Excerpt_of_Health_Benefits_from_Current_Contract.docx

Excerpt of Health Benefits from Current Contract 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 HR/OE/CM.

C.1.1 Employee and Dependent Health Services Benefits

The health benefits under this contract are as follows. Reimbursement of covered expenses is limited to the stated percentages of reasonable and customary costs. Proposals that contain more benefits (even if there is no increase in cost) or fewer benefits than stated in the solicitation may be deemed technically unacceptable.

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

Basic Coverage: With the exception of expenses incurred under paragraph J. below, the insurance company will reimburse covered expenses up to a limit of Bsf. 2,330,000 per event and per contact year.

For active employees who are regularly scheduled to work 30 or more hours per week: the USG will pay 100% of the premium cost for employee coverage. The USG will pay 100% of the premium cost for coverage of the eligible spouse and children and the .The USG will pay 66% and the employee will pay 34% of the premium cost for coverage of eligible parents.

For active employees who are regularly scheduled to work less than 30 hours per week: the USG will pay 50% of the premium cost and the employee will pay 50% of the premium cost for employee coverage. The employee will pay 100% of the premium cost for dependent coverage.

Excess Coverage: With the exception of expenses incurred under paragraph J. below, the insurance company will reimburse covered expenses up to a limit of Bsf. 6,190,000 per event and per contact year.

For active employees who are regularly scheduled to work 30 or more hours per week: the USG will pay 60% and the employee will pay 40% of the premium cost for employee coverage. The USG will pay 60% and the employee will pay 40% of the premium cost for coverage of the eligible spouse and children. The USG will pay 66% and the employee will pay 34 % of the premium cost for coverage of eligible parents.

For active employees who are regularly scheduled to work less than 30 hours per week: the USG will pay 50% of the premium cost and the employee will pay 50% of the premium cost for employee coverage. The employee will pay 100% of the premium cost for dependent coverage.

C.1.1.1.

The coverage annual amount is Bs.6,000.00 for each member of the group family.

Hospitalization:

100% coverage of room and board expenses for a ward room or semi-private room.

100% coverage of room and board expenses for a private room, not to exceed 100% of the cost of a semi-private room.

100% coverage of hospital medical expenses including laboratory tests and x-rays, nursing care, operating room expenses, intensive care, prescription medicines, and physical therapy.

100% coverage of land ambulance service; air transportation is not covered.

C.1.1.2. Surgery:

100% coverage of surgeons' fees incurred while hospitalized

C.1.1.3. Doctor Visits:

100% coverage of doctors’ fees incurred while hospitalized, at a hospital on an out-patient basis, at a clinic or doctor's office, or at home.

C.1.1.4. Prescription Drugs:

100% coverage of expenses when hospitalized, and 100% coverage of expenses when not hospitalized, of the cost of medicines and drugs for which a prescription is legally required. Expenses incurred for medicines, vitamins, cold remedies, etc., that are available over the counter without a prescription will not be reimbursed even if prescribed by a physician.

C.1.1.5. Maternity:

Obstetrical expenses, including prenatal and postnatal care, are covered 100% with maximums as follows:

Normal Delivery: Maximum: Bs. 33,000 Caesarean Delivery: Maximum: Bs. 33,000 Miscarriage: Maximum: Bs. 31,500 Amniocentesis, checking test (including laboratory tests) of pregnancy status, routine basic exam, and medicines, are included under prenatal care.

Family Planning: not covered

C.1.1.6. Hospital Outpatient Services:

100% coverage of for medical services and expenses when not hospitalized such as laboratory tests and x-rays, prescription medicines, physical therapy, routine annual physical examinations, and home care assistance.

40% coverage for and prescription eyeglass lenses.

Bs. 300 maximum for coverage of expenses for eyeglass frames.

Bs. 400 maximum coverage for contact lenses.

No coverage for nonprescription lenses or tinting

C.1.1.8 Dental Service:

50% coverage of expenses for dental services: preventative, minor and major restorative care, including dentists' fees, x-rays, examination and treatment, cleaning, fillings, extractions, false teeth, crowns, and bridges.

Orthodontia treatment is covered only if treatment is required as the result of an accident.

C.1.1.9. Physical Therapy:

Physiotherapeutic treatment is included as long as it is required for illness, recovering, or for injuries caused by an accident covered by this policy.

C.1.1.10. Psychiatric Treatment:

Not Covered

C.1.1.11. Ambulance Service:

100% coverage of land ambulance service; air transportation is not covered

C.1.1.12. Hearing Aids:

Not covered

C.1.1.13. Expenses Incurred Out-of-Country:

Medical expenses incurred out of country will be covered to a maximum of Bs. 260,000.

C.1.1.14 Funeral services costs:

C.1.1.15 Maximum Limits:

100% coverage, with the exception of expenses incurred under paragraph J above. The insurance company will reimburse covered expenses up to a limit of Bsf. 2,330,000 per event and per contract year for Basic Coverage and Bsf. 6,190,000 per event and per contract year for Excess Coverage.

C.1.2 Health Benefits Conditions and Limitations

Expenses will not be covered for elective cosmetic surgery; spa cures; rejuvenation cures; massage; exercise therapy; long term rehabilitative therapy; eyeglass frames; non-medical hospital charges such as telephones or television; home help, family help, or similar household assistance; fees of persons who are not licensed physicians or nurses; or services or supplies which have not been prescribed or approved by a physician or nurse.

No coverage of will be made for expenses that will be reimbursed or paid directly under a host country medical program, the U.S. workers' compensation program, or any Venezuelan workers' compensation type program.

No coverage of will be made for expenses related to an illness or injury that is a result of an unlawful action on the part of the patient; the practice of a dangerous sport; excessive or illegal use of alcohol or drugs; a self- inflicted wound; or service in the armed forces of any country.

No coverage of will be made for expenses incurred after an employee leaves the service of the U.S. Mission, except in the case of retired employees who elect to continue coverage

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

C.1.3 Eligible Participants

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

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

C.1.3.1.2. Foreign Service Nationals (FSNs) employed under direct hire appointments, Personal Services Agreements (PSAs) and Personal Services Contracts (PSCs);

C.1.3.1.3. Locally hired U.S. citizens employed under direct hire appointments, PSAs, and PSCs.

C.1.3.2 Location of Employment

The individuals covered by C.1.3.1 must be employed within the geographic boundaries of Venezuela by:

Department of State, DAO = Defense Attaché Office, MLGP= Military Group, FAS= Foreign Agriculture Service, APHIS = Animal, Plant, Health and Inspection Service, DEA = Drug Enforcement Agency, FCS= Foreign Commercial Service, DHS = Department for Homeland Security, USAID= U.S. Agency for International Development.

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

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