19TC1023R0001_LES Health Insurances Services for Abu Dhabi.pdf

SOLICITATION

DOCUMENT

United States Embassy

LES Health Insurance Services

Solicitation No.: 19TC1023R0001

Procurement and Contracting Office US Embassy P.O. Box 4009

Embassies District Area Abu Dhabi, United Arab Emirates

SOLICITATION, OFFER AND AWARD

1. THIS CONTRACT IS A RATED ORDER

UNDER DPAS (15 CFR 350)

RATING PAGE OF PAGES

1 | 78

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

3. SOLICITATION NO.

19TC1023R0001

4. TYPE OF SOLICITATION

[ ] SEALED BID (IFB)

[x] NEGOTIATED (RFP)

5. DATE ISSUED

August 4, 2023

6. REQUISITION/PURCHASE NO.

PR11178211

7. ISSUED BY CODE TC10 8. ADDRESS OFFER TO (If other than item 7) U.S. Embassy, Abu Dhabi

United Arab Emirates

Phone: 971 2 414 2443

Contracting Officer

U.S. Embassy, Abu Dhabi

AbuDhabiContracts@state.gov NOTE: In sealed bid solicitation "offer" and "offeror” mean "bid" and "bidder".

SOLICITATION

9. Sealed offers in original and 1 soft copy for furnishing the supplies or services in the Schedule will be received at AbuDhabiContracts@state.gov, until 4:00 P.M. local time on September 05, 2023.

CAUTION - LATE Submissions, Modifications, and Withdrawals: See Section L. Provision No. 52.214-7 or 52.215-1. All offers are subject to all terms and conditions contained in this solicitation.

10. FOR

INFORMATION

CALL:

A. NAME

Shelly Kadlec

Contracting Officer

B. TELEPHONE (NO COLLECT

CALLS)

AREA CODE NUMBER EXT

971-2-414 2200

C. E-MAIL ADDRESS:

AbuDhabiContracts@state.gov

11. TABLE OF CONTENTS

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

PART I - THE SCHEDULE PART II - CONTRACT CLAUSES

X A SOLICITATION/CONTRACT FORM (SF33) 1 X I CONTRACT CLAUSES 26-41

X B SUPPLIES OR SERVICE AND PRICES/COSTS 2-6 PART III - LIST OF DOCUMENTS, EXHIBITS, AND OTHER ATTACH.

X C DESCRIPTION/SPECS/WORK STATEMENT 7-14 X J LIST OF ATTACHMENTS 42-44

X D PACKAGING AND MARKING 15 PART IV - REPRESENTATIONS AND INSTRUCTIONS

X E INSPECTION AND ACCEPTANCE 16-17 X K REPRESENTATIONS, CERTIFICATIONS, AND 45-63

X F DELIVERIES OR PERFORMANCE 18 OTHER STATEMENTS OF OFFERORS

X G CONTRACT ADMINISTRATION 19-21 X L INSTRS., COND., AND NOTICES TO OFFERORS 64-75

X H SPECIAL CONTRACT REQUIREMENTS 22-25 X M EVALUATION FACTORS FOR AWARD 76-78

OFFER (Must be fully completed by offeror) NOTE: ITEM 12 does not apply if the solicitation includes the provisions at 52.214-16, Minimum Bid Acceptance Period.

12. In compliance with the above, the undersigned agrees, if this offer is accepted within 120 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

AND

CODE FACILITY 16. NAME AND TITLE OF PERSON AUTHORIZED

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

(1 copies unless otherwise specified)

ITEM

24. ADMINISTRATION BY (If other than Item 7)

CODE

19TC10 25. PAYMENT WILL BE MADE BY CODE

U.S. Embassy, Abu Dhabi Financial Management Center, U.S. Embassy, Abu Dhabi

26. NAME OF CONTRACTING OFFICER (Type or print)

Shelly Kadlec

27. UNITED STATES OF AMERICA

(Signature of Contracting Officer)

28. AWARD DATE

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

mailto:AbuDhabiContracts@state.gov mailto:AbuDhabiContracts@state.gov mailto:AbuDhabiContracts@state.gov

LES Health Insurance Services for U.S. Embassy, Abu Dhabi Page 2 of 78 Solicitation # 19TC1023R0001

SECTION B – PRICES

B.1. HEALTH INSURANCE SERVICES

The Contractor shall provide the Health Insurance services to employees of the Embassy of the

United States of America in Abu Dhabi, United Arab Emirates and their eligible dependents as described in Section C. This insurance shall be provided in accordance with Section C.

B.1.1. Official Residence Expense (ORE) Staff and American Embassy Employees Association

(AEEA) are covered under a rider to the contract. The Contractor shall bill the Chief of Mission, Deputy Chief of Mission (for ORE Staff), the American Embassy Employees Association

(AEEA) at the rates specified below. See Section G for billing procedures. Note that USG is neither responsible, nor liable, for any riders.

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

January 01, 2024, through December 31, 2024

Bi-Weekly

Rates Per

Premium

Category Estimated

Number of

Premiums*

Rate per

Premium in

AED

Extended Bi-

Weekly Total

a. Employee 212

b. Employee’s

Spouse

c. Employee’s dependent child

d. Subtotal 672

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

**does not include any premiums for Riders.

B.2.4 First Option

Year of Contract

January 01, 2025, through December 31, 2025

Bi-Weekly

Premiums*

Rate per

Premium in

AED

Extended Bi-

Weekly Total

a. Employee 212

b. Employee’s

Spouse

c. Employee’s dependent child

d. Subtotal 672

Total Price for Option

Year 1 (d x 26)**

B.2.5 Second Option

January 01, 2026, through December 31, 2026

Bi-Weekly

Premiums*

Rate per

Premium in

AED

Extended Bi-

Weekly Total

a. Employee 212

b. Employee’s

Spouse

c. Employee’s dependent child

d. Subtotal 672

Total Price for Second

Option Year (d x 26)**

Total Price for Base

Year (d x 26)**

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B.2.6 Third Option

January 01, 2027, through December 31, 2027

Bi-Weekly

Premiums*

Rate per

Premium in

AED

Extended Bi-

Weekly Total

a. Employee 212

b. Employee’s

Spouse

c. Employee’s dependent child

d. Subtotal 672

Total Price for Third

B.2.7 Fourth Option

January 01, 2028, through December 31, 2028

Bi-Weekly

Premiums*

Rate per

Premium in

AED

Extended Bi-

Weekly Total

a. Employee 212

b. Employee’s

Spouse

c. Employee’s dependent child

d. Subtotal 672

Total Price for Fourth

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

Base Year AED

First Option Year AED

Second Option Year AED

Third Option Year AED

Fourth Option Year AED

B.3 ADMINISTRATIVE RETENTION AMOUNTS

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

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

NOTE TO OFFEROR: Fill in the fixed bi-weekly retention amounts for each period of performance and for each category of premium. This fixed amount shall be expressed in the currency in which the premium amount is proposed. The fixed retention amount shall not be expressed in terms of a percentage of the premium.

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

Period of

Performance Employee Employee’s Spouse

Employee’s Dependent

Child

Base Period

First Option Year

Second Option Year

Third Option Year

Fourth Option Year

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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, i.e., 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 (30) days after complete information is received by the Government. Any failure to reach agreement under this clause shall be subject to the procedures in the Disputes clause.

B.4.2. Premium Adjustment Based on Laws - The rates may also be adjusted during the performance period of the contract as a result of laws enacted by the host Government, if such change in the laws has a direct impact on the cost to the Contractor to perform this contract at the contracted rate. In that event, the Contracting Officer may enter into negotiations with the

Contractor to modify the contract to adjust the premium rate. The Contractor agrees to provide all documentation necessary to support any requested adjustment.

B.4.2.1 Employee Pool – This clause is only in effect if the Contractor included details in its offer regarding a pooling arrangement, of which this contract is a part.

Before any adjustment is made under this price adjustment clause, the Contractor shall include in its proposal for adjustment, details setting forth how the pool impacts the request for equitable adjustment.

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SECTION C

DESCRIPTION/SPECIFICATION/WORK STATEMENT

C.1. HEALTH INSURANCE SERVICES

The Embassy of the United States of America, in Abu Dhabi requires Health Insurance coverage for its employees as described herein.

Note: We encourage proposals to contain more than the minimum levels as mentioned in the solicitation Section C to become more competitive and better match USG requirements.

C.1.1 Employee and Dependent Health Service Benefits

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

Minimum Coverage - 100%

Services and supplies provided during hospitalization including services provided by a licensed healthcare provider, bed and board (semi-private accommodations), operating room, recovery room, intensive care, imaging and diagnostic testing, and 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.

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

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

C.1.1.2 Emergency Services (Trips to Emergency Room): Minimum

Coverage - 100%

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

C1.1.3 Ambulance: Minimum Coverage - 100%

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

C.1.1.4 Outpatient Services: Minimum Coverage - 100%.

Employee Outpatient Co-Payment per visit may not exceed AED 35 or the

Employee Co-Payment required by local labor law, whichever is lower.

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 provided at a hospital, clinic, doctor’s office, medical facility, etc. Examples include, but are not limited to:

- Annual physical examinations

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- Specialist consultations and treatment, including second surgical opinion

- Minor surgical interventions

- Chemotherapy and radiation treatments

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

Organization

- Diagnostic tests and diagnostic imaging

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

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

C.1.1.5 Obstetric and Newborn Care: Minimum Coverage - Inpatient:

100%;

Outpatient:

80% Minimum Coverage, or the minimum level of coverage required by local labor law, whichever is higher.

Employee Outpatient Co-Payment per visit may not exceed AED 35 or the

Employee Co-Payment required by local labor law, whichever is lower.

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

C.1.1.6 Pediatric Services: Minimum Coverage - Inpatient: 100%

Outpatient:

80% Minimum Coverage, or the minimum level of coverage required by local labor law, whichever is higher

Employee Outpatient Co-Payment per visit may not exceed AED 35 or the

Employee Co-Payment required by local labor law per visit, whichever is lower.

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

Organization.

C.1.1.7 Prescription Drugs: Minimum Coverage -Inpatient: 100%, Outpatient: 80% Minimum Coverage, or the minimum level of coverage required by local labor law, whichever is higher.

Medications prescribed by a licensed health care provider that are medically required.

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

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

Minimum Coverage - 80%, or the minimum level of coverage required by local labor law, whichever is higher.

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

C.1.1.9 Hearing Aids:

Examinations and Treatment:

80% Minimum Coverage, or the minimum level of coverage required by local labor law, whichever is higher.

Hearing Aid Apparatus: Limited to one apparatus per ear up to a maximum of AED

5,510.00 per covered individual per three-year period.

whichever is higher; with annual cap.

C.1.1.10 Optical Care:

Examinations and Treatment:

Prescription lenses and frames or contact lenses: Covered up to a maximum of AED

1,102.00 per covered individual every two years.

80% Minimum Coverage; or the minimum level of coverage required by local labor law, whichever is higher; with annual cap.

C.1.1.11 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 AED

11,754.00 per covered individual per contract year.

80% Minimum Coverage, or the minimum level of coverage as required by local labor law, whichever is higher; with annual cap.

Orthodontia: Treatment is covered only if treatment begins before age 18, or if required as the result of an accident. A maximum of four years of orthodontia treatment will be covered per covered individual up to a maximum of AED 8,816.00 lifetime limit.

80% Minimum Coverage or the minimum level of coverage required by local labor law, whichever is higher; with contract lifetime cap.

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C.1.1.12 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).

C.1.1.13 Mental Health and Substance Abuse Care: Minimum Coverage -

50%, or the minimum level of coverage required by local labor law, whichever is higher.

Inpatient and outpatient care provided to evaluate, diagnose and treat a mental health condition or substance abuse disorder. This includes behavioral health treatment, counseling, and psychotherapy. Services must be provided by a licensed psychiatrist, psychoanalyst, psychologist, or psychiatric social worker. Inpatient care for alcohol and substance abuse must be provided at a facility licensed for detoxification and rehabilitation.

C.1.1.14 Rehabilitative and Habilitative Services and Devices:

Minimum Coverage - 50%, or the minimum level of coverage required by local labor law, whichever is higher.

Rehabilitative services (e.g., recovering skills, such as speech therapy after a stroke or physical therapy after an accident) and habilitative services (e.g., developing skills, such as speech therapy for children, etc.) that help develop skills needed for everyday life.

Devices to help gain or recover mental or physical skills lost due to injury, disability or a chronic condition, and devices needed for habilitative reasons.

C.1.1.15 HIV/AIDS: 100% up to AED 36,730.00 per contract year per covered individual

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

C.1.1.16 Catastrophic Coverage:

Additional coverage equal to AED 323,000.00 per covered individual per contract year.

Catastrophic conditions shall be defined as major medical conditions occurring as a result of a single/illness/accident or closely related set of major illnesses (or conditions relating to a single accident) that exceed the standard maximum coverage limit.

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C.1.1.17 Out-of-Country Medical Treatment:

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

C.1.1.18 Out-of-Country Medical Travel: 80% Reimbursement

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

C.1.1.19 180 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.

C.1.1.20 Employee Assistance Program (EAP):

An Employee Assistance Program (EAP) is a voluntary, work-based program that offers free and confidential assessments, short-term counseling, referrals, and follow-up services to employees who have personal and/or work-related problems.

C.1.1.21 Work Related Injury/Illness:

For work related injuries and illnesses which occur during work hours and during the commute on a direct route to and from work, the contractor shall follow Article 37 of

Law No 33 of 2021 and all related Cabinet Decrees including No. 1 of 2022, Article 23 and No. 33 of 2022. Contractor will pay the full amount of the clinic/hospital fees as well as the transportation costs incurred for the medical treatment until recovery or disability establishment, whichever is sooner. The treatments shall include hospital stay, surgical procedures, costs of X-rays and medical analyses as well as the purchase of medications and rehabilitation equipment and the provision of artificial and prosthetic limbs and devices for those whose disability is established.

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C.1.2 Annual Maximum Limit - The maximum annual reimbursement per covered individual per contract year, not including expenses defined under Exclusions and Limitations (C.1.3) and

C.1.1.16, Catastrophic Coverage, or those covered under C.1.1.15, HIV/AIDS, and C.1.1.21

Work Related Injury/Illness is equivalent to AED 323,000.00

C.1.3 Exclusions and Limitations

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

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

Removal of any exclusions require prior authorization.

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

C.1.4 Eligible Participants

C.1.4.1 Identification of Eligible Employees and Dependents: U.S. Embassy Abu Dhabi will provide a list of all eligible employees and dependents with relationship to employee

(self/spouse/child) and DOB for each. Updates will be provided to add or remove individuals on as needed basis.

C.1.4.1.1 Definition of Dependents

C1.4.1.1.1 Legal Spouse: one legal spouse as defined by local law will be covered. LE Staff with more than one legal spouse must select only one spouse for coverage. In cases where LE

Staff and their legal spouse both work for the mission and both are eligible to participate in the medical plan, one will be designated as the lead for purposes of the medical plan, and the other will be considered a legal spouse.

C.1.4.1.1.2 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.

C.1.4.2 Location of Employment:

The eligible employees covered by C.1.4.1 must be employed within the geographic

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Defense, Department of Justice, Department of the Treasury, Department of Transportation, Department of the Navy, Department of Homeland Security, Department of Commerce, Department of the Army, Department of Agriculture, etc.

C.1.4.3 Participants Covered Under a Rider

a. All current active ORE Staff, including their eligible dependents, personally employed by the Chief of Mission and the Deputy Chief of Mission, and assigned to their respective official Government residences are paid under an ORE account. All costs for coverage of ORE Staff and their eligible dependents, are the responsibility of the Chief of Mission and the

Deputy Chief of Mission, not the U.S. Government.

b. All current active employees and their eligible dependents of the Employee Association at

Embassy Abu Dhabi. All costs for coverage of American Embassy Employees Association

(AEEA) employees and their dependents are the responsibility of the AEEA, not the U.S.

Government.

C.1.5 Eligibility

C.1.5.1 Term of Eligibility and Effective Date

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

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

C.1.6 Brochure Requirement

C.1.6.1 The Contractor shall provide a document (brochure/pamphlet/other written document) in English that sets forth a complete listing of the health insurance benefits to be provided under this contract. This brochure shall be provided in sufficient quantities so that each covered employee receives a copy. The Contractor shall furnish all copies of the brochures to the COR, who will ensure that appropriate distribution is made.

C.1.6.2 The Contractor shall provide the document described in C.1.6.1 to the COR not later than 14 business days after date of contract award. The Contractor shall provide additional brochures for new employees within ten (10) business days of the COR’s request.

C.1.6.3 The Contractor assumes full responsibility for ensuring that the document described in C.1.6.1 accurately reflects the requirements, coverage, and contract terms of the contract, as implemented by the Contractor’s technical proposal. In all cases, the contract shall take precedence. Should the COR discover that the document contains inaccuracies, the Contractor will be notified in writing; however, failure on the part of the

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U.S. Government to notice any inaccuracies shall in no way limit, revise or otherwise affect the requirement under this contract for the Contractor to fully comply with all contract terms.

C.1.7. Network Capacity

Contractor shall maintain health care provider network adequate to serve the insured members under this contract. Contractor shall maintain and provide all insured members, a list of approved health care provider network. The Contractor shall accept the insured member’s choice to go for treatment/surgery to any hospital/medical facility designated by the Contractor under their network in order that the Contractor will pay for the expenses directly to the hospital/medical facility.

C.1.8. Claims Processing and Reimbursement

Insured members have formal right to make a choice about the medical services provider.

This includes the right to choose a doctor/hospital/medical provider of their choice who is outside the Contractor’s approved Network. In case an insured member chooses a medical service provider outside the Contractor’s approved Network, the Contractor shall be responsible for the settlement of medical expenses on reimbursement basis up to the benefits plan limit under this contract without applying any pricing limits set for the network providers. The Contractor shall be responsible for all planning, estimating, programming, project management, scheduling, dispatching, supervision, and inspection of claims reimbursement work.

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SECTION D

PACKAGING AND MARKING

(RESERVED)

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SECTION E

INSPECTION AND ACCEPTANCE

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

This contract incorporates one or more clauses by reference, with the same force and effect as if they were given in full text. Upon request, the Contracting Officer will make their full text available. In addition, the full text of a clause may be accessed electronically at: Acquisition.gov this address is subject to change.

If the Federal Acquisition Regulation (FAR) is not available at the location indicated above, use the Department of State Acquisition website at e-CFR to see the links to the FAR. You may also use an Internet “search engine” (for example, Google, Yahoo or Excite) to obtain the latest location of the most current FAR.

THE FOLLOWING FEDERAL ACQUISITION REGULATION CLAUSE(S) IS/ARE

INCORPORATED BY REFERENCE:

CLAUSE TITLE AND DATE

52.246-4 INSPECTION OF SERVICES - FIXED PRICE (AUG 1996)

E.2. QUALITY ASSURANCE AND SURVEILLANCE PLAN (QASP)

This plan is designed to provide an effective surveillance method to promote effective Contractor performance. The QASP provides a method for the Contracting Officer's Representative (COR) to monitor Contractor performance, advise the Contractor of unsatisfactory performance, and notify the Contracting Officer of continued unsatisfactory performance. The Contractor, not the

Government, is responsible for management and quality control to meet the terms of the contract.

The role of the Government is to conduct quality assurance to ensure that contract standards are achieved.

Performance Objective

PWS

Paragraph Performance Threshold

Services

Performs all the insurance services set forth in the Performance Work Statement (PWS)

C.1.0 thru

C.1.8

All required services are performed and no more than one

(1) customer complaint is received per month.

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

E.2.2 Standard. The performance standard is that the Government receives no more than one

(1) customer complaint per month. The COR shall notify the Contracting Officer of the complaints so that the Contracting Officer may take appropriate action to enforce the inspection https://acquisition.gov/browse/index/far https://gov.ecfr.io/cgi-bin/text-idx?SID=d9a7851186785ba2b1896db79b1b6b29&mc=true&tpl=/ecfrbrowse/Title48/48tab_02.tpl

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

E.2.3 Procedures

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

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

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

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

COR shall determine how much time is reasonable.

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

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

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

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

(i) The COR will document all communications with the Contractor and maintain on file all complaints valid and not valid.

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SECTION F

DELIVERIES OR PERFORMANCE

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

THE FOLLOWING FEDERAL ACQUISITION REGULATION CLAUSES ARE

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 01 January, 2024 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

Embassy of the United States of America, Abu Dhabi, United Arab Emirates

As an alternative, the contractor may deliver password-protected information by email to the

Contracting Officer’s Representative.

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

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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 Specialist.

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 United Arab Emirates Dirhams (AED).

G.4 SUBMISSION OF INVOICES AND PAYMENT

G.4.1. Invoices for U.S. Government employees shall be submitted via email to the Financial

Management Center at USMissionUAEInvoices@state.gov with a copy to the COR. Hard copies of invoices will not be accepted. To constitute a proper invoice, the invoice shall include all the items required by FAR 32.905(e). The Contractor shall show Value Added Tax (VAT) as a separate line item on invoices submitted for payment.

mailto:USMissionUAEInvoices@state.gov

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Note: All payment status inquiries shall be forwarded directly to ADDisbursingOffice@state.gov in case no payment update is received from the Embassy within 30 days after the date of invoice submission.

Payments at End of Covered Period

G.4.2. The Contracting Officer will issue a task order as soon as possible after contract award to identify all employees to be covered by the insurance described in this contract and the coverage selected by each employee, including eligible dependents to be covered.

The COR will make subsequent additions or deletions to this list in writing and provide the revised list to the Contractor. If any changes have been made to the coverage listing, the

Contracting Officer anticipates issuance of a new task order on quarterly basis. This new task order will include all changes made since the previous task order was issued and will include any increase or decrease in necessary funding. The changes to the list of eligible individuals will supersede the initial list provided under prior task orders. Task orders will indicate the effective date of employment, for purposes of calculating the premium due.

All funds under this contract will be obligated by issuance of task orders, as described above. Each task order will be funded with a specific period of time and number of employees, and the task orders will be issued on quarterly basis.

The Contractor may submit invoices on monthly basis, but the payments will be made on semi-annual basis. Each year, 1st payment will be made in the last week of January and 2nd payment will be made in the last week of July. All the necessary adjustments (additions/deletions) will be made at the end of each contract year upon receipt of final invoice/Statement of Account. The final invoice/Statement of Account will be processed within two weeks’ time upon verification/scrutiny of all adjustments.

G.4.3. U.S. Government Employees. The Government shall make payments directly to the

Contractor for all Government employees, whether or not the employee is contributing to the basic premium amount.

G.4.4 Riders:

a. ORE. The Chief of Mission and 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.

b. AEEA Staff. The American Employee Association will make payment directly to the contractor for the entire premium amount of the AEEA employee, whether or not the

AEEA employee is contributing to the premium amount.

mailto:ADDisbursingOffice@state.gov

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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.

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SECTION H

SPECIAL CONTRACT REQUIREMENTS

H.1 SECURITY: On occasion, a contractor employee may require entry into U.S.

Government-owned or -operated facilities. If so, the Contractor should be prepared to provide the necessary identification to permit escorted access within that facility.

H.2 STANDARDS OF CONDUCT: The Contractor shall maintain satisfactory standards of employee competency, conduct, cleanliness, appearance, and integrity and shall be responsible for taking such disciplinary action with respect to employees as may be necessary. Each

Contractor employee is to adhere to standards that reflect credit on themselves, their employer, and the United States Government.

H.3 ORDERING PROCEDURES: The Government will issue a task order as soon as possible after contract award to identify all employees to be covered by the insurance described in this contract and the coverage selected by each employee, including dependents to be covered.

The COR will make subsequent additions or deletions to this list in writing and provide the revised list to the Contractor. All such revisions shall be consolidated, and a new or modified task order will be issued by the Contracting Officer. If any changes have been made to the coverage listing, the Government anticipates issuance of a new task order on a [ ] monthly, [X] quarterly basis, [ ] semi-annual basis. This new task order will include all changes made since the previous task order was issued and will include any increase or decrease in necessary funding.

The changes to the list of eligible individuals will supersede the initial list provided under prior task orders without prejudice to the ineligibility clause. Task orders will indicate the effective date of employment, for purposes of calculating the premium due.

H.3.1. The ORE staff are under separate riders are not included under the task orders issued by the Contracting Officer. Because their coverage is under a rider, their employer are themselves are responsible for directly interacting with the Contractor to order any coverage. When contacted, the Contractor shall advise the person of the paperwork and payment that will be necessary to order coverage for the identified individuals. The Contractor may be contacted by more than one individual.

H.4. CONTRACTOR RESPONSIBILITY IN CLAIMS AND REIMBURSEMENT TO

CLAIMANTS

General.

The Contractor shall be responsible for all planning, estimating, programming, project management, scheduling, dispatching, supervision, and inspection of work. The Contractor shall maintain his own reference library of technical reference works and local laws and regulations, including current tariffs and registries. The Contractor shall treat the information provided by the Embassy concerning employee' personal data, medical information, and salaries as highly sensitive and not divulge any employee information to unauthorized persons. The Contractor shall establish procedures for handling medical insurance claims as follows:

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(a) Administrative Records:

(1) The Contractor shall maintain medical insurance files for each covered employee and each covered dependent including receipts and proof of paid claims, requests for claim reimbursements, and accounting of paid benefits with balances of amounts remaining in the annual per person reimbursement ceiling.

(2) The Contractor shall provide the COR with the necessary claim forms for each type of benefit that can be claimed under the contract. These forms shall specify a list of documents required to be appended to each claim and otherwise provide instructions for claim filing.

(3) The Contractor shall use the English spelling of the employees' names in all transactions, including reimbursement checks.

(4) The Contractor shall send employee claim reimbursement checks to employees not later than two weeks after a claim is submitted.

(b) Medical Insurance Claims: Settlement of medical insurance shall be completed as follows:

(1) All medical claims shall be submitted directly to the Contractor by employees or by the medical service providers on the employee’s behalf.

(2) The Contractor shall date stamp and screen all claims submitted on the day of receipt. If there are any missing documents or information thereby disallowing said claim to be payable, the Contractor shall notify the employee within two days.

(3) The Contractor shall settle the claims no later than two weeks from the date the claim is submitted to the Contractor.

(4) Settlement shall be by issuance of Electronic Funds Transfer (EFT) or checks in the name of the employee for each claim submitted. Each EFT/check shall be accompanied by a form providing details of the amount reimbursed with an explanation of deductions, if any.

(5) The Contractor shall accept the employee's or dependent's choice to go for surgery to hospitals designated by the Contractor in order that the Contractor will pay the expenses directly to the hospitals.

H.5. REPORT REQUIREMENTS

The Contractor shall provide the following monthly report. The report shall be received by the

COR no later than the 10th day of each month. The report shall report on the previous month's activities.

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(a) Employee Claims Report. The report shall list all claims paid by the Contractor to a claimant, including the name of the claimant, date claim is received by the Contractor, and the amount claimed. This report shall also include all outstanding and rejected claims and a brief description of why claim has not been paid. The report shall not include any claims information for riders.

H.6. MISCELLANEOUS CONTRACTOR REQUIREMENTS

H.6.1. General. The Contractor shall take all such steps as are necessary, and obtain and pay for all permits, taxes and fees as are required by the UAE government to establish and/or operate a commercial venture locally. A contract with the U.S. Government conveys no special privileges or immunities to the Contractor. The Contractor is an independent commercial concern and not a part of the U.S. mission. The Contractor's employees are not U.S.

Government employees. Registration of this contract with the UAE government, if required by law, will be the sole responsibility of the Contractor, and any fees, taxes, or other duties shall be payable by the Contractor without recourse to the Government of the amounts thereof.

H.6.2. Licenses and Local Laws. The Contractor shall possess all permits, licenses, and any other appointments required for the prosecution of work under this contract, all at no additional cost to the Government. The Contractor shall perform this contract in accordance with local laws.

H.7 ERRONEOUS PAYMENTS

If the Government becomes eligible for a refund of payment because of erroneous overpayment or other cause, the Contractor shall refund the amounts or use them to offset future payments owed by the Government, whichever the Government prefers. The Contractor shall refund any refunds not complete or discovered after the completion date of this contract.

H.8 REQUIRING ACTIVITY

The requiring activity under this contract is the U.S. Embassy, Abu Dhabi.

H.9 ONLINE RESOURCES REQUIREMENTS

The Contractor is required to make the following resources available:

a) On-line tools available to the COR to administer the group plan and obtain information

(e.g., plan changes, enrollments and termination, billing, reporting, forms, booklets, invoices, etc.);

b) On-line tools and mobile app available to employees to obtain claims information (e.g., submit claims, view claims information/history, access booklet and coverage card, access network providers list, update personal information, complete a wellness assessment, etc.);

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c) Communication information available to the COR (e.g., legislative changes, benefit trends, fraud prevention, health and wellness, cost-saving tools, new services and products, and other subjects.)

d) Communication/education available to employees (e.g., the impact of legislative changes on their coverage, changes in claims and administrative processes, fraud prevention, managing plan costs, managing their health and other benefit and wellness topics.

e) Customer service available to the COR and employees (e.g., toll-free, on-line, bilingual, from coast to coast from experienced and courteous staff).

H.10 ACCOUNT MANAGEMENT TEAM REQUIREMENTS

The Contractor is required to provide the insurance carrier’s dedicated account management team, which must be knowledgeable about all general areas of benefits, as well as have in-depth knowledge of the claims adjudication process, and be capable of providing support regarding administrative/ contractual issues and enquiries.