Attachment 1 - Statement of Work.pdf

CONTINUATION TO SF-1449

RFQ NUMBER 19BH2026Q0028

SCHEDULE OF SUPPLIES/SERVICES, BLOCK 20

DESCRIPTION/SPECIFICATIONS/WORK STATEMENT

PART I - HEALTH INSURANCE

III. Specification/Statement of Work

A.1 HEALTH INSURANCE SERVICES

The Government of the United States of America requires Health Insurance coverage for its employees as further described in A.1.1. in Belize. The Government has determined that the prevailing practice by employers in Belize is to provide for their employees health insurance protection and that the cost of such insurance protection is usually borne by both the employee and the employer. All LE Staff covered under Post’s medical benefit plan will pay a 10% share of the premium and the U.S. government will pay 90%. Health insurance protection will be representative of locally prevailing compensation practice as further described in A.1.2. The specific health benefit coverage under this contract is set forth in Section III and the Exhibits.

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.

A.1.1 Employee and Dependent Health Services Benefits

A.1.1.1. Hospitalization (treatment in the hospital for inpatient care):

Services and supplies provided during hospitalization, including services provided by a licensed healthcare provider, bed & board (semi-private accommodations), operating room, recovery room, intensive care, imaging and diagnostic testing, general hospital nursing care, physical therapy, as well as drugs and medicines administered while in-patient. When private accommodations are provided, coverage will be limited to the cost of a semi-private room unless otherwise covered in an off the shelf plan.

100% Coverage

See Mental Health and Substance Abuse care (below) for details concerning inpatient psychiatric care.

See Outpatient Services (below) for details concerning professional services.

A.1.1.2 Emergency Services (trips to emergency room):

Services provided for conditions that could lead to serious disability or death if not immediately treated, such as accidents or sudden illness.

100% Coverage

A.1.1.3 Ambulance:

Professional ground transport to move a patient from the place where s/he is injured or becomes ill to the nearest hospital able to provide treatment or to move a patient from one medical facility to another.

80% Minimum Coverage

A.1.1.4 Outpatient Services:

Services provided by a certified healthcare provider on an ambulatory or outpatient basis

(without being admitted to a hospital), including surgeon ’s fees and other medical services that may be provided in a hospital, clinic, doctor ’s office, medical facility, etc.

Examples include, but are not limited to:

- Annual physical examinations

- Specialist consultations and treatment, including second surgical opinion

- Minor surgical interventions

- Chemotherapy and radiation treatments

- Immunizations recommended by local authorities and/or the World Health Organization

- Diagnostic tests and diagnostic imaging

See Rehabilitative and Habilitative Services and Devices (below) for details concerning physical therapy.

See Mental Health and Substance Abuse Care (below) for details concerning psychiatric therapy.

A.1.1.5 Pediatric Services:

Primary and preventive routine care services for covered dependent children, including, but not limited to: physical examination, developmental assessment, laboratory tests, and immunizations recommended by local authorities or the World Health Organization.

Inpatient: 100% Coverage; Outpatient: 80% Minimum Coverage

A.1.1.6 Rehabilitative and Habilitative Services and Devices:

Rehabilitative services (e.g., recovering skills, such as speech therapy after a stroke or physical therapy after an accident) and habilitative services (e.g., developing skills, such as speech therapy for children) that help develop skills needed for everyday life. Devices to help gain or recover mental or physical skills lost due to injury, disability or a chronic condition, and devices needed for habilitative reasons.

50% Minimum Coverage

A.1.1.7. Prescription Drugs:

Medications prescribed by a certified health care provider that are medically necessary.

Examples include, but are not limited to: prescription antibiotics to treat an infection;

medication used to treat an ongoing condition, such as high cholesterol; prophylaxis; or contraceptive medication.

A.1.1.8 HIV/AIDS:

Medications to suppress opportunistic infections (such as tuberculosis or toxoplasmosis for covered individuals who have HIV/AIDS). Brief courses of anti-retroviral drugs during childbirth to prevent the transmission of HIV/AIDS to the child. Generally excludes medication for the long-term suppression of HIV/AIDS through the combination of anti-retroviral drugs in locations with inadequate local healthcare infrastructures.

100% up to BZD 20,000 per contract year per covered individual

A.1.1.9 Obstetrical Care and Newborn Care:

Care and services that women receive during pregnancy (prenatal care), throughout labor and delivery, and post-delivery, and outpatient care for newborn babies. Hospitalization during pregnancy and/or delivery will be covered as Hospitalization (treatment in the hospital for inpatient care). All other treatments will be considered Outpatient Services.

A.1.1.10 Reproductive Health:

Prescribed contraceptive devices, preventive care and routine examinations, voluntary sterilization, and diagnosis and treatment of conditions which may cause infertility.

Assisted reproductive technology (ART), fertility treatments, and reversal of sterilization are not covered (see Exclusions to Coverage).

A.1.1.11 Preventive and Wellness and Chronic Disease Management:

Counseling or preventive care designed to prevent or detect medical conditions and care for chronic conditions such as asthma and diabetes. Examples include, but not limited to:

physicals, immunization, and cancer screenings.

A.1.1.12 Hearing Aids:

Examinations and Treatment: 80% Minimum Coverage

Hearing Aid Apparatus : Limited to one apparatus per ear. The maximum coverage is

BZ$3,000 per covered individual per three-year period. 80% Minimum Coverage; with applicable cap.

A.1.1.13 Optical:

Examinations and Treatment: 80% Minimum Coverage

Prescription lenses and frames, or contact lenses: The maximum coverage is BZ$600 per covered individual every two years. 80% Minimum Coverage; with applicable cap

A.1.1.14 Dental:

Examinations and Treatment: Dentist’s fees, x-rays, examinations and treatment, cleanings, fillings, extractions, false teeth, crowns, and bridges. The maximum coverage is BZ$6,400 per covered individual per contract year. 80% Minimum Coverage; with annual cap

Orthodontia: Treatment is covered only if treatment begins before age 18, or if required as the result of an accident. A maximum of four years of orthodontia treatment will be covered per covered individual. The maximum coverage is BZ$4,800 lifetime limit.

80% Minimum Coverage; with contract lifetime cap.

A.1.1.15 Mental Health and Substance Abuse Care:

Inpatient and outpatient care provided to evaluate, diagnose and treat a mental health condition or substance abuse disorder. This includes behavioral health treatment, counseling, and psychotherapy. Services must be provided by a licensed psychiatrist, psychoanalyst, psychologist, or psychiatric social worker. Inpatient care for alcohol and substance abuse must be carried out at a facility licensed for detoxification and rehabilitation.

50% Minimum Coverage.

A.1.1.16 Medical Expenses Incurred Out of Country:

Medical expenses incurred out-of-country will be covered, but coverage will be the same and subject to the same total maximum annual limit as medical expenses incurred in-country.

A.1.1.17 Transportation for Out of Country Treatment:

Transportation for out-of-country medical treatment will be a covered expense for LE

Staff and eligible family members. To be considered a covered expense, the attending certified health care provider must certify in advance that the treatment is medically necessary and unavailable locally. 80% of covered individual’s transportation expenses by the least expensive, appropriate means of transportation to the nearest city with adequate medical facilities will be covered. 80% of the transportation expenses of an attendant will also be covered, but only if the covered individual's attending certified health care provider certifies that an attendant for the patient is necessary, (e.g., a parent in the case of a patient who is a minor, or a family member to make medical decisions in the case of a patient who is unwell or unconscious). All coverage for transportation for out-of-country medical treatment is subject to the total maximum annual limit.

Transportation to a neighboring country without the attending certified health care provider certifying that the treatment is medically necessary and unavailable locally will not be covered.

A.1.1.18 180 Day Coverage For Dependents After Employee’s Death:

At the time of a covered employee ’s death, his/her eligible dependents covered under post ’s medical plan are eligible to continue receiving the same level of medical coverage for up to 180 days. This optional benefit is subject to availability of funds at post and no extensions are permitted.

A.1.1.19 Annual Maximum Limit –The maximum annual medical coverage per covered individual per contract year, not including expenses covered under HIV/AIDS benefits if selected by post, is BZD 200,000.

A.1.1.20 Excess Coverage: Additional coverage equal to BZD 100,000 per covered individual per contract year. This excess coverage will be offered as an optional benefit to LE Staff. LE Staff must pay 100% of the premium if they elect Excess

Coverage.

A.1.2 Health Benefits Conditions and Limitations.

There is no reimbursement for elective cosmetic surgery; spa cures; rejuvenation cures; massage;

exercise therapy; long-term rehabilitative therapy; non-medical hospital charges

(e.g., telephone, television, etc.); home help, family help, or similar household assistance; fees of persons who are not certified health care providers; advanced reproductive technology (e.g., in-vitro fertilization, intra-cellular sperm injection, artificial insemination, microsurgical epididymal sperm aspiration, testicular sperm extraction, cryopreservation, etc.); or services or supplies which have not been prescribed or approved by a certified health care provider.

Exclusions to coverage may be amended if provided in an off the shelf plan and is the lowest-cost and technically acceptable. Removal of any exclusions require prior authorization.

There is no reimbursement for expenses that will be reimbursed or paid directly under a host country medical program or workers' compensation program, the U.S. workers ’ compensation program, or post ’s LE Staff workers ’ compensation program.

A.1.3 Eligible Participants

A.1.3.1 Eligible Employees - To be eligible to participate in the medical plan, LE Staff

(both full time and part time) must be: include the following:

A.1.3.1.1 All current active employees of the United States Government, employed within the geographic boundaries of Belize paid under the Local

Compensation Plan, and certified by the Contracting Officer. Covered employees include

A.1.3.1.2. Foreign Service Nationals (FSNs) employed under direct hire appointments, Personal Services Agreements (PSAs) and Personal Services

Contracts (PSCs);

A.1.3.1.3. Under a temporary direct hire appointment or PSA Fixed Term of one year or more. Locally hired U.S. citizens employed under direct hire appointments, PSAs, and PSCs.

A.1.3.2 Location of Employment

The individuals covered by A.1.3.1 must be employed within the geographic boundaries of Belize by:

U.S. Department of State

U.S. Department of Defense (MILGP)

U.S, Department of Defense (MSG)

U.S..Department of Justice (DEA)

U.S. Department of Agriculture (USDA)

Millennium Challenge Corporation (MCC)

Peace Corps (PC)

A.1.3.3 Participants Covered Under a Rider

A.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, Exhibit B). All costs for ORE employees are the responsibility of the employing officer, not the

U.S. Government.

A.1.3.3.2 Peace Corps (PSC) active employees may be covered under a rider to the contract. Peace Corps is responsible for the employer’s share of the premium costs for Peace Corps (PSC) employees.

A.1.4. Individuals not Eligible for Coverage

Not eligible are those working under temporary appointments; those working under a

PSC or PSA that is time limited to less than one year; non-personal services contract personnel and their employees, supplied by an independent contractor licensed to do business in Belize who provides services to other local organizations as well as to the

U.S. Mission; employees working on an intermittent or When Actually Employed (WAE) schedule; Peace Corps personal services contractors .

A.1.5. Other Eligible Participants

LE Staff who are eligible to participate in the medical plan automatically confer coverage to eligible family members who meet the following criteria:

Legal spouse or domestic partner, to include same-sex domestic partners, as certified by COM:

one legal spouse as defined by local law or one domestic partner may be covered. LE Staff with more than one legal spouse or domestic partner must select only one individual for coverage.

In cases where LE Staff and their legal spouse both work for the mission and both are eligible to participate in the medical plan, one will be designated as the lead for purposes of the medical plan, and the other will be considered a legal spouse.

Dependent children: a child is defined as the LE Staff ’s natural, adopted, stepchild, or foster child. The child must be unmarried and financially dependent upon the LE Staff. A child will be covered until the end of the contract year in which s/he reaches age 26. An unmarried child determined to be incapable of self-support due to a physical or mental condition will continue to be eligible to participate in the medical plan as long as the condition persists, the child remains unmarried, and the LE Staff maintains coverage.

A.1.6. Eligibility

A.1.6.1. Term of Eligibility and Effective Date

Each current active eligible employee is enrolled for health benefits under this contract upon award and thereafter during the performance period of this contract. Each new eligible employee will be enrolled upon entering on duty with the United States Government. An employee is considered active ("on the rolls") whenever such employee is on approved leave, whether paid or unpaid.

During a period of Leave Without Pay (LWP) or unpaid leave that is one pay period or less, coverage under the insurance contract will continue. The USG will pay the total premium cost to the Contractor. The employee’s share of the premium will be collected through payroll deduction in that or the subsequent pay period.

Premium: Premiums will be based on the number of individuals covered:

-- Self-Only: 1 covered individual

-- Self Plus One (two individuals)

-- Family (three or more individuals)

A.1.6.2. Period of Ineligibility

Employees and their dependents are not entitled to health benefits during any period of employment for which premiums are not paid.

Additionally, employee's dependents are not entitled to health benefits during any period of employment during which the employee was not eligible to participate.

During a period of extended Leave Without Pay (LWOP) or unpaid leave beyond one pay period, the employee is responsible for the full cost of the insurance premiums for self and dependents. The Mission will pay the premiums directly to the Contractor, and will collect the full cost from the employee on a quarterly basis. Alternatively, the employee may elect to have coverage cease if they prefer not to pay the premium.

A.1.7. Brochure Requirement.

A.1.7.1. The Contractor shall provide a document (brochure/pamphlet/other written document) in English that sets forth a complete listing of the health insurance benefits to be provided under this contract. This brochure shall be provided in sufficient quantities so that each covered employee receives a copy. The Contractor shall furnish all copies of the brochures to the COR, who will ensure that appropriate distribution is made.

A.1.7.2. The Contractor shall provide the document described in A.1.7.1 to the COR not later than thirty (30) calendar days after date of contract award. The Contractor shall provide additional brochures for new employees within ten (10) days of the COR’s request.

A.1.7.3. The Contractor assumes full responsibility for ensuring that the document described in A.1.7.1 accurately reflects the requirements of the contract, as implemented by the

Contractor’s technical proposal. In all cases, the contract shall take precedence. Should the

COR discover that the brochure contains inaccuracies, the Contractor will be notified in writing;

however, failure on the part of the Government to notice any inaccuracies shall in no way limit, revise or otherwise affect the requirement under this contract for the Contractor to fully comply with all contract terms.

PART II: GROUP LIFE INSURANCE

B.1. GROUP LIFE INSURANCE

The Government of the United States of America requires group life insurance coverage for its employees, as further described in B.1.2, in Belize. The Government has determined that the prevailing practice by employers in Belize is that group life insurance coverage is representative of locally prevailing compensation practice and that the cost of such insurance protection is usually borne by the employer. The USG will pay 100% of the premium costs. Therefore, the

Government desires to adopt such locally prevailing practice as part of its compensation plan for its employees as further described in B.1.2. The specific group insurance coverage under this contract is set forth in this part of Section C and the Attachments in Section J.

B.1.1. Group Life Insurance Coverage

The amount of group life insurance coverage is as follows:

B.1.1.1 Amount of Employee Life Insurance.

The amount of life insurance coverage for each employee is based upon

The following benefits will be paid to the participant's named beneficiaries or estate upon the death of the participant:

Natural Death: 24 times the monthly basic salary (Belize Dollars)

B.1.1.2 Amount of Accidental -Death and Dismemberment Coverage.

The employee's estate or employee will receive an amount equal to 30 times the amount of the monthly basic salary, in the event the employee is killed in an accident.

B.1.1.3 Partial and Total Disability Coverage

Total Disability: 24 times the monthly basic salary

Partial Disability as follows:

Both eyes: 24 times the monthly basic salary

Both hands or feet: 24 times the monthly basic salary

One hand and one foot: 24 times the monthly basic salary

One hand/foot and one eye: 24 times the monthly basic salary

One eye: 12 times the monthly basic salary

One hand or one foot: 12 times the monthly basic salary

B.1.1.4 Funeral Benefit:

The Mission does not provide Funeral Benefits.

B.1.2 Life Insurance Benefits Conditions and Limitations

Conditions and limitations on the entitlement to life insurance benefits under this contract are as follows:

No benefits shall be payable if an employee's death or other insurance event was caused directly or indirectly by war. War shall be defined as declared or non-declared war or any martial operations or invasion, hostile acts of foreign powers, rebellion, riot, civil war, uprising, mutiny, operations by military or usurpatory authorities, martial law or state of siege or any other similar event or reason for declaring martial law or war. A terrorist attack shall not be considered war.

No benefit shall be payable under this contract if the employee's bodily injuries have been caused directly or indirectly and totally or partially by:

a. Violating the law or in resisting detention or arrest,

b. Participation in competitions involving the use of wheeled vehicles, horses, boats or water skis.

c. An accident resulting from the employee being under the influence of alcohol, drugs or other toxic substance unless administered by a physician. Death as a result of a disease or physical or mental infirmities and medical or surgical treatment thereof (except pyogenic infection due to an accidental cut or wound) shall be considered a natural and not an accidental death. Suicide will not be covered.

B.1.3. Eligible Participants

B.1.3.1 Eligible Employees. The employees eligible for the group life insurance coverage include the following:

B.1.3.1.1. All current active employees of the United States Government, employed within the geographic boundaries of Belize, paid under the Local

Compensation Plan, and certified by the Contracting Officer. Covered employees include:

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

(PSCs);

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

B.1.3.2 Location of Employment

B.1.3.2 The individuals covered by B.1.3.1 must be employed within the geographic boundaries of Belize by:

Department of State

U.S. Department of Defense (MILGP)

U.S, Department of Defense (MSG)

U.S. Department of Justice (DEA)

U.S. Department of Agriculture (USDA)

Millennium Challenge Corporation (MCC)

Peace Corps (PC)

B.1.3.3 Participants Covered Under a Rider

B.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, Exhibit B). All costs for ORE employees are the responsibility of the employing officer, not the U.S. Government.

B.1.3.3.2 Peace Corps (PSC) active contractors; all costs for Peace Corps

(PSC) contractors are the responsibility of the employing agency, not the U.S.

Government.

B.1.4 Individuals not Eligible for Coverage

B.1.4.1. New employees who have reached the age of 65 (with the exception of LE

Staff U.S. Citizens per 12 STATE 103466) prior to entering on duty with the U.S. Government will not be eligible for life insurance coverage.

B.1.4.2 Individuals not eligible for coverage under this contract are non-personal services contract personnel and their employees; employees working on a temporary basis;

employees working under a PSC or PSA that is time limited to less than one year; non-personal services contract personnel and their employees, supplied by an independent contractor licensed to do business in Belize who provides services to other local organizations as well as to the U.S.

Mission; Peace Corps personal services contractors. Official Residence Expense (ORE) employees may be covered under a rider to the contract. The employing officer, not the USG, is responsible for the employer's share of the premium expenses for an ORE employee; employees with an intermittent, seasonal, or WAE (when actually employed) schedule; and any other individual not falling within one of the categories of employees described in this clause.

Dependents are not covered.

Retirees are not covered

B.1.5. Other Eligible Participants RESERVED

B.1.6 Eligibility and Effective Date

B.1.6.1. Term of Eligibility and Effective Date

Each current active eligible employee is enrolled for life insurance and disability benefits under this contract upon award and thereafter during the performance period of this contract. Each new eligible employee will be enrolled upon entering on duty with the United States Government. An employee is considered active ("on the rolls") whenever such employee is on approved leave, whether paid or unpaid.

During a period of Leave Without Pay (LWP) or unpaid leave that is one pay period or less, coverage under the insurance contract will continue. The USG will pay the total premium cost to the Contractor. The employee’s share of the premium will be collected through payroll deduction in that or the subsequent pay period.

B.1.6.2. Period of Ineligibility

Employees are not entitled to life insurance and disability benefits hereunder during any period of employment for which premiums are not paid.

During a period of extended (beyond one pay period) of Leave Without Pay

(LWOP) or unpaid leave, the employee is responsible for the full cost of the insurance premiums. The Mission will pay the premiums directly to the Contractor and will collect the full cost from the employee on a quarterly basis. Alternatively, the employee may elect to have coverage cease if that employee prefers not to pay the premium.

B.1.7. BROCHURE REQUIREMENT

B.1.7.1. The Contractor shall provide a document (brochure/pamphlet/other written document) in English that sets forth a complete listing of the life insurance benefits to be provided under this contract. This brochure shall be provided in sufficient quantities so that each covered employee receives a copy. The Contractor shall furnish all copies of the brochures to the COR, who will ensure that appropriate distribution is made.

B.1.7.2. The document described in B.1.7.1 shall be provided to the COR not later than 30 days after date of contract award. The Contractor shall provide additional brochures for new employees within ten days of the COR’s request.

B.1.7.3. The Contractor assumes full responsibility for ensuring that the document described in B.1.7.1 accurately reflects the requirements of the contract, as implemented by the

Contractor’s technical proposal. In all cases, the contract shall take precedence. Should the

COR discover that the brochure contains inaccuracies, the Contractor will be notified in writing;

however, failure on the part of the Government to notice any inaccuracies shall in no way limit, revise or otherwise affect the requirement under this contract for the Contractor to fully comply with all contract terms.

B.1.8. DEFINITIONS

B.1.8 DEFINITIONS

FMO The Financial Management Officer (FMO) or the paying office for all U.S.

Government Agencies.

COR Contracting Officer's Representative (COR) is the Human Resources

Specialist/Human Resources Assistant at post.

Contributory Insurance Insurance for which the employee contributes toward the premium.

Currency Premiums and benefits will be paid in local currency (Belize Dollars).

Customary and Reasonable Treatment A diagnostic test or medical treatment which is usually performed in the community where the individual is being treated.

Dependent For health insurance only, legal spouse or domestic partner, to include same-sex domestic partners, as certified by COM: one legal spouse as defined by local law or one domestic partner may be covered. LE Staff with more than one legal spouse or domestic partner must select only one individual for coverage.

In cases where LE Staff and their legal spouse both work for the mission and both are eligible to participate in the medical plan, one will be designated as the lead for purposes of the medical plan, and the other will be considered a legal spouse.

Dependent children: a child is defined as the LE Staff’s natural, adopted, stepchild, or foster child. The child must be unmarried and financially dependent upon the LE Staff. A child will be covered until the end of the contract year in which s/he reaches age 26. An unmarried child determined to be incapable of self-support due to a physical or mental condition will continue to be eligible to participate in the medical plan as long as the condition persists, the child remains unmarried, and the LE Staff maintains coverage.

Disability - Total and Permanent A physical or mental impairment which precludes the individual from performing ordinary motor or bodily functions and which requires separation from employment. If the impairment is the result of a previous impairment, it shall be considered a continuation of the prior impairment.

Employee An individual employed by the U.S. Government, under a direct-hire appointment, personal services contract (PSC), or personal services agreement

(PSA), as further defined in Section A.1.3 for health insurance and B..1.3 for life insurance. This may also include ORE Staff, and Peace Corp PSCs, if this category of individual is listed as participating under a rider in A.1.3.3 for health insurance and B.1.3.3 for life insurance.

Employer The United States Government or in the case of ORE employees, the Chief of

Mission/Deputy Chief of Mission.

GSO General Services Officer in charge of the General Services Office at post.

This officer is usually the Contracting Officer (CO) for this contract.

Hospital An institution established and operated for the care and treatment of sick and injured persons. It provides 24-hour nursing care and has diagnostic, laboratory, treatment, and surgical facilities. Any institution which does not meet this definition is not considered a hospital.

Hospital Patient An individual who has been admitted to a hospital, is assigned a bed, and is given diagnostic tests or receives treatment for a disease or an injury.

Maximum Benefit The total amount that will be paid to any one covered individual for covered medical expenses or life insurance/disability benefit.

Physician An individual who has graduated from an accredited medical school and is licensed to practice medicine in the jurisdiction in which the contract is to be performed. If the individual is a medical specialist, then he or she is Board

Certified in that specialty

Salary Monthly salary is one-twelfth of the employee's annual basic salary, exclusive of premium pay, allowances, bonuses, or any other separate payments.

Surgical Procedure Any invasive medical procedure by manual or instrument operation undertaken for diagnosis or treatment of a diseased patient.

IV. CONTRACT ADMINISTATIVE REQUIREMENTS AND PROCEDURES

A.1. QUALITY ASSURANCE AND SURVEILLANCE PLAN (QASP)

This plan is designed to provide an effective surveillance method to promote effective Contractor performance. The QASP provides a method for the Contracting Officer's Representative (COR) to monitor Contractor performance, advise the Contractor of unsatisfactory performance, and notify the Contracting Officer of continued unsatisfactory performance. The Contractor, not the

Government, is responsible for management and quality control to meet the terms of the contract.

The role of the Government is to conduct quality assurance to ensure that contract standards are achieved.

Performance Objective

PWS

Paragraph Performance Threshold

Services

Performs all the insurance services set forth in the Performance Work Statement (PWS)

A.1 thru

B.1.8

All required services are performed and no more than one

(1) customer complaint is received per month

A.1.1 Surveillance. The COR will receive and document all complaints from Government personnel regarding the services provided. If appropriate, the COR will send the complaints to the Contractor for corrective action.

A.1.2 Standard. The performance standard is that the Government receives no more than one (1) customer complaint per month. The COR shall notify the Contracting Officer of the complaints so that the Contracting Officer may take appropriate action to enforce the inspection clause

(FAR 52.246-4, Inspection of Services – Fixed Price (AUG 1996) or the appropriate Inspection of Services clause), if any of the services exceed the standard.

A.1.3 Procedures

(a) If any Government personnel observe unacceptable services, either incomplete work or required services not being performed, they should immediately contact the COR.

(b) The COR will complete appropriate documentation to record the complaint.

(c) If the COR determines the complaint is invalid, the COR will advise the complainant. The COR will retain the annotated copy of the written complaint for his/her files.

(d) If the COR determines the complaint is valid, the COR will inform the Contractor and give the Contractor additional time to correct the defect, if additional time is available. The

COR shall determine how much time is reasonable.

(e) The COR shall, as a minimum, orally notify the Contractor of any valid complaints.

(f) If the Contractor disagrees with the complaint and challenges the validity of the complaint, the Contractor will notify the COR. The COR will review the matter to determine the validity of the complaint.

(g) The COR will consider complaints as resolved unless notified otherwise by the complaint.

(h) Repeat customer complaints are not permitted for any services. If a repeat customer complaint is received for the same deficiency during the service period, the COR will contact the Contracting Officer for appropriate action under the Inspection clause.

A.1.4 Complaint Procedures

a. If USG personnel observe unacceptable services such as but not limited to lack of coordination during medical evacuation, extended referral periods, delays in receipt of payment, etc., they will immediately contact the COR.

b. The COR will complete appropriate documentation to record the complaint.

c. If the COR determines the complaint is invalid, the COR will advise the complainant. The

COR will retain the annotated copy of the written complaint for his / her files.

d. If the COR determines the complaint is valid, the COR will inform the contractor and give the contractor additional time to correct the defect, if additional time is available. The

COR shall determine how much time is reasonable.

e. The COR shall, as a minimum, provide e-mail notification informing the contractor of any valid complaints.

f. If the contractor disagrees with the complaint and challenges the validity of the complaint, the contractor shall notify the COR by e-mail. The COR will review the matter to determine the validity of the complaint.

g. The COR will consider complaints as resolved unless notified otherwise by the complainant.

h. Repeat customer complaints are not permitted for any services. If a repeat customer complaint is received for the same deficiency during the service period, the COR will contact the Contracting Officer for appropriate action under the Inspection clause.

A.1.5 Period of Performance

The period of performance is one year, with four (4) one option years. Option years, if exercised, shall be for twelve (12) months each, commencing at the expiration of the previous period of performance.

Notwithstanding the expressed contract expiration date, this contract shall remain in full force and effect until the last items or services ordered hereunder have been delivered and accepted by the Government.

Options

(a) The Government may extend this contract in accordance with the option clause at

Section I, clause I.2, FAR Clauses Incorporated by Full Text (FAR 52.217-9, Option to Extend the Term of the Contract), which also specifies the total potential duration of the contract.

(b) The Government may exercise the option set forth at Section I, "FAR 52.217-8, Option to Extend Services".

A.1.6 Report and Deliverables

All reports and other deliverables required under this contract shall be delivered by email to the

COR. and mailed to the following address:

U.S. Embassy Belmopan

Human Resources

4 Floral Park Road

Belmopan, Belize

ATTN: Contracting Officer Representative

Description Quantity Submission

Date

Deliver to and how

Reference

A.1.7

B.1.7

Brochure (digital and printed documents)

As instructed by COR

10 days after contract award

COR

Additional copies

Within 10 calendar days of the COR request

By email and hard copy

B.1.7 Invoice Monthly (first day of the month)

COR/Designated

Billing Office

A.1.10.4 Employee Claims

Report

Monthly – no later than the 5th day of each month

COR

A.1.7 Contract Requirements

Security. On occasion, a Contractor employee may require entry into U.S. Government-owned or -operated facilities. If so, the Contractor should be prepared to provide the necessary identification to permit escorted access within that facility.

A.1.8 Standard of Conduct. The Contractor shall maintain satisfactory standards of employee competency, conduct, cleanliness, appearance, and integrity and shall be responsible for taking such disciplinary action with respect to employees as may be necessary. Each Contractor employee is to adhere to standards that reflect credit on themselves, their employer, and the

United States Government.

A.1.9 Ordering Procedures. The Government will issue a task order as soon as possible after contract award to identify all employees to be covered by the insurance described in this contract and the coverage selected by each employee, including dependents to be covered. The COR will make subsequent additions or deletions to this list in writing and provide the revised list to the Contractor. All such revisions shall be consolidated, and a new or modified task order will be issued by the Contracting Officer. If any changes have been made to the coverage listing, the

Government anticipates issuance of a new task order on a [X ] monthly, [ ] quarterly basis. This new task order will include all changes made since the previous task order was issued and will include any increase or decrease in necessary funding. The changes to the list of eligible individuals will supersede the initial list provided under prior task orders without prejudice to the ineligibility clause. Task orders will indicate the effective date of employment, for purposes of calculating the premium due.

The ORE staff, and Peace Corp employees under separate riders are not included under the task orders issued by the Contracting Officer. Because their coverage is under a rider, their employer is responsible for directly interacting with the Contractor to order any coverage for their employees. When contacted by the employer, the Contractor shall advise the employer of the paperwork and payment that will be necessary to order coverage for the identified individuals. Because more than one employer may have ORE staff, the Contractor may be contacted by more than one employer (typically the Chief of Mission and Deputy Chief of

Mission).

A.1.10 Contractor Responsibility in Claims and Reimbursement to Claimants

General. The Contractor shall be responsible for all planning, estimating, programming, project management, scheduling, dispatching, supervision, and inspection of work. The Contractor shall maintain his own reference library of technical reference works and local laws and regulations, including current tariffs and registries. The Contractor shall treat the information provided by the Embassy concerning employee' personal data, medical information, and salaries as highly sensitive and not divulge any employee information to unauthorized persons.

The Contractor shall establish procedures for handling medical insurance claims as follows:

A.1.10.1 Administrative Records

(1) The Contractor shall maintain medical insurance files for each covered employee and each covered dependent including receipts and proof of paid claims, requests for claim reimbursements, and accounting of paid benefits with balances of amounts remaining in the annual per person reimbursement ceiling.

(2) The Contractor shall provide the COR with the necessary claim forms for each type of benefit that can be claimed under the contract. These forms specify a list of documents required to be appended to each claim and otherwise provide instructions for claim filing.

(3) The Contractor shall use the English spelling of the employees' names in all transactions, including reimbursement checks.

(4) The Contractor shall send employee claim reimbursement checks to employees not later than two weeks after a claim is submitted. Additionally, if the Contractor pays the provider directly, the Contractor shall send checks to the provider not later than two weeks after a claim is submitted.

A.1.10.2 Medical Insurance Claims. Settlement of medical insurance shall be completed as follows:

(1) All medical claims shall be submitted directly to the Contractor by employees, through a drop box in the COR's office or with the approval of the Contracting Officer, emailed directly to the Contractor. The claims shall be picked up from the COR each Tuesday.

(2) The Contractor shall date stamp and screen all claims submitted on the day of receipt. If there are any missing documents or information thereby disallowing said claim to be payable, the Contractor shall notify the employee within two days, with a copy to the COR (if notification is written).

(3) The Contractor shall settle the claims no later than two weeks from the date the claim is submitted to the Contractor.

(4) Settlement shall be issued in the name of the employee for each claim submitted. Each check shall be accompanied by a form providing details of the amount reimbursed with an explanation of deductions, if any.

(5) The Contractor shall accept the employee's or dependent's choice to go for surgery to hospitals designated by the Contractor in order that the

Contractor will pay the expenses directly to the hospitals.

A.1.10.3. Payment of Life Insurance Benefits to Beneficiaries. The Contractor shall settle life insurance claims as follows:

(1) The Contractor shall provide forms for the designation of beneficiaries for the life insurance benefits to the COR. The COR shall have all enrolled eligible employees complete designation of beneficiary forms and keep them in their personnel folders, ORE staff folders, or EAE folders. Upon the death of an enrolled employee, the COR shall provide this form to the

Contractor.

(2) The Contractor shall pay the employee's named beneficiary, legal heir, or estate the total amount of the claim within 60 days from the date the

Contractor receives a completed dismemberment or death claim. Payment shall be computed on the basis of the coverage as defined in Section B.1 and its subparagraphs.

A.1.10.4 Report Requirement. The Contractor shall provide the following reports monthly. All reports must be received by the COR no later than the 10th day of each month. These reports shall report on the previous month's activities.

(a) Employee Claims Report. The report will list all claims paid by the Contractor to a claimant, including the name of the claimant, date claim is received by the Contractor, and the amount claimed. This report shall also include all outstanding claims and a brief description of why claim has not been paid. The report shall not include any claims information for riders.

B.1. Miscellaneous Contractor requirements.

B.1.1 General. The Contractor shall take all such steps as are necessary, and obtain and pay for all permits, taxes and fees as are required by the Belize government to establish and/or operate a commercial venture locally.

A contract with the U.S. Government conveys no special privileges or immunities to the

Contractor. The Contractor is an independent commercial concern and not a part of the U.S.

mission. The Contractor's employees are not U.S. Government employees. Registration of this contract with the Belize government, if required by law, will be the sole responsibility of the

Contractor, and any fees, taxes, or other duties shall be payable by the Contractor without recourse to the Government of the amounts thereof.

B.1.2 Licenses and Local Laws. The Contractor shall possess all permits, licenses, and any other appointments required for the prosecution of work under this contract, all at no additional cost to the Government. The Contractor shall perform this contract in accordance with local laws.

B.1.3 Packaging and Markings

Brochures are to be printed in English. The cover must present the Department of State logo at the top right corner of the face page of the brochure. Additionally, in small but distinguished letters, the following message “This is the property of the United States”.

Printing should be in sufficient quantity for an initial distribution of the brochure for covered individuals and families. After the initial handout, the contractor must have on-hand additional copies of the brochure for covered individuals and families.

B.1.4 Erroneous Payment. If the Government becomes eligible for a refund of payment because of erroneous overpayment or other causes, the Contractor shall refund the amounts or use them to offset future payments owed by the Government, whichever the Government prefers.

The Contractor shall refund any refunds not complete or discovered after the completion date of this contract. The Contractor shall provide a line entry on invoices for erroneous payment offsets regardless of an actual offset existing.

B.1.5 Requiring Activity. The requiring activity under this contract is the U.S. Embassy

Belmopan.

B.1.6 Contract Administration Data

Authority of the Contracting Officer – All work shall be performed under the general direction of the Contracting Officer, who alone shall have the power to bind the Government and to exercise the rights, responsibilities, authorities and functions vested by the contract, except that the Contracting Officer shall have the right to designate authorized representatives to act for the Contracting Officer, as specifically provided in the designation of that individual, such as the COR.

Government Personnel

Contracting Officer: Salman Khalil

E-mail address: KhalilSK@state.gov

Contract Administrator: Elisa Gillett

E-mail address: GillettER@state.gov

Contracting Officer's Representative (COR): Tifarah Gill-Broaster

E-mail address: Gill-BroasterTS@state.gov

B.1.7 Submission of Invoices and Payment

Invoices for U.S. Government employees shall be submitted in an original and three (3) copies to the billing office listed below. Invoices shall include the contract line item (CLIN) and SubCLIN information. The designated billing office is for submitting invoices ONLY:

Financial Management Office (FMO)

U.S. Embassy Belmopan

4 Floral Park Road

Belmopan, Belize

Email: BelmopanInvoices@state.gov mailto:KhalilSK@state.gov mailto:GillettER@state.gov mailto:Gill-BroasterTS@state.gov mailto:BelmopanInvoices@state.gov

B.1.7 .1 Frequency of Payments. All funds under this contract will be obligated by issuance of task orders, as described in A.1.9. Each task order will fund a specific period of time and number of employees, and the task orders will be issued at the frequency described in A.1.9. All payments under this contract will be made at the conclusion of the period covered. Invoices may be submitted monthly with payments being made monthly by the Government. The Contractor shall provide a line entry on invoices for erroneous payment offsets regardless of an actual offset existing.

B.1.7.2 U.S. Government Employees. The Government shall make payments directly to the

Contractor for all Government employees, whether or not the employee is contributing to the premium amount.

B.1.7.3 ORE Staff. The Chief of Mission and/or Deputy Chief of Mission will make payment directly to the Contractor for the entire premium amount of the ORE staff, whether or not the

ORE employee is contributing to the premium amount.

B.1.7.4 Peace Corp Personal Service Contract (PSC) Staff. The Peace Corp Personal Service

Contract (PSC) will make payment directly to the Contractor for the entire premium amount of the Peace Corp employee, whether or not the Peace Corp employee is contributing to the premium amount.

B.1.7.5 Refund to the Government. If at any time during performance of the contract the

Government finds that the Contractor has been overpaid because the number of employees and/or dependents covered has decreased, the Contracting Officer may either allow that overpayment to be credited to the Government’s account or require that the Contractor refund the overpayment. If the Contracting Officer requests a refund, the Contractor shall make that refund to the Government within ten calendar days of receipt of the request.

B.1.7.6 General Sales Tax (GST)

The Government will not reimburse the Contractor for GST under this contract. The Contractor shall not include a line for GST on Invoices as the U.S. Embassy has a tax exemption certificate with the host government.

B.1.8 List of Attachments

Exhibit A Employee Statistics

Exhibit B ORE and Peace Corps Employees Rider

Exhibit C Peace Corp Employee Rider

Exhibit D Claims Paid out for the last three (3) years

Attachment 1 Statement of Work