals shall be arranged in accordance with those medical indications, which are not connected with their disability.

C.1.1.5 (25) Dynamic monitoring of chronic disease as prescribed by a physician: tumor markers; blood chemistry, including lipid profile screening; the study of blood hormones in maintenance of hormonal therapy in hypoestrogenic states, in the treatment of thyroid diseases, anticoagulant therapy, MRI with contrast material at the previously established diagnosis.

C.1.1.5 (26) Emergency seroprevention with antitime immunoglobulin.

C.1.1.5 (27) Treatment of degenerative disc disease without exacerbation.

C.1.1.5 (28) Removal of papilloma, warts, clams, nevi, corns, atheroma, lipomas, chlaziol, etc. in case of injury and inflammation.

C.1.1.6. Ambulance Services

The Contractor shall provide twenty-four hour emergency service including ambulance service equipped with licensed doctor or paramedic. The service provided should include diagnosis and treatment, as appropriate to an ambulance service. This service shall be available for all eligible participants regardless of their location at the time of illness as long as they are located within city limits and outside of cities within the distance of 50 km from the cities’ boundaries. All Contractors’ incurred costs for emergency services shall be covered by proposed prices.

C.1.1.7. Pre-Employment Physical Examination

As required by the Government, the Contractor will provide a pre-employment physical examination in accordance with the checklist included as Exhibit H of this contract. The Embassy and Consulates will refer approved applicants who are expected to become the Government employees’ after passing the test. The Embassy and Consulates will provide the Contractor the information on the applicant (name, date of birth, home address and telephone number) beforehand.

C.1.1.8. Appointment of Physician and Pediatrician Coordinator

The Contractor shall designate, at no extra change, a qualified doctor who will coordinate all medical services and administrative issues at each post, provide medical consultations to the locally employed staff and their dependents, be able to give professional advice, and to help in case of medical problems. The Contractor shall designate back-ups for health coordinators in each city.

C.1.1.9. The maximum annual reimbursement per patient per contract year is as follows:

Hospitalization: RUB 3,100,000.00 per contract year.

Outpatient Services: RUB 1,550,000.00 per contract year.

Maternity: USD 2,000.00 per occurrence.

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 LE Staff 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 the Russian Federation.

There is no reimbursement for round trip transportation expenses to travel out of country for medical treatment.

There is no reimbursement for expenses incurred after an employee leaves the service of the U.S. Mission.

C.1.3 Eligible Participants

C.1.3.1. Eligible Employees

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

C.1.3.1.1. All current active employees of the United States Government, employed within the geographic boundaries of the Russian Federation paid under the Local Compensation Plan, and certified by the Contracting Officer. Covered employees include:

C.1.3.1.2. Locally Employed Staff (LES) 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.1.3.1.4. Third country nationals (TCNs) employed as direct hires; 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 the Russian Federation by:

Department of Commerce (DOC);

Department of Defense (DOD);

Department of Energy (DOE);

Department of Homeland Security (DHS);

Department of Justice (DOJ);

Department of State (DOS);

Federal Aviation Administration (FAA);

Foreign Agricultural Service (FAS) and Agricultural Trade Office (ATO);

National Aeronautics and Space Administration (NASA).

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 in the U.S. Embassy in Moscow, and active employees of Consuls General in U.S.

Consulates General in Vladivostok and Yekaterinburg assigned to their respective official Government residences and paid under 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 American Embassy Community Association (AECA) and paid under AECA account (See separate rider, Exhibit C.) All costs for AECA employees are the responsibility of AECA, 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; Peace Corps Personal Services Contractors as required by MS 743; 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

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

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 21, 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. Individuals not eligible for coverage under this contract are dependents of employees who are regularly scheduled to work less than 30 hours per week, unless the employee agrees to pay 100% of the premium cost for dependent coverage.

C.1.6 Eligibility

C.1.6.1. Term of Eligibility

Each current active employee is eligible for health benefits under this contract upon award and thereafter during the performance period of this contract. Each new employee will be eligible upon entering on duty with the United States Government. Participating children who reach 21 or 23 will be covered until the end of the contract year in which they reach 21 or 23. Participation in the health-care program is voluntary: each eligible employee and/or dependent may not participate in this program at their own decision. However, they may be given another opportunity to enroll at a future date. Every year the Government will update the list of eligible participants of the contract.

There is no age limit for an eligible child who is physically or mentally handicapped so as to be unable to live independently. Parents, grandparents, siblings, and other relatives are not eligible dependents.

C.1.6.2. Period of Ineligibility

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

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

During a period of Leave Without Pay (LWOP) or unpaid leave that is one pay period or less, coverage under the insurance contract will continue. The Government will pay the total premium cost to the Contractor. The employee’s share of the premium will be collected through payroll deduction in that or the subsequent pay period.

During a period of extended (beyond one pay period) of Leave Without Pay or unpaid leave, the employee is responsible for the full cost of the insurance premiums for self and dependents. Employee will pay the premiums directly to the Contractor, not the Government.

C.1.7 Brochure Requirement

C.1.7.1. The Contractor shall provide a document (brochure/pamphlet/other written document) in Russian that sets forth a complete listing of the health insurance benefits to be provided under this contract. The brochure shall be issued for each city covered by this contract and contain specific information about services in each city. The 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 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 15 days after date of contract award. Additional supplies to meet the needs of newly enrolled employees shall be provided by the Contractor to the COR not later than 10 working days after requested.

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.1.8 Health Benefits Conditions and Limitations

C.1.8.1. The following treatments are not covered under this Contract and shall not be included among services covered by this contract and consequently shall not be paid by the Contractor:

a) Elective cosmetic treatment and elective cosmetic surgery;

b) Elective cosmetic and pedicure treatment by a dermatologist;

c) Elective cosmetic dentistry and denture fittings;

d) Restorative massage unless specifically requested by a hospital physician as part of covered treatment;

e) Home-care nursing or “hospital at home” treatment, except blood taking;

f) Outpatient surgical dermatological operations (removal of warts and moles), except for medical indications;

g) Outpatient surgical operations requiring general anesthesia;

h) Outpatient gynecological operations, except for medical indications;

i) Abortion, termination of pregnancy operations, except for medical indications;

j) Pharmaceuticals not prescribed and provided by an authorized hospital physician as part of medical treatment; drugs and over-the-counter remedies for which a prescription is not legally required, even prescribed by a physician;

k) Alcohol and drugs dependency, injuries sustained as a result of alcoholic, toxic or narcotic abuse; illness or injury that is the result of the practice of a dangerous sport; a self-inflicted wound; or service in the armed forces of any country;

l) Oncological diseases, acute and chronic radiation affections;

m) AIDS, except as provided under C.1.1.4;

n) Congenital anomalies and diseases;

o) Mental illnesses and their complications;

p) Tuberculosis, sarcoidosis, mucoviscidosis, conjunctive tissue diseases;

q) Chronic renal insufficiency requiring hemodialysis, liver cirrhosis;

r) Occupational diseases;

s) Diabetes at the state of decompensation;

t) Transplantation of organs or tissues;

u) Inpatient care mainly for wardship or rehabilitation by nature, spa services and osteochondrosis excluding exacerbation stage (prophylactic massage in this case is possible, but no more than 2 courses a year);

v) Certificates for driving licenses and swimming pools;

w) Expenses that will be reimbursed or paid directly under a Russian Government medical program or the U.S. workers’ compensation program;

x) Expenses incurred outside of Russia.

C.1.8.2. The Contractor agrees that the services listed above as excluded under this contract may be purchased by the locally employed staff and their dependents registered under this contract on an individual and private basis according to the Contractor’s price schedule, to the extent these services are provided by medical facilities.

C.1.9 Medical Facilities

C.1.9.1. Primary clinics

C.1.9.1.1. The Contractor agrees to offer only those medical facilities in Moscow and other cities (Vladivostok and Yekaterinburg), which are able to meet the requirements, as described in this contract. The Government has determined that only a few clinics in Moscow and in other cities, where U.S. Missions are located, can meet US Government requirements. The list of acceptable medical facilities for outpatient and inpatient services is shown in the Exhibit D.

C.1.9.1.2. The Contractor shall propose clinics noted in Exhibit D for use by eligible participants in each city covered by this contract. The Contractor may also propose other medical facilities to be used as primary clinics, if these clinics offer services equal to those offered by acceptable clinics shown in Exhibit D. The Offeror shall demonstrate and prove why other facilities are as well equipped, meet standards of quality and customer services, as those listed in Exhibition D.

C.1.9.1.3. The Government may select clinics proposed by the Contractor and not included in the list shown in Exhibit D to be used as primary clinics, and advise the Contractor about its decision.

C.1.9.1.4. All participating individuals shall be registered in each of the primary medical facilities. There will be no limit in frequency for polyclinic visits by participants. Also eligible members may select any contractually approved facility on a case-by-case basis. The Contractor may not refuse to provide services for employees and dependents covered under this contract.

C.1.9.2. Additional clinics

C.1.9.2.1. The Contractor shall not use other clinics not accepted by the Government

C.1.9.2.2. When specialized treatment is required, or if the primary clinics cannot offer adequate treatment, all participating individuals may use services of additional clinics, specialized medical centers, consultants and specialists whose services shall be provided as part of Contractor’s proposal at no extra charge.

C.2 RESERVED

C.3 DEFINITIONS

AECA Employees – current employees of the American Embassy Community Association, which was formed to provide non-government goods, services, and facilities for the benefits of U.S. Government employees and their families assigned overseas. Association is not instrumentality of the U.S. Government. It is considered U.S. Government instrumentality for the purpose of social security, medical care and taxes.

COR - Contracting Officer's Representative (Post Human Resources Officer).

Contributory - 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 – spouses and children of participating employees. Eligible dependent children are those who are unmarried and under 21 years of age; or unmarried, attending full-time undergraduate school and under age of 23; or unmarried regardless of age and physically or mentally disabled so as to be incapable of self-support.

Disability - A physical or mental impairment, which precludes the individual from performing ordinary motor or bodily functions. 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, or personal services agreement, as further defined in Section C.1.3 for health insurance. This may also include an ORE Staff and/or AECA employee, if this category of individual is an eligible participant, as defined in C.1.3 for health insurance.

Employer - The United States Government or in the case of ORE and AECA employees, the Chief of Mission/Deputy Chief of Mission and Employee Association, respectively.

FMO - The Financial Management Officer or the paying office for all U.S. Government Agencies except AID.

Government - means the Government of the United States of America unless specifically stated otherwise.

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

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

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

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

ORE employees – active employees of the of the Chief of Mission and the Deputy Chief of Mission at overseas posts assigned to their respective official Government residences and paid under ORE account.

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.

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 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 3 (three) customer complaints are received per month http://www.acquisition.gov/far/ http://farsite.hill.af.mil/vffara.htm http://www.statebuy.state.gov/

E.2.1. SURVEILLANCE. The COR will receive and document all complaints from Government personnel regarding the services provided. If appropriate, the COR will send the complaints to the Contractor for corrective action.

E.2.2. STANDARD. The performance standard is that the Government receives no more than three (3) customer complaints per month. The COR shall notify the Contracting Officer of the complaints so that the Contracting Officer may take appropriate action to enforce the inspection clause (FAR 52.246-4, Inspection of Services – Fixed Price (AUG 1996) or the appropriate Inspection of Services clause), if any of the services exceed the standard.

E.2.3. PROCEDURES.

(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 complainant.

(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)

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 clauses are incorporated by reference:

CLAUSE TITLE AND DATE

52.242-15 STOP WORK ORDER (AUG 1989)

52.242-17 GOVERNMENT DELAY OF WORK (APR 1984)

F.2 PERIOD OF PERFORMANCE. The performance period of this contract is one year beginning on July 1, 2019 with four 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 Resources Office

United States Embassy in Moscow

Bolshoy Devyatinsky Pereulok, 8

Moscow 121099 Russian Federation 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 is the Human Resources Officer.

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 Russian Rubles. The Contractor shall issue invoices in Rubles using official US Dollar/Russian Ruble exchange rate established by the Central Bank of Russia on the day of an invoice issuance.

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 Office, United States Embassy in Moscow, Bolshoy Devyatinsky Pereulok, 8, Moscow, Russian Federation 121099

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.

Contractor may submit invoices monthly or quarterly for payment to be made at the beginning of the month or quarter 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 and/or Deputy Chief of Mission will make payment directly to the Contractor for the entire premium amount of the ORE staff, whether or not the ORE employee is contributing to the premium amount.

G.4.5. EAE Staff. The Employee Association will make payment directly to the Contractor for the entire premium amount of the EA employee, whether or not the EA 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 Contractor shall include VAT as a separate charge on the Invoice and as a separate line item in Section B.

G.7 Premiums G.7.1. Annual premiums shall cover all Outpatient services (registration fees) and Inpatient services, as described in Section C for each individual for the period of one year. However, if an employee should resign or be terminated from his position, then the remaining monies shall go towards registration of a new employee.