Attachment_L-5,_Price_Proposal_Template.xlsx
XLSX spreadsheet 20 KB Posted
- Attached to
- TRICARE Overseas Program (TOP) 2021 Solicitation - HT940219R0001 Federal contract opportunity
- Solicitation number
- HT9402-19-R-0001
- Issued by
- Defense Health Agency
About this file
This document contains a price proposal template for a federal contract solicitation. The template includes pricing tables for various contract line item numbers covering health care support services for the TRICARE Overseas Program for a base year and up to seven option years. Services include care management, translation, medical evacuation, claims processing and other administrative support. Pricing is fixed unit price by member, case, page or claim. The solicitation number is HT9402-19-R-0001 and proposals were due by October 31, 2019. The period of performance includes a one-year base period for transition-in and up to seven one-year option periods, with a potential six-month extension, for a total performance period of up to eight years and six months. The contracting agency is the Defense Health Agency.
Section L Attachment L-5, Price Proposal Excel Template
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All CLINs
| TOP 21 HT9402-19-R-0001 | |||||||
| Section L Exhibit L-5 Price Proposal Template | |||||||
| OFFEROR: | CAGE | ||||||
| CLIN | CLIN Title | Type | Unit of Issue | Qty | Offeror Proposed Unit Price | Offeror Proposed Total Amount | |
| Base/Transition Period | |||||||
| 0001 | TRANSITION-IN (Firm Fixed Price) Planning and implementation of transition-in activities as stated in Section C.26. of the contract. (LO = Lot) | FFP | Lot | 1 | |||
| 0002 | CONTRACT DATA REQUIREMENTS LIST (CDRLs) (DD1423) as stated in Section C, Section F.5, and Section J, Exhibit A of the contract. (LO = Lot) | NSP | NSP | NSP | Not Seperately Priced | Not Seperately Priced | |
| 0003 | PERFORMANCE READINESS VALIDATION/PERFORMANCE READINESS ASSESSMENT AND VERIFICATION (Firm Fixed Price) 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) | FFP | Lot | 1 | |||
| Base Year Total | |||||||
| Option Period 1 | |||||||
| 1001 | HEALTH CARE SUPPORT SERVICES - PRIME ENROLLED MEMBERS (Fixed Unit Price) 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) | FFP | Each | 3,358,164 | |||
| 1002 | HEALTH CARE SUPPORT SERVICES - PRIME REMOTE ENROLLED MEMBERS (Fixed Unit Price) 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) | FFP | Each | 283,272 | |||
| 1003 | TRANSIENT CARE MANAGEMENT (Fixed Unit Price) 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) | FFP | Each | 6,621 | |||
| 1004 | TRANSIENT AMBULANCE/AEROMEDICAL EVACUATION SERVICES (Fixed Unit Price) Administration and support costs associated with providing transient ambulance/aeromedical evacuation services as stated in Section C.14. of the contract. (EA=Each Case) | FFP | Each | 200 | |||
| 1005 | WRITTEN TRANSLATION SERVICES - ROUTINE (Fixed Unit Price) Translation Services as stated in Section C.19. of the contract. (EA=Each Page) | FFP | Each | 152,064 | |||
| 1006 | WRITTEN TRANSLATION SERVICES - URGENT (Fixed Unit Price) Translation Services as stated in Section C.19. of the contract. (EA=Each Page) | FFP | Each | 16,896 | |||
| 1007 | CLAIMS PROCESSING FEE - TRICARE ELIGIBLE (DEFENSE HEALTHCARE PROGRAM (DHP)) (Fixed Unit Price) Administrative and support costs associated with providing services as stated in Section C.16. of the contract. (EA=Each Claim) | FFP | Each | 561,049 | |||
| 1008 | CLAIMS PROCESSING FEE - MEDICARE ELIGIBLE (MEDICARE ELIGIBLE RETIREE HEALTH CARE FUND (MERHCF)) (Fixed Unit Price) Administrative and support costs associated with providing services as stated in Section C.16. of the contract. (EA=Each Claim) | FFP | Each | 42,311 | |||
| 1009 | ACCESS TO CARE IN KINSHASA, DEMOCRATIC REPUBLIC OF THE CONGO (Fixed Unit Price) 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 X 12 Months) | FFP | Each | 360 | |||
| 1010 | MEDICAL CAPABILITY REPORTS (Fixed Unit Price). Administrative and support costs associated with providing services as stated in Section C.22. of the contract. (EA=Each Report) | FFP | Each | 100 | |||
| 1011 | 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) | FFP | Each | 1 | |||
| 1012 | PERFORMANCE INCENTIVE POOL OPTION PERIOD 1 INCENTIVES UP TO $221,974. | ||||||
| See Section H.6. of the contract for criteria for earning incentives. The amount shown is the maximum incentive available for OP1. (LO=Lot) | FFP | Lot | 1 | $221,974.00 | $221,974.00 | ||
| 1013 | DELIVERABLES, DD FORM 1423-1, CONTRACT DATA REQUIREMENTS LIST (CDRLs) (DD1423) as stated in Section C, Section F.5, and Section J, Exhibit A of the contract. | NSP | NSP | NSP | Not Seperately Priced | Not Seperately Priced | |
| 1014 | TRANSITION-OUT - IF EXERCISED (Firm Fixed Price) Implementation of transition-out activities as stated in Section C.26. of the contract. (LO=Lot) | FFP | Lot | 1 | |||
| OP 1 TOTAL | |||||||
| Option Period 2 | |||||||
| 2001 | HEALTH CARE SUPPORT SERVICES - PRIME ENROLLED MEMBERS (Fixed Unit Price) 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) | FFP | Each | 3,358,164 | |||
| 2002 | HEALTH CARE SUPPORT SERVICES - PRIME REMOTE ENROLLED MEMBERS (Fixed Unit Price) 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) | FFP | Each | 283,272 | |||
| 2003 | TRANSIENT CARE MANAGEMENT (Fixed Unit Price) 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) | FFP | Each | 6,221 | |||
| 2004 | TRANSIENT AMBULANCE/AEROMEDICAL EVACUATION SERVICES (Fixed Unit Price) Administration and support costs associated with providing transient ambulance/aeromedical evacuation services as stated in Section C.14. of the contract. (EA=Each Case) | FFP | Each | 200 | |||
| 2005 | WRITTEN TRANSLATION SERVICES - ROUTINE (Fixed Unit Price) Translation Services as stated in Section C.19. of the contract. (EA=Each Page) | FFP | Each | 152,064 | |||
| 2006 | WRITTEN TRANSLATION SERVICES - URGENT (Fixed Unit Price) Translation Services as stated in Section C.19. of the contract. (EA=Each Page) | FFP | Each | 16,896 | |||
| 2007 | CLAIMS PROCESSING FEE - TRICARE ELIGIBLE (DEFENSE HEALTHCARE PROGRAM (DHP)) (Fixed Unit Price) Administrative and support costs associated with providing services as stated in Section C.16. of the contract. (EA=Each Claim) | FFP | Each | 561,049 | |||
| 2008 | CLAIMS PROCESSING FEE - MEDICARE ELIGIBLE (MEDICARE ELIGIBLE RETIREE HEALTH CARE FUND (MERHCF)) (Fixed Unit Price) Administrative and support costs associated with providing services as stated in Section C.16. of the contract. (EA=Each Claim) | FFP | Each | 42,311 | |||
| 2009 | ACCESS TO CARE IN KINSHASA, DEMOCRATIC REPUBLIC OF THE CONGO (Fixed Unit Price) 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 X 12 Months) | FFP | Each | 360 | |||
| 2010 | MEDICAL CAPABILITY REPORTS (Fixed Unit Price). Administrative and support costs associated with providing services as stated in Section C.22. of the contract. (EA=Each Report) | FFP | Each | 100 | |||
| 2011 | 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) | FFP | Each | 1 | |||
| 2012 | PERFORMANCE INCENTIVE POOL OPTION PERIOD 2 INCENTIVES UP TO $226,413. | ||||||
| See Section H.6. of the contract for criteria for earning incentives. The amount shown is the maximum incentive available for OP1. (LO=Lot) | FFP | Lot | 1 | $226,413.00 | $221,974.00 | ||
| 2013 | DELIVERABLES, DD FORM 1423-1, CONTRACT DATA REQUIREMENTS LIST (CDRLs) (DD1423) as stated in Section C, Section F.5, and Section J, Exhibit A of the contract. | NSP | NSP | NSP | Not Seperately Priced | Not Seperately Priced | |
| 2014 | TRANSITION-OUT - IF EXERCISED (Firm Fixed Price) Implementation of transition-out activities as stated in Section C.26. of the contract. (LO=Lot) | FFP | Lot | 1 | |||
| OP 2 TOTAL | |||||||
| Option Period 3 | |||||||
| 3001 | HEALTH CARE SUPPORT SERVICES - PRIME ENROLLED MEMBERS (Fixed Unit Price) 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) | FFP | Each | 3,358,164 | |||
| 3002 | HEALTH CARE SUPPORT SERVICES - PRIME REMOTE ENROLLED MEMBERS (Fixed Unit Price) 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) | FFP | Each | 283,272 | |||
| 3003 | TRANSIENT CARE MANAGEMENT (Fixed Unit Price) 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) | FFP | Each | 6,221 | |||
| 3004 | TRANSIENT AMBULANCE/AEROMEDICAL EVACUATION SERVICES (Fixed Unit Price) Administration and support costs associated with providing transient ambulance/aeromedical evacuation services as stated in Section C.14. of the contract. (EA=Each Case) | FFP | Each | 200 | |||
| 3005 | WRITTEN TRANSLATION SERVICES - ROUTINE (Fixed Unit Price) Translation Services as stated in Section C.19. of the contract. (EA=Each Page) | FFP | Each | 152,064 | |||
| 3006 | WRITTEN TRANSLATION SERVICES - URGENT (Fixed Unit Price) Translation Services as stated in Section C.19. of the contract. (EA=Each Page) | FFP | Each | 16,896 | |||
| 3007 | CLAIMS PROCESSING FEE - TRICARE ELIGIBLE (DEFENSE HEALTHCARE PROGRAM (DHP)) (Fixed Unit Price) Administrative and support costs associated with providing services as stated in Section C.16. of the contract. (EA=Each Claim) | FFP | Each | 561,049 | |||
| 3008 | CLAIMS PROCESSING FEE - MEDICARE ELIGIBLE (MEDICARE ELIGIBLE RETIREE HEALTH CARE FUND (MERHCF)) (Fixed Unit Price) Administrative and support costs associated with providing services as stated in Section C.16. of the contract. (EA=Each Claim) | FFP | Each | 42,311 | |||
| 3009 | ACCESS TO CARE IN KINSHASA, DEMOCRATIC REPUBLIC OF THE CONGO (Fixed Unit Price) 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 X 12 Months) | FFP | Each | 360 | |||
| 3010 | MEDICAL CAPABILITY REPORTS (Fixed Unit Price). Administrative and support costs associated with providing services as stated in Section C.22. of the contract. (EA=Each Report) | FFP | Each | 100 | |||
| 3011 | 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) | FFP | Each | 1 | |||
| 3012 | PERFORMANCE INCENTIVE POOL OPTION PERIOD 3 INCENTIVES UP TO $230,942. | ||||||
| See Section H.6. of the contract for criteria for earning incentives. The amount shown is the maximum incentive available for OP1. (LO=Lot) | FFP | Lot | 1 | $230,942.00 | $230,942.00 | ||
| 3013 | DELIVERABLES, DD FORM 1423-1, CONTRACT DATA REQUIREMENTS LIST (CDRLs) (DD1423) as stated in Section C, Section F.5, and Section J, Exhibit A of the contract. | NSP | NSP | NSP | Not Seperately Priced | Not Seperately Priced | |
| 3014 | TRANSITION-OUT - IF EXERCISED (Firm Fixed Price) Implementation of transition-out activities as stated in Section C.26. of the contract. (LO=Lot) | FFP | Lot | 1 | |||
| OP 3 TOTAL | |||||||
| Option Period 4 | |||||||
| 4001 | HEALTH CARE SUPPORT SERVICES - PRIME ENROLLED MEMBERS (Fixed Unit Price) 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) | FFP | Each | 3,358,164 | |||
| 4002 | HEALTH CARE SUPPORT SERVICES - PRIME REMOTE ENROLLED MEMBERS (Fixed Unit Price) 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) | FFP | Each | 283,272 | |||
| 4003 | TRANSIENT CARE MANAGEMENT (Fixed Unit Price) 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) | FFP | Each | 6,221 | |||
| 4004 | TRANSIENT AMBULANCE/AEROMEDICAL EVACUATION SERVICES (Fixed Unit Price) Administration and support costs associated with providing transient ambulance/aeromedical evacuation services as stated in Section C.14. of the contract. (EA=Each Case) | FFP | Each | 200 | |||
| 4005 | WRITTEN TRANSLATION SERVICES - ROUTINE (Fixed Unit Price) Translation Services as stated in Section C.19. of the contract. (EA=Each Page) | FFP | Each | 152,064 | |||
| 4006 | WRITTEN TRANSLATION SERVICES - URGENT (Fixed Unit Price) Translation Services as stated in Section C.19. of the contract. (EA=Each Page) | FFP | Each | 16,896 | |||
| 4007 | CLAIMS PROCESSING FEE - TRICARE ELIGIBLE (DEFENSE HEALTHCARE PROGRAM (DHP)) (Fixed Unit Price) Administrative and support costs associated with providing services as stated in Section C.16. of the contract. (EA=Each Claim) | FFP | Each | 561,049 | |||
| 4008 | CLAIMS PROCESSING FEE - MEDICARE ELIGIBLE (MEDICARE ELIGIBLE RETIREE HEALTH CARE FUND (MERHCF)) (Fixed Unit Price) Administrative and support costs associated with providing services as stated in Section C.16. of the contract. (EA=Each Claim) | FFP | Each | 42,311 | |||
| 4009 | ACCESS TO CARE IN KINSHASA, DEMOCRATIC REPUBLIC OF THE CONGO (Fixed Unit Price) 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 X 12 Months) | FFP | Each | 360 | |||
| 4010 | MEDICAL CAPABILITY REPORTS (Fixed Unit Price). Administrative and support costs associated with providing services as stated in Section C.22. of the contract. (EA=Each Report) | FFP | Each | 100 | |||
| 4011 | 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) | FFP | Each | 1 | |||
| 4012 | PERFORMANCE INCENTIVE POOL OPTION PERIOD 1 INCENTIVES UP TO $235,560. | ||||||
| See Section H.6. of the contract for criteria for earning incentives. The amount shown is the maximum incentive available for OP1. (LO=Lot) | FFP | Lot | 1 | $235,560.00 | $235,560.00 | ||
| 4013 | DELIVERABLES, DD FORM 1423-1, CONTRACT DATA REQUIREMENTS LIST (CDRLs) (DD1423) as stated in Section C, Section F.5, and Section J, Exhibit A of the contract. | NSP | NSP | NSP | Not Seperately Priced | Not Seperately Priced | |
| 4014 | TRANSITION-OUT - IF EXERCISED (Firm Fixed Price) Implementation of transition-out activities as stated in Section C.26. of the contract. (LO=Lot) | FFP | Lot | 1 | |||
| OP 4 TOTAL | |||||||
| Option Period 5 | |||||||
| 5001 | HEALTH CARE SUPPORT SERVICES - PRIME ENROLLED MEMBERS (Fixed Unit Price) 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) | FFP | Each | 3,358,164 | |||
| 5002 | HEALTH CARE SUPPORT SERVICES - PRIME REMOTE ENROLLED MEMBERS (Fixed Unit Price) 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) | FFP | Each | 283,272 | |||
| 5003 | TRANSIENT CARE MANAGEMENT (Fixed Unit Price) 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) | FFP | Each | 6,221 | |||
| 5004 | TRANSIENT AMBULANCE/AEROMEDICAL EVACUATION SERVICES (Fixed Unit Price) Administration and support costs associated with providing transient ambulance/aeromedical evacuation services as stated in Section C.14. of the contract. (EA=Each Case) | FFP | Each | 200 | |||
| 5005 | WRITTEN TRANSLATION SERVICES - ROUTINE (Fixed Unit Price) Translation Services as stated in Section C.19. of the contract. (EA=Each Page) | FFP | Each | 152,064 | |||
| 5006 | WRITTEN TRANSLATION SERVICES - URGENT (Fixed Unit Price) Translation Services as stated in Section C.19. of the contract. (EA=Each Page) | FFP | Each | 16,896 | |||
| 5007 | CLAIMS PROCESSING FEE - TRICARE ELIGIBLE (DEFENSE HEALTHCARE PROGRAM (DHP)) (Fixed Unit Price) Administrative and support costs associated with providing services as stated in Section C.16. of the contract. (EA=Each Claim) | FFP | Each | 561,049 | |||
| 5008 | CLAIMS PROCESSING FEE - MEDICARE ELIGIBLE (MEDICARE ELIGIBLE RETIREE HEALTH CARE FUND (MERHCF)) (Fixed Unit Price) Administrative and support costs associated with providing services as stated in Section C.16. of the contract. (EA=Each Claim) | FFP | Each | 42,311 | |||
| 5009 | ACCESS TO CARE IN KINSHASA, DEMOCRATIC REPUBLIC OF THE CONGO (Fixed Unit Price) 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 X 12 Months) | FFP | Each | 360 | |||
| 5010 | MEDICAL CAPABILITY REPORTS (Fixed Unit Price). Administrative and support costs associated with providing services as stated in Section C.22. of the contract. (EA=Each Report) | FFP | Each | 100 | |||
| 5011 | 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) | FFP | Each | 1 | |||
| 5012 | PERFORMANCE INCENTIVE POOL OPTION PERIOD 1 INCENTIVES UP TO $240,272. | ||||||
| See Section H.6. of the contract for criteria for earning incentives. The amount shown is the maximum incentive available for OP1. (LO=Lot) | FFP | Lot | 1 | $240,272.00 | $240,272.00 | ||
| 5013 | DELIVERABLES, DD FORM 1423-1, CONTRACT DATA REQUIREMENTS LIST (CDRLs) (DD1423) as stated in Section C, Section F.5, and Section J, Exhibit A of the contract. | NSP | NSP | NSP | Not Seperately Priced | Not Seperately Priced | |
| 5014 | TRANSITION-OUT - IF EXERCISED (Firm Fixed Price) Implementation of transition-out activities as stated in Section C.26. of the contract. (LO=Lot) | FFP | Lot | 1 | |||
| OP 5 TOTAL | |||||||
| Option Period 6 | |||||||
| 6001 | HEALTH CARE SUPPORT SERVICES - PRIME ENROLLED MEMBERS (Fixed Unit Price) 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) | FFP | Each | 3,358,164 | |||
| 6002 | HEALTH CARE SUPPORT SERVICES - PRIME REMOTE ENROLLED MEMBERS (Fixed Unit Price) 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) | FFP | Each | 283,272 | |||
| 6003 | TRANSIENT CARE MANAGEMENT (Fixed Unit Price) 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) | FFP | Each | 6,221 | |||
| 6004 | TRANSIENT AMBULANCE/AEROMEDICAL EVACUATION SERVICES (Fixed Unit Price) Administration and support costs associated with providing transient ambulance/aeromedical evacuation services as stated in Section C.14. of the contract. (EA=Each Case) | FFP | Each | 200 | |||
| 6005 | WRITTEN TRANSLATION SERVICES - ROUTINE (Fixed Unit Price) Translation Services as stated in Section C.19. of the contract. (EA=Each Page) | FFP | Each | 152,064 | |||
| 6006 | WRITTEN TRANSLATION SERVICES - URGENT (Fixed Unit Price) Translation Services as stated in Section C.19. of the contract. (EA=Each Page) | FFP | Each | 16,896 | |||
| 6007 | CLAIMS PROCESSING FEE - TRICARE ELIGIBLE (DEFENSE HEALTHCARE PROGRAM (DHP)) (Fixed Unit Price) Administrative and support costs associated with providing services as stated in Section C.16. of the contract. (EA=Each Claim) | FFP | Each | 561,049 | |||
| 6008 | CLAIMS PROCESSING FEE - MEDICARE ELIGIBLE (MEDICARE ELIGIBLE RETIREE HEALTH CARE FUND (MERHCF)) (Fixed Unit Price) Administrative and support costs associated with providing services as stated in Section C.16. of the contract. (EA=Each Claim) | FFP | Each | 42,311 | |||
| 6009 | ACCESS TO CARE IN KINSHASA, DEMOCRATIC REPUBLIC OF THE CONGO (Fixed Unit Price) 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 X 12 Months) | FFP | Each | 360 | |||
| 6010 | MEDICAL CAPABILITY REPORTS (Fixed Unit Price). Administrative and support costs associated with providing services as stated in Section C.22. of the contract. (EA=Each Report) | FFP | Each | 100 | |||
| 6011 | 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) | FFP | Each | 1 | |||
| 6012 | PERFORMANCE INCENTIVE POOL OPTION PERIOD 1 INCENTIVES UP TO $246,278. | ||||||
| See Section H.6. of the contract for criteria for earning incentives. The amount shown is the maximum incentive available for OP1. (LO=Lot) | FFP | Lot | 1 | $246,278.00 | $246,278.00 | ||
| 6013 | DELIVERABLES, DD FORM 1423-1, CONTRACT DATA REQUIREMENTS LIST (CDRLs) (DD1423) as stated in Section C, Section F.5, and Section J, Exhibit A of the contract. | NSP | NSP | NSP | Not Seperately Priced | Not Seperately Priced | |
| 6014 | TRANSITION-OUT - IF EXERCISED (Firm Fixed Price) Implementation of transition-out activities as stated in Section C.26. of the contract. (LO=Lot) | FFP | Lot | 1 | |||
| OP 6 TOTAL | |||||||
| Option Period 7 | |||||||
| 7001 | HEALTH CARE SUPPORT SERVICES - PRIME ENROLLED MEMBERS (Fixed Unit Price) 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) | FFP | Each | 3,358,164 | |||
| 7002 | HEALTH CARE SUPPORT SERVICES - PRIME REMOTE ENROLLED MEMBERS (Fixed Unit Price) 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) | FFP | Each | 283,272 | |||
| 7003 | TRANSIENT CARE MANAGEMENT (Fixed Unit Price) 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) | FFP | Each | 6,221 | |||
| 7004 | TRANSIENT AMBULANCE/AEROMEDICAL EVACUATION SERVICES (Fixed Unit Price) Administration and support costs associated with providing transient ambulance/aeromedical evacuation services as stated in Section C.14. of the contract. (EA=Each Case) | FFP | Each | 200 | |||
| 7005 | WRITTEN TRANSLATION SERVICES - ROUTINE (Fixed Unit Price) Translation Services as stated in Section C.19. of the contract. (EA=Each Page) | FFP | Each | 152,064 | |||
| 7006 | WRITTEN TRANSLATION SERVICES - URGENT (Fixed Unit Price) Translation Services as stated in Section C.19. of the contract. (EA=Each Page) | FFP | Each | 16,896 | |||
| 7007 | CLAIMS PROCESSING FEE - TRICARE ELIGIBLE (DEFENSE HEALTHCARE PROGRAM (DHP)) (Fixed Unit Price) Administrative and support costs associated with providing services as stated in Section C.16. of the contract. (EA=Each Claim) | FFP | Each | 561,049 | |||
| 7008 | CLAIMS PROCESSING FEE - MEDICARE ELIGIBLE (MEDICARE ELIGIBLE RETIREE HEALTH CARE FUND (MERHCF)) (Fixed Unit Price) Administrative and support costs associated with providing services as stated in Section C.16. of the contract. (EA=Each Claim) | FFP | Each | 42,311 | |||
| 7009 | ACCESS TO CARE IN KINSHASA, DEMOCRATIC REPUBLIC OF THE CONGO (Fixed Unit Price) 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 X 12 Months) | FFP | Each | 360 | |||
| 7010 | MEDICAL CAPABILITY REPORTS (Fixed Unit Price). Administrative and support costs associated with providing services as stated in Section C.22. of the contract. (EA=Each Report) | FFP | Each | 100 | |||
| 7011 | 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) | FFP | Each | 1 | |||
| 7012 | PERFORMANCE INCENTIVE POOL OPTION PERIOD 1 INCENTIVES UP TO $252,435. | ||||||
| See Section H.6. of the contract for criteria for earning incentives. The amount shown is the maximum incentive available for OP1. (LO=Lot) | FFP | Lot | 1 | $252,435.00 | $252,435.00 | ||
| 7013 | DELIVERABLES, DD FORM 1423-1, CONTRACT DATA REQUIREMENTS LIST (CDRLs) (DD1423) as stated in Section C, Section F.5, and Section J, Exhibit A of the contract. | NSP | NSP | NSP | Not Seperately Priced | Not Seperately Priced | |
| 7014 | TRANSITION-OUT - IF EXERCISED (Firm Fixed Price) Implementation of transition-out activities as stated in Section C.26. of the contract. (LO=Lot) | FFP | Lot | 1 | |||
| OP 7 TOTAL | |||||||
| Total All Option Years |
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