HL_22R0001_Solicitation 080122.pdf

Health & Life Contract 19PM0722R0001

Table of Contents

B. SECTION B - PART I, PRICE - HEALTH INSURANCE

B.1. HEALTH INSURANCE SERVICES

B.2. PRICES

B.3. ADMINISTRATIVE RETENTION AMOUNTS

B.4. ECONOMIC PRICE ADJUSTMENT-HEALTH INSURANCE PREMIUMS

B.5. GROUP LIFE INSURANCE SERVICES

B.6. GROUP LIFE INSURANCE RATES

B.7. ADMINISTRATIVE RETENTION AMOUNTS

B.8. ECONOMIC PRICE ADJUSTMENT-LIFE INSURANCE PREMIUMS

C. SECTION C - DESCRIPTION/SPECIFICATION/WORK STATEMENT

PART I - HEALTH INSURANCE

C.1. HEALTH INSURANCE SERVICES

PART II GROUP LIFE INSURANCE

C.2. GROUP LIFE INSURANCE

C.3. DEFINITIONS

D. SECTION D - PACKAGING AND MARKING

E. SECTION E - INSPECTION AND ACCEPTANCE

E.1. 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

E.2. QUALITY ASSURANCE AND SURVEILLANCE PLAN (QASP)

F. SECTION F - DELIVERIES OR PERFORMANCE

F.1. 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

F.2. PERIOD OF PERFORMANCE

F.3. OPTIONS

F.4. REPORTS AND OTHER DELIVERABLES

G. SECTION G - CONTRACT ADMINISTRATION DATA

G.1. 652.242-70 CONTRACTING OFFICER’S REPRESENTATIVE (COR) (AUG 1999)

G.2. COR DUTIES

G.3. PAYMENT SHALL BE MADE IN U.S. DOLLARS

G.4. SUBMISSION OF INVOICES AND PAYMENT

G.5. RESERVED

G.6. VALUE ADDED TAX (VAT)

H. SECTION H - SPECIAL CONTRACT REQUIREMENTS

H.1. SECURITY

H.2. STANDARDS OF CONDUCT

H.3. ORDERING PROCEDURES

H.4. CONTRACTOR RESPONSIBILITY IN CLAIMS AND REIMBURSEMENT TO CLAIMANTS

H.5. REPORT REQUIREMENTS

H.6. MISCELLANEOUS CONTRACTOR REQUIREMENTS

H.7. ERRONEOUS PAYMENTS

H.8. REQUIRING ACTIVITY

I. SECTION I - CONTRACT CLAUSES

I.1. 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

I.2. FEDERAL ACQUISITION REGULATION FAR CLAUSES INCORPORATED IN FULL TEXT

I.3. DEPARTMENT OF STATE ACQUISITION REGULATION (DOSAR)

J. SECTION J - LIST OF EXHIBITS/ATTACHMENTS

K. SECTION K - REPRESENTATIONS, CERTIFICATIONS, AND OTHER STATEMENTS OF OFFERORS

K.1. 52.203-2 CERTIFICATE OF INDEPENDENT PRICE DETERMINATION (APR 1985)

K.2. 52.203-11 CERTIFICATION AND DISCLOSURE REGARDING PAYMENTS TO INFLUENCE

CERTAIN FEDERAL TRANSACTIONS (SEP 2007)

K.3. 52.203-18 PROHIBITION ON CONTRACTING WITH ENTITIES THAT REQUIRE CERTAIN

INTERNAL CONFIDENTIALITY AGREEMENTS OR STATEMENTS – REPRESENTATION (JAN 2017)

K.4. 52.204-3 TAXPAYER IDENTIFICATION (OCT 1998)

K.5. 52.204-24 REPRESENTATION REGARDING CERTAIN TELECOMMUNICATIONS AND VIDEO

SURVEILLANCE SERVICES OR EQUIPMENT (NOV 2021)

K.6. 52.204-26 COVERED TELECOMMUNICATIONS EQUIPMENT OR SERVICES-REPRESENTATION

(OCT 2020)

K.7. 52.225-20 PROHIBITION ON CONDUCTING RESTRICTED BUSINESS OPERATIONS IN

SUDAN—CERTIFICATION (AUG 2009)

K.8. 52.204-8 ANNUAL REPRESENTATIONS AND CERTIFICATIONS (MAY 2022)

K.9. 52.209-5 CERTIFICATION REGARDING RESPONSIBILITY MATTERS (AUG 2020)

K.10. 52.209-13 VIOLATION OF ARMS CONTROL TREATIES OR AGREEMENTS-CERTIFICATION (FEB

2021) 64

K.11. AUTHORIZED CONTRACT ADMINISTRATOR

K.12. 652.225-70 ARAB LEAGUE BOYCOTT OF ISRAEL (AUG 1999)

K.13. 52.209-2 PROHIBITION ON CONTRACTING WITH INVERTED DOMESTIC CORPORATIONS –

REPRESENTATIONS (NOV 2015)

K.14. 52.229-11 TAX ON CERTAIN FOREIGN PROCUREMENTS—NOTICE AND REPRESENTATION

(JUN 2020)

K.15. THE FOLLOWING PROVISION IS INCORPORATED BY REFERENCE:

L. SECTION L - INSTRUCTIONS, CONDITIONS AND NOTICES TO OFFERORS

L.1. SUBMISSION OF OFFERS

L.2. SUMMARY OF INSTRUCTIONS

L.3. DELIVERY OF PROPOSALS AND EXCEPTIONS TO SOLICITATION

L.4. CONTENTS OF PROPOSALS

L.5. 52.252-1 SOLICITATION PROVISIONS INCORPORATED BY REFERENCE (FEB 1998)

L.6. SOLICITATION PROVISIONS INCLUDED IN FULL TEXT

L.7. 652.206-70 ADVOCATE FOR COMPETITION/OMBUDSMAN (FEB 2015)

L.8. PRE-PROPOSAL CONFERENCE

L.9. FINANCIAL STATEMENT

M. SECTION M - EVALUATION FACTORS FOR AWARD

M.1. EVALUATION OF PROPOSALS

M.2. OVERALL EVALUATION

M.3. AWARD SELECTION

M.4. FIXED PRICES

M.5. TECHNICAL EVALUATION. OFFERS WILL BE EVALUATED ON:

M.6. 52.217-5 EVALUATION OF OPTIONS (JUL 1990)

M.7. PRICE EVALUATION

M.8. SEPARATE CHARGES

M.9. AWARD WITHOUT DISCUSSIONS

B. SECTION B - PART I, PRICE - HEALTH INSURANCE

B.1. HEALTH INSURANCE SERVICES

The Contractor shall provide Health Insurance services to employees of the Government of the

United States of America in Panama and their eligible dependents as described in Section C. This insurance shall be provided in accordance with Section C.

B.1.1. Official Residence Expense (ORE) Staff and American Employees Recreation Association

(AERA) Employees are included under this contract only as a rider; the Contractor shall bill the Chief of Mission and Deputy Chief of Mission (for ORE Staff), and the AERA (for AERA employees) at the rates specified below. Excess Coverage (C.1.1.19) is included under this contract only as rider benefits; the Contractor shall bill the individual covered at the rates specified below. See Section G for billing procedures. Note that USG is not responsible, nor liable, for any riders.

B.1.2. Grandfathered Retirees and their dependents.

Grandfathered Retirees and their dependents are included under this contract only as a rider; the

Contractor shall bill the retirees separately, at the rates specified below. See Section G for billing procedures. Note that USG is not responsible, nor liable, for any riders.

JAMES ZADROGA 9/11 VICTIMS HEALTH AND COMPENSATION ACT OF 2010 NOTICE:

UNLESS A WAIVER OR EXCEPTION APPLIES, PAYMENTS SUBSEQUENT TO THIS

PROCUREMENT ARE SUBJECT TO AN EXCISE TAX OF 2% PERSUANT TO 26 U.S.C.

5000C.

B.2. PRICES

B.2.1. VALUE ADDED TAX

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

B.2.2. This is a fixed price with economic price adjustment requirements type contract under which will be issued firm, fixed-price task orders. The fixed prices/premium rates for the health insurance services as specified in Section C are as follows:

B.2.3. BASE YEAR OF CONTRACT

Category Estimated Number of Premiums*

Monthly Rate per

Premium

Monthly Total

a. Self 50

b. Self Plus One 50

c. Family (3 or more individual)

d. Subtotal 210

Total Price for Base Year (d x 12)**

*estimated number of premiums does not include any Riders (B.1.1)

**does not include any premiums for Riders.

Rider Category*** Monthly Rate per Premium

C.1.1.19 Excess Coverage

***not included in the Total Price for Base Year Calculation

B.2.4. FIRST OPTION YEAR OF CONTRACT

of Premiums*

Monthly Rate per

Premium

Monthly Total

a. Self 50

b. Self Plus One 50

c. Family (3 or more individual)

Total Price for First Option Year (d x 12)**

***not included in the Total Price for First Option Year Calculation

B.2.5. SECOND OPTION YEAR OF CONTRACT

of Premiums*

Monthly Rate per

Premium

Monthly Total

a. Self 50

b. Self Plus One 50

c. Family (3 or more individuals)

Total Price for Second Option Year (d x 12)**

***not included in the Total Price for Second Option Year Calculation

B.2.6. THIRD OPTION YEAR OF CONTRACT

of Premiums*

Monthly Rate per

Premium

Monthly Total

a. Self 50

b. Self Plus One 50

c. Family (3 or more individuals)

Total Price for Third Option Year (d x 12)**

***not included in the Total Price for Third Option Year Calculation

B.2.7. FOURTH OPTION YEAR OF CONTRACT

of Premiums*

Monthly Rate per

Premium

Monthly Total

a. Self 50

b. Self Plus One 50

c. Family (3 or more individuals)

Total Price for Fourth Option Year (d x 12)**

***not included in the Total Price for Fourth Option Year Calculation

B.2.8. GRAND TOTAL BASE PERIOD PLUS OPTION YEARS

B.3. ADMINISTRATIVE RETENTION AMOUNTS

B.3.1. If the Contractor requests a price adjustment under B.4 below, the Contractor must present cost experience data that includes the retention amount. For purposes of any economic price adjustment, this retention amount is a fixed amount that is a part of the premium amounts in B.2. This retention amount will not be adjusted for any reason.

The retention amount is part of the premium and may include, but not be limited to, such costs as overhead and general and administrative costs. It will also include any profit. Essentially, it includes all costs except the actual portion of the premium intended to fund claims paid to the health care provider/claimant. B.3.2 sets forth the retention amounts per premium paid for each category of premium and for each period of performance.

NOTE TO OFFEROR - Fill in the fixed monthly retention amounts for each period of performance and for each category of premium. This fixed amount must be expressed in the

B.2.8. Grand Total of Base plus All Option Years

Base Year Total

First Option Year Total

Second Option Year Total

Third Option Year Total

Fourth Option Year Total

Grand Total of Base plus All Option Years currency in which the premium amount is proposed. The fixed retention amount shall NOT be expressed in terms of a percentage of the premium.

B.3.2. Monthly Retention Amounts per separate premium paid per single employee, self plus one and per family plan.

Period of

Performance

Single Employees (Self

Only)

Self Plus One Family (3 or more individuals)

Base Period

First Option Year

Second Option Year

Third Option Year

Fourth Option Year

B.4. ECONOMIC PRICE ADJUSTMENT-HEALTH INSURANCE PREMIUMS

B.4.1. Premium Adjustment Based on Experience - For health insurance, prices may be adjusted upward or downward based on the experience rating of the Mission(s) covered by this contract, and it specifically excludes all riders in B.1.1. No adjustment will be allowed during the first twelve months. After such time, the Contractor or the Government may request an adjustment in premiums on an annual basis. Adjustments are not retroactive to previous contract terms. Before any such adjustment is made, the Contractor agrees to provide the Government a balance sheet showing three main components for the time period: (1) receipts (premiums received) minus the retention amount,

(2) number of insurance plans and (3) claims paid. This information shall be provided per type of premium, ie per line item. The retention amount is not subject to adjustment. The Government reserves the right to have an independent third party review the balance sheet and claims and make recommendations regarding the appropriateness of the requested adjustment. Any adjustment shall be subject to mutual agreement of the parties and shall result in a written modification to the contract. Mutually agreed to adjustments shall be effective thirty days after complete information is received by the Government. Any failure to reach agreement under this clause shall be subject to the procedures in the Disputes clause.

B.4.2. Premium Adjustment Based on Laws - The rates may also be adjusted during the performance period of the contract as a result of laws enacted by the host Government, if such change in the laws has a direct impact on the cost to the Contractor to perform this contract at the contracted rate. In that event, the Contracting Officer may enter into negotiations with the Contractor to modify the contract to adjust the premium rate. The Contractor agrees to provide all documentation necessary to support any requested adjustment.

B.4.2.1 Employee Pool – This clause is only in effect if the Contractor included details in its offer regarding a pooling arrangement, of which this contract is a part.

Before any adjustment is made under this price adjustment clause, the Contractor shall include in its proposal for adjustment, details setting forth how the pool impacts the request for equitable adjustment.

PART II PRICE - GROUP LIFE INSURANCE

B.5. GROUP LIFE INSURANCE SERVICES

The Contractor shall provide the Group Life Insurance services described herein to employees of the

Government of the United States of America in Panama. The groups of employees who shall be provided this insurance are listed in C.2.3. This insurance shall be provided in accordance with

Section C and the Exhibits in Section J.

B.5.1. Official Residence Expense (ORE) Staff and American Employees Recreation Association

(AERA) Employees and Peace Corp Personal Service Contracts (PSC) are included under this contract only as a rider; the Contractor shall bill the Chief of Mission and Deputy Chief of Mission

(for ORE Staff), the AERA (for AERA employees) separately, at the rates specified below. See

Section G for billing procedures.

B.6. GROUP LIFE INSURANCE RATES

This is a fixed-price with economic-price- adjustment-requirements type contract under which the

Government will issue firm-fixed price task orders. The fixed prices/premium rates U.S. Dollar per one thousand U.S. dollars of salary to provide life insurance, accidental death and dismemberment and partial and total disability coverage are as follows:

B.6.1. BASE YEAR OF CONTRACT:

B.6.2. FIRST OPTION YEAR OF CONTRACT:

Type of Insurance

Premium

(per 1,000 of Salary)

Estimated Payroll

(Monthly in Thousands) Monthly Total

a. Basic Life $754

b. Accidental Death & Dismemberment $754

c. Partial & Total Disability Coverage $754

Monthly Rates

d. Subtotal (a + b + c)

e. Total Price for Base Year (d x 12)

Type of Insurance

Premium

(per 1,000 of Salary)

Estimated Payroll

(Monthly in Thousands) Monthly Total

a. Basic Life $754.00

b. Accidental Death & Dismemberment $754.00

c. Partial & Total Disability Coverage $754.00

Monthly Rates

d. Subtotal (a + b + c)

e. Total Price for Base Year (d x 12)

B.6.3. SECOND OPTION YEAR OF CONTRACT:

B.6.4. THIRD OPTION YEAR OF CONTRACT:

B.6.5. FOURTH OPTION YEAR OF CONTRACT:

Type of Insurance

Premium

(per 1,000 of Salary)

Estimated Payroll

(Monthly in Thousands) Monthly Total

a. Basic Life $754.00

b. Accidental Death & Dismemberment $754.00

c. Partial & Total Disability Coverage $754.00

Monthly Rates

d. Subtotal (a + b + c)

e. Total Price for Base Year (d x 12)

Type of Insurance

Premium

(per 1,000 of Salary)

Estimated Payroll

(Monthly in Thousands) Monthly Total

a. Basic Life $754.00

b. Accidental Death & Dismemberment $754.00

c. Partial & Total Disability Coverage $754.00

Monthly Rates

d. Subtotal (a + b + c)

e. Total Price for Base Year (d x 12)

Type of Insurance

Premium

(per 1,000 of Salary)

Estimated Payroll

(Monthly in Thousands) Monthly Total

a. Basic Life $754.00

b. Accidental Death & Dismemberment $754.00

c. Partial & Total Disability Coverage $754.00

Monthly Rates

d. Subtotal (a + b + c)

e. Total Price for Base Year (d x 12)

B.6.6. GRAND TOTAL PRICE FOR ALL YEARS:

B.7. ADMINISTRATIVE RETENTION AMOUNTS

B.7.1. If the Contractor requests a price adjustment under B.8 below, the Contractor must present cost experience data that includes the retention amount. For purposes of any economic price adjustment, this retention amount is a fixed amount that is a part of the premium amounts in B.6. This retention amount will not be adjusted for any reason.

The retention amount is part of the premium and may include, but not be limited to, such costs as overhead and general and administrative costs. It will also include any profit. Essentially, it includes all costs except the actual portion of the premium intended to fund claims paid to the claimant.

B.7.2. Sets forth the retention amounts per premium paid for each category of premium and for each period of performance.

NOTE TO OFFEROR - Fill in the fixed retention amounts for each period of performance and for each category of premium. This fixed amount must be expressed in the currency in which the premium amount is proposed. The fixed retention amount shall NOT be expressed in terms of a percentage of the premium.

B.7.3. Monthly Retention Amounts per separate premium paid per thousand dollars in salary:

Period of Performance Basic Life

Accidental Death and

Dismemberment

Partial and Total

Disability Coverage

Base Period

First Option Year

Second Option Year

Third Option Year

Fourth Option Year

Base Year Total

First Option Year Total

Second Option Year Total

Third Option Year Total

Fourth Option Year Total

Grand Total of Base plus All Option Years

B.8. ECONOMIC PRICE ADJUSTMENT-LIFE INSURANCE PREMIUMS

B.8.1. Premium Adjustment Based on Experience - For life insurance, prices may be adjusted upward or downward based on the experience rating of the Mission(s) covered by this contract, and it specifically excludes all riders in B.5.1. No adjustment will be allowed during the first twelve months. After such time, the Contractor or the Government may request an adjustment in premiums on an annual basis. Adjustments are not retroactive to previous contract terms. Before any such adjustment is made, the Contractor agrees to provide the Government a balance sheet showing three main components for the time period: (1) receipts (premiums received) minus the retention amount,

(2) number of insurance plans and (3) claims paid (see sample template below). The information shall be provided per type of premium, i.e. per line item. The retention amount is not subject to adjustment. The Government reserves the right to select an independent third party to review the balance sheet and claims and make recommendations regarding the appropriateness of the requested adjustment. Any adjustment shall be subject to mutual agreement of the parties and shall result in a written modification to the contract. Mutually agreed to adjustments shall be effective thirty days after complete information is received by the Government. Any failure to reach agreement under this clause shall be subject to the procedures in the Disputes clause.

B.8.2. Premium Adjustment Based on Law - The rates may also be adjusted during the performance period of the contract as a result of laws enacted by the host Government, if such change in the laws has a direct impact on the cost to the contractor to perform this contract at the rate contracted for herein. In that event, the Contracting Officer may enter into negotiations with the Contractor to modify the contract to adjust the premium rate. The contractor agrees to provide all documentation necessary to support any requested adjustment.

C. SECTION C - DESCRIPTION/SPECIFICATION/WORK STATEMENT

PART I - HEALTH INSURANCE

C.1. HEALTH INSURANCE SERVICES

The Government of the United States of America requires Health Insurance coverage for its employees as described herein.

C.1.1. Employee and Dependent Health Services Benefits

C.1.1.1 Hospitalization (Treatment in the Hospital for Inpatient Care): Minimum Coverage -

100%

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, and 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.

See Mental Health and Substance Abuse Care (below) (C.1.1.13) for details concerning inpatient psychiatric care.

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

C.1.1.2 Emergency Services (Trips to Emergency Room): Minimum Coverage - 100%

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

C.1.1.3 Ambulance: Minimum Coverage - 80%

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.

C.1.1.4 Outpatient Services: Minimum Coverage - 80%

Services provided by a licensed healthcare provider on an ambulatory or outpatient basis (without being admitted to a hospital), including surgeon’s fees and other medical services provided at 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.

C.1.1.5 Obstetric and Newborn Care: Inpatient: 100% Coverage; Outpatient: 80% Minimum

Coverage

Care and services that women receive during pregnancy (prenatal care), throughout labor, 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.

C.1.1.6 Pediatric Services: Inpatient: 100% Coverage; Outpatient: 80% Minimum Coverage

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.

C.1.1.7 Prescription Drugs: Inpatient: 100% Coverage; Outpatient: 80% Minimum Coverage

Medications prescribed by a certified health care provider that are medically required. 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, contraceptive medication.

C.1.1.8 Preventive and Wellness Services and Chronic Disease Management: Minimum

Coverage - 80%

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

physicals, immunizations, and cancer screenings.

C.1.1.9 Hearing Aids: Minimum Coverage – 80%

Examinations and Treatment: 80% Minimum Coverage

Hearing Aid Apparatus: Limited to one apparatus per ear up to a maximum of USD 1,500 per covered individual per three-year period. 80% Minimum Coverage: with annual cap.

C.1.1.10 Optical Care: Minimum Coverage – 80%

Examinations and Treatment: 80% Minimum Coverage

Prescription lenses and frames, or contact lenses: Covered up to a maximum of USD 300 per covered individual every two years. 80% Minimum Coverage; with annual cap.

C.1.1.11 Dental Care: Minimum Coverage – 80%

Examinations and Treatment: Dentist’s fees, x-rays, examinations and treatment, cleanings, fillings, extractions, false teeth, crowns, and bridges up to a maximum of USD 3,200 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 up to a maximum of USD 2,400 lifetime limit. 80% Minimum Coverage; with contract lifetime cap.

C.1.1.12 Reproductive Health: Minimum Coverage - 80%

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).

C.1.1.13 Mental Health and Substance Abuse Care: Minimum Coverage - 50%

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 provided at a facility licensed for detoxification and rehabilitation.

C.1.1.14 Rehabilitative and Habilitative Services and Devices: Minimum Coverage - 50%

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, etc.) 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.

C.1.1.15 HIV/AIDS: 100% up to USD 10,000 per contract year per covered individual

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.

C.1.1.16 Reserved

C.1.1.17 Out-of-Country Medical Treatment:

Medical expenses incurred out-of-country will be covered at the same benefit levels and subject to the same total maximum annual limit as for medical expenses incurred in-country.

C.1.1.18 Out-of-Country Medical Travel: 80% Reimbursement

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.

C.1.1.19 Excess Coverage:

NOTE: Employee responsible for paying 100% of premium for Excess Coverage

Additional coverage equal to $240,000 USD 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. The premium for this additional coverage is a rider to be paid by the employee to the vender directly and USG will not be responsible for collecting of these premium payments.

C.1.2. Annual Maximum Limit - The maximum annual reimbursement per covered individual per contract year, not including expenses defined under Exclusions and Limitations (C.1.3) or those covered under C.1.1.15, HIV/AIDS, and C.1.1.19 Excess Coverage is equivalent to $240,000 USD.

C.1.3. Exclusions 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, intracellular 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.

With the exception of retired employees covered under a rider in paragraph C.1.4.3. below, no coverage will be made for expenses incurred after an employee leaves the service of the U.S.

Mission.

C.1.4. Eligible Participants

C.1.4.1 Identification of Eligible Employees and Dependents: U.S. Mission Panama will provide a list of all eligible employees and dependents with relationship to employee

(self/spouse/child) and DOB for each. Updates will be provided to add or remove individuals on a monthly basis.

To be eligible to participate in the medical plan, LE Staff must be:

• Paid under the terms of the Local Compensation Plan (LCP); and –

• Under a non-temporary direct hire appointment, personal services agreement (PSA), or personal services contract (PSC); or

• Under a temporary direct hire appointment or PSA Fixed Term of one year or more.

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 Panama 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; employees of

USAID institutional contractors; Peace Corps personal services contractors as indicated in MS

743; and Recreation Association employees.

Official Residence Expense (ORE) and Employee Association (EA) employees may be covered under a rider to the contract. The employing officer/EA, not the USG, is responsible for the employer's share of the premium costs for an ORE employee.

Currently enrolled retired employees and their dependents can participate in this plan under a rider. Active employees will be eligible for continued coverage under a rider for themselves and their dependents once they retire based on the following criteria:

• Current active employees and currently retired employees, enrolled before February

1, 1995, are eligible for coverage under the rider until age 75.

• Current active employees and currently retired employees, enrolled after February 1, 1995, and before June 30, 2006, are eligible for coverage under the rider until age 70.

• Employees hired after June 30, 2006 are not eligible to continue coverage once retired.

The retired employee will be responsible for paying 100% of the premium costs for the coverage of themselves and their dependents.

C.1.4.1.1 Definition of Dependents:

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

C.1.4.1.2 Legal Spouse:

One legal spouse as defined by local law may be covered. LE Staff with more than one legal spouse must select only one spouse 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.

C.1.4.1.3 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.

C.1.4.2 Location of Employment

The individuals covered by C.1.4.1 must be employed within the geographic boundaries of Panama by:

Department of State

Department of Agriculture: APHIS, ARS, FAS

Department of Justice: DEA, LEGATT, OPDAT, OFL

Department of Homeland Security: ICE, CIS, CBP, USCG, TSA, OIA

Department of Health and Human Services: CDC

Department of Defense: DAO, ODC, TAT, NCIS

Department of Commerce: FCS

Department of Treasury: IRS

Department of Transportation: FAA

U.S. Peace Corps

American Battle Monuments Commission

Any other USG agency as required.

C.1.4.3 Participants Covered Under a Rider:

a. All current active ORE Staff personally employed by the Chief of Mission and the

Deputy Chief of Mission and assigned to their respective official Government residences and paid under an ORE account. All costs for coverage of ORE Staff are the responsibility of the Chief of Mission and the Deputy Chief of Mission, not the

U.S. Government.

b. All current active employees of the American Employee Recreation Association at

U.S. Embassy Panama. All costs for AERA employees are the responsibility of the

American Employee Recreation Association, not the U.S. Government.

c. Special Coverage for Retired Employees and Dependents:

Currently enrolled retired employees and their dependents can participate in this plan under a rider, subject to the following criteria. Active employees will be eligible for continued coverage under a rider for themselves and their dependents once they retire based on the following criteria:

• Current active employees and currently retired employees, enrolled before

February 1, 1995, are eligible for coverage under the rider until age 75.

• Current active employees and currently retired employees, enrolled after

February 1, 1995, and before June 30, 2006, are eligible for coverage under the rider until age 70.

• Employees hired after June 30, 2006 are not eligible to continue coverage once retired.

Note: Retired employees are responsible for 100% of premium payments.

C.1.5. Eligibility

C.1.5.1 Term of Eligibility and Effective Date

Each current active eligible employee and their eligible dependents are enrolled for health benefits under this contract upon award and thereafter during the performance period of this contract. Each new eligible employee and eligible dependents 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.

C.1.5.2 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.

C.1.6. Brochure Requirement

C.1.6.1 The contractor shall provide a document (brochure/pamphlet/other written document) in English and Spanish 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.

C.1.6.2 The contractor shall provide the document described in C.1.6.1 to the COR not later than 30 days after date of contract award. The Contractor shall provide additional brochures for new employees within ten (10) days of the COR’s request.

C.1.6.3 The contractor assumes full responsibility for ensuring that the document described in

C.1.6.1 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

C.2. GROUP LIFE INSURANCE

The Government of the United States of America requires group life insurance coverage for its employees, as further described in C.2.1, in Panama. The Government has determined that the prevailing practice by employers in Panama 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. Therefore, the Government desires to adopt such locally prevailing practice as part of its compensation plan for its employees as further described in C.2.1. The specific group insurance coverage under this contract is set forth in this part of Section C and the Attachments in

Section J.

Definitions:

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

Currency: premiums and benefits will be paid in U.S. Dollars.

C.2.1. Group Life Insurance Coverage

The amount of group life insurance coverage is as follows:

C.2.1.1 Amount of Employee Basic Life insurance:

Natural Death: The participant's named beneficiaries or estate will receive an amount equal to twenty-four (24) times his or her basic monthly salary at the time of death.

C.2.1.2 Amount of Accidental or Work-Related Death Coverage:

The participant's named beneficiaries or estate will receive an amount equal to thirty (30) times his or her basic monthly salary upon the death of the participant.

C.2.1.3 Partial and Total Disability Coverage:

(1) Total Disability: In the event of permanent disability the employee is eligible for an amount of coverage equal to twenty-four (24) times his or her monthly basic rate (BR).

(2) Partial Disability: All percentages are based on the amount for natural death.

i. Loss of both arms or hands; both legs or feet; one arm or hand and one leg or foot; loss of vision in both eyes: 100% of 24 months BR.

ii. Loss of one arm or hand; one leg or foot; loss of vision in one eye; total loss of speech or hearing: 50% of 24 months BR.

C.2.1.4 Funeral Benefit: not covered

C.2.2. Life Insurance Benefits Conditions and Limitations

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:

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

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

3. 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.

C.2.3. Eligible Participants

C.2.3.1 Eligible Employees:

Eligible employees are Locally Employed (LE) Staff who are:

(1) Working on a full-time or part-time basis under non-temporary direct-hire appointments and under personal services agreements/contracts that are not time limited to less than one year and

(2) paid under the terms of the Local Compensation Plan.

C.2.3.2 Location of Employment

The individuals covered by C.2.3.1 must be employed within the geographic boundaries of Panama by:

Department of State

Department of Agriculture: APHIS, ARS, FAS

Department of Justice: DEA, LEGATT, OPDAT, OFL

Department of Homeland Security: ICE, CIS, CBP, USCG, TSA, OIA

Department of Health and Huma Services: CDC

Department of Defense: DAO, ODC, TAT, NCIS

Department of Commerce: FCS

Department of Treasury: IRS

Department of Transportation: FAA

U.S. Peace Corps

American Battle Monuments Commission

Any other USG agency as required.

C.2.3.3 Participants Covered Under a Rider

Official Residence Expense (ORE) and Employee Association (EA) employees may be covered under a rider to the contract. The employing officer/EA, not the USG, is responsible for the employer's share of the premium costs for an ORE employee.

C.2.4. Individuals Not Eligible for Coverage

C.2.4.1 Reserved

C.2.4.2 Not eligible are LE Staff working under temporary appointments; those working under a PSC or PSA that is time limited to less than one year; those with an intermittent

(When Actually Employed (WAE)) workweek schedule; non-personal services contract personnel and their employees, supplied by an independent contractor licensed to do business in Panama who provide services to other local organizations as well as to the U.S. Mission; employees of USAID institutional contractors; and

Peace Corps personal services contractors as indicated in MS 743.

C.2.4.3 Retirees and dependents are not eligible.

C.2.5. Other Eligible Participants

The following additional categories of persons are covered by this insurance:

None

C.2.6. Eligibility and Effective Date

C.2.6.1 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.

C.2.6.2 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 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.

C.2.7. BROCHURE REQUIREMENT

C.2.7.1 The contractor shall provide a document (brochure/pamphlet/other written document) in English and Spanish 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.

C.2.7.2 The document described in C.2.7.1 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.

C.2.7.3 The contractor assumes full responsibility for ensuring that the document described in

C.2.7.1 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.

C.3. DEFINITIONS

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

U.S. Government Agencies, except U.S. AID.

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

Assistant at post.

Contributory

Insurance

Insurance for which the employee contributes toward the premium.

Currency Premiums and benefits will be paid in US Dollars (USD).

Customary and

Reasonable

Treatment

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

Dependent 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. There is no limit on the number of children covered per employee.

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 C.1.3 for health insurance and C.2.3 for life insurance. This may also include ORE

Staff and AERA employees, if this category of individual is listed as participating under a rider in C.1.3.3 for health insurance and C.2.3.3 for life insurance.

Employer The United States Government or in the case of ORE and AERA employees, the Chief of Mission/Deputy Chief of Mission and the

American Employee Recreation Association, respectively.

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 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.

D. SECTION D - PACKAGING AND MARKING

(RESERVED)

E. SECTION E - INSPECTION AND ACCEPTANCE

E.1. 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

This contract incorporates one or more clauses by reference, with the same force and effect as if they were given in full text. Upon request, the Contracting Officer will make their full text available. In addition, the full text of a clause may be accessed electronically at: Acquisition.gov this address is subject to change.

If the Federal Acquisition Regulation (FAR) is not available at the location indicated above, use the

Department of State Acquisition website at e-CFR to see the links to the FAR. You may also use an

Internet “search engine” (for example, Google, Yahoo or Excite) to obtain the latest location of the most current FAR.

The following Federal Acquisition Regulation clause(s) is/are incorporated by reference:

CLAUSE TITLE AND DATE

52.246-4 INSPECTION OF SERVICES - FIXED PRICE (AUG 1996)

E.2. 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 Para Performance Threshold

Services.

Performs all the insurance services set forth in the performance work statement (PWS)

C.1.0 thru

C.3.0

All required services are performed and no more than one

(1) customer complaint is received per month

E.2.1. 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.

E.2.2. 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 https://acquisition.gov/browse/index/far https://gov.ecfr.io/cgi-bin/text-idx?SID=d9a7851186785ba2b1896db79b1b6b29&mc=true&tpl=/ecfrbrowse/Title48/48tab_02.tpl

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

E.2.3. Procedures

(i) If any Government personnel…