RFP No.19GE5025R0041.pdf

CGFS // CGFS Document Number: 19GE5025R0041

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL PRODUCTS AND COMMERCIAL SERVICES

NOTE: OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24 & 30 1. REQUISITION NUMBER PAGE 1 OF 78

5. SOLICITATION NUMBER

19GE5025R0041

2. CONTRACT NUMBER

19GE5025R0041

3. AWARD/EFFECTIVE DATE

04/25/2025

4. ORDER NUMBER

19GE5025R0041

6. SOLICITATION ISSUE

DATE

04/25/2025

7. FOR SOLICITATION

INFORMATION CALL:

a. NAME Alexandra Perez Acevedo

b. TELEPHONE NUMBER (No collect calls) 8. OFFER DUE DATE / LOCAL

TIME

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

(SDVOSB)

WOMEN-OWNED SMALL

BUSINESS (WOSB)

ECONOMICALLY DISADVANTAGED WOMEN-

OWNED SMALL BUSINESS (EDWOSB)

8(A)

NORTH AMERICAN INDUSTRY

CLASSIFICATION STANDARD

(NAICS):

SIZE STANDARD:

10. THE ACQUISITION IS

SEE

SCHEDULE

11. DELIVERY FOR FREE ON BOARD

(FOB) DESTINATION UNLESS BLOCK IS

MARKED

0 Days: 0.00 %

0 Days: 0.00 % 0 Days: 0.00 % 0 Days: 0.00 %

12. DISCOUNT TERMS

13a. THIS CONTRACT IS

RATED ORDER UNDER THE

DEFENSE PRIORITIES AND

ALLOCATIONS SYSTEM -

DPAS (15 CFR 700)

13b. RATING

REQUEST

FOR

QUOTE

(RFQ)

INVITATION

FOR BID

(IFB)

X REQUEST

FOR

PROPOSAL

(RFP)

14. METHOD OF SOLICITATION

CODE15. DELIVER TO 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

ANKAR19310CODE18a. PAYMENT WILL BE MADE BY

AMERICAN EMBASSY ANKARA

110 ATATURK BLVD

ATTN: FMC

ANKARA, TURKEY 06100

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 NUMBER 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 Information

25. ACCOUNTING AND APPROPRIATION DATA 26. TOTAL AWARD AMOUNT (For Government 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: REFERENCE _____________________________

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) Daniel J Jackson

31c. DATE SIGNED 04/25/2025

AUTHORIZED FOR LOCAL REPRODUCTION

PREVIOUS EDITION IS NOT USABLE

STANDARD FORM 1449 (REV. 11/2021)

Prescribed by GSA - FAR (48 CFR) 53.212

CGFS // CGFS

CGFS // CGFS

Document Number: 19GE5025R0041

Section A - Solicitation/Contract Form

Line Item Summary

Solicitation Number:

19GE5025R0041

Contract Number: Title:

Health Insurance LES U.S. Consulate Ankara Turkey

Date of Solicitation:

04/25/2025

Number Supplies or Services Qty Unit Unit Price Total (Inc. disc., tax, and fees)

PSC: G007

PSC Description: SOCIAL- GOVERNMENT HEALTH

INSURANCE PROGRAMS

Type of Contract Pricing: Other

0.0 EA $0.00 $0.00

Period of Performance: 08/31/2025 - 08/30/2026

Description: BASE YEAR LES Health Insurance inclusive if Sub CLINs 0001A, 0001B, 0001C

Number Supplies or Services Qty Unit Unit Price Total (Inc. disc., tax, and fees)

PSC: G007

PSC Description: SOCIAL- GOVERNMENT HEALTH

INSURANCE PROGRAMS

Type of Contract Pricing: Other

0.0 EA $0.00 $0.00

Period of Performance: 08/31/2026 - 08/30/2027

Description: OPTION YEAR 1 LES Health Insurance inclusive if Sub CLINs 1001A, 1001B, 1001C

Number Supplies or Services Qty Unit Unit Price Total (Inc. disc., tax, and fees)

PSC: G007

PSC Description: SOCIAL- GOVERNMENT HEALTH

INSURANCE PROGRAMS

Type of Contract Pricing: Other

0.0 EA $0.00 $0.00

Period of Performance: 08/31/2027 - 08/30/2028

Description: OPTION YEAR 2 LES Health Insurance inclusive if Sub CLINs 2001A, 2001B, 2001C

Number Supplies or Services Qty Unit Unit Price Total (Inc. disc., tax, and fees)

PSC: G007

PSC Description: SOCIAL- GOVERNMENT HEALTH

INSURANCE PROGRAMS

Type of Contract Pricing: Other

0.0 EA $0.00 $0.00

Period of Performance: 08/31/2028 - 08/30/2029

Description: OPTION YEAR 3 LES Health Insurance inclusive if Sub CLINs 3001A, 3001B, 3001C

Number Supplies or Services Qty Unit Unit Price Total (Inc. disc., tax, and fees)

PSC: G007

PSC Description: SOCIAL- GOVERNMENT HEALTH

INSURANCE PROGRAMS

Type of Contract Pricing: Other

0.0 EA $0.00 $0.00

Period of Performance: 08/31/2029 - 08/30/2030

Description: OPTION YEAR 4 LES Health Insurance inclusive if Sub CLINs 4001A, 4001B, 4001C

CGFS // CGFS Document Number: 19GE5025R0041

CLIN Funding: Cost:

Base Totals: $0.00 $0.00

Exercised Options Totals: $0.00 $0.00

Unexercised Options Totals: $0.00 $0.00

Base and Options Totals: $0.00 $0.00

The remainder of this page is left intentionally blank

19GE5025R0041 U.S. Embassy Ankara, Turkey Health Insurance for LES Page 4 of 120

Contents

SECTION I – THE SCHEDULE

A. BACKGROUND / SCOPE OF SERVICES

1. GENERAL SCOPE OF SERVICES

2. TYPE OF CONTRACT

3. MINIMUM & MAXIMUM

B. PRICING

1. GENERAL

2. ECONOMIC PRICE ADJUSTMENT, PREMIUM

ADJUSTMENT BASED ON EXPERIENCE

3. PREMIUM ADJUSTMENT BASED ON LAWS

4. VAT – VALUE ADDED TAX

5. THE CURRENCY OF THIS CONTRACT IS TURKISH LIRA

7. PRICING TABLE

C. SPECIFICATIONS / STATEMENT OF WORK

C.1 HEALTH INSURANCE SERVICES

C.1.1 EMPLOYEE AND DEPENDENT HEALTH SERVICES

BENEFIT - MANDATORY BENEFITS:

C.2 OVERALL ANNUAL MAXIMUM LIMIT:

C.3 HEALTH BENEFITS EXCLUSIONS AND LIMITATIONS

C.4 ELIGIBLE PARTICIPANTS

C.5 DEPENDENTS:

C.6 INDIVIDUALS NOT ELIGIBLE FOR COVERAGE

C.7 ELIGIBILITY

C.8 BROCHURE REQUIREMENT

C.9 ACCRONYMS AND ABBREVIATIONS

D. CONTRACT ADMINISTATIVE REQUIREMENTS AND

PROCEDURES

D.1 Quality assurance and surveillance plan (QASP)

D.2 Deliverables and Reports Requirements

D.3 Contractor responsibility in claims and reimbursement to claims

D.4 Key Personal

D.5 Miscellaneous Contractor Requirements

D.6 Physical and Information Security Requirements

D.7 Changes in Ownership

E. FUNDING / TASK ORDERS / PROCEDURES

F. LAWS AND REGULATIONS

G. CONTRACT ADMINISTRATION DATA

H. INVOICES, REVIEW AND PAYMENT

H.1 INVOICES SUBMISSION

H..2 VALUE ADDED TAX (VAT)

H.3 ADVANCE PAYMENT SHALL NOT BE AUTHORIZED

UNDER THIS CONTRACT

H.4 ERRONEOUS PAYMENT

I. LIST OF ATTACHMENTS

Health Insurance for LES Page 5 of 120

SECTION II – CONTRACT CLAUSES

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

FAR 52.212-4 CONTRACT TERMS AND CONDITIONS-COMMERCIAL

ITEMS (NOV 2023)

FAR 52.212-5 CONTRACT TERMS AND CONDITIONS REQUIRED TO

IMPLEMENT STATUTES OR EXECUTIVE ORDERS-

COMMERCIAL PRODUCTS AND COMMERCIAL SERVICES

(JAN 2025) (DEVIATION FEB 2025)

FAR 52.204-25 PROHIBITION ON CONTRACTING FOR CERTAIN

TELECOMMUNICATIONS AND VIDEO SURVEILLANCE

SERVICES OR EQUIPMENT (NOV 2021)

FAR 52.216-18 - ORDERING (AUG 2020)

FAR 52.216-19 - ORDER LIMITATIONS (OCT 1995)

FAR 52.216-21 - REQUIREMENTS (OCT 1995)

FAR 52.216-22 - INDEFINITE QUANTITY (OCT 1995)

FAR 52.217-5 -EVALUATION OF OPTIONS (JULY 1990)

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

FAR 52.217-9 - OPTION TO EXTEND THE TERM OF THE CONTRACT

(MAR 2000)

FAR 52.229-12 - TAX ON CERTAIN FOREIGN PROCUREMENTS (FEB

2021)

DOSAR 652.232-70 PAYMENT SCHEDULE AND INVOICE SUBMISSION

(FIXED-PRICE) (AUG 1999)

DOSAR 652.242-70 – CONTRACTING OFFICER'S REPRESENTATIVE

(COR) AUG 1999)

DOSAR 652.242-73 – AUTHORIZATION AND PERFORMANCE (AUG 1999)

DOSAR 652.243-70 – NOTICES (AUG 1999)

SECTION III– SOLICITATION PROVISIONS

III.1 52.212-1 OFFEROR REPRESENTATIONS AND CERTIFICATIONS-

COMMERCIAL PRODUCTS AND COMMERCIAL SERVICES (SEP

2023) (DEVIATION FEB 2025)

III.2 INSTRUCTIONS TO OFFERORS

III.2.1 QUALIFICATIONS OF OFFERORS

III.2.2 JOINT VENTURE AGREEMENTS:

III.3 PRE-PROPOSAL CONFERENCE

III.4 SUBMISSION OF QUESTIONS

III.5 PROPOSAL DUE DATE

III.6 FAR 52.216-1 – TYPE OF CONTRACT (APR 1984)

III.7 DOSAR 652.206-70 – ADVOCATE FOR COMPETITION /

OMBUDSMAN (FEB 2015)

III.8 FAR 52.252-1 – SOLICITATION PROVISIONS INCORPORATED BY

REFERENCE (FEB 1998)

SECTION IV – EVALUATION FACTORS

Health Insurance for LES Page 6 of 120

IV.1 EVALUATION PROCESS AND FACTORS

IV.2 FAR 52.217-5 – EVALUATION OF OPTIONS (JUL 1990)

IV.3 FAR 52.225-17 – EVALUATION OF FOREIGN CURRENCY OFFERS

(FEB 2000)

SECTION V – REPRESENTATIONS AND CERTIFICATIONS

V.1 E.O. 14173 CERTIFICATION

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

COMMERCIAL PRODUCTS AND COMMERCIAL SERVICES (MAY

2024) (DEVIATION FEB 2025)

V.3 FAR 52.204-19 - INCORPORATION BY REFERENCE OF

REPRESENTATIONS AND CERTIFICATIONS (DEC 2014)

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 FAR 52.222-56 – CERTIFICATION REGARDING TRAFFICKING IN

PERSONS COMPLIANCE PLAN (OCT 2020)

V.6 FAR 52.204-24 REPRESENTATION REGARDING CERTAIN

TELECOMMUNICATIONS AND VIDEO SURVEILLANCE

SERVICES OR EQUIPMENT (NOV 2021)

V.7 FAR 52.229-11 TAX ON CERTAIN FOREIGN PROCUREMENTS—

NOTICE AND REPRESENTATION (JUN 2020)

V.8 DOSAR 652.225-70 – ARAB LEAGUE BOYCOTT OF ISRAEL (AUG

1999)

V.9 CERTIFICATION ON CONTRACTOR EMPLOYEES

Health Insurance for LES Page 7 of 120

SECTION I – THE SCHEDULE

CONTINUATION TO SF-1449

PRICES – BLOCK 23

A. BACKGROUND / SCOPE OF SERVICES

1. GENERAL SCOPE OF SERVICES

The Government of the United States of America (USG) requires Health Insurance for its

Locally Employed Staff (LES) and their dependents at US Mission Turkey. The

Contractor shall provide the Health Insurance services, as described in Section I.C.

Specifications / Statement of Work. The groups of employees who shall be provided this insurance are listed in Section I.C.4 Eligible Participants and section I.C.5

Dependents.

2. TYPE OF CONTRACT

2.1 This is a firm fixed-price Indefinite Delivery, Indefinite Quantity (IDIQ) type contract with economic price adjustment requirements type contract under which annual firm, fixed-price task orders will be issued. The required minimum purchase shall be obligated on a task order at the time the contract is executed. The fixed prices / premium rates for the health insurance services as specified in Section I.C. Specifications / Statement of

Work are listed in Section I.B. Prices.

2.2 The contract will be for a one base year period starting from August 31, 2025, and four

(4) one-year options periods, which may be exercised by modification to the contract.

Including option years in the contract does not obligate the Government to exercise one or all option years

2.3 Payments will be made only to the extent specifically authorized in the task order.

3. MINIMUM & MAXIMUM

3.1 As per FAR 52.216-22, "INDEFINITE QUANTITY," the minimum and maximum amounts for this indefinite quantity contract shall be any quantity or combination of supplies and services equal to the amount (s) set forth below. The US Government (USG) makes no guarantee as to the number of orders or actual amount of services that may be requested above the guaranteed minimum value for the life of the contract

Health Insurance for LES Page 8 of 120

3.2 The minimum guaranteed order amount: The Government shall order, as a minimum, services in an amount of 100 enrollees during the term of this contract. 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 100 enrollees.

3.3 The maximum ordered amount during the entire life of this contract is 6,000 enrollees.

3.4 The required minimum purchase shall be obligated on a task order at the time the contract is executed.

B. PRICING

1. GENERAL

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 considered to 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.

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

2. ECONOMIC PRICE ADJUSTMENT, PREMIUM ADJUSTMENT BASED ON

EXPERIENCE

2.1. 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.

No adjustment will be allowed during the base year.

2.2 The Contractor or the Government may request an adjustment 60 days prior to the end of the base year or current option year, to take effect at the start of the following option year. Adjustments are not retroactive to previous periods of performance, and

Contractors may not seek to recover costs incurred during a prior period of performance

Health Insurance for LES Page 9 of 120 through an Economic Price Adjustment. Economic Price Adjustments only apply as an adjustment to the rates to be charged by the Contractor for the services identified as in the contract, and cannot be recovered as a lump sum adjustment paid to the Contractor.

2.3 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, i.e. per line item for the preceding 12 months. 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.

2.4 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.

2.5 The U.S. 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 the 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.

3. 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(s). The contractor agrees to provide all documentation necessary to support any requested adjustment.

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.

Health Insurance for LES Page 10 of 120

Before any adjustment is made under this price adjustment clause, the contractor must include in its proposal for adjustment details setting forth how the pool impacts the request for equitable adjustment.

4. VAT – VALUE ADDED TAX

Value Added Tax is not applicable, as Embassy Ankara holds a VAT exemption certificate.

5. THE CURRENCY OF THIS CONTRACT IS TURKISH LIRA.

The fixed prices / premium rates for the health insurance services as specified in Section

IV are as follows:

Note: The coverage/maximum limits provided in US Dollars will be recalculated based on the exchange rate at the time of award and at the beginning of each exercised option year.

6. Excise Tax: 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% pursuant to 26 U.S.C. 5000C. The Contractor shall complete attached form W-14 in order to apply for an exemption of the Excise Tax, if applicable.

7. PRICING TABLE

A. Contract Pricing

B. Rider and Optional Benefits

(to be inserted at the time of award by the contracting Office)

Health Insurance for LES Page 11 of 120

C. SPECIFICATIONS / STATEMENT OF WORK

C.1 HEALTH INSURANCE SERVICES

The Government of the United States of America (USG) requires Health Insurance coverage for its employees as further described in in this section.

Retired employees are 100% responsible for the premium costs for themselves and their dependents. (See C.4.3 Participants and Benefits Covered Under a Rider)

The premium costs for any optional benefits, if elected, are 100% the responsibility of the employee or retiree. (See C.4.3 Participants and Benefits Covered Under a Rider)

Medical insurance 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)

During a period of extended Leave Without Pay (LWOP) or unpaid leave beyond one pay period, the employee is responsible for the full cost of the insurance premiums for self and dependents. 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 they prefer not to pay the premium

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

Pre-existing condition refers to any disease or health condition arising from injury, illness, congenital or genetic factors, disease caused by sexual transmission, and/or autoimmune conditions. Coverage of pre-existing conditions shall be extended to all covered employees.

C.1.1 EMPLOYEE AND DEPENDENT HEALTH SERVICES BENEFIT -

MANDATORY BENEFITS:

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

Reimbursement Rate for Inpatient and/or Emergency: 100% Coverage

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

Health Insurance for LES Page 12 of 120 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 (below) 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):

Reimbursement Rate - 100% Coverage

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

100% Coverage

C.1.1.3 Ambulance:

Reimbursement Rate – 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 Annual physical examinations

Reimbursement Rate - 100% Coverage

C.1.1.5 Outpatient Services:

Reimbursement Rate - 80% minimum coverage

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:

- 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

Health Insurance for LES Page 13 of 120

• 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.1.1.6 Obstetric and Newborn Care:

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

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 covered as Hospitalization (treatment in the hospital for inpatient care). All other treatments will be considered Outpatient Services.

C.1.1.7 Pediatric Services:

Reimbursement Rate for Inpatient: 100% Coverage; Outpatient: 80% Minimum Coverage

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.

C.1.1.8 Prescription Drugs:

Reimbursement Rate for Inpatient: 100% Coverage; Outpatient: 80% Minimum Coverage

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.

C.1.1.9 Preventive and Wellness Services and Chronic Disease Management:

Reimbursement Rate: 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 not limited to: physicals, immunization, and cancer screenings.

C.1.1.10 Hearing Aids:

Examinations and Treatment: 80% Minimum Coverage

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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; with applicable cap

C.1.1.11 Optical Care:

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

C.1.1.12 Dental Care:

Reimbursement Rate – 80% Minimum Coverage

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 limit. 80% Minimum

Coverage; with contract lifetime cap

[Note: C.1.1.10, C.1.1.11, C.1.1.12, C.1.1.16, C.1.1.20, C.1.1.21 will be converted to local currency using the DOS exchange rate for the date of contract Solicitation posting:

The Rate of exchange on April 24, 2025, was 1US Dollar – 38.314TRY]

The coverage/maximum limits will be recalculated based on the exchange rate at time of award and the beginning of each option year

C.1.1.13 Reproductive Health:

Reimbursement Rate: 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.1.1.14 Mental Health and Substance Abuse Care:

Reimbursement Rate: 50% Minimum Coverage

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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 carried out at a facility licensed for detoxification and rehabilitation.

C.1.1.15 Rehabilitative and Habilitative Services and Devices:

Reimbursement Rate: 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) 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.1.1.16 HIV/AIDS:

Reimbursement Rate: 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.1.1.17 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.

C.1.1.18 Pre-existing condition

Pre-existing condition refers to any disease or health condition arising from injury, illness, congenital or genetic factors, disease caused by sexual transmission, and/or autoimmune conditions. Coverage of pre-existing conditions will be extended to all covered employees

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

Health Insurance for LES Page 16 of 120 days. This benefit is subject to availability of funds at post and no extensions are permitted.

Premiums will be pay by the USG.

C.1.1.20 Catastrophic Coverage:

Additional coverage equal to the amount of Annual Maximum Limit, $30,000 [converted amount in local currency will be inserted at the time of award and each exercised option year] 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.

OPTIONAL BENEFITS WITH SEPARATE ANNUAL MAXIMUM LIMITS:

Employees have the option of electing the benefits outlined under C.1.1.21 at the beginning of the contract and may then subsequently opt in/out at the time of each extension.

C.1.1.21 Excess Coverage:

NOTE: Employee is responsible for paying 100% of premium for Excess Coverage

Additional coverage equal to the amount of Annual Maximum Limit, $30,000 [post to insert the converted amount in local currency] 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

[This shall be priced separately in the pricing sheet tab B. Rider and Optional services]

C.2 OVERALL ANNUAL MAXIMUM LIMIT:

The maximum annual coverage per covered individual per contract year, not including expenses covered under HIV/AIDS benefits if selected by post, is USD 30,000.

Basic Rates are denominated in USD and paid in Turkish Lira. The overall maximum annual reimbursement limit will be converted to TL and the rate of exchange will be used from the

Department of State (DOS) exchange rate for the date of solicitation posting.

[Note: C.2, Overall Annual Maximum Limit Will be converted to local currency using the DOS exchange rate for the date of solicitation posting. The Rate of exchange on April 24, 2025, was

1US Dollar – 38.314TRY]

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The coverage/maximum limits will be recalculated based on the exchange rate at time of award and the beginning of each option year

C.3 HEALTH BENEFITS EXCLUSIONS AND LIMITATIONS

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.

C.4 ELIGIBLE PARTICIPANTS

C.4.1 Eligible Employees

To be eligible to participate in the medical plan, LE Staff (both full time and part time) must be:

C.4.1.1 paid under the Local Compensation Plan (LCP); and -

C.4.1.1.1 Under a non-temporary direct hire appointment, personal services agreement (PSA), or personal services contract (PSC); or

C.4.1.1.2 Under a temporary direct hire appointment or PSA Fixed Term of one year or more.

C.4.2 Location of Employment

The individuals covered by section I C.1 and C.4.1 must be employed within the geographic boundaries of Turkey by: Department of State and U.S. Government agencies STATE, DHS

(USCIS, CBP, HSI, TSA), DOD (DAO, ODC, OSI), DOJ (DEA, LEGATT), FCS (FCS-BIS),

USDA, USAID and any other USG agency operating within the boundaries of Turkey.

C.4.3 Retiree Coverage:

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Retiree coverage be extended to currently enrolled retirees under the existing contract, as well as to any employees hired before the implementation of the GMC who may retire after its effective date, are grandfathered to continue coverage, for themselves and dependents, under a rider to the contract. The retiree, not the USG, is responsible for 100% of the premium costs associated with the plan. The retiree and insurance provider are responsible for the administration of the plan. All new hires starting after GMC’s effective date would follow GMC’s terms and conditions.

C.4.4 Official Residence Expense (ORE) and Employee Association (EA) employees:

Official Residence Expense (ORE) and Employee Association (EA) employees may be covered under a rider to the contract. The employing officer/EA, not the U.S. Government, is responsible for the employer's share of the premium costs for an ORE/EA employee.

C.4.5 Participants and Benefits Covered Under a Rider

C.4.5.1 The U.S. Government requires that an enrollee has the right to extend their enrollment during the open season for each option year; and under any circumstances, the contractor will not conduct any risk assessment and will cover pre-existing conditions

C.5 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.

C.6 INDIVIDUALS NOT ELIGIBLE FOR COVERAGE

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C.6.1 Individuals 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

Türkiye 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.

C.7 ELIGIBILITY

C.7.1 Term of Eligibility and Effective Date

C.7.1.1 Each current active eligible employee is enrolled for health benefits under this contract upon award and thereafter during the performance period of this contract. Each new eligible employee will have the option to enroll upon entering on duty with the United States

Government.

C.7.1.2 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. Children will be covered under either of the parents’ coverage.

C.7.1.3 Retiree coverage be extended to currently enrolled retirees under the existing contract, as well as to any employees hired before the implementation of the GMC who may retire after its effective date, are grandfathered to continue coverage, for themselves and dependents, under a rider to the contract. The retiree, not the USG, is responsible for 100% of the premium costs associated with the plan. The retiree and insurance provider are responsible for the administration of the plan. All new hires starting after GMC’s effective date would follow

GMC’s terms and conditions.

C.7.1.4 During a period of Leave Without Pay (LWOP) or unpaid leave that is one pay period or less, coverage under the insurance contract will continue. The employee will pay the total cost of the coverage for the duration of LWOP exceeding one pay period. The USG will pay the total premium cost to the Contractor.

C.7.1.5: In the event of death of an insured employee, he/she shall be removed from the insurance as of the date of 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

Health Insurance for LES Page 20 of 120 days. This optional benefit is subject to availability of funds at post and no extensions are permitted. Premiums will be paid by the USG in its entirety.

C.7.1.6: Open Season will be executed one (1) month prior to the beginning of each option year.

The HR office will make a management announcement that will open for at least 2 weeks and will collect the enrollment and exit requests from the employees.

C.7.2 Period 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.

During a period of extended Leave Without Pay (LWOP) or unpaid leave beyond one pay period, the employee is responsible for the full cost of the insurance premiums for self and dependents. 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 they prefer not to pay the premium.

C.7.3 Withdrawal from Insurance Coverage

C.7.3.1 If the U.S. Mission decides that there is a valid reason to permit an employee to withdraw from the ongoing insurance coverage, he/she will be permitted, and payment of premiums will cease with reference to the date of withdrawal.

C.7.3.2 If the U.S. Mission decides that there is a valid reason to permit an employee to withdraw from the ongoing insurance coverage after the said employee has been paid any claims, the said employee has to reimburse the Contractor for claims previously paid by the Contractor which could have been elective/scheduled in advance for a period of six months prior to withdrawal.

C.7.3.3 At the time of employment termination and/or death, subsequent claims should be disregarded. The insured will be responsible for payment of his/her share of the cost of insurance coverage up to the date of separation from duty.

C.8 BROCHURE REQUIREMENT

C.8.1 The Contractor shall provide a document (brochure/pamphlet/other written document) in

Turkish and English that sets forth a complete listing of the health insurance benefits to be

Health Insurance for LES Page 21 of 120 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.8.2 The Contractor shall provide the document described in C.8.1 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.

C.8.3 The Contractor assumes full responsibility for ensuring that the document described in

C.8.1 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.8.4 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.).

C.9 ACCRONYMS AND ABBREVIATIONS

Acronym Definition

CLIN Contract Line-Item Number

Contractor Insurance Company

CO

Contracting Officer

COR

Contracting Officer Representative

Customary and

Reasonable Treatment

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

Dependent An eligible spouse and/or child of the employee as further defined in C.6.1

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Disability- Total and

Permanent

A physical or mental impairment which precludes the individual from performing ordinary motor or bodily functions and which requires separation from employment.

If the impairment is the result of a previous impairment, it shall be considered a continuation of the prior impairment.

Employer

The United States Government = USG

Employee An individual employed by the US Government, under a direct-hire appointment, personal service contract (PSC), or personal services agreement (PSA), as further defined in

Section C.4. This may also include ORE staff, EAE and

Peace Corps PSCs, if this category of individuals is listed as participating under a rider in C.4.3

Employee plus one Any eligible spouse or child of the Employee

FMO Financial Management Officer

GSO General Services Officer in charge of the General Services

Office at post

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.

LS

Lump Sum

Maximum Benefit The total amount that will be paid to any one covered individual for covered medical expenses

PII

Personally Identifiable Information

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

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Pre-existing condition Refers to any disease or health condition arising from injury, illness, congenital or genetic factors, disease caused by sexual transmission, and/or autoimmune conditions.

QA

Quality Assurance

QC

Quality Control

QCP

Quality Control Plan

QTY

Quantity

SOW

Statement of Work

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

TBD

To be determined

USG

U.S. Government

D. CONTRACT ADMINISTATIVE REQUIREMENTS AND PROCEDURES

D.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

Timely payment of benefits (within

21 calendar days)

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

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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.

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.

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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.

D.2 Deliverables and Reports Requirements

All reports and other deliverables required under this contract shall be delivered by email to the

COR and mailed to the following address:

American Embassy in Ankara

Attn: HR

Cukurambar Mah. 1478 Cad., No:24

Cukurambar, Ankara, Turkey

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

C.8 Brochures

As instructed by COR

Additional copies

10 days after contract award

Within 10 calendar days of the COR’s request

COR

hard copy

D.9 Invoice 1 monthly COR / Designated

Billing Office

D.3 Contractor responsibility in claims and reimbursement to claims

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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

I. 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.

II. 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.

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

IV. The contractor shall provide employee claim reimbursement checks to the COR for disbursement to the employee not later than the Tuesday, which is two weeks after the claim has been submitted.

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

I. All medical claims shall be submitted directly to the Contractor by employees, through a drop box in the COR's office. The claims shall be picked up from the COR every week.

II. 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).

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

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

V. 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.

D.4 Key Personal

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

Project Manager Name: To be inserted by the Contracting Office at the time of award

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.

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.

D.5 Miscellaneous Contractor Requirements

A contract with the U.S. Government conveys no special privileges or immunities to the…