Attachment 1 Price Proposal Breakdown.xlsx
XLSX spreadsheet 16 KB Posted
- Solicitation number
- 19GE5025R0064
About this file
The file is a Price Proposal Breakdown Excel spreadsheet for a health insurance contract (Solicitation Number 19GE5025R0064) for Locally Employed Staff (LES) at the U.S. Embassy in Brussels, Belgium. The pricing template covers a base year and four option years, with detailed pricing categories for different employee and dependent coverage types, including:
- Coverage tiers include:
- Employee Only (under/over age 66)
- Employee Plus One (spouse/legal partner under/over age 66)
- Family Coverage (dependent children under/over age 21)
- Additional cost components include mandatory yearly taxes (9.25% on hospitalization and outpatient premiums) and mandatory yearly social security charges (10% on hospitalization premiums). The spreadsheet provides estimated quantities for each coverage type, with 295 employees expected for individual coverage under age 66, and varying numbers for other categories. The pricing structure allows for flexible healthcare coverage for locally employed staff and their dependents, with comprehensive options across different age groups and family configurations.
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Sheet1
| 19GE5025R0064 |
| Health Insurance for LES, U.S. Embassy Brussels, Belgium |
PRICE PROPOSAL BREAKDOWN
| BASE YEAR | |||||||
| A | B | C | D | E | F | G | Currency: |
| CLIN | Description | Unit | Quantity* | Month | Rate per month | Amount |
[D x E x F]
| 0001 | Employee Only Coverage under age 66 (One Individual) | EA | 295 | 12 | BASE YEAR | 0.00 | |
| 0002 | Employee Only Coverage over age 66 (One Individual) | EA | 1 | 12 | FIRST OPTION YEAR | 0.00 | |
| 0003 | Employee Plus One Coverage (Dependent Spouse/Legal Partner under age 66) (Two Individuals) | EA | 120 | 12 | SECOND OPTION YEAR | 0.00 | |
| 0004 | Employee Plus One Coverage (Dependent Spouse/Legal Partner over age 66) (Two Individuals) | 2 | THIRD OPTION YEAR | ||||
| 0005 | Family Coverage (Dependent Child under age 21) | EA | 177 | 12 | FOURTH OPTION YEAR | 0.00 | |
| 0006 | Family Coverage (Dependent Child over age 21) | EA | 23 | 12 | |||
| 0007 | MANDATORY YEARLY TAXES 9.25% for CLIN 0001 - CLIN 0006 **: (on hospitalization and outpatient premiums) | EA | 1 | 12 | GRAND TOTAL | 0.00 | |
| 0008 | MANDATORY YEARLY SOCIAL SECURITY CHARGES 10% for CLIN 0001 - CLIN 0006 **: (on hospitalization premium only) | EA | 1 | 12 | |||
| GRAND TOTAL COST (CLINs 0001-0008)*** | - 0 |
| FIRST OPTION YEAR | ||||||
| A | B | C | D | E | F | G |
| CLIN | Description | Unit | Quantity* | Month | Rate per month | Amount |
| [D x E x F] | ||||||
| 1001 | Employee Only Coverage under age 66 (One Individual) | EA | 295 | 12 | ||
| 1002 | Employee Only Coverage over age 66 (One Individual) | EA | 1 | 12 | ||
| 1003 | Employee Plus One Coverage (Dependent Spouse/Legal Partner under age 66) (Two Individuals) | EA | 120 | 12 | ||
| 1004 | Employee Plus One Coverage (Dependent Spouse/Legal Partner over age 66) (Two Individuals) | EA | 2 | 12 | ||
| 1005 | Family Coverage (Dependent Child under age 21) | EA | 177 | 12 | ||
| 1006 | Family Coverage (Dependent Child over age 21) | EA | 23 | 12 | ||
| 1007 | MANDATORY YEARLY TAXES 9.25% for CLIN 1001 - CLIN 1006 **: (on hospitalization and outpatient premiums) | EA | 1 | 12 | ||
| 1008 | MANDATORY YEARLY SOCIAL SECURITY CHARGES 10% for CLIN 1001 - CLIN 1006 **: (on hospitalization premium only) | EA | 1 | 12 | ||
| GRAND TOTAL COST (CLINs 1001-1008)*** | - |
| SECOND OPTION YEAR | ||||||
| A | B | C | D | E | F | G |
| CLIN | Description | Unit | Quantity* | Month | Rate per month | Amount |
| [D x E x F] | ||||||
| 2001 | Employee Only Coverage under age 66 (One Individual) | EA | 295 | 12 | ||
| 2002 | Employee Only Coverage over age 66 (One Individual) | EA | 1 | 12 | ||
| 2003 | Employee Plus One Coverage (Dependent Spouse/Legal Partner under age 66) (Two Individuals) | EA | 120 | 12 | ||
| 2004 | Employee Plus One Coverage (Dependent Spouse/Legal Partner over age 66) (Two Individuals) | EA | 2 | 12 | ||
| 2005 | Family Coverage (Dependent Child under age 21) | EA | 177 | 12 | ||
| 2006 | Family Coverage (Dependent Child over age 21) | EA | 2 | 12 | ||
| 2007 | MANDATORY YEARLY TAXES 9.25% for CLIN 2001 - CLIN 2006 **: (on hospitalization and outpatient premiums) | EA | 1 | 12 | ||
| 2008 | MANDATORY YEARLY SOCIAL SECURITY CHARGES 10% for CLIN 2001 - CLIN 2006 **: (on hospitalization premium only) | EA | 1 | 12 | ||
| GRAND TOTAL COST (CLINs 2001-2008)*** | - |
| THIRD OPTION YEAR | ||||||
| A | B | C | D | E | F | G |
| CLIN | Description | Unit | Quantity* | Month | Rate per month | Amount |
| [D x E x F] | ||||||
| 3001 | Employee Only Coverage under age 66 (One Individual) | EA | 295 | 12 | ||
| 3002 | Employee Only Coverage over age 66 (One Individual) | EA | 1 | 12 | ||
| 3003 | Employee Plus One Coverage (Dependent Spouse/Legal Partner under age 66) (Two Individuals) | EA | 120 | 12 | ||
| 3004 | Employee Plus One Coverage (Dependent Spouse/Legal Partner over age 66) (Two Individuals) | EA | 2 | 12 | ||
| 3005 | Family Coverage (Dependent Child under age 21) | EA | 177 | 12 | ||
| 3006 | Family Coverage (Dependent Child over age 21) | EA | 2 | 12 | ||
| 3007 | MANDATORY YEARLY TAXES 9.25% for CLIN 3001 - CLIN 3006 **: (on hospitalization and outpatient premiums) | EA | 1 | 12 | ||
| 3008 | MANDATORY YEARLY SOCIAL SECURITY CHARGES 10% for CLIN 3001 - CLIN 3006 **: (on hospitalization premium only) | EA | 1 | 12 | ||
| GRAND TOTAL COST (CLINs 3001-3008)*** | - |
| FORTH OPTION YEAR | ||||||
| A | B | C | D | E | F | G |
| CLIN | Description | Unit | Quantity* | Month | Rate per month | Amount |
| [D x E x F] | ||||||
| 4001 | Employee Only Coverage under age 66 (One Individual) | EA | 295 | 12 | ||
| 4002 | Employee Only Coverage over age 66 (One Individual) | EA | 1 | 12 | ||
| 4003 | Employee Plus One Coverage (Dependent Spouse/Legal Partner under age 66) (Two Individuals) | EA | 120 | 12 | ||
| 4004 | Employee Plus One Coverage (Dependent Spouse/Legal Partner over age 66) (Two Individuals) | EA | 2 | 12 | ||
| 4005 | Family Coverage (Dependent Child under age 21) | EA | 177 | 12 | ||
| 4006 | Family Coverage (Dependent Child over age 21) | EA | 2 | 12 | ||
| 4007 | MANDATORY YEARLY TAXES 9.25% for CLIN 4001 - CLIN 4006 **: (on hospitalization and outpatient premiums) | EA | 1 | 12 | ||
| 4008 | MANDATORY YEARLY SOCIAL SECURITY CHARGES 10% for CLIN 4001 - CLIN 4006 **: (on hospitalization premium only) | EA | 1 | 12 | ||
| GRAND TOTAL COST (CLINs 4001-4008)*** | - | |||||
| GRAND TOTAL | - |
Number of employees is an estimate only, based on the current situation
| *estimated quantity of premiums does not include any Riders. |
| ** Note to contyractor: Indicate which specific taxes and social charges are being added and give their respective amounts and percentages. |
| ***does not include any premiums for Riders. |
File details come from the government source that posted it. Updated .