Amendment_001_US_Embassy_Caracas_Health_and_Life_Insurance_2018_FINAL.docx

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

1. CONTRACT ID CODE

PAGE OF PAGES

1/7

2. AMENDMENT/MODIFICATION NO.

3. EFFECTIVE DATE

July 9, 2018

4. REQUISITION/PURCHASE REQ. NO.

5. PROJECT NO. (If applicable)

6. ISSUED BY CODE

7. ADMINISTERED BY (If other than Item 6) CODE

Department of State American Embassy General Services Office Caracas, Venezuela

8. NAME AND ADDRESS OF CONTRACTOR (NO., street,city,county,State,and ZIP Code)

9a. AMENDMENT OF SOLICITATION NO.

19VE3018R0005

9b. DATED (SEE ITEM 11) May 04 2018

10a. MODIFICATION OF CONTRACT/ORDER NO.

10b. DATED (SEE ITEM 13)

11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS

Offers must acknowledge receipt of this amendment prior to the hour and date specified in the solicitation or as amended, by one of the following methods: (a) By completing Items 8 and 15, and returning __3____ copies of the amendment;(b) By acknowledging receipt of this amendment on each copy of the offer submitted; or(c) By separate letter or telegram which includes a reference to the solicitation and amendment numbers.

FAILURE OF YOUR ACKNOWLEDGMENT TO BE RECEIVED AT THE PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY RESULT IN REJECTION OF YOUR OFFER. If by virtue of this amendment you desire to change an offer already submitted, such change may be made by telegram or letter, provided each telegram or letter makes reference to the solicitation and this amendment, and is received prior to the opening hour and date specified.

12. ACCOUNTING AND APPROPRIATION DATA (If required)

13. THIS ITEM APPLIES ONLY TO MODIFICATIONS OF CONTRACTS/ORDERS, IT MODIFIES THE CONTRACT/ORDER NO. AS DESCRIBED IN ITEM 14.

C. THIS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO AUTHORITY OF:

D. OTHER (Specify type of modification and authority)

E. IMPORTANT: Contractor [X is not, [ is required to sign this document and return ___ copies to the issuing office.

14. DESCRIPTION OF AMENDMENT/MODIFICATION (Organized by UCF section headings, including solicitation/contract subject matter where feasible.)

The purpose of this amendment is to (1) revise the pricing section for health insurance to add a pricing section for Excess Coverage Benefits, and (2) revise the B.4 economic price adjustment clause.

Except as provided herein, all terms and conditions of the document referenced in Item 9A or 10A, as heretofore changed, remains unchanged and in full force and effect.

Malenereynee G. Carr, CONTRACTING OFFICER

15B. NAME OF CONTRACTOR/OFFEROR

HEALTH AND LIFE INSURANCE COVERAGE

19VE3018R0005

AMENDMENT 0001

JULY 9, 2018

SUMMARY OF CHANGES:

Change #1, Section B.2.2: Addition of Pricing Charts for Excess Coverage.

Change #2, Section B.2.2: Reorganization of Basic Coverage Pricing Charts listing the base year and all option years together.

Change #3, Section B.2.8: Reorganization of Excess Coverage Pricing Charts listing the base year and all option years together.

Change # 4, Section B.4 Revision of Economic Price Adjustment Clause.

Note: Section B.3 Restated for reference only. No changes to Section B.3.

PRICING BASIC COVERAGE

B.2.2 BASE YEAR OF CONTRACT

B.2.3 FIRST OPTION YEAR OF CONTRACT

B.2.4 SECOND OPTION YEAR OF CONTRACT

B.2.5 THIRD OPTION YEAR OF CONTRACT

B.2.6 FOURTH OPTION YEAR OF CONTRACT

PRICING EXCESS COVERAGE

B.2.8 BASE YEAR OF CONTRACT

B.2.9 FIRST OPTION YEAR OF CONTRACT

B.2.10 SECOND OPTION YEAR OF CONTRACT

B.2.11 THIRD OPTION YEAR OF CONTRACT

B.2.12 FOURTH OPTION YEAR OF CONTRACT

B.3 ADMINISTRATIVE RETENTION AMOUNTS

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

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

NOTE TO OFFEROR: Fill in the fixed retention amounts for each period of performance and for each category of premium. This fixed amount must be expressed in dollars. The fixed retention amount shall NOT be expressed in terms of percentage of the premium.

B.3.2 Bi-Weekly Retention Amounts per separate premium paid per single employee and per 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 optional excess health insurance coverage and all riders in B.1.1. No adjustment will be allowed during the first twelve months. After such time, the Contractor or the Government may request an adjustment in premiums on an annual basis. Adjustments are not retroactive to previous contract terms. Before any such adjustment is made, the Contractor agrees to provide the Government a balance sheet showing three main components for the time period: (1) receipts (premiums received) minus the retention amount, (2) number of insurance plans and (3) claims paid. This information shall be provided per type of premium, ie per line item. The retention amount is not subject to adjustment. The Government reserves the right to have an independent third party review the balance sheet and claims and make recommendations regarding the appropriateness of the requested adjustment. Any adjustment shall be subject to mutual agreement of the parties and shall result in a written modification to the contract. Mutually agreed to adjustments shall be effective thirty days after complete information is received by the Government. Any failure to reach agreement under this clause shall be subject to the procedures in the Disputes clause.

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

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

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

Microsoft_Excel_Worksheet1.xlsx Sheet1

B.9 Option Year 4 Prices (Option Term: Twelve (12) Months)

(a) Standard Services. The fixed price for Option Year 4 of the contract is:

Price per Month 12 months Price per Year

X 12

(b) Temporary Additional Services. The hourly fixed rate for temporary additional services is:

Hourly Rate Estimated Number of Hours per Year Ceiling Price per Year

[Note to Contracting Officer: Fill in estimated hours]

(c) Materials or Equipment. The Government will reimburse the Contractor for any materials or equipment that the Government orders to be delivered in conjunction with any order for Temporary Additional Services. All reimbursements shall be at the Contractor's out of pocket cost, with no overhead, profit, or other charge added. [Note to Contracting Officer: You may change material/equipment amount to reflect post needs]

Material/Equipment Not to Exceed per Year: $100.00 [Note to Contracting Officer: Show equivalent in local currency]

Total Not to Exceed Price for Option Year 4 (a + b + c)

Grand Total

B.2.13. Grand Total of Base plus All Option Years

Base Year Total

First Option Year Total

Second Option Year Total

Third Option Year Total

Fourth Option Year Total

Grand Total of Base plus All Option Years

Sheet3 image1.emf

Microsoft_Excel_Worksheet.xlsx Sheet1

B.9 Option Year 4 Prices (Option Term: Twelve (12) Months)

(a) Standard Services. The fixed price for Option Year 4 of the contract is:

Price per Month 12 months Price per Year

X 12

(b) Temporary Additional Services. The hourly fixed rate for temporary additional services is:

Hourly Rate Estimated Number of Hours per Year Ceiling Price per Year

[Note to Contracting Officer: Fill in estimated hours]

(c) Materials or Equipment. The Government will reimburse the Contractor for any materials or equipment that the Government orders to be delivered in conjunction with any order for Temporary Additional Services. All reimbursements shall be at the Contractor's out of pocket cost, with no overhead, profit, or other charge added. [Note to Contracting Officer: You may change material/equipment amount to reflect post needs]

Material/Equipment Not to Exceed per Year: $100.00 [Note to Contracting Officer: Show equivalent in local currency]

Total Not to Exceed Price for Option Year 4 (a + b + c)

Grand Total

B.2.7. Grand Total of Base plus All Option Years

Base Year Total

First Option Year Total

Second Option Year Total

Third Option Year Total

Fourth Option Year Total

Grand Total of Base plus All Option Years

Sheet3 image2.emf