Attachment 1 - Pricing Table.xlsx

XLSX spreadsheet 22 KB Posted Apr 25, 2023

Attached to: LE Staff Health Insurance - Harare, Zimbabwe
Solicitation number: 19GE5023R0033
Issued by: Department of State Office of Acquisition Management

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Other files

File	Type	Posted
A0001 updated Benefit Levels.pdf	PDF	May 17, 2023
Questions-Answers 23R0033.pdf	PDF	May 17, 2023
23R0033 0001.pdf	PDF	May 17, 2023
Att 1 - 0001 Pricing Table.xlsx	XLSX spreadsheet	May 17, 2023
Att. 3 W14 Certificate.pdf	PDF	Apr 25, 2023
Cover Letter_19GE5023R0033.pdf	PDF	Apr 25, 2023
Solicitation 19GE5023R0033.pdf	PDF	Apr 25, 2023
Exh. A - Employee Statistic.pdf	PDF	Apr 25, 2023
Att. 2 Experience.pdf	PDF	Apr 25, 2023

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Pricing Tables

	Number of employees is an estimate only, based on the current situation
	BASE YEAR
	Sub-CLIN	Description	Number of Employees*	Rate per month	Rate per Year	Subtotal
	0001A	Single Employees (Self Only)	29		0	- 0
	0001B	Employee + 1	41		0	- 0
	0001C	Family Plan:
Employee + 2	32		0	- 0
	0001D	Family Plan:
Employee + 3	64		0	- 0
	0001E	Family Plan:
Employee +4	63		0	- 0
	0001F	Family Plan:
Employee + 5 and above	43		0	- 0
					Base YEAR TOTAL**	- 0

	OPTION YEAR 1
	Sub-CLIN	Description	Number of Employees*	Rate per month	Rate per Year	Subtotal
	1001A	Single Employees (Self Only)	31		0	- 0
	1001B	Employee + 1	43		0	- 0
	1001C	Family Plan:
Employee + 2	34		0	- 0
	1001D	Family Plan:
Employee + 3	66		0	- 0
	1001E	Family Plan:
Employee +4	65		0	- 0
	1001F	Family Plan:
Employee + 5 and above	43		0	- 0
					OPTION YEAR 1 TOTAL**	- 0

	OPTION YEAR 2
	Sub-CLIN	Description	Number of Employees*	Rate per month	Rate per Year	Subtotal
	2001A	Single Employees (Self Only)	33		0	- 0
	2001B	Employee + 1	45		0	- 0
	2001C	Family Plan:
Employee + 2	36		0	- 0
	2001D	Family Plan:
Employee + 3	68		0	- 0
	2001E	Family Plan:
Employee +4	67		0	- 0
	2001F	Family Plan:
Employee + 5 and above	43		0	- 0
					OPTION YEAR 2 TOTAL**	- 0

	OPTION YEAR 3
	Sub-CLIN	Description	Number of Employees*	Rate per month	Rate per Year	Subtotal
	3001A	Single Employees (Self Only)	34		0	- 0
	3001B	Employee + 1	47		0	- 0
	3001C	Family Plan:
Employee + 2	38		0	- 0
	3001D	Family Plan:
Employee + 3	70		0	- 0
	3001E	Family Plan:
Employee +4	69		0	- 0
	3001C	Family Plan:
Employee + 5 and above	44		0	- 0
					OPTION YEAR 3 TOTAL**	- 0

	OPTION YEAR 4
	Sub-CLIN	Description	Number of Employees*	Rate per month	Rate per Year	Subtotal
	4001A	Single Employees (Self Only)	34		0	- 0
	4001B	Employee + 1	49		0	- 0
	4001C	Family Plan:
Employee + 2	40		0	- 0
	4001D	Family Plan:
Employee + 3	72		0	- 0
	4001E	Family Plan:
Employee +4	71		0	- 0
	4001F	Family Plan:
Employee + 5 and above	46		0	- 0
					OPTION YEAR 4 TOTAL**	- 0

TOTAL BASE + ALL OPTIONS - 0

			VAT (if applicable)	Percentage: _______ %
			GRAND TOTAL		- 0
			CURRENCY:	United States Dollar (USD)
	*estimated number of premiums does not include any Riders (III, D)
	**does not include any premiums for Riders.
	Section 1, III Prices , E. Administrative Retemtion Amounts
	Period of
Performance	Single Employees
(Self Only)	Employee + 1	Family Plan
Employee + 2	Family Plan:
Employee + 3	Family Plan:
Employee + 4	Family Plan:

Employee + 5 and above

Base Year

Option Year 1

Option Year 2

Option Year 3

Option Year 4

19GE5023R0033

Locally Engaged Staff Health Insurance Attachment 1 Pricing Schedule

File details come from the government source that posted it. Updated Apr 25, 2023.