Attachment I - Price schedule.xlsx
XLSX spreadsheet 23 KB Posted
- Solicitation number
- 19GE5024R0025
About this file
This document contains a price schedule for health insurance services for locally employed staff at the US Embassy in Baku, Azerbaijan. The schedule provides pricing tables for the base year and four option years, with estimated numbers of employees and pricing for self-only, self-plus-one, and family coverage. Pricing is also included for excess coverage per covered individual. Coverage levels are further broken out by sub-CLINs for single employees, employees plus one, and family plans. The solicitation number is 19GE5024R0025 and was issued by the Department of State Office of Acquisition Management for health insurance services at the US Embassy Baku, Azerbaijan.
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Other files
| File | Type | Posted |
|---|---|---|
| Attachment VI - Loss data for vendors 04-25-2024.xlsx | XLSX spreadsheet | |
| QUESTIONS AND ANSWERS.pdf | ||
| Attachment V - Employees and dependents data April 25 2024.xlsx | XLSX spreadsheet | |
| 19GE5024R0025 0002.pdf | ||
| 19GE5024R0025 0001.pdf | ||
| 19GE5024R0025- Pre-proposal presentation.pdf | ||
| Attachment I - Price schedule_updated March 18 2024.xlsx | XLSX spreadsheet | |
| Attachment II - Employee data.pdf | ||
| Attachment III - W14 Form.pdf | ||
| Attachment IV - Instructions for W14 Form.pdf | ||
| 19GE5024R0025.pdf | ||
| 19GE5024R0025 Cover Letter.pdf |
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Pricing Tables
| BASE YEAR | |||||
| Sub-CLIN | Description | Estimated number of Employees | Rate per month | Rate per Year | Subtotal |
| 0001 | Self Only | 42 | 0.00 | 0.00 | |
| 0002 | Self Plus One (two individuals) | 152 | 0.00 | 0.00 | |
| 0003 | Family (three or more individuals) | 143 | 0.00 | 0.00 | |
| 1004 | Self Only - Excess Coverage/covered individual | 1 | 0.00 | 0.00 | |
| 1005 | Self Plus One (two individuals) - Excess Coverage/covered individual | 2 | 0.00 | 0.00 | |
| 1006 | Family (three or more individuals) - Excess Coverage/covered individual | 2 | 0.00 | 0.00 | |
| BASE YEAR TOTAL | 0.00 |
| OPTION YEAR 1 | ||||||||
| Sub-CLIN | Description | Estimated number of Employees | Rate per month | Rate per Year | Subtotal | |||
| 1001 | Self Only | 42 | 0.00 | 0.00 | ||||
| BASE YEAR TOTAL | ERROR:#REF! | 1002 | Self Plus One (two individuals) | 152 | 0.00 | 0.00 | ||
| 1003 | Family (three or more individuals) | 143 | 0.00 | 0.00 | ||||
| 1004 | Self Only - Excess Coverage/covered individual | 2 | 0.00 | 0.00 | ||||
| 1005 | Self Plus One (two individuals) - Excess Coverage/covered individual | 3 | 0.00 | 0.00 | ||||
| 1006 | Family (three or more individuals) - Excess Coverage/covered individual | 3 | 0.00 | 0.00 | ||||
| Family Plan shall be ine rate for Families with 2-4 children - additional children shall be added with a separate child rate | OPTION YEAR 1 TOTAL | 0.00 |
| The child rate shall also be added to 001A or 001B of Single Parents or Couples with one Child | OPTION YEAR 2 | ||||||||||
| OPTION YEAR 1 | Sub-CLIN | Description | Estimated number of Employees | Rate per month | Rate per Year | Subtotal | |||||
| Sub-CLIN | Description | Number of Employees | Rate per month | Rate per Year | Subtotal | 2001 | Self Only | 42 | 0.00 | 0.00 | |
| 1001B | Employee + 1 | 14 | 108 | 1,300 | 18,200 | 2002 | Self Plus One (two individuals) | 152 | 0.00 | 0.00 | |
| 2003 | Family (three or more individuals) | 143 | 0.00 | 0.00 | |||||||
| 2004 | Self Only - Excess Coverage/covered individual | 3 | 0.00 | 0.00 | |||||||
| 2005 | Self Plus One (two individuals) - Excess Coverage/covered individual | 4 | 0.00 | 0.00 | |||||||
| 2006 | Family (three or more individuals) - Excess Coverage/covered individual | 4 | 0.00 | 0.00 | |||||||
| 1001C | Family Plan | 130 | 178 | 2,132 | 277,160 | OPTION YEAR 2 TOTAL | 0.00 |
| The child rate shall also be added to 001A or 001B of Single Parents or Couples with one Child | OPTION YEAR 3 | ||||||||||
| OPTION YEAR 2 | Sub-CLIN | Description | Estimated number of Employees | Rate per month | Rate per Year | Subtotal | |||||
| Sub-CLIN | Description | Number of Employees | Rate per month | Rate per Year | Subtotal | 3001 | Self Only | 42 | 0.00 | 0.00 | |
| 2001B | Employee + 1 | 14 | 108 | 1,300 | 18,200 | 3002 | Self Plus One (two individuals) | 152 | 0.00 | 0.00 | |
| 3003 | Family (three or more individuals) | 143 | 0.00 | 0.00 | |||||||
| 3004 | Self Only - Excess Coverage/covered individual | 4 | 0.00 | 0.00 | |||||||
| 3005 | Self Plus One (two individuals) - Excess Coverage/covered individual | 5 | 0.00 | 0.00 | |||||||
| 3006 | Family (three or more individuals) - Excess Coverage/covered individual | 5 | 0.00 | 0.00 | |||||||
| 2001C | Family Plan | 130 | 178 | 2,132 | 277,160 | OPTION YEAR 3 TOTAL | 0.00 |
| The child rate shall also be added to 001A or 001B of Single Parents or Couples with one Child | OPTION YEAR 4 | ||||||||||
| OPTION YEAR 3 | Sub-CLIN | Description | Estimated number of Employees | Rate per month | Rate per Year | Subtotal | |||||
| Sub-CLIN | Description | Number of Employees | Rate per month | Rate per Year | Subtotal | 4001 | Self Only | 42 | 0.00 | 0.00 | |
| 3001B | Employee + 1 | 14 | 108 | 1,300 | 18,200 | 4002 | Self Plus One (two individuals) | 152 | 0.00 | 0.00 | |
| 4003 | Family (three or more individuals) | 143 | 0.00 | 0.00 | |||||||
| 4004 | Self Only - Excess Coverage/covered individual | 4 | 0.00 | 0.00 | |||||||
| 4005 | Self Plus One (two individuals) - Excess Coverage/covered individual | 5 | 0.00 | 0.00 | |||||||
| 4006 | Family (three or more individuals) - Excess Coverage/covered individual | 5 | 0.00 | 0.00 | |||||||
| 3001C | Family Plan | 130 | 178 | 2,132 | 277,160 | OPTION YEAR 4 TOTAL | 0.00 |
| Family Plan shall be ine rate for Families with 2-4 children - additional children shall be added with a separate child rate | |||||||
| The child rate shall also be added to 001A or 001B of Single Parents or Couples with one Child | ESTIMATED GRAND TOTAL (BASE + ALL OPTIONS) | 0.00 | |||||
| OPTION YEAR 4 | |||||||
| 4001A | Single Employees (Self Only) | 14 | 54 | 650 | 9,100 | ||
| 4001B | Employee + 1 | 14 | 108 | 1,300 | 18,200 | ||
| 4001C | Family Plan | 130 | 178 | 2,132 | 277,160 | ||
| Family Plan shall be ine rate for Families with 2-4 children - additional children shall be added with a separate child rate | |||||||
| The child rate shall also be added to 001A or 001B of Single Parents or Couples with one Child |
19GE5024R0025
Locally Employed Staff Health Insurance
File details come from the government source that posted it. Updated .