1_TOP_21_Amd_1_SF30_10-01-19_ma.pdf

(x)

HT940219R0001

x x

1 copies of the amendment; (b) By acknowledging receipt of this amendment on each copy of the offer submitted; or (c) By separate letter or telegram which includes a reference to the solicitation and amendment numbers. FAILURE OF YOUR ACKNOWLEDGEMENT TO BE RECEIVED AT

THE PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY RESULT IN REJECTION OF YOUR OFFER. If by virtue of this amendment you desire to change an offer already submitted, such change may be made by telegram or letter, provided each telegram or letter makes reference to the solicitation and this amendment, and is received prior to the opening hour and date specified.

x

HT9402

AURORA CO 80011-9066

16401 E CENTRETECH PARKWAY

DEFENSE HEALTH AGENCY-AURORA

DEFENSE HEALTH AGENCY

HT9402

AURORA CO 80011

16401 E CENTRETECH PARKWAY

DEFENSE HEALTH AGENCY-AURORA

DEFENSE HEALTH AGENCY

10/01/20190001

13. THIS ITEM ONLY APPLIES TO MODIFICATION OF CONTRACTS/ORDERS. IT MODIFIES THE CONTRACT/ORDER NO. AS DESCRIBED IN ITEM 14.

12. ACCOUNTING AND APPROPRIATION DATA (If required) is not extended.is extended, Items 8 and 15, and returning

Offers must acknowledge receipt of this amendment prior to the hour and date specified in the solicitation or as amended, by one of the following methods: (a) By completing

The above numbered solicitation is amended as set forth in Item 14. The hour and date specified for receipt of Offers

11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS

FACILITY CODE CODE

10B. DATED (SEE ITEM 13)

10A. MODIFICATION OF CONTRACT/ORDER NO.

9B. DATED (SEE ITEM 11)

9A. AMENDMENT OF SOLICITATION NO.

CODE

8. NAME AND ADDRESS OF CONTRACTOR (No., street, county, State and ZIP Code)

7. ADMINISTERED BY (If other than Item 6)CODE 6. ISSUED BY

PAGE OF PAGES

4. REQUISITION/PURCHASE REQ. NO.3. EFFECTIVE DATE2. AMENDMENT/MODIFICATION NO. 5. PROJECT NO. (If applicable)

1. CONTRACT ID CODE

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

08/01/2019

CHECK ONE A. THIS CHANGE ORDER IS ISSUED PURSUANT TO: (Specify authority) THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE CONTRACT

B. THE ABOVE NUMBERED CONTRACT/ORDER IS MODIFIED TO REFLECT THE ADMINISTRATIVE CHANGES (such as changes in paying office, C. THIS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO AUTHORITY OF:

D. OTHER (Specify type of modification and authority) appropriation date, etc.) SET FORTH IN ITEM 14, PURSUANT TO THE AUTHORITY OF FAR 43.103(b).

E. IMPORTANT: Contractor is not, is required to sign this document and return __________________ copies to the issuing office.

ORDER NO. IN ITEM 10A.

14. DESCRIPTION OF AMENDMENT/MODIFICATION (Organized by UCF section headings, including solicitation/contract subject matter where feasible.)

A. This amendment revises Solicitation HT9402-19-R-0001 Section B, Supplies or Services and Prices/Costs; Section C, Description/Specifications/Work Statement; Section G, Contract

Administration Data; Section H, Special Contract Requirements, Section I, Contract Clauses;

Section J, List of Attachments; Section K, Representations, Certifications, and Other

Statements of Bidders; and Section L, Instructions, Conditions, and Notices to Offerors.

B. The changes incorporated are listed in paragraph C. Summary of Changes of the Block 14 continuation on the continuation page. The Offeror shall acknowledge receipt of each amendment issued in accordance with instructions in Item 11 and Block 14 of the SF 33, Solicitation, Offer and Award.

Continued ...

16A. NAME AND TITLE OF CONTRACTING OFFICER (Type or print)15A. NAME AND TITLE OF SIGNER (Type or print)

15C. DATE SIGNED 16B. UNITED STATES OF AMERICA 15B. CONTRACTOR/OFFEROR 16C. DATE SIGNED

(Signature of person authorized to sign) (Signature of Contracting Officer)

MARGARET A. ZANCANELLA

STANDARD FORM 30 (REV. 10-83)

Prescribed by GSA

FAR (48 CFR) 53.243

NSN 7540-01-152-8070

Previous edition unusable

Except as provided herein, all terms and conditions of the document referenced in Item 9A or 10A, as heretofore changed, remains unchanged and in full force and effect.

Margaret.a.zancanella.civ@mail.mil

303-676-3451

19-TOPX-0035

ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

NAME OF OFFEROR OR CONTRACTOR

2 26

CONTINUATION SHEET

PAGE OFREFERENCE NO. OF DOCUMENT BEING CONTINUED

HT940219R0001/0001

(A) (B) (C) (D) (E) (F)

0001 1 LO

0003 1 LO

TRICARE OVERSEAS PROGRAM (TOP) 2021 Indefinite

Delivery/Indefinite Quantity Overseas Health Care

Support Contract in accordance with FAR Clause

52.216-1, Contract Type, for the scheduled period and for Option Periods 1-7 if exercised. All services shall be ordered in accordance with

Sections G and I, FAR Clauses 52.216-19, Order

Limitations; and 52.216-22, Indefinite Quantity;

and DFARS Clause 252.216-7006, Ordering. PSC:

Q201, Medical - General Healthcare; NAICS:

524114, Direct Health and Medical Insurance

Carriers.

Guaranteed Minimum: TBD (Award value of CLIN 0001)

Contract Ceiling: $995,000,000(Award Value, includes all CLINs X014, Transition-Out and

52.217-8 6 Month Extension)

Delivery Location Code: HT9402

DEFENSE HEALTH AGENCY

DEFENSE HEALTH AGENCY-AURORA

16401 E CENTRETECH PARKWAY

AURORA CO 80011-9066 USA

SECTION B, SUPPLIES OR SERVICES AND PRICES/COSTS.

Base Period (TRANSITION-IN): 12 months from the date of award.

TRANSITION-IN (Firm Fixed Price)

Planning and implementation of transition-in activities as stated in Section C.26. of the contract.

LO = Lot

DELIVERABLES, DD FORM 1423-1, CONTRACT DATA

REQUIREMENTS LIST (CDRLs) FOR TRANSITION-IN CDRLS

CDRLs(DD1423) as stated in Section C, Section

F.5, and Section J, Exhibit A of the contract.

(Not Separately Priced)

PERFORMANCE READINESS VALIDATION/PERFORMANCE

READINESS ASSESSMENT AND VERIFICATION (Firm Fixed

Price)

Continued ...

NSP

3 26

CONTINUATION SHEET

PAGE OFREFERENCE NO. OF DOCUMENT BEING CONTINUED

HT940219R0001/0001

(A) (B) (C) (D) (E) (F)

1001 3358164 EA

1002 283272 EA

1003 6221 EA

1004 200 EA

Administrative and support cost associated with providing the services as stated in Section

C.26.4 and C.26.5 of the contract.

LO = Lot

Option Period (OP) 1 (12 months)

For any CLIN with Unit of Issue "Each", the quantities are estimated

HEALTH CARE SUPPORT SERVICES - PRIME ENROLLED

MEMBERS (Fixed Unit Price)(Estimated Quantities)

Administrative and support costs associated with providing all services as stated in Section

C.1.2. of the contract.

EA = Each Member Per Month X 12 Months

(Option Line Item)

HEALTH CARE SUPPORT SERVICES - PRIME REMOTE

ENROLLED MEMBERS (Fixed Unit Price)(Estimated Quantities)

Administrative and support costs associated with providing all services as stated in Section

C.1.2. of the contract.

EA = Each Member Per Month X 12 Months

(Option Line Item)

TRANSIENT CARE MANAGEMENT (Fixed Unit Price) (Estimated Quantities)

Administrative and support costs associated with providing the services for urgent/emergency care as stated in Section C.21 of the contract.

EA = Each Case

(Option Line Item)

TRANSIENT AMBULANCE/AEROMEDICAL EVACUATION

SERVICES (Fixed Unit Price)(Estimated Quantities)

Administration and support costs associated with providing transient ambulance/aeromedical evacuation services as stated in Section C.14. of the contract.

Continued ...

4 26

CONTINUATION SHEET

PAGE OFREFERENCE NO. OF DOCUMENT BEING CONTINUED

HT940219R0001/0001

(A) (B) (C) (D) (E) (F)

1005 400000 EA

EA = Each Case

(Option Line Item)

WRITTEN TRANSLATION SERVICES - ROUTINE (Fixed

Unit Price)(Estimated Quantities)

Translation Services as stated in Section C.19.

of the contract.

EA = Each Page

(Option Line Item)

WRITTEN TRANSLATION SERVICES - URGENT (Fixed Unit 50000 EA Price)(Estimated Quantities)

Translation Services as stated in Section C.19.

of the contract.

EA = Each Page

(Option Line Item)

CLAIMS PROCESSING FEE - TRICARE ELIGIBLE (DEFENSE 561049 EA

HEALTHCARE PROGRAM (DHP)) (Fixed Unit Price)

(Estimated Quantities)

Administrative and support costs associated with providing services as stated in Section C.16. of the contract.

EA = Each Claim

(Option Line Item)

1008 42311 EA

1009 360 EA

CLAIMS PROCESSING FEE - MEDICARE ELIGIBLE

(MEDICARE ELIGIBLE RETIREE HEALTH CARE FUND

(MERHCF)) (Fixed Unit Price)(Estimated Quantities)

Administrative and support costs associated with providing services as stated in Section C.16. of the contract.

EA = Each Claim

(Option Line Item)

ACCESS TO CARE IN KINSHASA, DEMOCRATIC REPUBLIC

OF THE CONGO (Fixed Unit Price)

Continued ...

manderson Highlight manderson Highlight

5 26

CONTINUATION SHEET

PAGE OFREFERENCE NO. OF DOCUMENT BEING CONTINUED

HT940219R0001/0001

(A) (B) (C) (D) (E) (F)

1010 200 EA

1011 1 LO

1012 1 LO

1014 1 LO

Access to care in Kinshasa, Democratic Republic of the Congo as stated in Section C.42.2. of the contract.

EA = Each Member Per Month.

(Option Line Item)

MEDICAL CAPABILITY REPORTS (Fixed Unit Price) (Estimated Quantities).

Administrative and support costs associated with providing services as stated in Section C.22. of the contract.

EA = Each Report

(Option Line Item)

BLOCK OVERFLIGHT PERMITS (Firm Fixed Price).

Administrative and support costs associated with providing Block Overflight Permits as stated in

Section C.14.10 and C.14.11 of the contract.

LO = Lot

(Option Line Item)

PERFORMANCE INCENTIVE POOL

OPTION PERIOD 1.

See Section H.6. of the contract for criteria for earning incentives. The amount shown is the maximum incentive available for OP1.

LO = Lot

(Option Line Item)

DELIVERABLES, DD FORM 1423-1, CONTRACT DATA

REQUIREMENTS LIST (CDRLs)

CDRLs(DD1423) as stated in Section C, Section

F.5, and Section J, Exhibit A of the contract.

(Option Line Item)

(Not Separately Priced)

TRANSITION-OUT - IF EXERCISED (Firm Fixed Price)

Continued ...

NSP

6 26

CONTINUATION SHEET

PAGE OFREFERENCE NO. OF DOCUMENT BEING CONTINUED

HT940219R0001/0001

(A) (B) (C) (D) (E) (F)

2001 3358164 EA

2002 283272 EA

2003 6221 EA

2004 200 EA

Implementation of transition-out activities as stated in Section C.26. of the contract.

LO = Lot

(Option Line Item)

Option Period (OP) 2 (12 months)

For any CLIN with Unit of Issue "Each", the quantities are estimated

HEALTH CARE SUPPORT SERVICES - PRIME ENROLLED

MEMBERS (Fixed Unit Price)(Estimated Quantities)

Administrative and support costs associated with providing all services as stated in Section

C.1.2. of the contract.

EA = Each Member Per Month X 12 Months

(Option Line Item)

HEALTH CARE SUPPORT SERVICES - PRIME REMOTE

ENROLLED MEMBERS (Fixed Unit Price)(Estimated Quantities)

Administrative and support costs associated with providing all services as stated in Section

C.1.2. of the contract.

EA = Each Member Per Month X 12 Months

(Option Line Item)

TRANSIENT CARE MANAGEMENT (Fixed Unit Price) (Estimated Quantities)

Administrative and support costs associated with providing the services for urgent/emergency care as stated in Section C.21 of the contract.

EA = Each Case

(Option Line Item)

TRANSIENT AMBULANCE/AEROMEDICAL EVACUATION

SERVICES (Fixed Unit Price)(Estimated Quantities)

Administration and support costs associated with providing transient ambulance/aeromedical evacuation services as stated in Section C.14. of the contract.

Continued ...

7 26

CONTINUATION SHEET

PAGE OFREFERENCE NO. OF DOCUMENT BEING CONTINUED

HT940219R0001/0001

(A) (B) (C) (D) (E) (F)

2005 400000 EA

EA = Each Case

(Option Line Item)

WRITTEN TRANSLATION SERVICES - ROUTINE (Fixed

Unit Price)(Estimated Quantities)

Translation Services as stated in Section C.19.

of the contract.

EA = Each Page

(Option Line Item)

WRITTEN TRANSLATION SERVICES - URGENT (Fixed Unit 50000 EA Price)(Estimated Quantities)

Translation Services as stated in Section C.19.

of the contract.

EA = Each Page

(Option Line Item)

CLAIMS PROCESSING FEE - TRICARE ELIGIBLE (DEFENSE 561049 EA

HEALTHCARE PROGRAM (DHP)) (Fixed Unit Price)

(Estimated Quantities)

Administrative and support costs associated with providing services as stated in Section C.16. of the contract.

EA = Each Claim

(Option Line Item)

2008 42311 EA

2009 360 EA

CLAIMS PROCESSING FEE - MEDICARE ELIGIBLE

(MEDICARE ELIGIBLE RETIREE HEALTH CARE FUND

(MERHCF)) (Fixed Unit Price)(Estimated Quantities)

Administrative and support costs associated with providing services as stated in Section C.16. of the contract.

EA = Each Claim

(Option Line Item)

ACCESS TO CARE IN KINSHASA, DEMOCRATIC REPUBLIC

OF THE CONGO (Fixed Unit Price)(Estimated Quantities) Continued ...

manderson Highlight

8 26

CONTINUATION SHEET

PAGE OFREFERENCE NO. OF DOCUMENT BEING CONTINUED

HT940219R0001/0001

(A) (B) (C) (D) (E) (F)

2010 200 EA

2011 1 LO

2012 1 LO

2014 1 LO

Access to care in Kinshasa, Democratic Republic of the Congo as stated in Section C.42.2. of the contract.

EA = Each Member Per Month.

(Option Line Item)

MEDICAL CAPABILITY REPORTS (Fixed Unit Price) (Estimated Quantities).

Administrative and support costs associated with providing services as stated in Section C.22. of the contract.

EA = Each Report

(Option Line Item)

BLOCK OVERFLIGHT PERMITS (Firm Fixed Price) (Estimated Quantities).

Administrative and support costs associated with providing Block Overflight Permits as stated in

Section C.14.10 and C.14.11 of the contract.

LO = Lot

(Option Line Item)

PERFORMANCE INCENTIVE POOL

OPTION PERIOD 2.

See Section H.6. of the contract for criteria for earning incentives. The amount shown is the maximum incentive available for OP2.

LO = Lot

(Option Line Item)

DELIVERABLES, DD FORM 1423-1, CONTRACT DATA

REQUIREMENTS LIST (CDRLs)

CDRLs(DD1423) as stated in Section C, Section

F.5, and Section J, Exhibit A of the contract.

(Option Line Item)

(Not Separately Priced)

TRANSITION-OUT - IF EXERCISED (Firm Fixed Price)

Continued ...

NSP

9 26

CONTINUATION SHEET

PAGE OFREFERENCE NO. OF DOCUMENT BEING CONTINUED

HT940219R0001/0001

(A) (B) (C) (D) (E) (F)

3001 3358164 EA

3002 283272 EA

3003 6221 EA

3004 200 EA

Implementation of transition-out activities as stated in Section C.26. of the contract.

LO = Lot

(Option Line Item)

Option Period (OP) 3 (12 months)

For any CLIN with Unit of Issue "Each", the quantities are estimated

HEALTH CARE SUPPORT SERVICES - PRIME ENROLLED

MEMBERS (Fixed Unit Price)(Estimated Quantities)

Administrative and support costs associated with providing all services as stated in Section

C.1.2. of the contract.

EA = Each Member Per Month X 12 Months

(Option Line Item)

HEALTH CARE SUPPORT SERVICES - PRIME REMOTE

ENROLLED MEMBERS (Fixed Unit Price)(Estimated Quantities)

Administrative and support costs associated with providing all services as stated in Section

C.1.2. of the contract.

EA = Each Member Per Month X 12 Months

(Option Line Item)

TRANSIENT CARE MANAGEMENT (Fixed Unit Price) (Estimated Quantities)

Administrative and support costs associated with providing the services for urgent/emergency care as stated in Section C.21 of the contract.

EA = Each Case

(Option Line Item)

TRANSIENT AMBULANCE/AEROMEDICAL EVACUATION

SERVICES (Fixed Unit Price)(Estimated Quantities)

Administration and support costs associated with providing transient ambulance/aeromedical evacuation services as stated in Section C.14. of the contract.

Continued ...

10 26

CONTINUATION SHEET

PAGE OFREFERENCE NO. OF DOCUMENT BEING CONTINUED

HT940219R0001/0001

(A) (B) (C) (D) (E) (F)

3005 400000 EA

EA = Each Case

(Option Line Item)

WRITTEN TRANSLATION SERVICES - ROUTINE (Fixed

Unit Price)(Estimated Quantities)

Translation Services as stated in Section C.19.

of the contract.

EA = Each Page

(Option Line Item)

WRITTEN TRANSLATION SERVICES - URGENT (Fixed Unit 50000 EA Price)(Estimated Quantities)

Translation Services as stated in Section C.19.

of the contract.

EA = Each Page

(Option Line Item)

CLAIMS PROCESSING FEE - TRICARE ELIGIBLE (DEFENSE 561049 EA

HEALTHCARE PROGRAM (DHP)) (Fixed Unit Price)

(Estimated Quantities)

Administrative and support costs associated with providing services as stated in Section C.16. of the contract.

EA = Each Claim

(Option Line Item)

3008 42311 EA

3009 360 EA

CLAIMS PROCESSING FEE - MEDICARE ELIGIBLE

(MEDICARE ELIGIBLE RETIREE HEALTH CARE FUND

(MERHCF)) (Fixed Unit Price)(Estimated Quantities)

Administrative and support costs associated with providing services as stated in Section C.16. of the contract.

EA = Each Claim

(Option Line Item)

ACCESS TO CARE IN KINSHASA, DEMOCRATIC REPUBLIC

OF THE CONGO (Fixed Unit Price)(Estimated Quantities) Continued ...

manderson Highlight

11 26

CONTINUATION SHEET

PAGE OFREFERENCE NO. OF DOCUMENT BEING CONTINUED

HT940219R0001/0001

(A) (B) (C) (D) (E) (F)

3010 200 EA

3011 1 LO

3012 1 LO

3014 1 LO

Access to care in Kinshasa, Democratic Republic of the Congo as stated in Section C.42.2. of the contract.

EA = Each Member Per Month.

(Option Line Item)

MEDICAL CAPABILITY REPORTS (Fixed Unit Price) (Estimated Quantities).

Administrative and support costs associated with providing services as stated in Section C.22. of the contract.

EA = Each Report

(Option Line Item)

BLOCK OVERFLIGHT PERMITS (Firm Fixed Price).

Administrative and support costs associated with providing Block Overflight Permits as stated in

Section C.14.10 and C.14.11 of the contract.

LO = Lot

(Option Line Item)

PERFORMANCE INCENTIVE POOL

OPTION PERIOD 3.

See Section H.6. of the contract for criteria for earning incentives. The amount shown is the maximum incentive available for OP3.

LO = Lot

(Option Line Item)

DELIVERABLES, DD FORM 1423-1, CONTRACT DATA

REQUIREMENTS LIST (CDRLs)

CDRLs(DD1423) as stated in Section C, Section

F.5, and Section J, Exhibit A of the contract.

(Option Line Item)

(Not Separately Priced)

TRANSITION-OUT - IF EXERCISED (Firm Fixed Price)

Continued ...

NSP

12 26

CONTINUATION SHEET

PAGE OFREFERENCE NO. OF DOCUMENT BEING CONTINUED

HT940219R0001/0001

(A) (B) (C) (D) (E) (F)

4001 3358164 EA

4002 283272 EA

4003 6221 EA

4004 200 EA

Implementation of transition-out activities as stated in Section C.26. of the contract.

LO = Lot

(Option Line Item)

Option Period (OP) 4 (12 months)

For any CLIN with Unit of Issue "Each", the quantities are estimated

HEALTH CARE SUPPORT SERVICES - PRIME ENROLLED

MEMBERS (Fixed Unit Price)(Estimated Quantities)

Administrative and support costs associated with providing all services as stated in Section

C.1.2. of the contract.

EA = Each Member Per Month X 12 Months

(Option Line Item)

HEALTH CARE SUPPORT SERVICES - PRIME REMOTE

ENROLLED MEMBERS (Fixed Unit Price)(Estimated Quantities)

Administrative and support costs associated with providing all services as stated in Section

C.1.2. of the contract.

EA = Each Member Per Month X 12 Months

(Option Line Item)

TRANSIENT CARE MANAGEMENT (Fixed Unit Price) (Estimated Quantities)

Administrative and support costs associated with providing the services for urgent/emergency care as stated in Section C.21 of the contract.

EA = Each Case

(Option Line Item)

TRANSIENT AMBULANCE/AEROMEDICAL EVACUATION

SERVICES (Fixed Unit Price)(Estimated Quantities)

Administration and support costs associated with providing transient ambulance/aeromedical evacuation services as stated in Section C.14. of the contract.

Continued ...

13 26

CONTINUATION SHEET

PAGE OFREFERENCE NO. OF DOCUMENT BEING CONTINUED

HT940219R0001/0001

(A) (B) (C) (D) (E) (F)

4005 400000 EA

EA = Each Case

(Option Line Item)

WRITTEN TRANSLATION SERVICES - ROUTINE (Fixed

Unit Price)(Estimated Quantities)

Translation Services as stated in Section C.19.

of the contract.

EA = Each Page

(Option Line Item)

WRITTEN TRANSLATION SERVICES - URGENT (Fixed Unit 50000 EA Price)(Estimated Quantities)

Translation Services as stated in Section C.19.

of the contract.

EA = Each Page

(Option Line Item)

CLAIMS PROCESSING FEE - TRICARE ELIGIBLE (DEFENSE 561049 EA

HEALTHCARE PROGRAM (DHP)) (Fixed Unit Price)

(Estimated Quantities)

Administrative and support costs associated with providing services as stated in Section C.16. of the contract.

EA = Each Claim

(Option Line Item)

4008 42311 EA

4009 360 EA

CLAIMS PROCESSING FEE - MEDICARE ELIGIBLE

(MEDICARE ELIGIBLE RETIREE HEALTH CARE FUND

(MERHCF)) (Fixed Unit Price)(Estimated Quantities)

Administrative and support costs associated with providing services as stated in Section C.16. of the contract.

EA = Each Claim

(Option Line Item)

ACCESS TO CARE IN KINSHASA, DEMOCRATIC REPUBLIC

OF THE CONGO (Fixed Unit Price)(Estimated Quantities) Continued ...

manderson Highlight

14 26

CONTINUATION SHEET

PAGE OFREFERENCE NO. OF DOCUMENT BEING CONTINUED

HT940219R0001/0001

(A) (B) (C) (D) (E) (F)

4010 200 EA

4011 1 LO

4012 1 LO

4014 1 LO

Access to care in Kinshasa, Democratic Republic of the Congo as stated in Section C.42.2. of the contract.

EA = Each Member Per Month.

(Option Line Item)

MEDICAL CAPABILITY REPORTS (Fixed Unit Price) (Estimated Quantities).

Administrative and support costs associated with providing services as stated in Section C.22. of the contract.

EA = Each Report

(Option Line Item)

BLOCK OVERFLIGHT PERMITS (Firm Fixed Price).

Administrative and support costs associated with providing Block Overflight Permits as stated in

Section C.14.10 and C.14.11 of the contract.

LO = Lot

(Option Line Item)

PERFORMANCE INCENTIVE POOL

OPTION PERIOD 4.

See Section H.6. of the contract for criteria for earning incentives. The amount shown is the maximum incentive available for OP4.

LO = Lot

(Option Line Item)

DELIVERABLES, DD FORM 1423-1, CONTRACT DATA

REQUIREMENTS LIST (CDRLs)

CDRLs(DD1423) as stated in Section C, Section

F.5, and Section J, Exhibit A of the contract.

(Option Line Item)

(Not Separately Priced)

TRANSITION-OUT - IF EXERCISED (Firm Fixed Price)

Continued ...

NSP

15 26

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

HT940219R0001

(A) (B) (C) (D) (E) (F)

5001 3358164 EA

5002 283272 EA

5003 6221 EA

5004 200 EA

Implementation of transition-out activities as stated in Section C.26. of the contract.

LO = Lot

(Option Line Item)

Option Period (OP) 5 (12 months)

For any CLIN with Unit of Issue "Each", the quantities are estimated

HEALTH CARE SUPPORT SERVICES - PRIME ENROLLED

MEMBERS (Fixed Unit Price)(Estimated Quantities)

Administrative and support costs associated with providing all services as stated in Section

C.1.2. of the contract.

EA = Each Member Per Month X 12 Months

(Option Line Item)

HEALTH CARE SUPPORT SERVICES - PRIME REMOTE

ENROLLED MEMBERS (Fixed Unit Price)(Estimated Quantities)

Administrative and support costs associated with providing all services as stated in Section

C.1.2. of the contract.

EA = Each Member Per Month X 12 Months

(Option Line Item)

TRANSIENT CARE MANAGEMENT (Fixed Unit Price) (Estimated Quantities)

Administrative and support costs associated with providing the services for urgent/emergency care as stated in Section C.21 of the contract.

EA = Each Case

(Option Line Item)

TRANSIENT AMBULANCE/AEROMEDICAL EVACUATION

SERVICES (Fixed Unit Price)(Estimated Quantities)

Administration and support costs associated with providing transient ambulance/aeromedical evacuation services as stated in Section C.14. of the contract.

Continued ...

16 26

CONTINUATION SHEET

PAGE OFREFERENCE NO. OF DOCUMENT BEING CONTINUED

HT940219R0001/0001

(A) (B) (C) (D) (E) (F)

5005 400000 EA

EA = Each Case

(Option Line Item)

WRITTEN TRANSLATION SERVICES - ROUTINE (Fixed

Unit Price)(Estimated Quantities)

Translation Services as stated in Section C.19.

of the contract.

EA = Each Page

(Option Line Item)

WRITTEN TRANSLATION SERVICES - URGENT (Fixed Unit 50000 EA Price)(Estimated Quantities)

Translation Services as stated in Section C.19.

of the contract.

EA = Each Page

(Option Line Item)

CLAIMS PROCESSING FEE - TRICARE ELIGIBLE (DEFENSE 561049 EA

HEALTHCARE PROGRAM (DHP)) (Fixed Unit Price)

(Estimated Quantities)

Administrative and support costs associated with providing services as stated in Section C.16. of the contract.

EA = Each Claim

(Option Line Item)

5008 42311 EA

5009 360 EA

CLAIMS PROCESSING FEE - MEDICARE ELIGIBLE

(MEDICARE ELIGIBLE RETIREE HEALTH CARE FUND

(MERHCF)) (Fixed Unit Price)(Estimated Quantities)

Administrative and support costs associated with providing services as stated in Section C.16. of the contract.

EA = Each Claim

(Option Line Item)

ACCESS TO CARE IN KINSHASA, DEMOCRATIC REPUBLIC

OF THE CONGO (Fixed Unit Price)(Estimated Quantities) Continued ...

manderson Highlight

17 26

CONTINUATION SHEET

PAGE OFREFERENCE NO. OF DOCUMENT BEING CONTINUED

HT940219R0001/0001

(A) (B) (C) (D) (E) (F)

5010 200 EA

5011 1 LO

5012 1 LO

5014 1 LO

Access to care in Kinshasa, Democratic Republic of the Congo as stated in Section C.42.2. of the contract.

EA = Each Member Per Month.

(Option Line Item)

MEDICAL CAPABILITY REPORTS (Fixed Unit Price) (Estimated Quantities).

Administrative and support costs associated with providing services as stated in Section C.22. of the contract.

EA = Each Report

(Option Line Item)

BLOCK OVERFLIGHT PERMITS (Firm Fixed Price).

Administrative and support costs associated with providing Block Overflight Permits as stated in

Section C.14.10 and C.14.11 of the contract.

LO = Lot

(Option Line Item)

PERFORMANCE INCENTIVE POOL

OPTION PERIOD 5.

See Section H.6. of the contract for criteria for earning incentives. The amount shown is the maximum incentive available for OP5.

LO = Lot

(Option Line Item)

DELIVERABLES, DD FORM 1423-1, CONTRACT DATA

REQUIREMENTS LIST (CDRLs)

CDRLs(DD1423) as stated in Section C, Section

F.5, and Section J, Exhibit A of the contract.

(Option Line Item)

(Not Separately Priced)

TRANSITION-OUT - IF EXERCISED (Firm Fixed Price)

Continued ...

NSP

18 26

CONTINUATION SHEET

PAGE OFREFERENCE NO. OF DOCUMENT BEING CONTINUED

HT940219R0001/0001

(A) (B) (C) (D) (E) (F)

6001 3358164 EA

6002 283272 EA

6003 6221 EA

6004 200 EA

Implementation of transition-out activities as stated in Section C.26. of the contract.

LO = Lot

(Option Line Item)

Option Period (OP) 6 (12 months)

For any CLIN with Unit of Issue "Each", the quantities are estimated

HEALTH CARE SUPPORT SERVICES - PRIME ENROLLED

MEMBERS (Fixed Unit Price)(Estimated Quantities)

Administrative and support costs associated with providing all services as stated in Section

C.1.2. of the contract.

EA = Each Member Per Month X 12 Months

(Option Line Item)

HEALTH CARE SUPPORT SERVICES - PRIME REMOTE

ENROLLED MEMBERS (Fixed Unit Price)(Estimated Quantities)

Administrative and support costs associated with providing all services as stated in Section

C.1.2. of the contract.

EA = Each Member Per Month X 12 Months

(Option Line Item)

TRANSIENT CARE MANAGEMENT (Fixed Unit Price) (Estimated Quantities)

Administrative and support costs associated with providing the services for urgent/emergency care as stated in Section C.21 of the contract.

EA = Each Case

(Option Line Item)

TRANSIENT AMBULANCE/AEROMEDICAL EVACUATION

SERVICES (Fixed Unit Price)(Estimated Quantities)

Administration and support costs associated with providing transient ambulance/aeromedical evacuation services as stated in Section C.14. of the contract.

Continued ...

19 26

CONTINUATION SHEET

PAGE OFREFERENCE NO. OF DOCUMENT BEING CONTINUED

HT940219R0001/0001

(A) (B) (C) (D) (E) (F)

6005 400000 EA

EA = Each Case

(Option Line Item)

WRITTEN TRANSLATION SERVICES - ROUTINE (Fixed

Unit Price)(Estimated Quantities)

Translation Services as stated in Section C.19.

of the contract.

EA = Each Page

(Option Line Item)

WRITTEN TRANSLATION SERVICES - URGENT (Fixed Unit 50000 EA Price)(Estimated Quantities)

Translation Services as stated in Section C.19.

of the contract.

EA = Each Page

(Option Line Item)

CLAIMS PROCESSING FEE - TRICARE ELIGIBLE (DEFENSE 561049 EA

HEALTHCARE PROGRAM (DHP)) (Fixed Unit Price)

(Estimated Quantities)

Administrative and support costs associated with providing services as stated in Section C.16. of the contract.

EA = Each Claim

(Option Line Item)

6008 42311 EA

6009 360 EA

CLAIMS PROCESSING FEE - MEDICARE ELIGIBLE

(MEDICARE ELIGIBLE RETIREE HEALTH CARE FUND

(MERHCF)) (Fixed Unit Price)(Estimated Quantities)

Administrative and support costs associated with providing services as stated in Section C.16. of the contract.

EA = Each Claim

(Option Line Item)

ACCESS TO CARE IN KINSHASA, DEMOCRATIC REPUBLIC

OF THE CONGO (Fixed Unit Price)(Estimated Quantities) Continued ...

manderson Highlight

20 26

CONTINUATION SHEET

PAGE OFREFERENCE NO. OF DOCUMENT BEING CONTINUED

HT940219R0001/0001

(A) (B) (C) (D) (E) (F)

6010 200 EA

6011 1 LO

6012 1 LO

6014 1 LO

Access to care in Kinshasa, Democratic Republic of the Congo as stated in Section C.42.2. of the contract.

EA = Each Member Per Month.

(Option Line Item)

MEDICAL CAPABILITY REPORTS (Fixed Unit Price) (Estimated Quantities).

Administrative and support costs associated with providing services as stated in Section C.22. of the contract.

EA = Each Report

(Option Line Item)

BLOCK OVERFLIGHT PERMITS (Firm Fixed Price).

Administrative and support costs associated with providing Block Overflight Permits as stated in

Section C.14.10 and C.14.11 of the contract.

LO = Lot

(Option Line Item)

PERFORMANCE INCENTIVE POOL

OPTION PERIOD 6.

See Section H.6. of the contract for criteria for earning incentives. The amount shown is the maximum incentive available for OP6.

LO = Lot

(Option Line Item)

DELIVERABLES, DD FORM 1423-1, CONTRACT DATA

REQUIREMENTS LIST (CDRLs)

CDRLs(DD1423) as stated in Section C, Section

F.5, and Section J, Exhibit A of the contract.

(Option Line Item)

(Not Separately Priced)

TRANSITION-OUT - IF EXERCISED (Firm Fixed Price)

Continued ...

NSP

21 26

CONTINUATION SHEET

PAGE OFREFERENCE NO. OF DOCUMENT BEING CONTINUED

HT940219R0001/0001

(A) (B) (C) (D) (E) (F)

7001 3358164 EA

7002 283272 EA

7003 6221 EA

7004 200 EA

Implementation of transition-out activities as stated in Section C.26. of the contract.

LO = Lot

(Option Line Item)

Option Period (OP) 7 (12 months)

For any CLIN with Unit of Issue "Each", the quantities are estimated

HEALTH CARE SUPPORT SERVICES - PRIME ENROLLED

MEMBERS (Fixed Unit Price)(Estimated Quantities)

Administrative and support costs associated with providing all services as stated in Section

C.1.2. of the contract.

EA = Each Member Per Month X 12 Months

(Option Line Item)

HEALTH CARE SUPPORT SERVICES - PRIME REMOTE

ENROLLED MEMBERS (Fixed Unit Price)(Estimated Quantities)

Administrative and support costs associated with providing all services as stated in Section

C.1.2. of the contract.

EA = Each Member Per Month X 12 Months

(Option Line Item)

TRANSIENT CARE MANAGEMENT (Fixed Unit Price) (Estimated Quantities)

Administrative and support costs associated with providing the services for urgent/emergency care as stated in Section C.21 of the contract.

EA = Each Case

(Option Line Item)

TRANSIENT AMBULANCE/AEROMEDICAL EVACUATION

SERVICES (Fixed Unit Price)(Estimated Quantities)

Administration and support costs associated with providing transient ambulance/aeromedical evacuation services as stated in Section C.14. of the contract.

Continued ...

22 26

CONTINUATION SHEET

PAGE OFREFERENCE NO. OF DOCUMENT BEING CONTINUED

HT940219R0001/0001

(A) (B) (C) (D) (E) (F)

7005 400000 EA

EA = Each Case

(Option Line Item)

WRITTEN TRANSLATION SERVICES - ROUTINE (Fixed

Unit Price)(Estimated Quantities)

Translation Services as stated in Section C.19.

of the contract.

EA = Each Page

(Option Line Item)

WRITTEN TRANSLATION SERVICES - URGENT (Fixed Unit 50000 EA Price)(Estimated Quantities)

Translation Services as stated in Section C.19.

of the contract.

EA = Each Page

(Option Line Item)

CLAIMS PROCESSING FEE - TRICARE ELIGIBLE (DEFENSE 561049 EA

HEALTHCARE PROGRAM (DHP)) (Fixed Unit Price)

(Estimated Quantities)

Administrative and support costs associated with providing services as stated in Section C.16. of the contract.

EA = Each Claim

(Option Line Item)

7008 42311 EA

7009 360 EA

CLAIMS PROCESSING FEE - MEDICARE ELIGIBLE

(MEDICARE ELIGIBLE RETIREE HEALTH CARE FUND

(MERHCF)) (Fixed Unit Price)(Estimated Quantities)

Administrative and support costs associated with providing services as stated in Section C.16. of the contract.

EA = Each Claim

(Option Line Item)

ACCESS TO CARE IN KINSHASA, DEMOCRATIC REPUBLIC

OF THE CONGO (Fixed Unit Price)(Estimated Quantities) Continued ...

manderson Highlight

23 26

CONTINUATION SHEET

PAGE OFREFERENCE NO. OF DOCUMENT BEING CONTINUED

HT940219R0001/0001

(A) (B) (C) (D) (E) (F)

7010 200 EA

7011 1 LO

7012 1 LO

7014 1 LO

Access to care in Kinshasa, Democratic Republic of the Congo as stated in Section C.42.2. of the contract.

EA = Each Member Per Month.

(Option Line Item)

MEDICAL CAPABILITY REPORTS (Fixed Unit Price) (Estimated Quantities).

Administrative and support costs associated with providing services as stated in Section C.22. of the contract.

EA = Each Report

(Option Line Item)

BLOCK OVERFLIGHT PERMITS (Firm Fixed Price).

Administrative and support costs associated with providing Block Overflight Permits as stated in

Section C.14.10 and C.14.11 of the contract.

LO = Lot

(Option Line Item)

PERFORMANCE INCENTIVE POOL

OPTION PERIOD 7.

See Section H.6. of the contract for criteria for earning incentives. The amount shown is the maximum incentive available for OP7.

LO = Lot

(Option Line Item)

DELIVERABLES, DD FORM 1423-1, CONTRACT DATA

REQUIREMENTS LIST (CDRLs)

CDRLs(DD1423) as stated in Section C, Section

F.5, and Section J, Exhibit A of the contract.

(Option Line Item)

(Not Separately Priced)

TRANSITION-OUT - IF EXERCISED (Firm Fixed Price)

Continued ...

NSP

24 26

CONTINUATION SHEET

PAGE OFREFERENCE NO. OF DOCUMENT BEING CONTINUED

HT940219R0001/0001

(A) (B) (C) (D) (E) (F)

Implementation of transition-out activities as stated in Section C.26. of the contract.

LO = Lot

(Option Line Item)

HT9402-19-R-0001 Page 25 of 26 Amendment 0001

Continuation Page Block 14 Continuation

C. Summary of Changes. The following Solicitation documents were revised as indicated.

Changes are indicated by a vertical line in the left margin.

Document Section Change/Revision SF 33, Solicitation, Offer, and Award Block 9, 11.

Section B, Supplies or Services and Prices/Costs

The quantities of CLINs X005, X006, and X0010 were changed. Other minor edits were made to CLINs.

Section C, Description/Specifications/Work Statement

The following paragraphs were revised:

C.3.1.1.

C.8.4.

C.11.1.

C.11.5.

C.11.5.2.

C.11.16.

C.11.16.1.

C.11.16.1.2.

C.12.9.

C.13.1.2.

C.13.3.3.5.

C.13.4.1.2.

C.13.4.2.3.4.

C.14.1.

C.14.3.

C.19.4.

C.19.4.1.

C.19.6.

C.23.2.

C.23.5.

C.23.5.3.

C.23.5.4.

C.26.3.2.

Section G, Contract Administration Data Added paragraph G.17. Variation in Quantity.

Section H, Special Contract Requirements Revised paragraph H.7.10.2.3.

Section I, Contract Clauses Added FAR Clause 52.204-25, Prohibition on Contracting for Certain Telecommunications and Video Surveillance Services or Equipment and updated various clause dates.

Section J, List of Attachments The following attachments were revised:

J-1, TOP Prime Locations.

J-2, TOP Prime Remote Locations.

J-3, Non-network Designated Remote Locations.

J-4, Government Furnished Space and Equipment by Location.

J-12, Negotiated Rate Locations.

HT9402-19-R-0001 Page 26 of 26 Amendment 0001

J-17, Draft TOM, Chapter 24, Section 4.

Exhibit A, DD Form 1423-1 Contract Data Requirements List (CDRL).

Section K, Representations, Certifications, and Other Statements of Bidders

Added FAR Provision 52.204-24, Representation Regarding Certain Telecommunications and Video Surveillance Services or Equipment.

Section L, Instructions, Conditions, and Notices to Offerors

The following paragraphs/attachments were revised:

L.4.1. Table L-1, Volume Copies L.7.1.

L.7.2.

L.7.3.

L.7.5.1.

L.8.1.

L.8.3.

L.8.6.

L.8.7.

L.8.8.

L.8.9.

L.8.10.

L.8.11.

L.8.12.

L.8.13.

L.8.14.

L.8.15.

L.8.16.

Revised Section L, Attachment L-5, Price Proposal Template quantities.

Added Section L, Attachment L-6, TOP TRICARE Select and Total Call Volume Data.

D. Proposals are due 1:00 PM MT, November 22, 2019, per Block 11 of the SF 30.