RFP_19GE5025R0010.pdf

19GE5025R0010

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS

OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24 & 30

1. REQUISITION NUMBER

5. SOLICITATION NUMBER

19GE5025R0010

2. CONTRACT NO. 3. AWARD/EFFECTIVE DATE 4. ORDER NUMBER 6. SOLICITATION ISSUE

DATE

01/16/2025

7. FOR SOLICITATION

INFORMATION CALL:

a. NAME

Ielyzaveta M Ishchenko

b. TELEPHONE NUMBER (No collect calls)

c. EMAIL IshchenkoIM@state.gov

8. OFFER DUE DATE / LOCAL

TIME

02/17/2025 14:00

CODE FRANK

AMERICAN CONSULATE GENERAL FRANKFURT

GIESSENER STRASSE 30

ATTN: RPSO

60435, FRANKFURT, GERMANY

9. ISSUED BY X UNRESTRICTED OR SET ASIDE: % FOR

SMALL BUSINESS

HUBZONE SMALL

BUSINESS

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

WOMEN-OWNED SMALL BUSINESS (WOSB)

ELIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM

EDWOSB

8(A)

NAICS:

SIZE STANDARD:

10. THE ACQUISITION IS

SEE

SCHEDULE

11. DELIVERY FOR FOB DESTINATION

UNLESS BLOCK IS MARKED

12. DISCOUNT TERMS

13a. THIS CONTRACT IS

RATED ORDER UNDER DPAS

(15 CFR 700)

13b. RATING

RFQ IFB X RFP

14. METHOD OF SOLICITATION

CURACCODE15. DELIVER TO

AMERICAN CONSULATE GENERAL CURACAO

PO BOX 158, WILLEMSTAD

ATTN: GSO

CURACAO, CURACAO

CODE OPEAQM16. ADMINISTERED BY

RPSO Frankfurt OPE/AQM/IP/RPSO Frankfurt Office of Acquisition (AQM) Frankfurt

FACILITY

CODE

CODE

Contact UEI:

Telephone No.

17a. CONTRACTOR/

OFFEROR

OPEAQMCODE18a. PAYMENT WILL BE MADE BY

AMERICAN CONSULATE GENERAL CURACAO

PO BOX 158, WILLEMSTAD

ATTN: GSO

CURACAO, CURACAO

17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN

OFFER SEE ADDENDUM

18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK BELOW IS

CHECKED

19. ITEM NO. 20. SCHEDULE OF SUPPLIES/SERVICES

(Use Reverse and/or Attach Additional Sheets as Necessary)

21. QUANTITY 22. UNIT 23. UNIT PRICE 24. AMOUNT

See Line Items Section

25. ACCOUNTING AND APPROPRIATION DATA 26. TOTAL AWARD AMOUNT (For Govt. Use Only)

X 27a. SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1, 52.212-4. FAR 52.212-3 AND 52.212-5 ARE ATTACHED. ADDENDA X ARE ARE NOT ATTACHED

27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA ARE ARE NOT ATTACHED

X 28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN 1 COPIES TO

ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND DELIVER ALL ITEMS SET FORTH

OR OTHERWISE IDENTIFIED ABOVE AND ON ANY ADDITIONAL SHEETS SUBJECT TO THE

TERMS AND CONDITIONS SPECIFIED.

29. AWARD OF CONTRACT: REF. _____________________________ OFFER

DATED _________________ . YOUR OFFER ON SOLICITATION (BLOCK 5)

INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE SET FORTH HEREIN,

IS ACCEPTED AS TO ITEMS:

30a. SIGNATURE OF OFFEROR/CONTRACTOR 31a. UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER)

30b. NAME AND TITLE OF SIGNER (TYPE OR PRINT) 30c. DATE SIGNED 31b. NAME OF THE CONTRACTING OFFICER (TYPE OR PRINT) Nicolas Wilhelm

31c. DATE SIGNED 01/16/2025

AUTHORIZED FOR LOCAL REPRODUCTION

PREVIOUS EDITION IS NOT USABLE

STANDARD FORM 1449 (REV. 02/2012)

Prescribed by GSA - FAR (48 CFR) 53.212

CGFS // CGFS

19.

ITEM NO.

20.

SCHEDULE OF SUPPLIES/SERVICES

21.

QUANTITY

22.

UNIT

23.

UNIT PRICE

24.

AMOUNT

32a. QUANTITY IN COLUMN 21 HAS BEEN

RECEIVED INSPECTED ACCEPTED, AND CONFORMS TO THE CONTRACT, EXCEPT AS NOTED: _________________________________

32b. SIGNATURE OF AUTHORIZED GOVERNMENT

REPRESENTATIVE

32c. DATE 32d. PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT

REPRESENTATIVE

32e. MAILING ADDRESS OF AUTHORIZED GOVERNMENT REPRESENTATIVE 32f. TELEPHONE NUMBER OF AUTHORIZED GOVERNMENT

REPRESENTATIVE

32g. E-MAIL OF AUTHORIZED GOVERNMENT REPRESENTATIVE

PARTIAL FINAL

33. SHIP NUMBER 34. VOUCHER NUMBER 35. AMOUNT VERIFIED

CORRECT FOR

COMPLETE PARTIAL FINAL

36. PAYMENT 37. CHECK NUMBER

38. S/R ACCOUNT NUMBER 39. S/R VOUCHER NUMBER 40. PAID BY

41a. I CERTIFY THIS ACCOUNT IS CORRECT AND PROPER FOR PAYMENT 42a. RECEIVED BY (Print)

41b. SIGNATURE AND TITLE OF CERTIFYING OFFICER 41c. DATE

42b. RECEIVED AT (Location)

42c. DATE REC'D (YY/MM/DD) 42d. TOTAL CONTAINERS

STANDARD FORM 1449 (REV. 02/2012) BACK

Line Item Summary

Solicitation Number:

19GE5025R0010

Contract Number: Title: FSN Health Insurance Willemstad, Curacao

Date of Solicitation:

01/16/2025

Line Item No.

Description Quantity Unit Unit Price Total Cost

001 BASE YEAR

LES Health Insurance inclusive of Sub CLINs 0001A, 0001B, 0001C Type of Contract Pricing: FFP

Doc Ref No:

Delivery Date FOB:

12.00 EA $0.00 $0.00

1001 OPTION YEAR 1

LES Health Insurance inclusive of Sub CLINs 1001A, 1001B, 1001C Type of Contract Pricing: FFP

Doc Ref No:

Delivery Date FOB:

12.00 EA $0.00 $0.00

2001 OPTION YEAR 2

LES Health Insurance inclusive of Sub CLINs 2001A, 2001B, 2001C Type of Contract Pricing: FFP

Doc Ref No:

Delivery Date FOB:

12.00 EA $0.00 $0.00

3001 OPTION YEAR 3

LES Health Insurance as per attached Pricing Schedule inclusive of Sub CLINs 3001A, 3001B, 3001C Type of Contract Pricing: FFP

Doc Ref No:

Delivery Date FOB:

12.00 EA $0.00 $0.00

4001 OPTION YEAR 4

LES Health Insurance inclusive of Sub CLINs 4001A, 4001B, 4001C Type of Contract Pricing: FFP

Doc Ref No:

Delivery Date FOB:

12.00 EA $0.00 $0.00

Locally Employed Staff Health Insurance U.S. Embassy Willemstad, Curacao

Solicitation No. 19GE5025R0010 Page 4 of 99

TABLE OF CONTENTS

TABLE OF CONTENTS

SECTION I – THE SCHEDULE

I.1 SUPPLIES OR SERVICES AND PRICES / COSTS

I.1.1 BACKGROUND / SCOPE OF SERVICES

I.1.2 TYPE OF CONTRACT

I.1.3 MINIMUM

I.1.4 PRICING

I.1.5 ABBREVIATIONS

I.2 DESCRIPTION/SPECIFICATIONS/SCOPE OF WORK

I.2.1 MANDATORY/REQUIRED BENEFITS

I.2.2 ANNUAL MAXIMUM LIMIT

I.2.3 EXCLUSION TO COVERAGE

I.2.4 ELIGIBILITY

I.2.5 PREMIUM

I.2.6 PERIODS OF INELIGIBILITY

I.2.7 BROCHURE REQUIREMENT

I.3 CONTRACT ADMINISTATIVE REQUIREMENTS AND PROCEDURES

I.3.1 QUALITY ASSURANCE AND SURVEILLANCE PLAN (QASP)

I.3.2 DELIVERABLES

I.3.3 CONTRACTOR RESPONSIBILITY IN CLAIMS AND REIMBURSEMENT TO CLAIMS

I.3.4 REPORT REQUIREMENTS

I.3.5 MISCELLANEOUS CONTRACTOR REQUIREMENTS

I.3.6 ERRONEOUS PAYMENT

I.3.7 KEY PERSONNEL

I.3.8 PHYSICAL AND INFORMATION SECURITY REQUIREMENTS

I.3.9 LAWS AND REGULATIONS

I.3.10 CONTRACT ADMINISTRATION DATA

I.3.11 INVOICES, REVIEW AND PAYMENT

I.3.12 CHANGES IN OWNERSHIP

I.3.13 FUNDING / TASK ORDERS / PROCEDURES

I.3.14 CHOICE OF LAW

I.3.15 START / PERIOD OF PERFORMANCE

I.3.16 LIST OF ATTACHMENTS

SECTION II - CONTRACT CLAUSES

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

II.2 FAR 52.212-4 CONTRACT TERMS AND CONDITIONS—COMMERCIAL

PRODUCTS AND COMMERCIAL SERVICES (NOV 2023)

II.3 FAR 52.212-5 CONTRACT TERMS AND CONDITIONS REQUIRED TO IMPLEMENT

STATUTES OR EXECUTIVE ORDERS—COMMERCIAL PRODUCTS AND

COMMERCIAL SERVICES (NOV 2024)

Locally Employed Staff Health Insurance U.S. Embassy Willemstad, Curacao

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II.4 FAR 52.204-25 PROHIBITION ON CONTRACTING FOR CERTAIN

TELECOMMUNICATIONS AND VIDEO SURVEILLANCE SERVICES OR EQUIPMENT

(NOV 2021) 40

II.5 52.216-4 ECONOMIC PRICE ADJUSTMENT LABOR AND MATERIAL (JAN 2017) 43

II.6 FAR 52.216-18 ORDERING (AUG 2020)

II.7 FAR 52.216-19 ORDER LIMITATIONS (OCT 1995)

II.8 FAR 52.216-21 REQUIREMENTS (OCT 1995)

II.9 FAR 52.216-22 INDEFINITE QUANTITY (OCT 1995)

II.10 FAR 52.217-5 EVALUATION OF OPTIONS (JULY 1990)

II.11 FAR 52.217-8 OPTION TO EXTEND SERVICES (NOV 1999)

II.12 FAR 52.217-9 OPTION TO EXTEND THE TERM OF THE CONTRACT(MAR 2000) 47

II.13 FAR 52.222-50 COMBATING TRAFFICKING IN PERSONS (NOV 2021)

II.14 FAR 52.229-12 TAX ON CERTAIN FOREIGN PROCUREMENTS (FEB 2021)

II.15 652.232-70 PAYMENT SCHEDULE AND INVOICE SUBMISSION (FIXED-PRICE)

(AUG 1999)

II.16 652.242-70 CONTRACTING OFFICER'S REPRESENTATIVE (COR) AUG 1999)

II.17 652.242-73 AUTHORIZATION AND PERFORMANCE (AUG 1999)

II.18 652.243-70 NOTICES (AUG 1999)

SECTION III - SOLICITATION PROVISIONS

III.1 FAR 52.252-1 SOLICITATION PROVISIONS INCORPORATED BY REFERENCE

(FEB 1998)

III.2 FAR 52.212-1 INSTRUCTIONS TO OFFERORS—COMMERCIAL PRODUCTS AND

COMMERCIAL SERVICES (SEP 2023)

III.3 INSTRUCTIONS TO OFFERORS

III.4 PRE-PROPOSAL CONFERENCE

III.5 SUBMISSION OF QUESTIONS

III.6 PROPOSAL DUE DATE

SECTION IV - EVALUATION FACTORS FOR AWARD

IV.1 EVALUATION PROCESS AND FACTORS

IV.2 SEPARATE CHARGES

IV.3 AWARD WITHOUT DISCUSSIONS

SECTION V - REPRESENTATIONS, CERTIFICATIONS AND OTHER STATEMENTS OF

OFFERORS OR RESPONDENTS

V.1 FAR 52.204-19 INCORPORATION BY REFERENCE OF REPRESENTATIONS AND

CERTIFICATIONS (DEC 2014)

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V.2 FAR 52.212-3 OFFEROR REPRESENTATIONS AND CERTIFICATIONS—

COMMERCIAL PRODUCTS AND COMMERCIAL SERVICES (MAY 2024)

V.3 52.204-24 REPRESENTATION REGARDING CERTAIN TELECOMMUNICATIONS

AND VIDEO SURVEILLANCE SERVICES OR EQUIPMENT (NOV 2021)

V.4 FAR 52.209 -11 REPRESENTATION BY CORPORATONS REGARDING AN UNPAID

TAX LIABILITY OR A FELONY CRIMINAL CONVITION UNDER ANY FEDERAL LAW

(FEB 2016)

V.5 52.222-56 CERTIFICATION REGARDING TRAFFICKING IN PERSONS

COMPLIANCE PLAN (OCT 2020)

V.6 52.229-11 TAX ON CERTAIN FOREIGN PROCUREMENTS—NOTICE AND

REPRESENTATION (JUN 2020)

The remainder of this page is left intentionally blank

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SECTION I – THE SCHEDULE

I.1 SUPPLIES OR SERVICES AND PRICES / COSTS

I.1.1 BACKGROUND / SCOPE OF SERVICES

The Government of the United States of America requires Health Insurance for its Locally Employed

Staff (LE Staff) and their dependents at the US Embassy Willemstad, Curacao.

The Contractor shall provide the Health Insurance services to employees of the Government of the

United States of America in Willemstad, Curacao, as described in Section I.2

Description/Specifications/Scope of Work and the Exhibits attached. The groups of employees who shall be provided this insurance are listed in I.2.4 Eligibility.

I.1.2 TYPE OF CONTRACT

This is a fixed price with economic price adjustment requirements type contract under which annual firm, fixed-price task orders will be issued. The contract shall remain unfunded. The fixed prices / premium rates for the health insurance services as specified in Section I.2 are listed in Section I.1.4

Pricing.

I.1.3 MINIMUM

(Reference Section II.9, Clause 52.216-22(b))

During the term of this contract, the Government shall order, as a minimum, services in an amount of at least $5,000.00 or equivalent in local currency.

The Government makes no guarantee as to the number of orders or actual amount of services that will be requested above the guaranteed minimum of $5,000.00 or equivalent in local currency.

The maximum dollar value during the entire life of this contract is $5,500,000.00.

I.1.4 PRICING

The contractor shall complete all work, including furnishing all labor, material, equipment and services, unless otherwise specified herein, required under this contract for the firm fixed unit prices indicated below and within the time specified herein. These individual prices shall include all labor, materials, profit, and, if applicable, value-added tax (VAT).

Any costs not separately priced will be included in the individual prices as overhead or other indirect cost. No additional sums will be payable on account of any escalation in the cost of materials, equipment or labor, or because of the contractor's failure to properly estimate or accurately predict the cost or difficulty of achieving the results required by this contract. Nor will the contract price be adjusted on account of fluctuations in the currency exchange rates.

I.1.4.1 Economic Price Adjustment, Premium Adjustment Based on Experience

Locally Employed Staff Health Insurance U.S. Embassy Willemstad, Curacao

Solicitation No. 19GE5025R0010 Page 8 of 99

For health insurance, prices may be adjusted upward or downward based on the experience rating of the Mission covered by this contract.

No adjustment will be allowed during the first twelve months.

After such time, the contractor or the USG may request an adjustment in premiums on an annual basis to be effective per contract year. Adjustments are not retroactive to previous contract terms. Before any such adjustment is made, the contractor agrees to provide the USG a balance sheet showing three main components for the previous time period:

(1) receipts (premiums received),

(2) number of insurance policies and

(3) claims paid.

This information shall be provided per type of premium, i.e. per line item.

The USG 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 effective for the following option year. Any failure to reach agreement under this clause shall be subject to the procedures in the Disputes clause.

I.1.4.2 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.

I.1.4.3 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.

I.1.2 VAT

The Government will not reimburse the Contractor for VAT under this contract. The Contractor shall not include a line for VAT on Invoices as the U.S. Embassy has a tax exemption certificate with the host government.

I.1.3 CURRENCY

The currency shall be fixed and cannot be changed by modification to the contract.

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The offeror shall insert the prices, and the currency in which the offer is made, below:

Currency: ________________

The fixed prices / premium rates for the health insurance services as specified in Section I.2 are specified below:

ATTACHMENT 001 – PRICES WILL BE INSERTED HERE

Locally Employed Staff Health Insurance U.S. Embassy Willemstad, Curacao

Solicitation No. 19GE5025R0010 Page 10 of 99

ATTACHMENT 001 – PRICES WILL BE INSERTED HERE

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Solicitation No. 19GE5025R0010 Page 11 of 99

I.1.5 ABBREVIATIONS

Acronym Definition

CLIN Contract Line-Item Number

Contractor Insurance Company

CO

Contracting Officer

COR

Contracting Officer Representative

Dependent Dependents include one legal spouse as defined by local law. LE Staff with more than one legal spouse must select only one spouse for coverage.

Dependent 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.

Employer

The United States Government = USG

Employee Locally Employed Staff member of the US Embassy Willemstad, Curacao

Employee plus one Any eligible spouse or child of the Employee

FMO Financial Management Officer

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.

PII

Personally Identifiable Information

QA

Quality Assurance

QC

Quality Control

QCP Quality Control Plan

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Solicitation No. 19GE5025R0010 Page 12 of 99

QTY

Quantity

SOW

Statement of Work

TBD

To be determined

USG

U.S. Government

ORE Official Residence Expense

The remainder of this page is left intentionally blank

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I.2 DESCRIPTION/SPECIFICATIONS/SCOPE OF WORK

The Government of the United States of America requires Health Insurance coverage for its employees and their dependents as described herein.

I.2.1 MANDATORY/REQUIRED BENEFITS

I.2.1.1 Hospitalization (treatment in the hospital for inpatient care):

Services and supplies provided during hospitalization, including services provided by a licensed healthcare provider, bed & board (semi-private accommodations), operating room, recovery room, intensive care, imaging and diagnostic testing, 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.

100% Coverage

See Mental, Nervous and Substance Abuse care (below) for details concerning inpatient psychiatric care.

See Outpatient Services (below) for details concerning professional services.

I.2.1.2 Emergency Services (trips to emergency room):

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

100% Coverage.

I.2.1.3 Ambulance:

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.

80% Minimum Coverage, or the minimum level of coverage required by local labor law, whichever is higher.

I.2.1.4 Outpatient Services:

Services provided by a certified healthcare provider on an ambulatory or outpatient basis (without being admitted to a hospital), including surgeon’s fees and other medical services that may be provided in 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

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-- Minor surgical interventions

-- Chemotherapy and radiation treatments

-- Immunizations recommended by local authorities and/or the World Health Organization

-- Diagnostic tests and diagnostic imaging

80% Minimum Coverage or the minimum level of coverage required by local labor law, whichever is

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.

I.2.1.5 Obstetric and Newborn Care:

Care and services that women receive during pregnancy (prenatal care), throughout labor and delivery, and post-delivery, and outpatient care for newborn babies. Hospitalization during pregnancy and/or delivery will be reimbursed as Hospitalization (treatment in the hospital for inpatient care). All other treatments will be considered Outpatient Services.

Inpatient: 100% Coverage; Outpatient: 80% Minimum Coverage

I.2.1.6 Pediatric Services:

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

Inpatient: 100% Coverage; Outpatient: 80% Minimum Coverage.

I.2.1.7 Prescription Drugs:

Medications prescribed by a certified health care provider that are medically necessary. 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.

Inpatient: 100% Coverage; Outpatient: 80% Minimum Coverage, or the minimum level of coverage required by local labor law, whichever is higher

I.2.1.8 Preventive and Wellness and Chronic Disease Management:

Locally Employed Staff Health Insurance U.S. Embassy Willemstad, Curacao

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Counseling or preventive care designed to prevent or detect medical conditions and care for chronic conditions such as asthma and diabetes. Examples include, but not limited to: physicals, immunization, and cancer screenings.

80% Minimum Coverage, or the minimum level of coverage required by local labor law, whichever is

I.2.1.9 Hearing Aids:

Examinations and Treatment: 80% Minimum Coverage, or the minimum level of coverage required by local labor law, whichever is higher.

Hearing Aid Apparatus: Limited to one apparatus per ear. The maximum coverage is USD 1,500 per covered individual per three-year period. 80% Minimum Coverage, or the minimum level of coverage required by local labor law, whichever is higher; with applicable cap.

I.2.1.10 Optical:

Examinations and Treatment: 80% Minimum Coverage

Prescription lenses and frames or contact lenses: The maximum coverage is USD 300 per covered individual every two years. 80% Minimum Coverage; with applicable cap.

I.2.1.11 Dental:

Examinations and Treatment: Dentist’s fees, x-rays, examinations and treatment, cleanings, fillings, extractions, false teeth, crowns, and bridges. The maximum coverage is 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. The maximum coverage is USD 2,400 lifetime. 80% Minimum Coverage; with contract lifetime cap.

I.2.1.12 Reproductive Health:

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).

80% Minimum Coverage

I.2.1.13 Mental Health and Substance Abuse Care:

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

Locally Employed Staff Health Insurance U.S. Embassy Willemstad, Curacao

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50% Minimum Coverage, or the minimum level of coverage required by local labor law, whichever is

I.2.1.14 Rehabilitative and Habilitative Services and Devices:

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) 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.

50% Minimum Coverage, or the minimum level of coverage required by local labor law, whichever is

I.2.1.15 HIV/AIDS:

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.

100% up to USD 10,000 per contract year per covered individual.

I.2.1.16 Out-of-Country Medical Treatment:

Medical expenses incurred out-of-country will be covered, but coverage will be the same and subject to the same total maximum annual limit as for medical expenses incurred in-country.

I.2.1.17 Out-of-Country Medical Travel:

Transportation for out-of-country medical treatment will be a covered expense for LE Staff and eligible family members. To be considered a covered expense, the attending certified health care provider must certify in advance that the treatment is medically necessary and unavailable locally. 80% of covered individual’s transportation expenses by the least expensive, appropriate means of transportation to the nearest city with adequate medical facilities will be covered. 80% of the transportation expenses of an attendant will also be covered, but only if the covered individual's attending certified health care provider certifies that an attendant for the patient is necessary, (e.g., a parent in the case of a patient who is a minor, or a family member to make medical decisions in the case of a patient who is unwell or unconscious). All coverage for transportation for out-of-country medical treatment is subject to the total maximum annual limit. Transportation to a neighboring country without the attending certified health care provider certifying that the treatment is medically necessary and unavailable locally will not be covered.

I.2.1.18 Catastrophic Coverage:

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Additional coverage equal to ANG 150,000.00 per covered individual per contract year. Catastrophic conditions shall be defined as major medical conditions occurring as a result of a single/illness/accident or closely related set of major illnesses (or conditions relating to a single accident) that exceed the standard maximum coverage limit.

I.2.1.19 Excess Coverage:

Additional coverage equal to ANG 150,000.00 per covered individual per contract year. This excess coverage will be offered as an optional benefit to LE Staff. LE Staff must pay 100% of the premium if they elect Excess Coverage.

I.2.1.20 180 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.

I.2.2 ANNUAL MAXIMUM LIMIT

The maximum annual reimbursement per covered individual per contract year, not including expenses covered under work related injury/illness and HIV/AIDS benefits if selected by post, is ANG 150,000.

I.2.3 EXCLUSION TO COVERAGE

There is no reimbursement 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 reimbursement 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.

I.2.4 ELIGIBILITY

To be eligible to participate in the medical plan, LE Staff must be:

-- Paid under the terms of the Local Compensation Plan (LCP); and –

-- Under a non-temporary direct hire appointment, personal services agreement (PSA), or personal services contract (PSC); or

-- Under a temporary direct hire appointment or PSA Fixed Term of one year or more.

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Not eligible are those working under temporary 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 the Dutch Caribbean who provides services to other local organizations as well as to the U.S. Mission; employees working on an intermittent or When Actually Employed (WAE) schedule; employees of USAID institutional contractors; Peace Corps personal services contractors as indicated in MS 743; and Recreation

Association employees.

I.2.4.1 Definition of Dependents

LE Staff who are eligible to participate in the medical plan automatically confer coverage to eligible family members who meet the following criteria:

Legal spouse: one legal spouse as defined by local law may be covered. LE Staff with more than one legal spouse must select only one spouse for coverage.

In cases where LE Staff and their legal spouse 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.

Dependent 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.

I.2.5 PREMIUM

Premiums will be based on the number of individuals covered:

-- Self-Only: 1 covered individual

-- Self Plus One (two individuals).

-- Family (three or more individuals).

I.2.6 PERIODS OF INELIGIBILITY

Employees and their dependents are not entitled to health benefits during any period of employment for which premiums are not paid.

Additionally, employee's dependents are not entitled to health benefits during any period of employment during which the employee was not eligible to participate.

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During a period of extended Leave Without Pay (LWOP) or unpaid leave beyond one pay period, the

USG is responsible for the full cost of the insurance premiums for self and dependents. Alternatively, the employee may elect to have health coverage cease if they prefer not to be covered for health benefits.

I.2.7 BROCHURE REQUIREMENT

I.2.7.1 The Contractor shall provide a document (brochure/pamphlet/other written document) in

Dutch, Papiamentu, and English 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.

I.2.7.2 The Contractor shall provide the document described in C.2.1 to the COR not later than 10

(ten) days after date of contract award. The Contractor shall provide additional brochures for new employees within ten (10) days of the COR’s request.

I.2.7.3 The Contractor assumes full responsibility for ensuring that the document described in

C.2.1 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.

I.2.7.4 During the contract period, any changes regarding the information in the submitted documents/brochures will be updated and re-submitted as revised documents/brochures (i.e. changes to the list of approved institutes, etc.).

The remainder of this page is left intentionally blank.

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I.3 CONTRACT ADMINISTATIVE REQUIREMENTS AND PROCEDURES

I.3.1 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 USG, is responsible for management and quality control to meet the terms of the contract. The role of the USG is to conduct quality assurance to ensure that contract standards are achieved.

Performance Objective Performance Threshold

Services

Performs all the insurance services set forth in the Performance Work Statement (PWS)

All required services are performed and no more than one (1) customer complaint is received per month

Timely payment of benefits (within 14 calendar days)

No more than one (1) customer complaint is received per month.

No incorrectly denied claims.

No more than one (1) customer complaint is received per month.

• Surveillance – The COR will receive and document all complaints from USG personnel regarding the services provided. If found valid, the COR will send the complaints to the contractor for corrective action.

• Standard – The performance standard is that the USG 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.

• Complaint Procedures

a. If USG personnel observe unacceptable services such as but not limited to lack of coordination during medical evacuation, extended referral periods, delays in receipt of payment, etc., they will 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.

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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, provide e-mail notification informing the contractor of any valid complaints.

f. If the contractor disagrees with the complaint and challenges the validity of the complaint, the contractor shall notify the COR by e-mail. 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 complainant.

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.

I.3.2 DELIVERABLES

All reports and other deliverables required under this contract shall be delivered by email to the COR and mailed to the following address:

U.S. EMBASSY WILLEMSTAD

Attn: HR

(Contact details to be provided in contract document)

NOTE: Any and all costs for the preparation, handling, mailing and submission of progress reports or any other required reports and documentation shall be included in the total price of each delivery order.

Description QTY Submission Date Deliver to and how:

Reference

I.2.7 Brochures

As instructed by COR

10 days after contract award hard copy

Additional copies

Within 10 calendar days of the COR’s request hard copy

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I.3.4 Employee Claims Report 1 monthly COR

I.3.11 Invoice 1 monthly COR /

Designated

Billing

Office

I.3.3 CONTRACTOR RESPONSIBILITY IN CLAIMS AND REIMBURSEMENT TO CLAIMS

General – The contractor shall be responsible for all planning, estimating, programming, project management, scheduling, dispatching, supervision, and inspection of work. The contractor shall maintain his own reference library of technical reference works and local laws and regulations, including current tariffs and registries. The contractor shall treat the information provided by the

Embassy concerning employees' personal data, medical information, and salaries as highly sensitive and not divulge any employee information to unauthorized persons.

The contractor shall establish procedures for handling medical insurance claims as follows:

a. Administrative Records

(1) The contractor shall maintain medical insurance files for each eligible employee including receipts and proof of paid claims, requests for claim reimbursements, and accounting of paid benefits with balances of amounts remaining in the annual per employee per year reimbursement ceiling.

(2) The contractor shall provide the COR with the necessary claim forms for each type of benefit that can be claimed under the contract. These forms shall specify a list of documents required to be appended to each claim and otherwise provide instructions for claim filing.

(3) The contractor shall use the English spelling of the employees' names in all transactions, including reimbursement checks.

(4) The Contractor shall send employee claim reimbursement checks to employees not later than two weeks after a claim is submitted.

b. Medical Insurance Claims – Settlement of medical insurance shall be completed as follows:

(1) All medical claims shall be submitted directly to the Contractor by employees.

(2) The Contractor shall date stamp and screen all claims submitted on the day of receipt. If there are any missing documents or information thereby disallowing said claim to be payable, the Contractor shall notify the employee within two days, with a copy to the COR (if notification is written).

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(3) The Contractor shall settle the claims no later than two weeks from the date the claim is submitted to the Contractor.

(4) Settlement shall be by issuance of checks in the name of the employee for each claim submitted or via EFT. Each payment shall be accompanied by a form providing details of the amount reimbursed with an explanation of deductions, if any.

(5) The Contractor shall accept the employee's or dependent's choice to go for surgery to hospitals designated by the Contractor in order that the Contractor will pay the expenses directly to the hospitals.

I.3.4 REPORT REQUIREMENTS

The Contractor shall provide the following monthly report. The report shall be received by the COR no later than the 10th day of each month. The report shall report on the previous month's activities.

(a) Employee Claims Report. The report shall list all claims paid by the Contractor to a claimant, including the name of the claimant, date claim is received by the Contractor, and the amount claimed. This report shall also include all outstanding claims and a brief description of why claim has not been paid.

I.3.5 MISCELLANEOUS CONTRACTOR REQUIREMENTS

D.5.1 A contract with the U.S. Government conveys no special privileges or immunities to the contractor. The contractor is an independent commercial concern and not a part of the U.S. mission.

The contractor's employees are not U.S. Government employees. Registration of this contract with the local government, if required by law, will be the sole responsibility of the contractor, and any fees, taxes, or other duties shall be payable by the contractor without recourse to the Government of the amounts thereof.

D.5.2 Licenses and Local Laws. The Contractor shall possess all permits, licenses, and any other appointments required for the prosecution of work under this contract, all at no additional cost to the

Government. The Contractor shall perform this contract in accordance with local laws.

I.3.6 ERRONEOUS PAYMENT

If the USG becomes eligible for a refund of payment because of erroneous overpayment or other cause, the contractor shall refund the amounts or use them to offset future payments owed by the USG, whichever the USG prefers. The contractor shall refund any refunds not complete or discovered after the completion date of this contract.

I.3.7 KEY PERSONNEL

The US Government considers the contractors Project Manager as Key Personnel for this contract.

During the entire performance period of this contract, the contractor shall make no substitutions of key personnel unless the substitution is necessitated by illness, death, or termination of employment.

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The contractor shall notify the Contracting Officer Representative within 15 calendar days after the occurrence of any of these events. The proposed substitute shall possess qualifications comparable to the original key person, as well as satisfying any minimum standards set forth elsewhere in the solicitation / contract. The Contracting Officer Representative will notify the contractor within 15 calendar days after receipt of all required information of the decision on the substitution.

I.3.8 PHYSICAL AND INFORMATION SECURITY REQUIREMENTS

The contractor shall be responsible for safeguarding all government information provided for contractor use. All material / documentation produced for the USG will be the sole property of the

USG. The contractor shall not release any documents to anyone unless authorized by the USG. The following considerations shall be followed by the contractor.

• All documents received or generated under the contract are the property of the USG.

• All documents shall be controlled and disseminated on a need-to-know basis. Reproduction and distribution are prohibited without express approval of the USG. All design documents generated shall be annotated as follows:

• All documents shall be marked and handled in strict accordance with all applicable requirements and regulations. Proposed and actual contract documents shall only be disseminated on a strict need-to-know basis and shall not be further disseminated without prior authorization from the USG.

• Those receiving any type of proposed and / or actual contract documents shall be responsible for these materials while in their possession, or that of any of their subcontractors. They shall return all documents, including all copies, promptly upon demand by the USG.

I.3.9 LAWS AND REGULATIONS

• Compliance Required - If the contractor has or will establish a local office, he shall without additional expense to the USG, be responsible for complying with all laws, codes, ordinances, and regulations applicable to the performance of the work, including those of the host country, and with the lawful orders of any governmental authority having jurisdiction.

• Labor, Health and Safety Laws and Customs – If the contractor has or will establish a local office, he shall comply with all local labor laws, regulations, customs and practices pertaining to labor, safety, and similar matters, to the extent that such compliance is not inconsistent with the requirements of this contract.

A contract with the USG conveys no special privileges or immunities to the contractor. The contractor is an independent commercial concern and not a part of the U.S. mission. The contractor's employees are not USG employees. Registration of this contract with the host country government, if required by law, will be the sole responsibility of the contractor, and any fees, taxes, or other duties shall be payable by the contractor without recourse to the USG of the amounts thereof.

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The only items that the USG will consider for price adjustments are those that are mandated e.g., changes in the VAT rate (if applicable) or minimum hourly wage rate.

I.3.10 CONTRACT ADMINISTRATION DATA

Authority of the Contracting Officer – All work shall be performed under the general direction of the Contracting Officer, who alone shall have the power to bind the Government and to exercise the rights, responsibilities, authorities and functions vested by the contract, except that the Contracting

Officer and the Procurement Executive shall have the right to designate authorized representatives to act for the Contracting Officer, as specifically provided in the designation of that individual, such as the COR

Government Personnel

Contracting Officer: Nicolas A. Wilhelm

Contract Administrator: Ielyzaveta Ishchenko

E-mail address: IshchenkoIM@state.gov

Contracting Officer's Representative (COR): named at time of award

I.3.11 INVOICES, REVIEW AND PAYMENT

The Contractor shall submit monthly invoices to the Contracting Officer Representative.

• A proper invoice must include the following information:

• Contractor’s name and bank account information for payments by wire transfers

• Invoice Date

• Contract Number

• A summary showing a listing of each member with total monthly price the currency the contract has been issued in. A detailed invoice for each Agency has to be attached to each summary invoice and should include the cost breakdown by each membership fee line according to the pricing schedule

• Value Added Tax (VAT), if applicable, shall be a separate line item on each invoice.

• Each invoice shall include the items listed in Section II.2, FAR 52.212-4 g.1.

• Payment shall be made in the currency the contractor specified in Section I.1.4 Pricing.

• Advance Payment shall not be authorized under this contract.

• Payment will be made via EFT.

I.3.12 CHANGES IN OWNERSHIP

The contractor shall furnish the COR advance notification (90 calendar days prior to the effective date) of any disposition or the change in ownership or terms of lease of any facilities utilized by him for performance of any service under this contract.

mailto:IshchenkoIM@state.gov

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I.3.13 FUNDING / TASK ORDERS / PROCEDURES

The contract remains unfunded; funding will be provided by issuing annual task orders with possible modification for staffing changes. Each task order will contain the following information:

• Name of contractor

• Contract number

• Date of purchase

• Task order number

• Name of person placing the order

• Quantity, unit price, and total price of each service / insurance premium

• VAT or other taxes as a separate item, if applicable

• COR and post points of contact, including e-mail addresses

• applicable contract clauses, either in reference or in full text if necessary

Only an RPSO Contracting Officer may place a written order.

Ordering Procedures – The Government shall issue annual funded task orders to cover all eligible employees and their dependents. No task order shall include any names or PII (personally identifiable information). The COR informs the contracting officer if any additions or deletions are required throughout the year and the Contracting Officer will issue funded modifications as required.

Therefore, any ORE and EA staff are not included under the task orders issued by the Contracting

Officer. As their coverage is under a rider, their employer is responsible for directly interacting with the Contractor to order any coverage for their employees. When contacted by the employer, the

Contractor shall advise the employer of the paperwork and payment that will be necessary to order coverage for the identified individuals. Because more than one employer may have ORE staff, the

Contractor may be contacted by more than one employer (typically the Chief of Mission and Deputy

Chief of Mission).

I.3.14 CHOICE OF LAW

This contract shall be construed and interpreted in accordance with the substantive laws of the United

States of America. By the execution of this contract, the contractor expressly agrees to waive any rights to invoke the jurisdiction of local national courts where this contract is performed and agrees to accept the exclusive jurisdiction of the United States Civilian Board of Contract Appeals and the

United States Court of Federal Claims for hearing and determination of any and all disputes that may arise under the Disputes clause of this contract.

I.3.15 START / PERIOD OF PERFORMANCE

Contract performance is estimated to start May / June 2025.

The period of performance is one year, with four possible annual option years. Option years, if exercised, shall be for twelve (12) months each, commencing at the expiration of the previous period of performance.

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The Government may extend this contract in accordance with the option clause in Section II.12, FAR

52.217-9, Option to Extend the Term of the Contract - Deviation, which also specifies the total duration of this contract.

The Government may exercise the option set forth at Section II.11, FAR 52.217-8, Option to Extend

Services", within the currently ongoing period of performance.

Notwithstanding the…