Amendment_0002_to_PC-16-R-007_11-10-16.pdf

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 items 8 and 15, and returning or (c) By separate letter or telegram which includes a reference to the solicitation and amendment numbers. 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 your 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.

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

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT 1. CONTRACT ID CODE

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

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

STANDARD FORM 30 (REV. 10-83)

Prescribed by GSA FAR (48 CFR) 53.243

FACILITY CODE

9A. AMENDMENT OF SOLICITATION

NO.

9B. DATED (SEE ITEM 11)

10A. MODIFICATION OF CONTRACT/ORDER NO.

10B. DATED (SEE ITEM 13)

11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS

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

12. ACCOUNTING AND APPROPRIATION DATA (If required) copies of the amendment; (b) By acknowledging receipt of this amendment on each copy of the offer submitted;

13. THIS ITEM ONLY APPLIES TO MODIFICATION OF CONTRACTS/ORDERS.

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

CHECK ONE 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.

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).

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

D. OTHER (Specify type of modification and authority)

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.

15C. DATE SIGNED

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

16C. DATE SIGNED

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

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

PAGE OF PAGES

6. ISSUED BY CODE

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

CODE

15B. CONTRACTOR/OFFEROR

(Signature of person authorized to sign)

16B. UNITED STATES OF AMERICA

(Signature of Contracting Officer)

NSN 7540-01-152-8070

Previous edition unusable

PCISSUE

See page 2.

Peace Corps Office of Acquisition and Contract Management 1111 20th Street, NW, 4th Floor Washington, DC 20526

See Block 6

J

PC-16-R-007

1 7

11/10/2016

10/12/2016

PC-16-R-007

Amendment 0002

SECTION SF 30 BLOCK 14 CONTINUATION PAGE

SUMMARY OF CHANGES

The purpose of this Amendment to Solicitation PC-16-R-007 is to 1) delete Attachment L- 2_PRICING TABLE in its entirety and replace it with the new Attachment L-2_PRICING TABLE; and 2) revise Section B Contract Line Item Numbers (CLINs) 0001 through 0029.

Accordingly, said Solicitation is hereby amended as follows:

1. Attachment L-2_ PRICING TABLE is hereby deleted in its entirety and replaced with the new Attachment L-2_PRICING TABLE attached hereto.

2. Section B CLINs 0001 through 00029 are hereby revised as follows:

DELETE:

SECTION B - SUPPLIES OR SERVICES AND COSTS/PRICES

ITEM NO. SUPPLIES/SERVICES QTY UNIT

UNIT

PRICE AMOUNT

BASE

AWARD

Transition Phase-In (FFP) Planning and Implementation of Transition Period In Accordance With (IAW) Statement of Work (SOW), Sections C.1, C.3.1 1 Lot

Invitee Cost -Reimbursement Administrative Services (Plan 1) (FFP (Unit Price)) IAW Sections C.1, C.2 and

C.4 6,500 CL

Health Care Administrative Services for Peace Corps Volunteers (Plan 2) (FFP (Unit Price)) IAW Sections C.1, C.2 and C.5 (See Note A) 7,000 MM

Health Care Administrative Services for Returned Peace Corps Volunteer- (Plan 3) (FFP (Unit Price)) IAW Sections C.1, C.2 and C.6 (See Note A) 4,000 MM

0005 Access to Short-Term Group Health Insurance Policy (Plan 4) (FP EPA) IAW Sections C.1, C.2 and C.7. (See 4,000 MM See

Note

Notes A and B) B

0006 Other Direct Cost - Medical Claims IAW Section C.8.

(See Note C) 1 Lot $6,600,000

0007 Automated Eligibility and Authorization System (Option) (FFP) IAW Section C.9 (See Note D) 1 Lot

Data for Items 0001 - 0007, and (if options are exercised) 0009 through 0029 IAW Section C.10 (Not Separately Priced (NSP)) 1 Lot NSP

OPTION I

Invitee Cost -Reimbursement Administrative Services (Plan 1) (FFP (Unit Price)) IAW Sections C.1, C.2 and C.4 (See Note D) 6,825 CL

Health Care Administrative Services for Peace Corps Volunteers (Plan 2) (FFP (Unit Price)) IAW Sections C.1, C.2 and C.5 (See Notes A and D) 7,800 MM

Health Care Administrative Services for Returned Peace Corps Volunteers (Plan 3) (FFP (Unit Price)) IAW Sections C.1, C.2 and C.6 (See Notes A and D) 4,300 MM

Access to Short-Term Group Health Insurance Policy (Plan 4) (FP EPA) IAW Sections C.1, C.2 and C.7. (See Notes A, B, and D) 4,200 MM

See Note B

Other Direct Cost - Medical Claims IAW Section C.8.

(See Notes C and D) 1 Lot $6,930,000

OPTION II

Invitee Cost -Reimbursement Administrative Services (Plan 1) (FFP (Unit Price)) IAW Sections C.1, C.2 and C.4 (See Note D) 7,166 CL

Health Care Administrative Services for Peace Corps Volunteers (Plan 2) (FFP (Unit Price)) IAW Sections C.1, C.2 and C.5 (See Notes A and D) 8,500 MM

Health Care Administrative Services for Returned Peace Corps Volunteers (Plan 3) (FFP (Unit Price)) IAW Sections C.1, C.2 and C.6 (See Notes A and D) 4,600 MM

Access to Short-Term Group Health Insurance Policy (Plan 4) (FP EPA) IAW Sections C.1, C.2 and C.7. (See Notes A, B, and D) 4,410 MM

See Note B

Other Direct Cost (ODC) - Medical Claims IAW Section C.8. (See Notes C and D) 1 Lot $7,276,500

OPTION III

Invitee Cost -Reimbursement Administrative Services (Plan 1) (FFP (Unit Price)) IAW Sections C.1, C.2 and C.4 (See Note D) 7,524 CL

Health Care Administrative Services for Peace Corps Volunteers (Plan 2) (FFP (Unit Price)) IAW Sections C.1, C.2 and C.5 (See Notes A and D) 8,700 MM

Health Care Administrative Services for Returned Peace Corps Volunteers (Plan 3) (FFP (Unit Price)) IAW Sections C.1, C.2 and C.6 (See Notes A and D) 4,630 MM

Access to Short-Term Group Health Insurance Policy (Plan 4) (FP EPA) IAW Sections C.1, C.2 and C.7. (See Notes A, B, and D) 4,630 MM

See Note B

Other Direct Cost - Medical Claims IAW Section C.8.

(See Notes C and D) 1 Lot $7,640,325

OPTION IV

Invitee Cost -Reimbursement Administrative Services (Plan 1) (FFP (Unit Price)) IAW Sections C.1, C.2 and C.4 (See Note D) 7,900 CL

Health Care Administrative Services for Peace Corps Volunteers (Plan 2) (FFP (Unit Price)) IAW Sections C.1, C.2 and C.5 (See Notes A and D) 8.900 MM

Health Care Administrative Services for Returned Peace Corps Volunteers (Plan 3) (FFP (Unit Price)) IAW Sections C.1, C.2 and C.6 (See Notes A and D) 4,700 MM

Access to Short-Term Group Health Insurance Policy (Plan 4) (FP EPA) IAW Sections C.1, C.2 and C.7. (See Notes A, B, and D) 4,862 MM

See Note B

Other Direct Cost - Medical Claims IAW Section C.8.

(See Notes C and D) 1 Lot $8,022,341

Transition Phase-Out (FFP) IAW Section C.3.2 (See Note D) 1 Lot

CL – Price per Claim MM – Price per Member per Month

INSERT:

SECTION B - SUPPLIES OR SERVICES AND COSTS/PRICES

ITEM NO. SUPPLIES/SERVICES QTY UNIT

UNIT

PRICE AMOUNT

BASE

AWARD

Transition Phase-In (FFP) Planning and Implementation of Transition Period In Accordance With (IAW) Statement of Work (SOW), Sections C.1, C.3.1 1 Lot

0002 Invitee Cost -Reimbursement Administrative Services (Plan 1) (FFP (Unit Price)) IAW Sections C.1, C.2 and

Up to

6,500 CL

C.4

Health Care Administrative Services for Peace Corps Volunteers (Plan 2) (FFP (Unit Price)) IAW Sections C.1, C.2 and C.5 (See Note A)

Up to

7,000 MM

Health Care Administrative Services for Returned Peace Corps Volunteer- (Plan 3) (FFP (Unit Price)) IAW Sections C.1, C.2 and C.6 (See Note A)

Up to

4,000 MM

Access to Short-Term Group Health Insurance Policy (Plan 4) (FP EPA) IAW Sections C.1, C.2 and C.7. (See Notes A and B)

Up to

4,000 CA

See Note B

0006 Other Direct Cost - Medical Claims IAW Section C.8.

(See Note C) 1 Lot $6,600,000

0007 Automated Eligibility and Authorization System (Option) (FFP) IAW Section C.9 (See Note D) 1 Lot

Data for Items 0001 - 0007, and (if options are exercised) 0009 through 0029 IAW Section C.10 (Not Separately Priced (NSP)) 1 Lot NSP

OPTION I

Invitee Cost -Reimbursement Administrative Services (Plan 1) (FFP (Unit Price)) IAW Sections C.1, C.2 and C.4 (See Note D)

6,825 CL

Health Care Administrative Services for Peace Corps Volunteers (Plan 2) (FFP (Unit Price)) IAW Sections C.1, C.2 and C.5 (See Notes A and D)

7,800 MM

Health Care Administrative Services for Returned Peace Corps Volunteers (Plan 3) (FFP (Unit Price)) IAW Sections C.1, C.2 and C.6 (See Notes A and D)

Up to

4,300 MM

Access to Short-Term Group Health Insurance Policy (Plan 4) (FP EPA) IAW Sections C.1, C.2 and C.7. (See Notes A, B, and D)

Up to

4,200 CA

See Note B

Other Direct Cost - Medical Claims IAW Section C.8.

(See Notes C and D) 1 Lot $6,930,000

OPTION II

Invitee Cost -Reimbursement Administrative Services (Plan 1) (FFP (Unit Price)) IAW Sections C.1, C.2 and C.4 (See Note D)

Up to

7,166 CL

Health Care Administrative Services for Peace Corps Volunteers (Plan 2) (FFP (Unit Price)) IAW Sections C.1, C.2 and C.5 (See Notes A and D)

Up to

8,500 MM

Health Care Administrative Services for Returned Peace Corps Volunteers (Plan 3) (FFP (Unit Price)) IAW Sections C.1, C.2 and C.6 (See Notes A and D)

Up to

4,600 MM

Access to Short-Term Group Health Insurance Policy (Plan 4) (FP EPA) IAW Sections C.1, C.2 and C.7. (See Notes A, B, and D)

Up to

4,410 CA

See Note B

Other Direct Cost (ODC) - Medical Claims IAW Section C.8. (See Notes C and D) 1 Lot $7,276,500

OPTION III

Invitee Cost -Reimbursement Administrative Services (Plan 1) (FFP (Unit Price)) IAW Sections C.1, C.2 and C.4 (See Note D)

Up to

7,524 CL

Health Care Administrative Services for Peace Corps Volunteers (Plan 2) (FFP (Unit Price)) IAW Sections C.1, C.2 and C.5 (See Notes A and D)

8,700 MM

Health Care Administrative Services for Returned Peace Corps Volunteers (Plan 3) (FFP (Unit Price)) IAW Sections C.1, C.2 and C.6 (See Notes A and D)

Up to

4,630 MM

Access to Short-Term Group Health Insurance Policy (Plan 4) (FP EPA) IAW Sections C.1, C.2 and C.7. (See Notes A, B, and D)

Up to

4,630 CA

See Note B

Other Direct Cost - Medical Claims IAW Section C.8.

(See Notes C and D) 1 Lot $7,640,325

OPTION IV

Invitee Cost -Reimbursement Administrative Services (Plan 1) (FFP (Unit Price)) IAW Sections C.1, C.2 and C.4 (See Note D)

Up to

7,900 CL

Health Care Administrative Services for Peace Corps Volunteers (Plan 2) (FFP (Unit Price)) IAW Sections C.1, C.2 and C.5 (See Notes A and D)

Up to

8,900 MM

Health Care Administrative Services for Returned Peace Corps Volunteers (Plan 3) (FFP (Unit Price)) IAW Sections C.1, C.2 and C.6 (See Notes A and D)

Up to

4,700 MM

Access to Short-Term Group Health Insurance Policy (Plan 4) (FP EPA) IAW Sections C.1, C.2 and C.7. (See Notes A, B, and D)

Up to

4,862 CA

See Note B

Other Direct Cost - Medical Claims IAW Section C.8.

(See Notes C and D) 1 Lot $8,022,341

Transition Phase-Out (FFP) IAW Section C.3.2 (See Note D) 1 Lot

CL – Price per Claim CA – Price per Case (Unit Price is based on the Peace Corps paying the first month premium) MM – Price per Member per Month

(End of Summary of Changes)