9523ZY-20-R-0001 - Solicitation - Final.pdf

U.S. COMMODITY FUTURES TRADING COMMISSION

Three Lafayette Centre 1155 21st Street, NW, Washington, DC 20581

Telephone: (202) 418-5180 Facsimile: (202) 418-5529

Financial Management Branch

Request for Proposals (RFP) No.

9523ZY-20-R-0001

Issuance Date: April 30, 2020

Due Date: June 01, 2020

To Whom It May Concern:

You are invited to submit a proposal in response to the subject RFP for “Dental Insurance Plan for the Commodity Futures Trading Commission”, as described in Part I, “Statement of Work”, of the RFP.

It is the Government’s intent to award one Fixed Unit Price with Economic Price Adjustment contract for this plan. The best value award approach will be utilized by the Government. To ensure a fair and thorough evaluation, your response should be tailored according to the proposal preparation instructions contained in Part III of the RFP, in order to ensure a fair and thorough evaluation of your response.

The due date and time for receipt of proposals is June 01, 2020, at 12:00 p.m. local (Washington, DC) time at the issuing office. Instructions for the proper preparation and submission of your proposal are set forth in Part III of the RFP.

All questions pertaining to this RFP must be received by the Contracting Officer no later than 9:00 a.m. local (Washington, DC) time on May 12, 2020. CFTC expects, but does not guarantee, to answer questions submitted by this time. Questions, if answered, will be responded to in the form of an amendment to this RFP.

All communication in response to the RFP shall be directed to Contracting Officer Kathryn (Kay) Rison, who may be contacted on (202)418-5419 or by e-mail at krison@cftc.gov. Collect calls will not be accepted.

This letter is intended to be an introduction to the RFP, but is not an integral part thereof. In the event of any inconsistency between this letter and the RFP, the RFP shall govern.

Sincerely, Kathryn M. Rison Contracting Officer mailto:krison@cftc.gov

SEE ADDENDUMIS CHECKED

CODE 18a. PAYMENT WILL BE MADE BY

CODE

FACILITYCODE

17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN OFFER

OFFEROR

CFTC-FMB

WASHINGTON DC 20581

1155 21ST STREET NW

THREE LAFAYETTE CENTER

COMMODITY FUTURES TRADING COMM

CFTC-WDC CODE 16. ADMINISTERED BYCODE

X

X

524114

SIZE STANDARD:

% FOR:SET ASIDE:UNRESTRICTED ORCFTC-FMB

RFPIFB

10. THIS ACQUISITION ISCODE

RFQ

14. METHOD OF SOLICITATION

13b. RATING

NAICS:

SMALL BUSINESS

04/30/2020

202-418-5419KATHRYN RISON

(No collect calls)

INFORMATION CALL:

FOR SOLICITATION 8. OFFER DUE DATE/LOCAL TIME

06/01/2020 1200 ET

b. TELEPHONE NUMBERa. NAME

4. ORDER NUMBER3. AWARD/ 6. SOLICITATION

9523ZY20R0001

5. SOLICITATION NUMBER

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS 1. REQUISITION NUMBER PAGE OF

1 69 OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30

TELEPHONE NO.

17a. CONTRACTOR/

WASHINGTON DC 20581

1155 21ST STREET NW

THREE LAFAYETTE CENTER

COMMODITY FUTURES TRADING COMM

15. DELIVER TO

WASHINGTON DC 20581

1155 21ST STREET NW

THREE LAFAYETTE CENTER

9. ISSUED BY

7.

2. CONTRACT NO.

EFFECTIVE DATE

$41.50

18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK BELOW

ISSUE DATE

DELIVERY FOR FOB DESTINA-

TION UNLESS BLOCK IS

MARKED

11.

SEE SCHEDULE

12. DISCOUNT TERMS

THIS CONTRACT IS A

RATED ORDER UNDER

DPAS (15 CFR 700)

13a.

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

HUBZONE SMALL

BUSINESS

8(A)

COMMODITY FUTURES TRADING COMM

WOMEN-OWNED SMALL BUSINESS

(WOSB) ELIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM

EDWOSB

24.

AMOUNT

23.

UNIT PRICE

22.

UNIT

21.

QUANTITY

20.

SCHEDULE OF SUPPLIES/SERVICES

19.

ITEM NO.

"Dental Insurance Plan for the Commodity Futures Trading Commission"

(Use Reverse and/or Attach Additional Sheets as Necessary)

HEREIN, IS ACCEPTED AS TO ITEMS:

X

XX

DATED

KATHRYN RISON

. YOUR OFFER ON SOLICITATION (BLOCK 5),

INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE SET FORTH

COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND DELIVER

ARE

ARE

31c. DATE SIGNED

27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA

31a. UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER)

30c. DATE SIGNED 31b. NAME OF CONTRACTING OFFICER (Type or print)

ALL ITEMS SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND ON ANY ADDITIONAL

SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED.

27a. SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1, 52.212-4. FAR 52.212-3 AND 52.212-5 ARE ATTACHED. ADDENDA

26. TOTAL AWARD AMOUNT (For Govt. Use Only)

OFFER

STANDARD FORM 1449 (REV. 2/2012)

Prescribed by GSA - FAR (48 CFR) 53.212

ARE NOT ATTACHED.

ARE NOT ATTACHED.

AUTHORIZED FOR LOCAL REPRODUCTION

PREVIOUS EDITION IS NOT USABLE

30b. NAME AND TITLE OF SIGNER (Type or print)

30a. SIGNATURE OF OFFEROR/CONTRACTOR

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN

25. ACCOUNTING AND APPROPRIATION DATA

29. AWARD OF CONTRACT:

REF.

32e. MAILING ADDRESS OF AUTHORIZED GOVERNMENT REPRESENTATIVE

32c. DATE 32b. SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE

ACCEPTED, AND CONFORMS TO THE CONTRACT, EXCEPT AS NOTED:

32a. QUANTITY IN COLUMN 21 HAS BEEN

RECEIVED INSPECTED

40. PAID BY39. S/R VOUCHER NUMBER38. S/R ACCOUNT NUMBER

37. CHECK NUMBER

FINALPARTIAL

36. PAYMENT

FINALPARTIAL

35. AMOUNT VERIFIED

CORRECT FOR

34. VOUCHER NUMBER33. SHIP NUMBER

COMPLETE

32g. E-MAIL OF AUTHORIZED GOVERNMENT REPRESENTATIVE

42d. TOTAL CONTAINERS42c. DATE REC'D (YY/MM/DD)

42b. RECEIVED AT (Location)

42a. RECEIVED BY (Print)

41c. DATE41b. SIGNATURE AND TITLE OF CERTIFYING OFFICER

41a. I CERTIFY THIS ACCOUNT IS CORRECT AND PROPER FOR PAYMENT

STANDARD FORM 1449 (REV. 2/2012) BACK

24.

AMOUNT

23.

UNIT PRICE

22.

UNIT

21.

QUANTITY

20.

SCHEDULE OF SUPPLIES/SERVICES

19.

ITEM NO.

32f. TELEPHONE NUMBER OF AUTHORIZED GOVERNMENT REPRESENTATIVE

32d. PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT REPRESENTATIVE

9523ZY-20-R-0001 Page 2

PART I

STATEMENT OF WORK

Dental Insurance Plan for the Commodity Futures Trading Commission

Background

The U.S. Commodity Futures Trading Commission (“CFTC” or “Commission”) was created by Congress in 1974 as an independent agency with the mandate to regulate commodity futures and option markets in the United States. The mission of the Commission is to promote the integrity, resilience, and vibrancy of the U.S. derivatives markets through sound regulation. As part of the Farm Security and Rural Investment Act of 2002 (FSRIA), CFTC received authority to implement pay and benefit parity with other Federal Financial Regulatory Agencies in order to better attract and retain employees.

Following a study of pay and benefits, CFTC implemented a new dental insurance program for employees and their dependents effective July 11, 2004. CFTC employees continue to be eligible for all Federal benefit programs including health, life and retirement.

Purpose

The successful contractor shall administer and insure the CFTC dental insurance plan (“the Plan”).

CFTC’s current census reflects 694 eligible employees who primarily work in Washington, DC; New York, NY; Chicago, IL; and Kansas City, MO. All employees eligible to enroll in the Federal Employees Health Benefits (FEHB) Program (which generally excludes only those on a temporary appointment of less than 90 days) are eligible for dental benefits. Eligible dependents of employees are lawful spouses, including domestic partners of CFTC employees and same-sex spouses, and children up to age 26, and children over age 26 who are incapable of self-support because of a mental or physical disability that began before age 26 (if FEHB expands the definitions of eligible dependents beyond these limits during the contract period, the Plan shall likewise expand its coverage). Of those eligible employees, currently 626 have elected to enroll in the CFTC dental insurance plan. Retirees are not eligible for the Plan and will remain ineligible, despite being covered under FEHB. Appendix A of this Statement of Work summarizes the plan design. CFTC pays the full cost of dental benefits for eligible employees and their enrolled dependents.

Requirements

The Contractor’s products and services shall comply with the Affordable Care Act as well as the Department of Health and Human Services (HHS) Health Insurance Portability and Accountability Act (HIPAA) requirements. The Contractor shall provide CFTC employees with HIPAA certificates of coverage and CFTC-specific HIPAA notices of privacy practices.

The contractor shall, at a minimum, provide the following administrative services for the Plan.

9523ZY-20-R-0001 Page 3

1. Administrative and Enrollment Services

• Administer a dental plan that provides the benefits described in Appendix A of this Statement of Work on a fully-insured, non-participating basis.

• Design, produce and distribute, subject to the approval of CFTC, enrollment forms, claim forms, employee booklets, summary plan descriptions (SPDs), and all other forms required to administer the plan.

• Provide electronic files of the Plan materials (booklets, SPDs, etc.) and fillable forms in a .pdf format to be uploaded to the CFTC Intranet.

• As requested by CFTC, assist in the communication to employees regarding benefits, including initial employee meetings at Headquarters in Washington, DC; Chicago, IL; Kansas City, MO;

and New York, NY.

• Receive initial eligibility data and updates electronically or by hardcopy (CFTC may or may not be able to provide current enrollment data files sufficient to accomplish initial Plan enrollment electronically).

• Provide monthly enrollment reports, included with the monthly invoice. These reports shall account for the covered employees in the plan, including enrollment code, reconciled with the invoice submitted for the reporting period. These reports shall also indicate any employees or other covered individuals that were added or removed during the previous month. Additionally, the reports shall provide the loss ratio for the month being reported, as well as the cumulative loss ratio for the trailing 12-month period. The loss ratio is defined as the actual dental paid claims for covered CFTC employees and dependents divided by the premium paid for the identified time period.

• Meet with CFTC on an as needed basis to review status of overall operation of program.

• Provide a network of dental providers sufficient to cover the CFTC population. (See CFTC

Census Data for required network statistics.)

• Provide an electronic portal where covered employees and eligible individuals may enroll, change coverage, submit documentation, access claim related information and access a list of providers.

2. Claims Processing Requirements

• Adjudicate and process claims, including:

o Processing all claims on a direct claims verification and payment basis.

o Establishing and maintaining a clean turnaround time. (i.e., 90% of claims received are processed in 10 work days or less, and 98% are processed in 15 work days or less.)

9523ZY-20-R-0001 Page 4 o Verifying claim charges are for covered employees and dependents.

o Determining eligibility for benefits.

o Providing Explanation of Benefits (EOB) statements.

o Maintaining current, complete and confidential records for each covered person.

o Maintaining a claims and technical services unit(s) with standard office hours, Monday through Friday (except Federal holidays), and installing a message device to handle calls after business hours or on weekends, located inside of the U.S. The contractor shall provide a toll-free telephone service that has the capability to place calls on hold and queue during peak calling hours.

o Providing for direct communication between CFTC administrative staff and the assigned program administrator.

o Providing legal defense on disputed claims except when a legal action or proceeding alleges conduct on the part of CFTC which gives rise to claims for other than contractual damages.

o Providing effective coordination of claims payment and reporting formats.

o Providing service personnel who are accessible and knowledgeable in all aspects of the Plan.

o Maintaining an automated calendar system to ensure follow-up to correspondence and claims review and establishing a mechanism to resolve errors expeditiously.

• Preparing a customized administrative manual (i.e., policies, procedures, and forms for administering the Plan) to be used by CFTC.

3. Management Information System / Reporting and Monitoring Service Requirements

Provide an annual utilization report including, but not limited to, a breakdown of claims experience by types of service (i.e., total amounts paid and number of claims for each type of service).

4. Phase-Out / Transition of Operations and Cooperation with Successor

The contractor shall perform phase-out activities to transition work to a successor contractor.

Specifically, the contractor shall cooperate with any successor contractor, and perform all actions necessary to transfer operations to ensure full continuity of services. If requested by the Contracting Officer or the Contracting Officer’s Representative (“COR”), the contractor shall submit a transition plan, which addresses certain areas including, but not limited to, specific phase-out milestones, actions that implement cooperation with the successor, and transfer of data to the successor. The contractor shall incorporate all comments received from the Contracting Officer and/or the COR into the transition plan.

9523ZY-20-R-0001 Page 5

Deliverables and Reports

The following table summarizes the required deliverables and reports under this contract.

Deliverable Due Date Claim Forms, Employee Booklets, Summary Plan Descriptions, and all other forms required to administer the plan. (hardcopy and .pdf format)

As required by the Contracting Officer or the Contracting Officer’s Representative.

Enrollment Report Monthly; with invoice submittal.

Customized Administrative Manual December 31, 2020; updates submitted each December 31st thereafter.

Annual Utilization Report January 31, 2021; subsequent reports submitted January 31st following each contract year.

Transition Plan As required by the Contracting Officer or the Contracting Officer’s Representative

All reports shall be submitted to the COR electronically in a format agreeable to the COR (e.g., Word, Excel, PowerPoint, .pdf, etc.). Additionally, a copy of each report shall be provided electronically to the Contracting Officer.

Rest of Page Intentionally Left Blank

9523ZY-20-R-0001 Page 6

Appendix A – Dental Insurance Plan Design

Description of Dental Plan

Eligibility Employees and Dependents

All employees eligible under current (or future, if more expansive) coverage provisions of the Federal Employees Health Benefits (FEHB)

Program (generally excludes those employees on temporary appointments of one year or less)

All dependents eligible under current (or future, if more expansive) coverage provisions of the Federal Employees Health Benefits (FEHB)

Program (generally includes spouses, including domestic partners of CFTC employees and same-sex spouses and children up to age 26)

Children up to age 26.

Children who are incapable of self-support because of a mental or physical disability that began before age 26.

Enrollment

Employees must enroll. Employees not enrolling will not be covered by the Plan.

Employees may make an election change consistent with a qualifying status change during the plan year.

Effective Date of Coverage

New Employee First full pay period following their enrollment election and onboard date.

Employees may elect to enroll up to 60 days after their start date.

Qualifying Life Event

(QLE)

First pay period following QLE. Employees may change or enroll up to 30 days prior to or 60 days after their QLE.

*Status changes follow the guidelines of a QLE as set forth by OPM’s FEHB plan.

Premium Sharing Arrangement CFTC pays full cost of premium

Opt Out Provision Employees may opt out of the Plan at any time. However, to reenroll, employees must submit proof of a QLE, otherwise, must wait until the

FEHB Open Season Risk Arrangement Fully-Insured

Type of Plan Passive Preferred Provider Organization (PPO) – percent of reimbursement is the same if the member goes in- or out-of-network

Eligible Providers Any Licensed Dentist

In- and Out-of-Network

Annual Deductible

Individual $50; not required for Diagnostic & Preventive (Class I) Services Individual + 1 $100; not required for Diagnostic & Preventative (Class I) Services

9523ZY-20-R-0001 Page 7

Description of Dental Plan – continued

Family $150 for 3 or more family members; not required for Diagnostic & Preventive Services

Maximum Reimbursement

Annual (Classes I-III) $3,000 per individual Orthodontia $3,500 Lifetime Limit per individual

Plan Reimbursement

Plan reimburses specified percentage of allowable expenses, based on class of expense. Allowable expenses will be based on the 90th percentile of Usual and Customary. In-network reimbursement will be based on negotiated fee schedules.

Description of Dental Plan (cont.)

In-Network Out-of-Network Diagnostic & Prevention (Class I)

100% of fee schedule 100% of allowable expenses

Covered Services

Periodic oral exam (no more than 2 per calendar year) Additional cleanings for diabetics (2 per calendar year)

Intra-oral and Bitewing x-rays Prophylaxis cleaning with or without oral exam (2 per calendar year) Additional prophylaxis cleanings for diabetics (2 per calendar year)

Periodontal prophylaxis Topical application of stannous fluoride for individual under 19 yrs (1 per calendar year) Space maintainers, fixed, unilateral

Topical application on a posterior tooth for individual under 14 years (sealant)

Emergency pain treatment In-Network Out-of-Network Basic Restorative, Endodontics, Periodontics, Maintenance of Prosthodontics & Oral Surgery (Class II)

80% of fee schedule, after deductible 80% of allowable expenses, after deductible

Covered Services:

General anesthesia Amalgam fillings Silicate cement

Acrylic or plastic filling Composite acrylic resin filling

Root canal therapy

9523ZY-20-R-0001 Page 8

Apicoectomy Gingivectomy or gingivoplasty

Gingival Curettage and Root Planning Osseous surgery

Osseous Graft, Multiple Site Periodontal scaling

Adjustments to dentures (partial denture) Replace broken tooth on complete or partial denture, not in conjunction with other repairs Recement bridge

Simple extractions Surgical extractions (impacted); soft tissue; bone-partial; bone-complete

Biopsy of oral tissue (hard) Biopsy of oral tissue (soft)

Routine post-operative care is considered part of each Dental Service for oral surgery under this Schedule In-Network Out-of-Network Major Restorative, Installation of Prosthodontics (Class III Services)

60% of fee schedule, after deductible 60% of allowable expenses, after deductible

Implants

Covered Services:

Gold inlay fillings Crowns (porcelain) Crowns-cast gold

Complete dentures (upper or lower) Partial dentures

Bridge pontics (cast gold) Bridge pontics (porcelain fused to gold)

Bridge pontics (plastic processed to gold) Abutment crowns (porcelain)

Abutment crowns (porcelain with gold) Abutment crowns (full, cast gold)

In-Network Out-of-Network Orthodontics (Class IV Services) 60% of fee schedule, after deductible 60% of fee schedule after deductible

Covered services: Preliminary study including cephalometric radiographs, diagnostic casts and treatment plan.

9523ZY-20-R-0001 Page 9

First month of active treatment including all active and retention appliances.

Active treatment per month after the first month.

Removable and/or fixed appliance(s) insertion for interception treatment or to control harmful habits (e.g., night guards to control grinding) General Exclusions

Exclusions

No payment will be made for expenses incurred for:

1) Services performed solely for cosmetic reasons.

2) Replacement of a lost or stolen appliance.

3) Replacement of a bridge, crown, denture or mandibular orthopedic repositioning appliance within 5 years after the date it was originally installed unless: (a) such replacement is made necessary by the placement of an original opposing full denture or the necessary extraction of natural teeth; or (b) the bridge, crown, denture or mandibular orthopedic repositioning appliance, while in the mouth, has been damaged beyond repair as a result of an injury received while the covered member is insured for such benefits.

4) Any replacement of a bridge, crown, denture or mandibular orthopedic repositioning appliance that is or can be made useable according to common dental standards.

5) Procedures, appliance or restorations, except for full dentures, whose main purpose is to: (a) alter vertical dimension; (b) diagnose or treat conditions or dysfunction of the temporomandibular joint; (c) stabilize periodontally involved teeth or (d) restore occlusion.

6) Porcelain or acrylic veneers of crowns or pontics on or replacing the upper and lower first, second and third molars.

7) Bite registrations; precision or semi-precision attachments; or splinting.

8) A surgical implant of any type. (However, payment will be made for expenses incurred for prosthetic devices attached to an implant.)

9) Instruction for plaque control, oral hygiene and diet.

10) Dental services that do not meet common dental standards.

11) Services that are deemed to be medical services.

12) Services and supplies received from a hospital.

13) Services for which benefits are not payable according to the "General Limitations" section.

14) Any adjustment or repair to a denture performed within six months of the installation of the denture

9523ZY-20-R-0001 Page 10

Other Exclusions

General Limitations No payment will be made for expenses incurred:

1) For missing teeth except that the amount payable for replacement of teeth missing on the date an individual becomes insured will be 100% of the amount otherwise payable. (No limitation. Reflects the Contractor’s proposal deviation.)

2) For or in connection with an injury arising out of, or in the course of, any employment for wage or profit.

3) For or in connection with a sickness which is covered under any workers' compensation or similar law.

4) For charges made by a hospital owned or run by the United States

Government.

5) To the extent that payment is unlawful where the employee or dependent resides when the expenses are incurred.

6) For charges which the employee or dependent is not legally required to pay.

7) For charges which would not have been made if the employee or dependent had no insurance.

8) To the extent that they are more than Reasonable and Customary.

9) For charges for unnecessary care, treatment or surgery.

10) To the extent that the employee or dependent is in any way paid or entitled to payment for those expenses by or through a public program, other than Medicaid.

11) For or in connection with experimental procedures or treatment methods not approved by the American Dental Association or the appropriate dental specialty society.

12) Services to the extent the covered person is compensated for them under any automobile insurance policy Other General Limitations

Coordination of Benefits

This plan is primary for employees. The “Birthday Rule” applies to dependent children when parents have another contract for dental benefits that limits total payments to 100% of allowable expenses.

Other Coordination of Benefits

Termination of Insurance

Coverage will terminate on the last day of the month in which an employee separates from employment with the CFTC or when the group policy terminates, whichever happens first.

9523ZY-20-R-0001 Page 11

Approved Leave Without Pay: Insurance will be continued for up to 12 months while employee is in a non-pay status.

Completion of Existing Treatment: This Program provides coverage for a dental service rendered within three months after termination of insurance or employment, whichever occurs first, provided the service was started before the termination date. All services started after the termination date, including Orthodontia, are not payable.

Other Termination of Insurance

Retirement Coverage not continued.

Rest of Page Intentionally Left Blank

9523ZY-20-R-0001 Page 12

PART II

ADDITIONAL TERMS AND CONDITIONS / CONTRACT CLAUSES

1. FIXED UNIT PRICES FOR SERVICES

The following fixed unit prices for servicing the dental insurance policies shall apply for the duration of the contract.

CLIN

DESCRIPTION

QUANTITY

UNIT PRICE

TOTAL AMOUNT

BASE PERIOD

(date of award thru 01/02/21)

The contractor shall implement the Dental Insurance Plan for the Commodity Futures Trading Commission and train staff.

1 Job

NOT-TO-EXCEED

AMOUNT

OPTION PERIOD I

(01/03/2021 – 12/31/2021)

Dental Benefits in accordance with Part I, Statement of Work

(SOW).

12 Months

Plan Coverage

Estimated Number of Employees*

Unit Price

Fixed Unit Price (Self Only) 210 $ Fixed Unit Price (Self plus One) 110 $ Fixed Unit Price (Self & Family) 374 $

OPTION PERIOD II

(01/01/2022 –12/31/2022)

Dental Benefits in accordance

9523ZY-20-R-0001 Page 13

Employees *

Fixed Unit Price (Self Only) 210 $ Fixed Unit Price (Self plus One) 110 $ Fixed Unit Price (Self & Family) 374 $

OPTION PERIOD III

(01/01/2023 – 12/31/2023)

Dental Benefits in accordance

Fixed Unit Price (Self Only) 210 ** Fixed Unit Price (Self plus One) 110 ** Fixed Unit Price (Self & Family) 374 **

OPTION PERIOD IV

(01/01/2024 –12/31/2024)

Dental Benefits in accordance

9523ZY-20-R-0001 Page 14

OPTION PERIOD V

(01/01/2025 – 12/31/2025)

Dental Benefits in accordance

OPTION TO EXTEND

SERVICES

Subject to Clause II.5

Dental Benefits in accordance

Not-to-Exceed 6 Months

TOTAL VALUE OF THE CONTRACT (base plus all option periods)

*The number of persons likely to enroll in the dental plan is estimated. Contract Option Periods I and II dental premiums are fixed unit prices. Population fluctuations may occur. In the event the actual number of employees in any category exceeds a 20% variance from the estimated levels of participation, either party may request an adjustment to the respective Fixed Unit Price(s). Any requested adjustments resulting from exceeding the variance will be negotiated to ensure the modified Fixed Unit Prices are fair and reasonable. The incorporation of any adjustment to the Fixed Unit Prices is not guaranteed.

** Except in the event the number of employees in any category exceeds a 20% variance, the unit prices for Contract Option Periods I and II shall not be subject to price adjustment. However, the unit prices for Contract Option Periods III, IV, V and Option to Extend Services shall be determined in accordance with clause II.2 “Economic Price Adjustment – Contract Option Periods III, IV, V, and Option to Extend

9523ZY-20-R-0001 Page 15

Services Premiums” of this contract and may be adjusted in accordance with the 20% variance in actual number of employees in a given category.

2. ECONOMIC PRICE ADJUSTMENT – CONTRACT OPTION PERIODS III, IV, V AND

OPTION TO EXTEND SERVICES PREMIUMS

The prices for Contract Option Periods III, IV, V, and Option to Extend Services shall be established based on the claims experience of the Plan. These prices may represent an increase or decrease from the respective prior period, as they will be determined by the contractor’s demonstrated loss ratio. The demonstrated loss ratio is defined as the actual dental paid claims for covered CFTC employees and dependents divided by the premium paid for the identified time period. The unit prices (i.e., Self Only, Self Plus One and Self & Family) for the applicable contract period shall be determined by applying the appropriate unit price change percentage in the below tables to the unit prices of the respective prior period.

The data used to calculate the loss ratio shall be taken from the contractor’s monthly enrollment reports for the previous period of November 1st through October 31st. The Contracting Officer may require the contractor to provide additional information to support the accuracy and reliability of the data in these reports. The Government reserves the right to have an independent third party review the data and make recommendations regarding the appropriateness of the proposed unit prices. The determination of the adjusted unit prices shall be made by the Contracting Officer on a unilateral basis. Any dispute regarding the determination (i.e., the appropriate unit price change percentage) shall be subject to the “Disputes” provisions of clause 52.212-4, “Contract Terms and Conditions–Commercial Items” of this contract.

The following table shall be used to calculate the prices for Contract Option Period III, Option Period IV, Option Period V and the Option to Extend Services.

Loss Ratio Unit Price change percent 75% or less 76% to 80% 81% to 85% 86% to 90% 91% to 95% 96% to 100% 101% or more

Note: The loss ratio will be rounded to the nearest whole number for purposes of calculating the EPA.

3. PERIOD OF PERFORMANCE

The phase-in period of performance of this contract shall be from the effective date of award through January 2, 2021.

9523ZY-20-R-0001 Page 16

4. OPTION TO EXTEND THE TERM OF THE CONTRACT

(a) The Government may unilaterally extend the term of this contract by the Contracting Officer giving written notice of renewal (a modification to the contract) to the contractor within sixty (60) days prior to contract expiration; provided that the Contracting Officer shall give the contractor preliminary notice of the Government’s intention to extend at least thirty (30) days before the contract expires.

(b) The preliminary notice does not commit the Government to an extension. Should the Government exercise an option(s) hereunder, all contractual ceilings, terms, or conditions in force shall apply during the option(s) period(s).

(c) Exercise of the option(s) cited shall be in accordance with the term and prices set forth in clause II.1

“Fixed Unit Prices for Services” of this contract.

5. OPTION TO EXTEND SERVICES

The Government may require continued performance of any services within the limits and at the rates specified in the contract. These rates may be adjusted only as a result of the repricing terms described in Clause II.2 “Economic Price Adjustment – Contract Option Periods III, IV, V and Option to Extend Services Premiums.” The option provision described in this clause may be exercised more than once, but the total extension of performance hereunder shall not exceed 6 months. The Contracting Officer may exercise the option by written notice to the Contractor within 30 days prior to contract expiration (i.e., Option Period V).

6. ELECTRONIC INVOICING AND PAYMENT REQUIREMENTS – DENTAL BENEFITS

The requirements of the Prompt Payment Act, P.L. 97-177, as reflected in the clauses incorporated into the contract (e.g., FAR clauses 52.232-25, Prompt Payment, and 52.212-4, Contract Terms and Conditions--Commercial Items) apply to this contract.

The first invoice shall be submitted at the successful completion of the Base Period. Monthly invoices shall be submitted thereafter. Monthly invoices shall be submitted at the beginning of the month using actual population and enrollment information for the respective month and applying the applicable fixed unit prices in Clause II.1 Fixed Unit Prices. Additionally, the monthly invoice shall include any new enrollments or change in plans based on a qualifying life event that occurred but was not previously invoiced in the prior month. The contractor shall pro-rate the fixed unit prices for any new enrollments or change in plans based on a qualifying life event that occurred in the previous month when determining the amount to be invoiced. Payment requests (i.e., invoices) shall be submitted electronically through the Delphi eInvoicing system via Login.gov on a monthly basis for processing and payment. The CFTC’s Delphi eInvoicing system is managed by the Department of Transportation’s Enterprise Services Center (ESC).

https://login.gov/

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Upon contract award, the contractor shall provide an invoicing point of contact to the Contracting Officer as follows:

• First and Last Name

• Email Address (not a centralized email address)

• Phone Number

The contractor shall notify the Contracting Officer of changes to the above information within ten (10) days after the change.

The contractor shall access the eInvoicing System using the following link:

http://einvoice.esc.gov/

If the contractor requires assistance with the eInvoicing system, they may contact the ESC help desk:

ESC Help Desk for the Delphi eInvoicing System

• Business Hours: 8:00am to 7:00pm

• 1-866-641-3500

7. F.O.B. POINT

Delivery of any and all items under this contract shall be shipped F.O.B. destination.

8. CONTRACTING OFFICER

For the purpose of this contract, the Contracting Officer is:

Kathryn (Kay) Rison Commodity Futures Trading Commission Financial Management Branch 1155 21st Street, NW Washington, DC 20581 Phone: (202)418-5419 E-Mail: krison@cftc.gov

9. CONTRACTING OFFICER’S REPRESENTATIVE

For the purpose of this contract, the Contracting Officer’s Representative is:

(to be determined at time of award) http://einvoice.esc.gov/ mailto:krison@cftc.gov

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10. TECHNICAL DIRECTION AND SURVEILLANCE

(a) Performance of work under this contract shall be subject to the surveillance and written technical direction of the Contracting Officer’s Representative (COR). The term “technical direction” is defined to include:

(1) Directions to the contractor that provide clarification of the requirements described in the Statement of Work.

(2) Inspection and acceptance of deliverables completed by the contractor under this contract.

(b) The COR does not have authority to, and may not, issue any technical direction which:

(1) Assigns additional work outside the scope of work for the contract;

(2) Constitutes a change as defined in the contract clause(s) that address “changes”;

(3) In any manner causes an increase or decrease in the contract price or the time required for performance;

(4) Changes any of the expressed terms, conditions or specifications of the contract; or

(5) Interferes with the contractor’s right to perform the terms and conditions of the contract.

(c) All technical direction shall be issued in writing by the COR. The contractor shall proceed promptly with the performance of technical directions duly issued by the COR in the manner prescribed in this clause and within his/her authority under the provisions of this clause. If, in the opinion of the contractor, any instruction or direction by the COR would increase or decrease the cost of the contract or result in work outside the scope of this contract, the contractor shall not proceed but shall immediately notify the Contracting Officer in writing. It is anticipated that within 30 days of receiving the notification from the contractor, the Contracting Officer will either issue an appropriate contract modification or advise the contractor in writing that:

(1) The technical direction is rescinded in its entirety;

(2) The technical direction is within the scope of the contract, does not constitute a change as defined in the contract clause(s) that address “changes” and that the contractor should continue with the performance of the technical direction.

(d) A failure of the contractor and Contracting Officer to agree that the technical direction is within scope of the contract, or a failure to agree upon the contract action to be taken with respect thereto, shall be subject to the “Disputes” provisions of clause 52.212-4, “Contract Terms and Conditions– Commercial Items” of the contract.

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(e) Any action(s) taken by the contractor in response to any direction given by any person other than the Contracting Officer or the COR whom the Contracting Officer shall appoint shall be at the contractor’s risk.

11. NON-DISCLOSURE OF CONFIDENTIAL INFORMATION – DENTAL INSURANCE

PLAN

(a) As used in this clause, “confidential information” means information obtained during performance of the contract that is private or confidential in nature, and which is not meant for public disclosure.

Examples of “confidential information” include, but are not limited to, investigatory materials, sensitive or proprietary procurement, business, technical, financial or personally identifiable information (PII) belonging to the Government, other companies or individuals in paper or electronic form, including but not limited to home addresses or personal contact information, full or partial social security numbers, credit card numbers, date of birth, passport numbers, employee performance or evaluation information, or any information related to a security adjudication of any CFTC employee or contractor.

(b) Procurement confidential information may be disclosed only to CFTC and contractor personnel directly concerned with the performance of the contract and who have a need to know such information to perform their assigned duties. It may be disclosed to no other parties, including CFTC and contractor personnel that do not have a need to know, and any and all other non-CFTC parties. Procurement confidential information includes but is not limited to information contained on CFTC requisitions and the documents attached thereto; Independent Government Cost Estimates and budgets pertaining to acquisitions and existing CFTC contracts; the content of existing CFTC contracts, whether derived directly from the contract itself or from other sources; contractor bid and proposal information, including technical and cost/price information; the number of bids or proposals received in response to solicitations; the content of CFTC Technical Evaluation Plans and Source Selection Plans; technical and cost or price evaluations of proposals; competitive range and phase 2 determinations; ranking of bids, proposals or competitors; reports and evaluations of source selection panels, boards, and advisory councils; and other information marked “Source Selection Information.”

(c) Pursuant to the Commodity Exchange Act, as amended (7 U.S.C. § 1, et. seq.), other laws and the terms and conditions of this contract, the contractor agrees to use confidential information only for the purposes of performing work under this contract, and to otherwise hold such information confidential. The contractor shall not directly or indirectly use or allow the use of or access to confidential information for any purpose other than that directly associated with officially assigned duties, and shall not, either by direct action or by counsel, discussion, recommendation, or suggestion to any third party, reveal the nature or content of any confidential information. The contractor shall take appropriate steps to secure both paper and computer files and access to same to protect confidential information, shall lock paper records in cabinets or offices when not in use, shall only electronically transmit confidential information in encrypted form in compliance with CFTC policies and procedures, and shall dispose of paper records by shredding or similar means of secure destruction.

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(d) If disclosure of confidential information to a third party is determined to be necessary by the Commission, the contractor shall first obtain written authorization from the Contracting Officer prior to disclosing the confidential information. The contractor shall continue to comply with this clause after expiration of this contract.

(e) The contractor shall comply with the Privacy Act of 1974, 5 U.S.C. § 552a, the Federal Information

Security Management Act (FISMA), 44 U.S.C. § 3541 et seq., the Procurement Integrity Act, 41 U.S.C. § 423 as amended, and related regulations, shall use administrative, technical and physical security measures to protect CFTC confidential information from unauthorized access, disclosure and misuse.

(f) Within thirty (30) days of the conclusion of all services under the contract, the contractor shall securely destroy or return to the CFTC all CFTC confidential information, at the CFTC’s election, except that the contractor may retain one (1) copy of records related to the procurement process and written deliverables if necessary for the contractor’s recordkeeping purposes. If the CFTC elects for the contractor to destroy the CFTC confidential information, the contractor shall confirm secure destruction in writing within thirty (30) days of the CFTC’s request.

(g) In the event of an incident involving the loss, compromise or unauthorized disclosure, real or potential, of PII, the contractor shall report the incident to the COR immediately and no later than one (1) hour upon discovery of the incident, and if the COR cannot be immediately reached, to the CFTC Chief Information Security Officer and Chief Privacy Officer. In the event of an incident involving the loss, compromise or unauthorized disclosure, real or potential, of procurement confidential information, the contractor shall report the incident to the Contracting Officer and COR immediately and no later than one (1) hour upon discovery of the incident. The contractor shall cooperate with CFTC personnel in handling any investigation of the incident and mitigating risks of similar future incidents.

12. ORGANIZATIONAL CONFLICTS OF INTEREST (OCI)

(a) The contractor warrants that to the best of its knowledge and belief, and except as otherwise disclosed, it does not have any organizational conflict of interest, which is defined in FAR Subpart

9.5 as a situation in which the nature of work under a Government contract and a contractor’s organizational, financial, contractual or other interests are such that:

1. Award of the contract may result in an unfair competitive advantage; or

2. The contractor’s objectivity in performing the contract work is or might be otherwise be impaired.

(b) The contractor agrees that if after award it discovers an organizational conflict of interest with respect to this contract, it shall make an immediate and full disclosure in writing to the Contracting Officer, which shall include a description of the action(s) that the contractor has taken or intends to take to mitigate, eliminate, or neutralize the conflict.

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(c) The provisions of this clause shall be included in all subcontracts and consulting agreements wherein the work to be performed is similar to the service provided by the prime contractor under this contract. The contractor shall include in such subcontracts and consulting agreements any necessary provisions to mitigate, eliminate, or neutralize organizational conflicts of interest.

(d) The Contracting Officer has determined, however, that the nature of the work to be performed under this contract may give rise to potential perceived or actual organizational conflicts of interest in future CFTC contracts. Accordingly, the contractor and CFTC have agreed to the following conditions:

1. The contractor shall not be required to develop specifications or statements of work that are to be incorporated into any CFTC solicitation; and

2. The contractor shall not be provided any Government cost estimates, source-selection information, or third-party proprietary technical or cost data.

(e) Additionally, the contractor understands that for any related follow-on contract, it may be required to provide a statement which describes concisely all relevant facts concerning any past, present or planned interest (financial, contractual, organizational, or otherwise) relating to the work to be performed under the proposed contract and bearing on whether the offeror has a possible organizational conflict of interest with respect to:

1. Being able to render impartial and objective assistance or advice; or

2. Being given an unfair competitive advantage. The offeror may also provide relevant facts that show how its organizational structure and/or management systems limit its knowledge of possible organizational conflicts of interest relating to other divisions or sections of the organization and how that structure or system would avoid or mitigate such actual or perceived organizational conflict.

The contractor understands that no award shall be made until any potential conflict of interest has been neutralized or mitigated to the satisfaction of the Contracting Officer, or unless a waiver has been granted.

13. INHERENTLY GOVERNMENTAL FUNCTIONS

No inherently government functions as defined in FAR 2.101 and FAR 7.5 shall be performed by the contractor under this contract. Contractor employees shall not participate in any deliberations or meetings intended to exercise an inherently governmental function. All final determinations such as binding the United States to take or not to take some action, selecting program priorities, and providing direction to Federal employees shall be made by the Government. The contractor shall immediately notify the Contracting Officer’s Representative and the Contracting Officer if performance of an activity would result in the performance of an inherently governmental function.

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14. NON-PERSONAL SERVICES CONTRACT

In accordance with FAR 37.101, this contract is a non-personal services contract. Contractor personnel rendering the services shall not be subject, either by the contract's terms or by the manner of its administration, to the continuous supervision and control of a Government officer or employee. The contractor shall immediately notify the COR and the Contracting Officer if, through contract administration, the actions of a government employee will result in the performance of personal services as described in FAR 37.104.

15. LIABILITY

The contractor shall be responsible for all liabilities which result from willful misconduct, gross negligence, or lack of good faith on the part of any of its officers and employees. Such liability is not restricted by any dollar limitations.

16. MINIMUM INSURER FINANCIAL RATING / PREMIUM SIZE

The prime contractor shall be an insurance carrier responsible for the creation and management of the insurance products covered under this contract. The prime contractor shall maintain at least one of the following minimum insurer financial ratings during the life of this contract: A.M. Best: B+ ; Standard & Poor’s or Fitch: BBB ; or Moody’s: Baa2. If a prime contractor is rated by more than one of these rating organizations, each rating shall at least meet the above minimums. In lieu of being rated by one or more of these financial agencies, the contractor must have an annual premium volume of $1 billion or more as documented in the contractor’s annual report.

17. POLICY CHANGES MANDATED BY STATE INSURANCE LAWS OR OTHER

GOVERNMENTAL ENTITIES

The contractor agrees to abide by all terms and conditions of this contract. The mutually agreed upon terms of the policy and certificate of insurance will govern all matters of insurance.

Any future change to the terms and conditions of the contractor’s normal policies mandated by State Insurance laws or other governmental entities shall be brought to the Contracting Officer’s attention as soon as they are known to the contractor. These changes shall be discussed and accommodated within the CFTC contract as agreed to by both parties. In the unlikely event mutual agreement cannot be reached, the “Disputes” provisions of clause 52.212-4, “Contract Terms and Conditions–Commercial Items” of this contract shall be used to resolve.

18. IT SYSTEMS AND SUPPORT SERVICES CONTRACT REQUIREMENTS

General All contractors and contractor personnel shall be subject to the same Federal laws, regulations, standards and CFTC policies as CFTC, and CFTC personnel, regarding information and information systems

9523ZY-20-R-0001 Page 23 security. Contractors must follow policies and procedures outlined in CFTC IT Security Program to ensure appropriate security controls are in place.

Access to CFTC Information and CFTC Information Systems A contractor shall request logical (technical) and/or physical access to CFTC information and CFTC information systems for employees, subcontractors, and affiliates only to the extent necessary: (1) to perform the services specified in the contract, (2) to perform necessary maintenance functions for electronic storage or transmission media necessary for performance of the contract, and (3) individuals must satisfy the same conditions, requirements and restrictions comparable to CFTC employees in order to access the same type of CFTC information.

All contractors and subcontractors working with CFTC information are subject to the same investigative requirements as those of regular CFTC appointees or employees who have access to the same types of information. Contractors are responsible for screening their employees. Furthermore, contract personnel who require access to national security programs must have a valid security clearance.

National Industrial Security Program (NISP) was established by Executive Order 12829 to ensure that cleared U.S. defense industry safeguards the classified information in their possession while performing work on contracts, programs, bids, or research and development efforts. Defense Security Service (DSS) administers the NISP on behalf of the Department of Defense and 23 other federal agencies within the Executive Branch. CFTC will verify clearance through DSS.

CFTC Information Custodial Requirements Information made available to the contractor by CFTC for the performance or administration of this contract or information developed by the contractor in performance or administration of the contract shall be used only for those purposes and shall not be used in any other way without the prior written agreement of the contracting officer.

CFTC information will not be co-mingled with any other data on the contractors/subcontractors information systems/media storage systems in order to ensure CFTC requirements related to data protection and media sanitization can be met. CFTC also reserves the right to conduct IT resource inspections to ensure data separation and on-site inspection of information destruction/media sanitization or disposal procedures to ensure they are in compliance with CFTC policy requirements.

Prior to termination or completion of this contract, contractor will not destroy information received from CFTC or gathered or created by the contractor in the course of performing this contract without prior written approval by the CFTC contracting officer.