I.A - RFP May 24.pdf

SECTION B - PRICES

PART I: PRICE - HEALTH INSURANCE

B.1. HEALTH INSURANCE SERVICES

The Contractor shall provide the Health Insurance services to employees of the Government of the United States of America in Lima, Peru and their eligible dependents as described in Section

C and Exhibits in Section J. The groups of employees who shall be provided this insurance are listed in C.1.4 (medical) and C.2.3 (life). This insurance shall be provided in accordance with

Section C and the Exhibits in Section J.

B.1.1. American Employees Community Association (AECA) are included under this contract only as a rider. The actual number of insured personal services contractors are not considered under the breakdown specified below. The actual number of insured members is mentioned under

Exhibit D. The Contractor shall bill AECA separately, at the rates specified below. All costs for

AECA personal services contractors are the responsibility of AECA, not the U.S. Government.

AECA shall make payments directly to the contractor. See Section G for billing procedures.

B.1.2. Peace Corps Personal Services Contractors are covered under this contract only as a rider. The actual number of insured personal services contractors, dependents and parents are not considered under the breakdown specified below. The actual number of insured members is mentioned under Exhibit E. The Contractor shall bill Peace Corps separately, at the rates specified below. All costs for Peace Corps personal services contractors are the responsibility of

Peace Corps, not the U.S. Government. Peace Corps shall make payments directly to the contractor. See Section G for billing procedures.

B.1.3. Retirees and their dependents who were covered by the Embassy’s health insurance plan until June 30, 2008 are covered under this contract only as a rider. Employees and their dependents, who were covered by the Embassy's health insurance plan until June 30, 2008, are grandfathered to have the option to continue being covered upon retirement. The actual number of insured retirees, dependents and parents are not considered under the breakdown specified below. The actual number of retires is mentioned under Exhibit G. The Contractor shall bill each retiree separately, at the rates specified below. All costs for retirees are the responsibility of each retiree, not the U.S. Government. Retirees shall make payments directly to the contractor. See

Section G for billing procedures.

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 Contractor shall include VAT as a separate charge on the Invoice and as a separate line item in Section B.

B.2.2 This is a fixed price with economic price adjustment requirements type contract. 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

No of

Premiums*

Bi-weekly

Premium (S/.)

Total (S/.)

Single employee 150

Employee + 1 dependent 140

Employee + 2 dependents 77

Employee + 3 or more dependents 70

Dependents over 18 years (each) 123

Parents (each 27

Subtotal

18% IGV

Subtotal including IGV

Total Base Year (subtotal including IGV x 26 **

*estimated number of premiums does not include any Riders (B.1.1, B.1.2, B.1.3)

**does not include any premiums for Riders.

B.2.4 FIRST OPTION YEAR OF CONTRACT:

No of

Premiums*

Bi-weekly

Premium (S/.)

Total (S/.)

Single employee 150

Employee + 1 dependent 140

Employee + 2 dependents 77

Employee + 3 or more dependents 70

Dependents over 18 years (each) 123

Parents (each 27

Subtotal

18% IGV

Subtotal including IGV

Total 1st Option Year (subtotal including IGV x 26**

B.2.5 SECOND OPTION YEAR OF CONTRACT:

No of

Premiums*

Bi-weekly

Premium (S/.)

Total (S/.)

Single employee 150

Employee + 1 dependent 140

Employee + 2 dependents 77

Employee + 3 or more dependents 70

Dependents over 18 years (each) 123

Parents (each 27

Subtotal

18% IGV

Subtotal including IGV

Total 2nd Option Year (subtotal including IGV x 26**

B.2.6 THIRD OPTION YEAR OF CONTRACT:

No of

Premiums*

Bi-weekly

Premium (S/.)

Total (S/.)

Single employee 150

Employee + 1 dependent 140

Employee + 2 dependents 77

Employee + 3 or more dependents 70

Dependents over 18 years (each) 123

Parents (each 27

Subtotal

18% IGV

Subtotal including IGV

Total 3rd Option Year (subtotal including IGV x 26)**

B.2.7 FOURTH OPTION YEAR OF CONTRACT:

No of

Premiums*

Bi-weekly

Premium (S/.)

Total (S/.)

Single employee 150

Employee + 1 dependent 140

Employee + 2 dependents 77

Employee + 3 or more dependents 70

Dependents over 18 years (each) 123

Parents (each 27

Subtotal

18% IGV

Subtotal including IGV

Total 4th Option Year (subtotal including IGV x 26**

MINIMUM AND MAXIMUM AMOUNTS

During the Base Year of the contract, and during the option year that might be exercised, the

United States Government (USG) shall place orders totaling a minimum of S/.160,000.00. This reflects the contract minimum guarantee for each period of performance. The amount of all orders, for base and all option years shall not exceed S/.40,000,000.00 This reflects the contract maximum.”

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

B.3 ADMINISTRATIVE RETENTION AMOUNTS

B.3.1 If the Contractor requests a price adjustment under B.4 below, the Contractor shall 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 bi-weekly retention amounts for each period of performance and for each category of premium. This fixed amount shall 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.3.2 Bi-Weekly Retention Amounts per separate premium paid per single employee and per family plan.

Period of Performance Single

Employees

Single Employees + 1

Dependent

Single Employees + 2

Dependent

Single Employees + 3

Dependent

Dependents over 18 years

Parents

Base Year

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, B.1.2 and B.1.3. 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 Peru. 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.6 GROUP LIFE INSURANCE RATES

This is a fixed-price with economic-price- adjustment-requirements type contract. The fixed prices/premium rates are stated in Peruvian Soles per one thousand of salary to provide life insurance, accidental death and dismemberment and partial and total disability coverage are as

B.6.1. BASE YEAR OF CONTRACT

Premium Monthly Total

(Per 1000 USD) Payroll (Etd.)

Life Insurance by Law _______ S/.4,451,778.72 S/.________

Supplemental Life Insurance _______ S/.4,408,375.53 S/.________

Subtotal S/.________

18% IGV S/.________

Total Price for Base Year: Sub-total plus IGV S/._________ x 12 months S/.________

B.6.2. FIRST OPTION YEAR OF CONTRACT:

Total Price for 1st Option Year: Sub-total plus IGV S/._________ x 12 months S/.________

B.6.3. SECOND OPTION YEAR OF CONTRACT:

Total Price for 2nd Option Year: Sub-total plus IGV S/._________ x 12 months S/.________

B.6.4. THIRD OPTION YEAR OF CONTRACT:

Total Price for 3rd OptionYear: Sub-total plus IGV S/._________ x 12 months S/.________

B.6.5. FOURTH OPTION YEAR OF CONTRACT:

Total Price for 4th Option Year: Sub-total plus IGV S/._________ x 12 months S/.________

TOTAL PRICE FOR BASE PERIOD AND OPTION YEARS OF THE LIFE PROGRAM (in

Peruvian Soles, including IGV):

Base Period: S/._____________

First Option Year: S/._____________

Second Option Year: S/._____________

Third Option Year: S/._____________

Fourth Option Year: S/._____________

Grand total Firm-Fixed Price S/.______________ (Base Year plus all option 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 Peruvian Soles.

The fixed retention amount shall NOT be expressed in terms of a percentage of the premium.

B.7.2 Retention Amounts per Separate Premium Paid per Employee:

Period of Performance Life Insurance by Law Supplemental Life Insurance

Base Period S/. S/.

First Option Year S/. S/.

Second Option Year S/. S/.

Third Option Year S/. S/.

Fourth Option Year S/. S/.

B.8 ECONOMIC PRICE ADJUSTMENT (EPA)-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.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. The 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 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.

SECTION C

DESCRIPTION/SPECIFICATION/WORK STATEMENT

C.1. HEALTH INSURANCE SERVICES

The Government of the United States of America requires Health Insurance coverage for its employees as further described in C.1.2 in Lima, Peru. The Government has determined that the prevailing practice by employers in Peru is to provide for their employees’ health insurance protection and that the cost of such insurance protection is usually borne by both the employee and the employer. Health insurance protection will be representative of locally prevailing compensation practice as further described in C.1.2. The specific health benefit coverage under this contract is set forth in Section C and the Exhibits in Section J.

Heath insurance coverage set forth in this section shall be provided to the USG from primary health insurance providers registered as an “Empresa Prestadora de Salud” (EPS) or designated representatives licensed for this purpose in Peru. If a company prefers to work through a broker or have a broker operate on their behalf, this shall be permitted. The agreement between the broker and the company shall be submitted as part of this offer. The contract for the services will be between the USG and the company providing the services.

The Contractor shall insure that health care under this contract does not exclude HIV/AIDS care.

There shall be no waiting period for HIV/AIDS coverage.

Premium Costs:

A. For active employees who are regularly scheduled to work 30 or more hours per week: the

USG will pay 90% of the premium cost and the employee will pay 10% of the premium cost for employee and dependent coverage.

B. For eligible employees who are regularly scheduled to work less than 30 hours per week: The

USG will pay a prorated share of the premium cost for employee and dependent coverage, based on the number of hours the employee is regularly scheduled to work.

C. During a period of leave without pay or unpaid leave beyond one pay period the employee is responsible for the full cost of premiums. Alternatively, the employee may elect to have coverage cease if he/she prefers not to pay the premium.

D. Mission employees and their dependents, who were covered by the Embassy's health insurance plan until June 30, 2008, will be grandfathered to have the option to continue being covered upon retirement. Premium costs will be the sole responsibility of the retiree. Payment will be made directly to the provider. Coverage ends with the death of the recipient of the insurance.

E. For RIF employees: the RIF employee can continue coverage for 6 months only and will pay

100% of the premium cost for employee and dependent coverage. Payment will be made directly to the provider by the RIFED employee.

F. For parents, the parents of eligible employees who were covered by the Embassy’s health insurance plan until June 30, 2008, will be grandfathered to have the option to continue being covered. Premium cost will be the sole responsibility of the employee.

H. Annual Maximum Limit – The maximum annual coverage per covered individual per contract year, not including expenses covered under HIV/AIDS benefits is S/.383,000 Soles per covered individual, per year.

C.1.1 Employee and Dependent Health Service Benefits

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

100% Coverage

Services and supplies provided during hospitalization including services provided by a licensed healthcare provider, bed, and 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

(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): 100% Coverage

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

C1.1.3 Ambulance: 80% Minimum Coverage

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 (ambulatory or reimbursement): 80% Minimum Coverage

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 and will be reimbursed at that rate.

C.1.1.6 Pediatric Services: Minimum Coverage - Inpatient/Emergency: 100% Coverage, Outpatient: 80% Minimum Coverage

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

C.1.1.7 Prescription Drugs: Inpatient/Emergency: 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, or contraceptive medication.

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

80% Minimum Coverage

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: 80% Minimum Coverage

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: 80% Minimum Coverage

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: 80% Minimum Coverage

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: 80% Minimum Coverage

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: 50% Minimum Coverage

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: 50% Minimum Coverage

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 Catastrophic Coverage: (RESERVED)

C.1.1.17 Out-of-Country Medical Treatment: (RESERVED)

C.1.1.18 Out-of-Country Medical Travel: (RESERVED)

C.1.1.19 180 Day Coverage for Dependents After Employee’s Death

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

C.1.1.20 Employee Assistance Program (EAP): (RESERVED)

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) and

C.1.1.15, HIV/AIDS is equivalent to S/.383,000 Soles.

C.1.3 Exclusions and Limitations

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

exercise therapy; long-term rehabilitative therapy; non-medical hospital charges (e.g., telephone, television, etc.); home help, family help, or similar household assistance; fees of persons who are not certified health care providers; advanced reproductive technology (e.g., in-vitro fertilization, intra-cellular sperm injection, artificial insemination, microsurgical epididymal sperm aspiration, testicular sperm extraction, cryopreservation, etc.); or services or supplies which have not been prescribed or approved by a certified health care provider. Exclusions to coverage may be amended if provided in an off the shelf plan and is the lowest-cost and technically acceptable.

Removal of any exclusions require prior authorization.

There is no coverage 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.

There is no coverage for medical expenses incurred out-of-country. There is no reimbursement for out-of-country treatment.

C.1.4 ELIGIBLE PARTICIPANTS

C.1.4.1 Identification of Eligible Employees and Dependents: U.S. Mission in Peru 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 bi-weekly/monthly basis.

C.1.4.1.1 Definition of Dependents

C1.4.1.1.1 Legal spouse or domestic partner, to include same-sex domestic partners, as certified by COM: one legal spouse as defined by local law or one domestic partner may be covered. LE Staff with more than one legal spouse or domestic partner must select only one individual for coverage.

In cases where LE Staff and their legal spouse or domestic partner 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 or domestic partner.

Dependent children: a child is defined as the LE Staff’s natural, adopted, stepchild, or foster child.

Any child of a recognized domestic partner shall be deemed a stepchild of the employee. Children 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.1.4.1.1.2 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.1.4.1.1.3 Parents: Parents of eligible employees who were covered by the Embassy’s health insurance plan on June 30, 2008, are grandfathered to have the option to continue being covered.

Employee pays 100% of the premium.

C.1.4.2 Location of Employment: The eligible employees covered by C.1.4.1 must be employed within the geographic boundaries of by: Department of State, U.S. Agency for

International Development, ACE, APHIS, DAO, DEA, FAS, FCS, FPD, INL, MAAG, NAMRU-

6, PAS, PC, ICE/HSI, USSS, USFWS, LEGAT

C.1.4.3 Participants Covered Under a Rider

a. American Employees Community Association (AECA) at Embassy Lima (see Exhibit D). All costs for AECA are the responsibility of AECA , not the U.S. Government.

b. Peace Corps (PSC) active employee may be covered under a rider to the contract (see Exhibit

E). All costs for Peace Corps are the responsibility of Peace Corps, not the U.S. Government.

c. Retirees, dependents and their parents, who were covered by the Embassy’s health insurance plan on June 30, 2008, are grandfathered to have the option to continue being covered upon retirement (see Exhibit G). Employees and their dependents, who were covered by the Embassy’s health insurance plan on June 30, 2008, are grandfathered to have the option to continue being covered upon retirement. Premium costs will be the sole responsibility of the retiree and paid directly to the provider. Coverage ends with the death of the recipient of the insurance.

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.1.6 Brochure Requirement

C.1.6.1 The Contractor shall provide a document (brochure/pamphlet/other written document) in 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 fifteen (15) business days after award. The Contractor shall provide additional brochures for new employees within ten (10) business 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, coverage, and contract terms 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 document contains inaccuracies, the

Contractor will be notified in writing; however, failure on the part of the U.S. 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.1.7 PRE EXISTING CONDITIONS

Coverage of pre-existing conditions will be extended to all employees actually employed/enrolled and dependents, parent, retirees and RIF employees at the time the contract is signed. If an employee wishes to enroll or re-enroll at a later date, pre-existing conditions will not be covered.

PART II: GROUP LIFE INSURANCE

C.2.0 GROUP LIFE INSURANCE

The Government of the United States of America requires group life insurance coverage for its employees, as further described in C.2.2, in Peru. The Government has determined that the prevailing practice by employers in Peru 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 both the employee and the employer at 100%. Therefore, the Government desires to adopt such locally prevailing practice as part of its compensation plan for its employees as further described in C.2.2. The specific group insurance coverage under this contract is set forth in this part of Section C and the Attachments in Section J.

Premium Costs:

The USG will pay 100% of the premium cost for the employee coverage.

C.2.1. GROUP LIFE INSURANCE COVERAGE

The amount of group life insurance coverage is as follows:

C.2.1.1. Amount of Employee Life Insurance.

The amount of the mandatory life insurance coverage for each employee is based upon their monthly salary. Monthly salary are those earnings which are included in the payroll and earning statement, with the exception of bonuses and other earning which are not paid monthly.

“Monthly adjusted salary” is the monthly basic salary plus fringe benefits.

The amount of the supplemental life insurance coverage for each employee is based upon their basic monthly salary. Basic monthly salary does not include the Miscellaneous Benefit

Allowance.

C.2.1.2. Mandatory Life Insurance (Peruvian Law 688)

Employees receive the following levels of life insurance coverage after nine (9) months of service:

Natural Death: 16 monthly adjusted salaries

Accidental Death: 32 monthly adjusted salaries

Permanent Disability: 32 monthly adjusted salaries

C.2.1.3. Amount of Supplemental Natural Death Life Insurance

The employee’s estate will receive an amount equal to four (4) times the amount of monthly basic salary in the event the employee dies of natural causes (work-related or non-work related)

C.2.1.4. Amount of Supplemental Accidental Death Life Insurance

Employees estate will receive an amount equal to six (6) times the amount of monthly basic salary in the event the employee dies of natural causes (work-related or non-work related).

C.2.2. LIFE INSURANCE BENEFITS CONDITIONS AND LIMITATIONS

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

Life insurance will not be paid in cases of suicide.

C.2.3. ELIGIBLE PARTICIPANTS

C.2.3.1. Eligible Employees. The employees eligible for the group life insurance coverage include the following:

C.2.3.1.1. All current active employees of the United States Government, employed within the geographic boundaries of Peru, paid under the Local Compensation Plan, and certified by the

Contracting Officer. Covered employees include:

C.2.3.1.2. LE Staff employed under direct hire appointments, Personal Services Agreements

(PSAs)and Personal Services Contracts (PSCs) working on a full-time or part-time basis under non-temporary direct hire appointments or under personal services agreements/contracts

(PSA/PSC) 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 Peru by: STATE, USAID, ACE, APHIS, DAO, DEA, FAS, FCS, FPD, INL, MAAG, NAMRU-6, PAS, PC, ICE/HSI, USSS, USFWS, LEGAT

C.2.3.3. Participants Covered Under a Rider

C.2.3.3.1. Peace Corps personal services contractors (PC PSC) at Embassy Lima (see Exhibit E).

All costs for PC PSCs are the responsibility of PC.

C.2.3.3.2. American Employees Community Association (AECA) at Embassy Lima (see Exhibit

D). All costs for AECA are the responsibility of AECA , not the U.S. Government.

C.2.3.3.3. Upon retirement, an employee may continue life insurance coverage. The retiree is responsible for 100% of the premium, not the U.S. Government.

C.2.4. INDIVIDUALS NOT ELIGIBLE FOR COVERAGE

Individuals not eligible for coverage under this contract are dependents, those working under temporary direct hire 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 Peru who provides 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.2.5. OTHER ELIGIBLE PARTICIPANTS - RESERVED

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 and thereafter during the performance period of this contract. 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 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 (LWP) 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

Spanish and at least five (5) copies in English that sets forth a complete listing of the life insurance benefits to be provided under this contract. This brochure shall be provided in sufficient quantities so that each covered employee receives a copy. The Contractor shall furnish all copies of the brochures to the COR, who will ensure that appropriate distribution is made.

C.2.7.2. The contractor shall provide the document described in C.1.7.1 to the COR not later than fifteen (15) business 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.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.3.0 DEFINITIONS

Adjusted Salary

Is the amount paid to an employee by an employer. It represents the basic salary plus benefits.

Basic Salary

Is the amount paid to an employee by an employer. It does not include benefits, bonuses or any other potential compensation.

FMO

The Financial Management Officer or the paying office for all U.S. Government Agencies except

AID.

COR

Contracting Officer's Representative (Human Resources Officer at post).

Contributory

Insurance for which the employee contributes toward the premium.

Customary and Reasonable Treatment

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

Dependents

Dependents are defined as the employee’s legal spouse/cohabitant/same-sex domestic partner

(limit one) and unmarried, economically dependent children who primarily reside with the employee unless away at school. Child is defined as the employee’s natural child, adopted child, stepchild, or foster child. An eligible child will be covered until the end of the contract year in which she/she reaches age 25. There is no age limit for an eligible child who is physically or mentally handicapped so as to be unable to live independently. There is no limit on the number of children covered per employee. The parents of eligible employee who are currently covered will be grandfathered under the new plan.

Disability, Total and Permanent

The following health conditions are considered to constitute total and permanent disability caused by an accident, absolute and incurable mental alienation, brain death which prevents the individual from carrying out any work or occupation or occupation for the rest of his life, incurable fracture of the spine which causes total and permanent disability, loss of the vision in both eyes, loss of both hands, loss of both feet, or loss of one hand and one foot and other ailments which might be established through a Supreme Decree.

Employee

An individual employed by the U.S. Government, under a direct-hire appointment, personal services contract, or personal services agreement, as further defined in Section C.1.3 for health insurance and C.2.3 for life insurance. This includes the American Employees Community

Association (AECA) employees and Peace Corp PSCs, 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 and in case of AECA employees and Peace Corps PSCs, AECA and Peace Corps, respectively.

GSO

General Services Officer in charge of the General Services Office at post. This officer is usually the Contracting Officer 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.

Surgical Procedure

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

SECTION D

PACKAGING AND MARKING

(RESERVED)

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

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

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

52.246-4, Inspection of Services – Fixed Price (AUG 1996) or the appropriate Inspection of

Services clause), if any of the services exceed the standard.

E.2.3 Procedures

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

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

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

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

COR shall determine how much time is reasonable.

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

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

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

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

SECTION F

DELIVERIES OR PERFORMANCE

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

THE FOLLOWING FEDERAL ACQUISITION REGULATION CLAUSES ARE

52.242-15 STOP WORK ORDER (AUG 1989)

52.242-17 GOVERNMENT DELAY OF WORK (APR 1984)

F.2 PERIOD OF PERFORMANCE. The performance period of this contract is one year beginning on October 1, 2023 with four (4) one-year options to renew.

F.3 OPTIONS

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

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

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

F.4 REPORTS AND OTHER DELIVERABLES

All reports and other deliverables required under this contract shall be delivered to:

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

SECTION G

CONTRACT ADMINISTRATION DATA

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

(a) The Contracting Officer may designate in writing one Government employee, by name or position title, to take action for the Contracting Officer under this contract. This designee shall be identified as a Contracting Officer’s Representative (COR). Such designation shall specify the scope and limitations of the authority so delegated; provided, that the designee shall not change the terms or conditions of the contract, unless the COR is a warranted Contracting Officer and this authority is delegated in the designation.

(b) The COR for this contract is the Human Resources Management Specialist

G.2 COR DUTIES

G.2.1 The COR is responsible for inspection and acceptance of services. These duties include review of Contractor invoices, including the supporting documentation required by the contract.

The COR may provide technical advice, substantive guidance, inspections, invoice approval, and other purposes as deemed necessary under the contract.

G.2.2 In addition, the COR shall maintain updated list of employees and dependents insured, which will supersede the initial list provided under this contract and as reported to the insurer or thru the broker, if available, without prejudice to the ineligibility clause.

G.2.3. The COR has the additional responsibility of maintaining the eligible listing of employees and dependents for insurance coverage.

G.2.4 The COR may not change the terms and conditions of the contract. While the COR is authorized to provide the Contractor with updated listings of eligible employees and dependents, only the Contracting Officer may modify existing contract and commit the Government.

G.3. Payment shall be made in Peruvian Soles.

G.4 SUBMISSION OF INVOICES AND PAYMENT

G.4.1. Invoices for U.S. Government employees shall be submitted as follows:

Insured Issue in the name of

- All U.S. Government employees, except USAID American Embassy, Lima

- USAID employees USAID/PERU

- American Employees Community…