FEDVIP_Application_-_Amendment_0001-s.doc

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AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

1. CONTRACT ID CODE

PAGE OF PAGES

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2. AMENDMENT/MODIFICATION NO.PRIVATE

3. EFFECTIVE DATE

February 1, 2013

4. REQUISITION/PURCHASE REQ. NO

5. PROJECT NO. (If applicable)

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6. ISSUED BY

U.S. Office of Personnel Management

Healthcare and Insurance

FEIO

1900 E Street, NW, Room 3425

Washington, DC 20415 Same as item 6

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8. NAME AND ADDRESS OF CONTRACTOR (No., Street, County, State, and Zip Code)

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9A. AMENDMENT OF SOLICITATION NO. OPM01-FEDVIP-01AP

9B. DATED (SEE ITEM 11)

January 15, 2013

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10A. MODIFICATION OF CONTRACT/ORDER NO.

CODE:

FACILITY CODE:

10B. DATED (SEE ITEM 11)

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11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS

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The above numbered, solicitation is amended as set forth in item 14. The hour and date specified for receipt of Offers FORMCHECKBOX is extended FORMCHECKBOX is not extended.

Offers must acknowledge receipt of this amendment prior to the hour and date specified in the solicitation or as amended by:

(1) Acknowledging receipt of this amendment on each copy of your application submitted.

FAILURE OF YOUR ACKNOWLEDGMENT 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.

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12. ACCOUNTING AND APPROPRIATION DATA (If Required)

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13. THIS ITEM APPLIES ONLY TO MODIFICATIONS OF CONTRACTS/ORDERS,

IT MODIFIES THE CONTRACT/ORDER NO., AS DESCRIBED IN ITEM 14

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A. THIS CHANGE ORDER IS ISSUED PURSUANT TO: (Specify Authority) THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE CONTRACT ORDER NO. IN ITEM 10A.

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B. THE ABOVE NUMBERED CONTRACT/ORDER IS MODIFIED TO REFLECT THE ADMINISTRATIVE CHANGES (such as changes in paying office, appropriation date, etc.) SET FORTH IN ITEM 14, PURSUANT TO THE AUTHORITY OF FAR 43,103 (b).

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C. THIS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO AUTHORITY OF:

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D. OTHER (Specify type of modification and authority)

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E. IMPORTANT: Contractor

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

See page 2

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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.

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15A. NAME AND TITLE OF SIGNER

16A. NAME AND TITLE OF CONTRACTING OFFICER

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15B. CONTRACTOR/OFFEROR

15C. DATE

SIGNED

16B. UNITED STATES OF AMERICA

16C. DATE

SIGNED

(Signature of person authorized to sign)

(Signature of Contracting Officer)

NSN 7540-01-152-8070

STANDARD FORM 30 (REV. 10-83)

Previous Edition Unusable

Prescribed by GSA FAR (48 CFR) 53.243

APPLICATION NUMBER OPM01-FEDVIP-01AP

AMENDMENT 0001

The purpose of Amendment Number 0001 to Application OPM01-FEDVIP-01AP is to extend the due date; revise some sections of the application and provide clarification. Accordingly, the application is amended as follows:

1. The submission due date is extended from February 18, 2013 to February 19, 2013.

2. Section L, L.14.3.3 - Certifications for a Drug-free work place and Anti-lobbying has been removed from this application.

3. The following FAR clauses are incorporated into the application:

· FAR 52.203-11 Certification and Disclosure Regarding Payments to Influence Certain Federal Transactions (Sept 2007)

· FAR 52.203-12 Limitation on Payments to Influence Certain Federal Transactions (Oct 2010)

· FAR 52.212-3 Offeror Representations and Certifications—Commercial Items (Dec 2012)

4. Section C, Appendix E has been updated as per the following:

· Page C-42 currently states that the cost share should not exceed 45%. Total member cost sharing for Intermediate Services (Class B) is updated and should not exceed 50%.

· Page C-44 currently states that the cost share should not exceed 65%. Total member cost sharing for Major Services (Class C) is updated and should not exceed 70%.

· Page C-48 currently states that the cost share should not exceed 60%. Total member cost sharing for Orthodontia Coverage (Class D) is updated and should not exceed 65%.