19SA7026R0004 - Life and Medical Solicitation.pdf

Riyadh, Saudi Arabia

March 17, 2026

Dear Prospective Offeror:

Subject: Request for Proposals Number 19SA7026R0004

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

Life and Medical Insurance Coverage for locally employed staff of the U.S. Mission to Saudi

Arabia (Embassy Riyadh and Consulates General Jeddah and Dhahran). The Embassy encourages prospective offerors to offer off-shelf plans that meet at least the minimum benefit levels required in this solicitation.

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

The Embassy intends to conduct a pre-proposal Digital Video Conference (DVC), and all prospective offerors are invited to attend. See Section L.8 of the attached Request for Proposals

(RFP).

Proposals are due by Thursday, April 23, 2026, 17:00 Saudi Arabian Time. No proposals will be accepted after this time. Proposals must be in English and incomplete proposals will not be accepted.

Your proposal must be submitted electronically to Riyadhcontracting@state.gov. It is important to make sure the submission is made in specific size and format; in MS-Word 2007/2010 or MS-

Excel 2007/2010 or Adobe Acrobat (pdf) file format. The file size must not exceed 30MB. If the file size should exceed 30MB, the submission must be made in separate files and attached to separate emails with less than 30MB each.

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

1. SF-33

2. Section B, Pricing Schedule.

3. Section B, Retention Amounts in B.3 and B.7.

4. Section K, Representations and Certifications; and

5. Additional information as required in Section L.

6. The Offeror should submit a completed IRS Form W-14, found at www.irs.gov/w14, to ensure compliance with FAR 52.229-11;

7. Proof of SAM Registration

Direct any questions regarding this solicitation to the Contracting Officer by email at

RiyadhContracting@state.gov during regular business hours on or before 17:00 Saudi Arabian

Time, Sunday, April 5, 2026.

mailto:Riyadhcontracting@state.gov http://www.irs.gov/w14 mailto:RiyadhContracting@state.gov

Life and Medical Cover for LES Solicitation No. 19SA7026R0004

Embassy of the United States of America, Riyadh Page 2 of 106

Notwithstanding FAR 4.203-1(b)(5)(ii), the Contracting Officer has determined that it is in the best interest of the U.S. Government that offerors be registered in the SAM (System for Award

Management) database at https://www.sam.gov at the time of submitting a proposal.

Sincerely, William Ryan Barker

Contracting Officer https://www.sam.gov/

Embassy of the United States of America, Riyadh Page 3 of 106

SOLICITATION

DOCUMENT

The Embassy of United States of America, Riyadh, Saudi Arabia

Life and Medical Insurance Coverage for Locally

Employed Staff

SOLICITATION No. 19SA7026R0004

Embassy of the United States of America

P.O. Box 94309

Riyadh 11693

Kingdom of Saudi Arabia

Embassy of the United States of America, Riyadh Page 4 of 106

SOLICITATION, OFFER AND AWARD

1. THIS CONTRACT IS A RATED ORDER

UNDER DPAS (15 CFR 350)

RATING PAGE OF PAGES

4 | 106

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

3. SOLICITATION NO.

19SA7026R0004

4. TYPE OF SOLICITATION

[ ] SEALED BID (IFB)

[X] NEGOTIATED (RFP)

5. DATE ISSUED

03/17/2026

6. REQUISITION/PURCHASE NO.

PR15783249

7. ISSUED BY CODE 19SA70 8. ADDRESS OFFER TO (If other than item 7) The Embassy of the United States of America

Riyadh – Kingdom of Saudi Arabia

Phone: +966-11-835-4000

The Embassy of the United States of America

P.O. Box 94309

Riyadh – 11693, Kingdom of Saudi Arabia

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

SOLICITATION

9 Submit sealed offers with original and 3 copies for furnishing the supplies and/or services in the Schedule to U.S. Embassy Riyadh, Diplomatic Quarter, or send electronically to RiyadhContracing@state.gov by Thursday, April 23, 2026, local time 1700 Hours (Saudi Arabian Time)

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

William R. Barker

B. TELEPHONE (NO

COLLECT CALLS)

+966-11-835-4000

C. E-MAIL ADDRESS

RiyadhContracting@state.gov

11. TABLE OF CONTENTS

(x) SEC

DESCRIPTION PAGE(S) (x) SE

C.

DESCRIPTION PAGE(S)

PART I - THE SCHEDULE PART II - CONTRACT CLAUSES

X A SOLICITATION/CONTRACT FORM 4-5 X I CONTRACT CLAUSES 41-63

X B SUPPLIES OR SERVICE AND PRICES/COSTS 6-17 PART III - LIST OF DOCUMENTS, EXHIBITS, AND OTHER ATTACH.

X C DESCRIPTION/SPECS/WORK STATEMENT 18-30 X J LIST OF ATTACHMENTS 64-70

D PACKAGING AND MARKETING PART IV - REPRESENTATIONS AND INSTRUCTIONS

X E INSPECTION AND ACCEPTANCE 31-32 X K REPRESENTATIONS, CERTIFICATIONS, AND 71-96

X F DELIVERIES OR PERFORMANCE 33-34 OTHER STATEMENTS OF OFFERORS

X G CONTRACT ADMINISTRATION 35-36 X L INSTRS., COND., AND NOTICES TO OFFERORS 97-103

X H SPECIAL CONTRACT REQUIREMENTS 37-40 X M EVALUATION FACTORS FOR AWARD 104-106

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

13. DISCOUNT FOR PROMPT PAYMENT SEE 14

(See section I, Clause No 52.232-8)

10 CALENDAR DAYS

20 CALENDAR

DAYS

30 CALENDAR

DAYS

CALENDAR DAYS

14. ACKNOWLEDGMENT OF AMENDMENTS AMENDMENT NO. DATE AMENDMENT NO. DATE

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

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

AUTHORIZED

AND

ADDRESS

OF

OFFEROR

TO SIGN OFFER (Type or print)

15B. TELEPHONE NO. (Include area code)

15C. CHECK IF REMITTANCE

ADDRESS [ ] IS DIFFERENT FROM

ABOVE - ENTER SUCH ADDRESS

17. SIGNATURE 18. OFFER DATE

AWARD (To be completed by Government)

19. ACCEPTED AS TO ITEM NUMBERED

20. AMOUNT 21. ACCOUNTING AND APPROPRIATION

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

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

23. SUBMIT INVOICES TO ADDRESS

SHOWN IN (4 copies unless otherwise specified)

ITEM

24. ADMINISTRATION BY (If other than Item 7)

CODE

25. PAYMENT WILL BE MADE BY CODE

26. NAME OF CONTRACTING OFFICER (Type or print)

27. UNITED STATES OF AMERICA

(Signature of Contracting Officer)

28. AWARD DATE

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

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

PREVIOUS EDITION NOT USABLE Prescribed by GSA mailto:RiyadhContracing@state.gov mailto:RiyadhContracting@state.gov

Embassy of the United States of America, Riyadh Page 5 of 106

11. SCHEDULE

(Include applicable Federal, State and local taxes)

ITEM NO.

(a)

SUPPLIES/SERVICES

(b)

QUANTITY

(c)

UNIT

(d)

UNIT PRICE

(e)

AMOUNT

(f)

The Contractor shall provide life and medical insurance coverage to all

Locally Employed Staff of the United

States Government mission-wide in

Saudi Arabia for a period of five (5) years, as specified in Sections B and

C and Exhibit J. The groups of employees to receive these services are identified in Sections C.1.2 and

C.2.2.

Embassy of the United States of America, Riyadh Page 6 of 106

SECTION B

PART I: PRICE - HEALTH INSURANCE

ALTERNATE A – Coverage for ORE Staff and EAE Staff

B.1. PART I HEALTH INSURANCE SERVICES

The Contractor shall provide the Health Insurance services to employees of the Government of the United States of America in Kingdom of Saudi Arabia as described in Section C and the

Exhibits in Section J. The groups of employees who shall be provided with this insurance are listed in C.1.3 (medical) and C.2.3 (life). This insurance shall be provided in accordance with

Section C and the Exhibits in Section J.

NOTE: Details listed in Clause 52.229-11 and 52.22912 (Section I and K)

B.1.1. Official Residence Expense (ORE) Staff and United States Embassy Association

Employees (EAE) 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 Embassy Association

(for EAEs) 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 firm fixed price with economic price adjustment requirements type contract under which the Contracting Officer will issue firm fixed price task orders on a quarterly basis.

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.

Embassy of the United States of America, Riyadh Page 7 of 106

B.2.3 CLIN 0001 Base Year of Contract

NAICS Code: 524114 Health insurance Carriers

Bi-Weekly Rates per Employee

Category

Estimated

Number of

Employees

Rate per

Employee

Bi-Weekly

Total

Sub CLIN A. Single Employees (Self

Only) 626

Sub CLIN B. Family Plan 1,589

CLIN C. Subtotal (A + B)

CLIN 0001 Total Price for Base Year (c x 26)

Value Added Tax (VAT) for Base Year SAR: _____________________________

B.2.3. Grand Total Base Year (Including VAT) SAR: ____________________________

B.2.3 CLIN 1001 First Year of Contract

Number of

Employees

Rate per

Employee

Bi-Weekly

Total

Sub CLIN A. Single Employees (Self

CLIN 1001 Total Price for First Year (c x 26)

Value Added Tax (VAT for First Option Year SAR: ___________________________

B.2.4. Grand Total for First Option Year (Including VAT) SAR: _________________________

Embassy of the United States of America, Riyadh Page 8 of 106

B.2.3 CLIN 2001 Second Year of Contract

Number of

Employees

Rate per

Employee

Bi-Weekly

Total

Sub CLIN A. Single Employees (Self

CLIN 2001 Total Price for Second Year (c x 26)

Value Added Tax (VAT for Second Option Year SAR: ___________________________

B.2.5. Grand Total for Second Option Year (Including VAT) SAR: _______________________

B.2.3 CLIN 3001 Third Year of Contract

Number of

Employees

Rate per

Employee

Bi-Weekly

Total

Sub CLIN A. Single Employees (Self

CLIN 3001 Total Price for Third Year (c x 26)

Value Added Tax (VAT for Third Option Year SAR: ___________________________

B.2.6. Grand Total for Third Option Year (Including VAT) SAR: _______________________

Embassy of the United States of America, Riyadh Page 9 of 106

B.2.3 CLIN 4001 Fourth Year of Contract

Number of

Employees

Rate per

Employee

Bi-Weekly

Total

Sub CLIN A. Single Employees (Self

CLIN 4001 Total Price for Fourth Year (c x 26)

B.2.7. Grand Total for Fourth Option Year (Including VAT) SAR: _______________________

Value Added Tax (VAT for Fourth Option Year SAR: ___________________________

MINIMUM AND MAXIMUM AMOUNTS

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

United States Government (USG) shall place orders totaling a minimum of one employee. 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 Three thousand (3,000). This reflects the contract maximum.

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

CLIN 0001 Base Year Total

CLIN 1001 First Option Year Total

CLIN 2001 Second Option Year Total

CLIN 3001Third Option Year Total

CLIN 4001 Fourth Option Year Total

Grand Total of Base plus All Option Years

Embassy of the United States of America, Riyadh Page 10 of 106

B.3 ADMINISTRATIVE RETENTION AMOUNTS

B.3.1 If the Contractor requests a price adjustment under B.4 below, the Contractor must present cost experience data that includes the retention amount. For purposes of any economic price adjustment, this retention amount is a fixed amount that is a part of the premium amounts in B.2. This retention amount will not be adjusted for any reason.

The retention amount is part of the premium and may include, but not be limited to, such costs as overhead and general and administrative costs. It will also include any profit. Essentially, it includes all costs except the actual portion of the premium intended to fund claims paid to the health care provider/claimant. B.3.2 sets forth the retention amounts per premium paid for each category of premium and for each period of performance.

NOTE TO OFFEROR: Fill in the fixed bi-weekly retention amounts for each period of performance and for each category of premium. This fixed amount must be expressed in the currency in which the premium amount is proposed. The fixed retention amount shall

NOT be expressed in terms of a percentage of the premium.

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

Period of Performance Single Employees (Self Only) Family Plan

Base Period

First Option Year

Second Option Year

Third Option Year

Fourth Option Year

B.4. ECONOMIC PRICE ADJUSTMENT-HEALTH INSURANCE PREMIUMS

B.4.1. Premium Adjustment Based on Experience - For health insurance, prices may be adjusted upward or downward based on the experience rating of the Mission(s) covered by this contract, and it specifically excludes all riders in B.1.1. No adjustment will be allowed during the first twelve months. After such time, the Contractor or the Government may request an adjustment in premiums on an annual basis. Adjustments are not retroactive to previous contract terms. Before any such adjustment is made, the Contractor agrees to provide the Government a balance sheet showing three main components for the time period: (1) receipts (premiums received) minus the retention amount, (2) number of insurance plans and (3) claims paid. This information shall be provided per type of premium, ie per line item. The retention amount is not subject to adjustment. The Government reserves the right to have an independent third party review the balance sheet and claims and make recommendations regarding the appropriateness of the requested adjustment. Any adjustment shall be subject to mutual agreement of the parties

Embassy of the United States of America, Riyadh Page 11 of 106 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.

Embassy of the United States of America, Riyadh Page 12 of 106

PART II: PRICE - GROUP LIFE INSURANCE

ALTERNATE A

B.5. GROUP LIFE INSURANCE SERVICES

The Contractor shall provide the Group Life Insurance services described herein to employees of the Government of the United States of America in Kingdom of Saudi Arabia. The groups of employees who shall be provided this insurance are listed in C.2.3. This insurance shall be provided in accordance with Section C and the Exhibits in Section J.

B.5.1. Official Residence Expense (ORE) Staff and U.S. Embassy Association Employees

(EAE) 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), the Embassy Association (for EAEs) separately, at the rates specified below. See Section G for billing procedures.

B.6. GROUP LIFE INSURANCE RATES

This is a fixed-price with economic-price- adjustment-requirements type contract under which the Government will issue firm-fixed price task orders. The fixed prices/premium rates the amount of Life Insurance coverage for each employee is SAR 352,000 to provide life insurance, accidental death and dismemberment and partial and total disability coverage are as follows:

B.6.1 CLIN 6001 Base Year of Contract

NAICS Code: 524113 Direct Life Insurance Carriers

Type of Insurance

Premium

(per 1,000 of

Salary)

Estimated Payroll

(Bi-Weekly in

Thousands)

Bi-Weekly

Total

SubCLIN A. Basic Life OMR 126,151

SubCLIN B. Accidental Death &

Dismemberment

OMR 126,151

SubCLIN C. Partial & Total Disability

Coverage

NA

SubCLIN D. Subtotal (A + B + C)

CLIN 6001 Total Price for Base Year (d x 26)

Embassy of the United States of America, Riyadh Page 13 of 106

B.6.2 CLIN 7001 First Year of Contract

(per 1,000 of

Salary)

Estimated Payroll

(Bi-Weekly in

Thousands)

Bi-Weekly

Total

SubCLIN A. Basic Life OMR 132,459

OMR 132,459

CLIN 7001 Total Price for First Year (d x 26)

B.6.3 CLIN 8001 Second Year of Contract

(per 1,000 of

Salary)

Estimated Payroll

(Bi-Weekly in

Thousands)

Bi-Weekly

Total

SubCLIN A. Basic Life OMR 139,081

OMR 139,081

CLIN 8001 Total Price for Second Year (d x 26)

Embassy of the United States of America, Riyadh Page 14 of 106

B.6.5 CLIN 10001 Fourth Year of Contract

(per 1,000 of

Salary)

Estimated Payroll

(Bi-Weekly in

Thousands)

Bi-Weekly Total

SubCLIN A. Basic Life OMR 153,337

OMR 153,337

CLIN 10001 Total Price for Fourth Year (d x 26)

B.6.4 CLIN 9001 Third Year of Contract

(per 1,000 of

Salary)

Estimated Payroll

(Bi-Weekly in

Thousands)

Bi-Weekly

Total

SubCLIN A. Basic Life OMR 146,036

OMR 146,036

CLIN 9001 Total Price for Third Year (d x 26)

Embassy of the United States of America, Riyadh Page 15 of 106

B.6.6. Grand Total of Base plus All Option Years

CLIN 6001 Base Year Total

CLIN 7001 First Option Year Total

CLIN 8001 Second Option Year Total

CLIN 9001 Third Option Year Total

CLIN 10001 Fourth Option Year Total

Grand Total of Base plus All Option Years

Embassy of the United States of America, Riyadh Page 16 of 106

B.7. ADMINISTRATIVE RETENTION AMOUNTS

B.7.1 If the Contractor requests a price adjustment under B.8 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.6. 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 claimant.

B.7.2 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.7.2. Retention Amounts per Separate Premium Paid per Employee:

Period of Performance Basic Life

Accidental Death and

Dismemberment

Partial and Total

Disability Coverage

Base Period

First Option Year

Second Option Year

Third Option Year

Fourth Option Year

B.8. ECONOMIC PRICE ADJUSTMENT (EPA)-LIFE INSURANCE PREMIUMS

B.8.1. Premium Adjustment Based on Experience: For life 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. The 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 select an independent third party to

Embassy of the United States of America, Riyadh Page 17 of 106 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.8.2. Premium Adjustment Based on Law: 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 rate contracted for herein. 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.

Embassy of the United States of America, Riyadh Page 18 of 106

SECTION C

DESCRIPTION/SPECIFICATION/WORK STATEMENT

PART I - HEALTH INSURANCE

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 Riyadh, Jeddah and Dhahran, Kingdom of Saudi

Arabia. The Government has determined that the prevailing practice by employers in Saudi

Arabia is to provide for their employee’s health insurance protection and that the cost of such insurance protection is usually solely by the employer. The USG will pay 100% of the premium cost for the employee and their covered dependents. Health insurance protection will be representative of locally prevailing compensation practice as further described in C.1.2. The specific health benefit coverage under this contract is set forth in Section C and the Exhibits in

Section J.

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

The approved health benefit levels and terms to be included in the solicitation are as outlined below. The benefit levels set forth in the authorization cable are the minimum benefit levels acceptable for post’s health insurance contract. Post may accept offers of higher benefit levels as long as post complies with the applicable acquisition regulations. The GMC methodology encourages post to consider off-the-shelf insurance products which meet or exceed the minimum levels. Reimbursement of covered expenses is limited to the stated percentages of reasonable and customary costs.

Reimbursements or payments shall be made for the following covered benefits, subject to reasonable and customary costs in the locality where treatment was provided.

C.1.1 Employee and Dependent Health Services Benefits

Deductible (For Outpatient Treatment Expenses): Vendors may include deductibles in their proposals in accordance with CCHI benefit guidelines.

C.1.1.1. Hospitalization: (treatment in the hospital for inpatient care):

Services and supplies provided during hospitalization, including services provided by a licensed healthcare provider, bed & board (semi-private accommodations), operating room, recovery room, intensive care, imaging and diagnostic testing, general hospital nursing care, physical therapy, as well as drugs and medicines administered while in-patient. When private accommodations are provided, coverage will be limited to the cost of a semi-private room unless otherwise covered in an off-the-shelf plan. 100% Coverage

See Mental Health and Substance Abuse care (below) for details concerning inpatient psychiatric care. See Outpatient Services (below) for details concerning professional services.

Embassy of the United States of America, Riyadh Page 19 of 106

Emergency Services (trips to emergency room):

Services provided for conditions that could lead to serious disability or death if not immediately treated, such as accidents or sudden illness. 100% Coverage

Ambulance:

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. 100% Coverage (Emergencies); 80% Minimum Coverage (Non-

Emergencies)

C.1.1.2 Outpatient Services:

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

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

-- Annual physical examinations

-- Specialist consultations and treatment, including second surgical opinion

-- Minor surgical interventions

-- Chemotherapy and radiation treatments

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

-- Diagnostic tests and diagnostic imaging

--Treatment of congenital illness if current or future life-threatening impact for newborns

90% Minimum Coverage.

A visit to a specialized clinic without obtaining a referral from a primary care facility will be covered at 80% minimum. Primary care facilities and specialized clinics as defined in accordance with CCHI may be covered at a higher rate in accordance with CCHI and standard vendor practices. 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.

Preventive and Wellness and Chronic Disease Management:

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

90% Minimum Coverage

C.1.1.3. Prescription Drugs and Medicines: 100% reimbursement when hospitalized; 80% reimbursement and 20% deductible per visit with maximum of SAR 30 per visit when not hospitalized, of the cost of medicines and drugs for which a prescription is legally required for generic medicines, over the counter (OTC) drug, and/or innovative treatment (Brand

Name) when no generic alternative is available. If an innovative treatment (Brand Name) is chosen when a generic medicine is available, the difference between the innovative treatment

(Brand Name) and generic medicine will be paid in full by the employee/beneficiary. The price difference will not be included in the maximum deductible amount. There is no maximum cap on employee/beneficiary payment in this situation.

Embassy of the United States of America, Riyadh Page 20 of 106

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

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

Inpatient: 100% Coverage; Outpatient: 80% Minimum Coverage

C.1.1.4 For Employees Only HIV/AIDS: 100% reimbursement for Medications to suppress opportunistic infections (such as tuberculosis or toxoplasmosis for covered individuals who have HIV/AIDS). Brief courses of anti-retroviral drugs during childbirth to prevent the transmission of HIV/AIDS to the child. Generally, excludes medication for the long-term suppression of HIV/AIDS through the combination of anti-retroviral drugs in locations with inadequate local healthcare infrastructures.

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

The maximum limit for expenses reimbursed under section C.1.1.4 is 100% up to SAR

37,500.00 per contract year per covered individual.

C.1.1.5 Obstetrical Care: Care and services that women receive during pregnancy

(prenatal care), throughout labor and delivery, and post-delivery, and outpatient care for newborn babies. Hospitalization during pregnancy and/or delivery will be covered as Hospitalization

(treatment in the hospital for inpatient care). All other treatments will be considered Outpatient

Services.

Inpatient: 100% Coverage; Outpatient: 90% Minimum Coverage

Critical maternity care, as defined by CCHI: 90% Minimum Coverage. For example, treatment of congenital defects if current or future life-threatening impact.

Reproductive Health:

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). 90% Minimum Coverage

C.1.1.6 Pediatric Services:

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

Inpatient: 100% Coverage; Outpatient: 90% Minimum Coverage

C.1.1.7 Hearing Aids: Examinations and Treatment: 90% Minimum Coverage

Hearing Aid Apparatus: Limited to one apparatus per ear. The maximum coverage is

SAR 6,000.00 per covered individual per three-year period. 90% Minimum Coverage; with applicable cap

Embassy of the United States of America, Riyadh Page 21 of 106

C.1.1.8 Optical Care: Examinations and Treatment: 90% Minimum Coverage

Prescription lenses and frames, or contact lenses: The maximum coverage is SAR

1,125.00 per covered individual every two years annually. 90% Minimum Coverage; with applicable cap. Functional vision corrective intervention treatment is covered for each covered individual irrespective of age, only if treatment will prevent vision loss. No reimbursement for nonprescription lenses or tinting. 90% Minimum Coverage; with cap.

C.1.1.9 Dental Care: Examinations and Treatment: Dentist’s fees, x-rays, examinations and treatment, cleanings, fillings, extractions, false teeth, crowns, and bridges up to a maximum of SAR 12,000.00 per covered individual per contract year. 90% Minimum

Coverage; with annual cap. Of the SAR 12,000, SAR 7,200.00 maximum coverage for corrective dentistry mentioned above without deductible from insured individual, and SAR 4,800.00 for treatment of root canals and emergencies with 20 percent deductible with no upper 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. The maximum coverage is SAR 9,000.00 lifetime limit. 90% Minimum

Coverage; with contract lifetime cap.

C.1.1.10 Mental Health and Substance Abuse Care:

Inpatient and outpatient care provided to evaluate, diagnose and treat mental health condition or substance abuse disorder. This includes but is not limited to: Depression, bipolar disorder, anxiety or stress, and other 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 carried out at a facility licensed for detoxification and rehabilitation. Up to maximum SAR 50,000.00 per patient per contract year. Alzheimer’s cases treatment up to maximum SAR 15,000.00 per patient per contract year.

Inpatient/Emergency: 100% Coverage; Outpatient: 90% Minimum Coverage

Rehabilitative and Habilitative Services and Devices:

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) that help develop skills needed for everyday life. Devices to help gain or recover mental or physical skills lost due to injury, disability or chronic condition, and devices needed for habilitative reasons. 90% Minimum Coverage

Autism: Coverage of the costs of detecting diagnosis and treatment of autistic cases in accordance with the service provided to autistic patients, up to SAR 50,000.00 90% Minimum

Coverage; per individual per contract year.

C.1.1.11

Kidney Dialysis Treatment:

In accordance with the maximum limits set out in Saudi Council Cooperative Health

Insurance (CCHI) Policy, up to SAR 180,000.00 per patient per contract year. 90% Minimum

Kidney Transplant:

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When hospitalized in accordance with the maximum limits set out in Saudi Council

Cooperative of Health Insurance (CCHI) policy, up to SAR 250,000.00 per patient per contract year. 100% Minimum Coverage

Obesity Treatment:

Procedures and surgeries such as sleeve gastrectomy surgery, if BMI exceeds 40 or 35 with complications, based on eligibility criteria based on the best indication and international clinical guidelines and The Saudi Guide to Bariatric and Metabolic Surgery, such as but not limited to; Laparoscopic Adjustable Gastric Banding (LABG), Laparoscopic Sleeve Gastrotomy, etc. The maximum limit for operation expenses reimbursed is 80% - 100% with SAR 1,000 cap, up to SAR 15,000.00. 80% - 100% Minimum Coverage

Comprehensive Integrated Program for Diabetics Care:

Personalized health care plan created based on the patient’s health profile to provide comprehensive health care services in accordance with medical best practices. 90% Minimum

Coverage.

Telemedicine Services:

Using electronic information and communication technology to provide diagnostic, screening, and medical inspection service to the insured member, service must be provided by a licensed center by the Saudi Ministry of Health (MOH) and in accordance with the rules and regulations approved by the Council Cooperative of Health Insurance (CCHI).

C.1.1.12 Medical Expenses Incurred Out of Country:

Out-of-Country Medical Treatment:

Medical expenses incurred out-of-country will be covered, but coverage will be the same and subject to the same total maximum annual limit as for medical expenses incurred in-country.

Out-of-Country Medical Travel:

Transportation for out-of-country medical treatment will be a covered expense for LE

Staff and eligible family members. To be considered a covered expense, the attending certified health care provider must certify in advance that the treatment is medically necessary and unavailable locally. 80% of covered individual’s transportation expenses by the least expensive, appropriate means of transportation to the nearest city with adequate medical facilities will be covered. 80% of the transportation expenses of an attendant will also be covered, but only if the covered individual's attending certified health care provider certifies that an attendant for the patient is necessary, (e.g., a parent in the case of a patient who is a minor, or a family member to make medical decisions in the case of a patient who is unwell or unconscious). All coverage for transportation for out-of-country medical treatment is subject to the total maximum annual limit.

Transportation to a neighboring country without the attending certified health care provider certifying that the treatment is medically necessary and unavailable locally will not be covered.

180 Day 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

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C.1.1.13 Annual Maximum Limit – The maximum annual reimbursement per patient per contract year, not including expenses covered under C.1.1.4, is SAR 1,000,000 per patient per contract year.

C.1.2 Health Benefits Conditions and Limitations.

Exclusions to Coverage:

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

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

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

C.1.3 Eligible Participants

C.1.3.1 Eligible Employees - Employees eligible for the health insurance services include the following:

- Paid under the terms of Mission Saudi Arabia’s Local Compensation Plan (LCP); and –

- Under a non-temporary direct hire appointment, personal services agreement (PSA), or personal services contract (PSC); or

- Under a temporary direct hire appointment or PSA Fixed Term of one year or more.

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

PSA that is time limited to less than one year; non-personal services contract personnel and their employees, supplied by an independent contractor licensed to do business in Saudi Arabia who provides services to other local organizations as well as to the U.S. Mission; employees working on an intermittent or When Actually Employed (WAE) schedule; employees of USAID institutional contractors; Peace Corps personal services contractors as indicated in MS 743; and

Recreation Association employees.

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.1.3.2 Location of Employment

The eligible employees covered by C.1.3.1 must be employed within the geographic boundaries of the Kingdom of Saudi Arabia by the U.S. Embassy in Riyadh and U.S. Consulates General in

Jeddah and Dhahran.

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C.1.3.3 Participants Covered Under a Rider

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

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

C.1.3.3.2 All current active employees of the Employee Association at

Embassy in Riyadh and U.S. Consulates in Jeddah and Dhahran (see separate rider, Exhibit C). All costs for Embassy Employee Association EAEs are the responsibility of the Employee Association, not the U.S. Government.

C.1.4. Individuals not Eligible for Coverage .

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

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

C.1.5. Other Eligible Participants

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

C.1.5. Other Eligible Participants

Dependents:

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

• Legal spouse: one legal spouse as defined by local law may be covered. LE Staff with more than one legal spouse must select only one spouse for coverage. Post may continue its current practice of allowing tandem employees to enroll separately as individuals.

• Dependent children: a child is defined as the LE Staff’s natural, adopted, stepchild, or foster child. The child must be unmarried and financially dependent upon the LE Staff. A child will be covered until the end of the contract year in which s/he reaches age 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.

Unmarried adult female daughter: an adult female daughter of an eligible employee is covered under the medical plan up until the age of 40, if unmarried and unemployed.

C.1.6. Eligibility

C.1.6.1. Term of Eligibility and Effective Date

Each current active eligible employee is enrolled for health benefits under this contract upon award and thereafter during the performance period of this contract. Each new eligible employee

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

C.1.6.2. Period of Ineligibility

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

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

During a period of extended Leave Without Pay (LWOP) or unpaid leave beyond one pay period, the employer is responsible for the full cost of the insurance premiums for self and dependents. The Mission will pay the premiums directly to the Contractor.

C.1.7. Brochure Requirement.

C.1.7.1. The Contractor shall provide a document (brochure/pamphlet/other written document) in English and Arabic that sets forth a complete listing of the health and life insurance information, benefits and network providers to be provided annually under this contract. This brochure shall be provided in sufficient quantities so that each covered employee receives a copy. The Contractor shall furnish all copies of the brochures to the COR, who will ensure that appropriate distribution is made.

C.1.7.2. The Contractor shall provide the document described in C.1.7.1 to the COR not later than 10 days after date of contract award. The Contractor shall provide additional brochures for new employees within ten (10) days of the COR’s request. And any update should be notified to the COR as it arise.

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.

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PART II: GROUP LIFE INSURANCE

C.2. GROUP LIFE INSURANCE

The Government of the United States of America requires group life insurance coverage for its employees, as further described in C.2.2, in the Kingdom of Saudi Arabia. The Government has determined that the prevailing practice by employers in the Kingdom of Saudi Arabia is that group life insurance coverage is representative of locally prevailing compensation practice and that the cost of such insurance protection is usually borne by solely by the employer. The USG will pay 100% of the premium cost for the employee. Premium will be based on the number of individuals covered (i.e. self only). Therefore, the Government desires to adopt such locally prevailing practice as part of its compensation plan for its employees as further described in

C.2.2. The specific group insurance coverage under this contract is set forth in this part of

Section C and the Attachments in Section J.

C.2.1. Group Life Insurance Coverage

The amount of group life insurance coverage is as follows:

C.2.1.1 Amount of Employee Life Insurance.

The following benefit will be paid to the participant's named beneficiaries or estate upon the death of the participant:

(1) Natural Death: SAR 352,000.00

(2) Accidental Death: SAR 352,000.00

C.2.1.2 Amount of Accidental Death and Dismemberment Coverage.

The employee's estate or employee will receive full amount of the life insurance coverage

C.2.1.1, in the event the employee is killed in an accident or dismembered.

C.2.1.3 Partial and Total Disability Coverage

Partial and Total Disability Coverage: In the event the employee is partially or totally disabled, the employee will receive partial and total disability coverage in accordance with compensation table provided in Saudi Arabian Laws. Per the CCHI Basic Health Insurance

Policy, cost of disability cases will be covered up to a maximum of 100,000 SAR per covered employee per policy period.

C.2.1.4 Repatriation of Remains:

(1) As per labor law Article 40, upon the death of a foreign LE Staff employee, the contractor will pay the cost of preparation of remains, purchase of coffin, and shipment of corpse to the home country of record or place of residence upon the demand of the employee’s heir beneficiaries. In accordance with Article 40 (4), the payment shall be exempted in case the

General Organization for Social Insurance assumes this responsibility. Maximum covered expenses will be limited to reasonable and customary costs.

C.2.2 Life Insurance Benefits Conditions and Limitations

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Conditions and limitations on the entitlement to life insurance benefits under this contract are as follows:

No benefits shall be payable if an employee's death or other insurance event was caused directly or indirectly by war. War shall be defined as declared or non-declared war or any martial operations or invasion, hostile acts of foreign powers, rebellion, riot, civil war, uprising, mutiny, operations by military or usurpatory authorities, martial law or state of siege or any other similar event or reason for declaring martial law or war. A terrorist attack shall not be considered war.

No benefit shall be payable under this contract if the employee's bodily injuries have been caused directly or indirectly and totally or partially by:

1. Violating the law or resisting detention or arrest.

2. Participation in competitions involving the use of wheeled vehicles, horses, boats or water skis.

3. An accident resulting from the employee being under the influence of alcohol, drugs or other toxic substance unless administered by a physician. Death as a result of a disease or physical or mental infirmities and medical or surgical treatment thereof (except pyogenic infection due to an accidental cut or wound) shall be considered a natural and not an accidental death. Suicide will not be covered.

C.2.3. Eligible Participants

C.2.3.1 Eligible Employees. The employees eligible for the group life insurance coverage include the following:

Eligible employees are Locally Employed (LE) Staff who are (1) working on a full-time or part-time basis under non-temporary direct-hire appointments and under personal services agreements/contracts that are not time limited to less than one year and (2) paid under the terms of the Local Compensation Plan. Not eligible are LE Staff working under temporary appointments; those working under a PSA or PSC that is time limited to less than one year; those with a When Actually Employed (WAE) workweek schedule; non-personal services contract personnel and their employees, supplied by an independent contractor licensed to do business in Saudi Arabia who provide services to other local organizations as well as to the U.S. Mission; and Peace Corps personal services contractors as indicated in MS 743.

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

C.2.3.2 Location of Employment

The individuals covered by C.2.3.1 must be…