Amend_3_to_19RS5019R0002_final.pdf
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- Solicitation number
- 19RS5019R0002
- Issued by
-
Department of State US Embassy Moscow
About this file
This amendment is issued to replace the original Price Schedule in Section B Para B.2 and Administrative Retention Amounts in Section B Para B.3 with the revised ones attached to this Amendment.
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Other files
| File | Type | Posted |
|---|---|---|
| Amendment_2_to_19RS5019R0002.pdf | ||
| Questions_and_Answers_19RS5019R0002.pdf | ||
| Amend___1_19RS5019R0002.pdf | ||
| 19RS5019R0002_Health_Ins_Emb_Moscow_FINAL.pdf |
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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, Bi-weekly premiums per employee:
Total Annual Fee for all
Estimated # of Bi-weekly employees and employees and premium per eligible eligible person (p/p), dependents, Description dependents $/RUB $/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) 324 __________________ ______________
0.3 Pre-employment Exam 10 __________________ ______________
0.4 Childbirth Services 10 __________________ ______________
SUBTOTOTAL,
$/RUB ______________
VAT, $/RUB ______________
SUBTOTAL (a) including VAT, $/RUB ______________
TOTAL PRICE FOR BASE YEAR (subtotal x 26 pay periods): ______________
(b) Health Insurance Services for locally employed staff of the U.S. Consulate General in Vladivostok and their eligible dependents:
for all Estimated # of Bi-weekly employees and employees and premium per eligible
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 __________________ ______________
0.3 Pre-employment Exam 5 __________________ ______________
0.4 Childbirth Services 2 __________________ ______________
SUBTOTOTAL,
SUBTOTAL (b) including VAT, $/RUB ______________
(c) Health Insurance Services for locally employed staff of the U.S. Consulate General in Yekaterinburg and their eligible dependents:
for all Estimated # of Bi-weekly employees and employees and premium per eligible
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 __________________ ______________
0.3 Pre-employment Exam 5 __________________ ______________
0.4 Childbirth Services 2 __________________ ______________
SUBTOTOTAL,
SUBTOTAL (c) including VAT, $/RUB ______________
TOTAL ESIMATED PRICE FOR BASE YEAR OF CONTRACT
((Totals (a) + (b) + (c) ) ____________
B.2.4 FIRST OPTION YEAR OF CONTRACT.
(a) Health Insurance Services for locally employed staff of the U.S. Embassy Moscow and their eligible dependents, Bi-weekly premiums per employee:
Total Annual Fee for all
Estimated # of Bi-weekly employees and employees and premium per eligible
03. Outpatient Services:
04. Inpatient Services (for adults and children) 324 __________________ ______________
0.3 Pre-employment Exam 10 __________________ ______________
0.4 Childbirth Services 10 __________________
SUBTOTOTAL,
TOTAL PRICE FOR FIRST OPTION YEAR OF CONTRACT (subtotal x 26 pay periods): ______________ for all Estimated # of Bi-weekly employees and employees and premium per eligible
Child (age 18-23) 8 _______________ ______________
Child (age 1-17) 14 _______________ ______________
(for adults and children) 62 __________________ ______________
0.3 Pre-employment Exam 5 __________________ ______________
0.4 Childbirth Services 2 __________________ ______________
SUBTOTOTAL,
TOTAL PRICE FOR FIRST OPTION YEAR OF CONTRACT (subtotal x 26 pay periods): ______________ for all Estimated # of Bi-weekly employees and employees and premium per eligible
(for adults and children) 52 __________________ ______________
0.3 Pre-employment Exam 5 __________________ ______________
0.4 Childbirth Services 2 __________________ ______________
SUBTOTOTAL,
TOTAL PRICE FOR FIRST OPTION YEAR (subtotal x 26 pay periods): ______________
TOTAL ESIMATED PRICE FOR FIRST OPTION YEAR OF CONTRACT
B.2.5 SECOND OPTION YEAR OF CONTRACT
eligible dependents, Bi-weekly premiums per employee:
Total Annual Fee for all
Estimated # of Bi-weekly employees and employees and premium per eligible
05. Outpatient Services:
06. Inpatient Services (for adults and children) 324 __________________ ______________
0.3 Pre-employment Exam 10 __________________ ______________
0.4 Childbirth Services 10 __________________ ______________
SUBTOTOTAL,
TOTAL PRICE FOR SECOND OPTION YEAR OF CONTRACT (subtotal x 26 pay periods): ______________ for all Estimated # of Bi-weekly employees and employees and premium per eligible
(for adults and children) 62 __________________ ______________
0.3 Pre-employment Exam 5 __________________ ______________
0.4 Childbirth Services 2 __________________ ______________
SUBTOTOTAL,
TOTAL PRICE FOR SECOND OPTION YEAR OF CONTACT (subtotal x 26 pay periods): ______________ for all Estimated # of Bi-weekly employees and employees and premium per eligible
(for adults and children) 52 __________________ ______________
0.3 Pre-employment Exam 5 __________________ ______________
0.4 Childbirth Services 2 __________________ ______________
SUBTOTOTAL,
TOTAL ESIMATED PRICE FOR SECOND OPTION YEAR OF CONTRACT
B.2.5 SECOND OPTION YEAR OF CONTRACT
eligible dependents, Bi-weekly premiums per employee:
Total Annual Fee
Estimated # of Bi-weekly employees and employees and premium per eligible
07. Outpatient Services:
08. Inpatient Services (for adults and children) 324 __________________ ______________
0.3 Pre-employment Exam 10 __________________ ______________
0.4 Childbirth Services 10 __________________ ______________
SUBTOTOTAL,
for all Estimated # of Bi-weekly employees and employees and premium per eligible
(for adults and children) 62 __________________ ______________
0.3 Pre-employment Exam 5 __________________ ______________
0.4 Childbirth Services 2 __________________ ______________
SUBTOTOTAL,
for all Estimated # of Bi-weekly employees and employees and premium per eligible
(for adults and children) 52 __________________ ______________
0.3 Pre-employment Exam 5 __________________ ______________
0.4 Childbirth Services 2 __________________ ______________
SUBTOTOTAL,
TOTAL ESIMATED PRICE FOR SECOND OPTION YEAR OF CONTRACT
B.2.6 THIRD OPTION YEAR OF CONTRACT
eligible dependents, Bi-weekly premiums per employee:
Total Annual Fee
Estimated # of Bi-weekly employees and employees and premium per eligible
09. Outpatient Services:
10. Inpatient Services (for adults and children) 324 __________________ ______________
0.3 Pre-employment Exam 10 __________________ ______________
0.4 Childbirth Services 10 __________________ ______________
SUBTOTOTAL,
TOTAL PRICE FOR THIRD OPTION YEAR OF CONTRACT (subtotal x 26 pay periods): ______________ for all Estimated # of Bi-weekly employees and employees and premium per eligible
(for adults and children) 62 __________________ ______________
0.3 Pre-employment Exam 5 __________________ ______________
0.4 Childbirth Services 2 __________________ ______________
SUBTOTOTAL,
TOTAL PRICE FOR THIRD OPTION YEAR OF CONTRACT (subtotal x 26 pay periods): ______________ for all Estimated # of Bi-weekly employees and employees and premium per eligible
(for adults and children) 52 __________________ ______________
0.3 Pre-employment Exam 5 __________________ ______________
0.4 Childbirth Services 2 __________________ ______________
SUBTOTOTAL,
TOTAL PRICE FOR THIRD OPTION YEAR OF CONTACT (subtotal x 26 pay periods): ______________
TOTAL ESIMATED PRICE FOR THIRD OPTION YEAR OF CONTRACT
B.2.7 FOURTH OPTION YEAR OF CONTRACT
eligible dependents, Bi-weekly premiums per employee:
Total Annual Fee for all
Estimated # of Bi-weekly employees and employees and premium per eligible
11. Outpatient Services:
12. Inpatient Services (for adults and children) 324 __________________ ______________
0.3 Pre-employment Exam 10 __________________ ______________
0.4 Childbirth Services 10 __________________ ______________
SUBTOTOTAL,
TOTAL PRICE FOR FOURTH OPTION YEAR OF CONTRACT (subtotal x 26 pay periods): ______________ for all Estimated # of Bi-weekly employees and employees and premium per eligible
(for adults and children) 62 __________________ ______________
0.3 Pre-employment Exam 5 __________________ ______________
0.4 Childbirth Services 2 __________________ ______________
SUBTOTOTAL,
for all Estimated # of Bi-weekly employees and employees and premium per eligible
(for adults and children) 52 __________________ ______________
0.3 Pre-employment Exam 5 __________________ ______________
0.4 Childbirth Services 2 __________________ ______________
SUBTOTOTAL,
TOTAL ESIMATED PRICE FOR FOURTH OPTION YEAR OF CONTRACT
B.28 Grand Total of Base Year plus All Option Years
Price, pre-VAT, $/RUB
VAT, $/RUB Price including
VAT
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 bi-weekly retention amounts for each period of performance and for each category of premium. This fixed amount must be expressed in the currency in which the premium amount is proposed. The fixed retention amount shall NOT be expressed in terms of a percentage of the premium.
B.3.2 Bi-Weekly Retention Amounts per separate premium paid for each type of service for U.S. Embassy Moscow
Type of service
Period of Performance
Base Period First Option Year
Second Option Year
Third Option Year
Fourth Option Year
Outpatient Services
Adult Annual Premium
Child (Age 18- 23)
Child (age 1-17)
Child (age below 1)
Inpatient
Pre- Employment Exam
Childbirth
B.3.3 Bi-Weekly Retention Amounts per separate premium paid for each type of service for U.S. Consulate General in Vladivostok
Type of service
Period of Performance
Base Period First Option Year
Second Option Year
Third Option Year
Fourth Option Year
Child (Age 18-
B.3.3 Bi-Weekly Retention Amounts per separate premium paid for each type of service for U.S. Consulate General in Yekaterinburg
Type of service
Period of Performance
Base Period First Option Year
Second Option Year
Third Option Year
Fourth Option Year
Child (age 18-
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