Final Sept 11 2012 ASPE SAQMMA12R0261.pdf

SOLICITATION/CONTRACT/ORDER FOR

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

1. REQUISITION NUMBER

10721PR1287

5. SOLICITATION NUMBER

SAQMMA12R0261

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

DATE

09/11/2012

7. FOR SOLICITATION

INFORMATION CALL

a. NAME

Maureen P. Borek

b. TELEPHONE NUMBER (No collect calls) 703-875-4469

c. EMAIL borekmp@state.gov

8. OFFER DUE DATE / LOCAL

TIME

CODE LMAQM

OFFICE OF ACQUISITION MANAGEMENT (A/LM/AQM)

PO BOX 9115, ROSSLYN STATION

US DEPARTMENT OF STATE

ARLINGTON, VA 22219

9. ISSUED BY

X UNRESTRICTED

SET ASIDE: % FOR

SMALL BUSINESS

HUBZONE SMALL BUSINESS

SERVICE-DISABLED VETERAN

OWNED SMALL BUSINESS

8(A)

NAICS: 524292

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

ECAEXCODE15. DELIVER TO

Cynthia A. Malecki,202-632-6405

OFC OF THE EXECUTIVE DIRECTOR (ECA-IIP/EX)

2200 C Street, NW SA-5, Fourth Floor

WASHINGTON, DC 20547

CODE16. ADMINISTERED BY

FACILITYCODE

Contact Duns Telephone No.

17a. CONTRACTOR/OFFEROR RMGFOCODE18a. PAYMENT WILL BE MADE BY

GLOBAL FIN. SVCS (RM/GFS/ADO/FM) CHARLESTON,

SOUTH CAROLINA

PO BOX 150008; Fax To: 1-866-483-3436

OFFICE OF CLAIMS (RM/GFS/F/C)

CHARLESTON, SC 29415-5008

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)

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

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

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN____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 HEREIN.

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)

Anthony J. McIntosh 31c. DATE SIGNED

AUTHORIZED FOR LOCAL REPRODUCTION

PREVIOUS EDITION IS NOT USABLE

STANDARD FORM 1449 (REV. 10/2010)

Prescribed by GSA - FAR (48 CFR) 53.212

SAQMMA12R0261

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. 10/2010) BACK

Table of Contents

Section Description Page Number

B Supplies or Services and Prices/Costs

B-1 BACKGROUND

B-2 Period of Performance

B-3 CONTRACT TYPE

B-4 Cost B-6 Travel Costs

B-7 CLIN STRUCTURE

C Descriptions/Specifications/Statement of Work C-1 General Program Description and Requirements Overview

D Packaging and Marking

D-001 DATA PACKAGING REQUIREMENTS

E Inspection and Acceptance E-004 INSPECTION AND ACCEPTANCE (Services)

F Deliveries or Performance 52.242-15 Stop-Work Order (Aug 1989) 52.242-17 Government Delay of Work (Apr 1984) F-1 Deliverables or Performance F-001 Place of Performance

G Contract Administration Data

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

01INV DEPARTMENT OF STATE INVOICE INSTRUCTIONS

H Special Contract Requirements

652.204-70 DEPARTMENT OF STATE PERSONAL IDENTIFICATION CARD ISSUANCE

PROCEDURES (MAY 2011)

H-016 KEY PERSONNEL

H-020 SAFEGUARDING INFORMATION

H-024 NONPAYMENT FOR UNAUTHORIZED WORK

H-031 SECURITY REQUIREMENTS

H-032 ORGANIZATIONAL CONFLICT OF INTEREST - General

I Contract Clauses 52.202-1 Definitions (Jan 2012) 52.203-3 Gratuities (Apr 1984) 52.203-5 Covenant Against Contingent Fees (Apr 1984) 52.203-7 Anti-Kickback Procedures (Oct 2010) 52.203-8 Cancellation, Rescission, and Recovery of Funds for Illegal or Improper Activity (Jan 1997) 52.203-10 Price Or Fee Adjustment For Illegal Or Improper Activity (Jan 1997) 52.203-12 Limitation On Payments To Influence Certain Federal Transactions (Oct 2010) 52.204-7 Central Contractor Registration (Feb 2012) 52.204-9 Personal Identity Verification of Contractor Personnel (Jan 2011) 52.212-4 Contract Terms and Conditions--Commercial Items (Feb 2012) 52.212-5 Contract Terms and Conditions Required to Implement Statutes or Executive Orders -- Commercial Items (May 2012) 52.216-24 Limitation of Government Liability (Apr 1984) 52.216-25 Contract Definitization (Oct 2010) 52.232-1 Payments (Apr 1984) 52.233-3 Protest after Award (Aug 1996) 52.233-4 Applicable Law for Breach of Contract Claim (Oct 2004)

652.243-70 NOTICES (AUG 1999)

J List of Attachments

J-1 SF-3881

J-2 Disclosure of Lobbying Activities

J-3 DD FORM 254

J-4 Past Performance Questionnaire J-6 Public Voucher for Purchases and Services Other than Personnel Standard Form 1034 J-7 Invoice Summary Report - Example from the FAR and Market Research J-8 Resume Format Template J-9 Acronym List

J-10 Outline of the Transition Plan J-11 Performance Contract Profile J-12 MRPT Processing Procedures

K Representations, Certifications, and Other Statements of Offerors or Respondents 52.204-8 Annual Representations and Certifications (May 2012) 52.209-5 Certification Regarding Responsibility Matters (Apr 2010) 52.209-7 Information Regarding Responsibility Matters (FEB 2012) 52.225-25 Prohibition on Contracting With Entities Engaging in Sanctioned Activities Relating to Iran - Representation and Certification (Nov 2011)

652.225-70 ARAB LEAGUE BOYCOTT OF ISRAEL (AUG 1999)

L Instructions, Conditions, and Notices to Offerors and Respondents 52.252-1 Solicitation Provisions Incorporated by Reference (Feb 1998) 52.214-15 Period for Acceptance of Bids (Apr 1984) 52.215-1 Instructions to Offerors--Competitive Acquisition (Jan 2004) 52.233-2 Service of Protest (Sept 2006)

652.206-70 COMPETITION ADVOCATE/OMBUDSMAN (AUG 99)(DEVIATION)

L-6 Exceptions and/or Deviations L-7 Reserved L-10 Proposal Submission L-11 Points of Contact L-13 Period of Acceptance of Offers L-14 Security Requirements L-15 Multiple Proposals/Alternative Solutions L-16 Government Holidays L-17 Government Shutdown Provision L-18 Government Furnished Information L-19 Government Furnished Equipment L-21 Communication Concerning Solicitation L-22 Questions Regarding Solicitation (May 1995) L-24 Pre-proposal Conference L-25 Post-Award Conference L-26 Past Performance Questionnaire L-27 Delivery of Proposal L-28 Authorized Official and Submission of Proposal L-29 Modifications to the Proposal L-30 Pre-Award Audit Requirements L-31 Proposal Preparation Costs L-32 Information to Offerors L-33 Disposition of Proposals L-34 Contractor Performance Information L-35 General Proposal Instructions L-36 Electronic Media General Information L-37 Electronic Media Version Requirements L-38 Detailed Proposal Instructions

M Evaluation Factors for Award M-1 General M-2 Basis for Award M-3 Evaluation Factors and Methodology M-4 Eligibility for Award M-5 Source Selection Process M-6 Solicitation Amendments M-7 Evaluation Support M-8 Non-Price Factor Ratings M-9 Technical Evaluation M-9.1 Technical Approach and Competencies Factor M-9.2 Management Approach M-9.3 Past Performance Factor M-9.4 Key and Support Personnel Factor M-9.5 Price Factor

001 Services 0.00 HR Doc Ref No:

Delivery Date (Start to End) Date FOB:

10/30/2012 to 10/29/2013 Destination

002 Travel 0.00 HR Doc Ref No:

Delivery Date (Start to End) Date FOB:

10/30/2012 to 10/29/2013

1001 Services 0.00 HR Doc Ref No:

Delivery Date (Start to End) Date FOB:

10/30/2013 to 10/29/2014 Destination

OPTION PERIOD

1002 Travel 0.00 HR Doc Ref No:

Delivery Date (Start to End) Date FOB:

10/30/2013 to 10/29/2014 Destination

OPTION PERIOD

3001 Services 0.00 HR Doc Ref No:

Delivery Date (Start to End) Date FOB:

10/30/2015 to 10/29/2016 Destination

OPTION PERIOD

3002 Travel 0.00 HR Doc Ref No:

Delivery Date (Start to End) Date FOB:

10/30/2015 to 10/29/2016

OPTION PERIOD

4001 Services 0.00 HR Doc Ref No:

Delivery Date (Start to End) Date FOB:

10/30/2016 to 10/29/2017 Destination

OPTION PERIOD

4002 Travel 0.00 HR Doc Ref No:

Delivery Date (Start to End) Date FOB:

10/30/2016 to 10/29/2017

OPTION PERIOD

B-1 BACKGROUND

The Department of State (STATE) is the cabinet agency responsible for formulating and carrying out the nation’s foreign policy. The Department operates in Washington, DC and in nearly 200 countries with over 285 locations worldwide. One of State’s major areas is Public Diplomacy, and the Department’s Bureau of Educational and Cultural Affairs (ECA or the Bureau) is responsible for fostering mutual understanding between the people of the United States and other countries to promote friendly, peaceful relations, as mandated by the Mutual Educational and Cultural Exchange Act of 1961 (Pub. L.

87-256), also known as the Fulbright-Hays Act.

ECA accomplishes its mission through a variety of international public diplomacy programs based on the benefits of mutual understanding, international educational and cultural exchange, and leadership development. ECA programs engage participants from a range of backgrounds and specialties. ECA engages youth, students, educators, artists, athletes, and rising leaders in many fields in the US and more than 160 countries through academic, cultural, sports, and professional exchanges. Striving to reflect the diversity of the US and the global

SAQMMA12R0261

Line Item Summary

Solicitation Number:

SAQMMA12R0261

Contract Number: Title: ASPE Health Benefits Program

Date of Solicitation:

09/11/2012

Line Item No. Description Quantity Unit Unit Price Total Cost society, ECA encourages the involvement of American and international participants from traditionally underrepresented groups, including women, racial and ethnic minorities, and people with disabilities. Detailed information about these programs may be found at the official ECA website: http://exchanges.state.gov. ECA’s exchange participants range in age from 15 to 80, and program lengths vary from approximately 5 weeks to approximately 5 years.

To aid ECA in carrying out its exchange mission, the Bureau gives grants to over 300 programming agents, who arrange and manage its programs. These agents include, but are not limited to:

cooperating agencies in the field of international exchange; Bi-national Fulbright Commissions/Foundations abroad; grant-receiving organizations in the public and private sectors; and academic institutions in the United States and abroad.

To support its varied exchange programs, ECA provides The Accident and Sickness Program for Exchanges (ASPE). ASPE is a self-funded health benefits policy designed to cover eligible exchange participants in the event they get sick or injured while on an ECA-sponsored exchange grant, in the United States and/or outside the United States. ASPE follows the J1 Visa Regulations, in particular 22 CFR 62.14 for health coverage of exchange participants. Spouses and/or dependents of ECA’s sponsored exchange participants are not eligible for coverage under the ASPE. State has statutory authority to self-insure under the Smith-Mundt Act, Section 804 (9). (22 USC 1474).

B-2 Period of Performance

The period of performance for the contract is one (1) year with four (4) one year option periods.

Base Year: 10/30/2012 – 10/29/ 2013

Options Periods

Option Year/Period One: 10/30/2013 – 10/29/ 2014

Option Year/Period Two: 10/30/2014 – 10/29/ 2015

Option Year/Period Three: 10/30/ 2015 – 10/29/2016

Option Year/Period Four: 10/30/ 2016 – 10/29/2017

NOTE: The actual award dates will be defined at time award. Option periods must be “exercised” (awarded) by the Department prior to the completion of the latest (current) period of performance. Initial award and all option period awards are dependent upon availability of funds.

B-3 CONTRACT TYPE

CONTRACT TYPE (FAR 16.601) Fixed Firm Price (FFP) for (1) base year and for (4) option years.

The Bureau is seeking to award a firm fixed price contract to a qualified Contractor to administer the Agency’s self-insured Accident and Sickness Program for Exchanges (ASPE). ECAs’ primary objective is to contract with an experienced Third Party Administrator (TPA) that shall provide quality health services.

B-4 Cost

The cost of this procurement will be acquiring the services called for in the Statement of Work at a fair and reasonable price. A solicitation for quotations will be posted on FBO and set aside for (SDVOSB) Service Disabled Veteran-Owned Small Business and an award will be made based on best value.

Table below is an estimate of the total cost for a new contract.

Firm Fixed Price (FFP) Contract

Period of Performance (PoP)

Financial Information Other

ASPE Estimates 2012 -

Contract Time-Line (Estimate) Labor Costs Travel Costs

Base year 10/30/2012 - 10/29/2013

*Option yr 1 10/30/2013 - 10/29/2014

*Option yr 2 10/30/2014- 10/29/2015

*Option yr 3 10/30/2015 - 10/29/2016

*Option yr 4 10/30/2016 - 10/29/2017

Sub-Total

Total for 5 Years

Proposed price will be evaluated to determine if the price is realistic for the work to be performed, reflects a clear understanding of the requirements, and is consistent with the unique methods of performance. The proposed price will be evaluated to determine if it is unreasonable in relation to the proposed technical and management approaches and in comparison with the Independent Government Cost Estimate (IGCE).

The Contractor shall provide a cost proposal to provide support for the ASPE program. The tasking for the requirements identified in Section of this Request for Proposals (RFP). The offeror to whom the award is made must be registered in the Central Contractor Registration-FAR 52.204-7 and have completed the annual representations and certifications electronically via Online Representations and Certifications Application (ORCA) website at http://orca.bpn.gov. After reviewing the ORCA database information, the offeror verifies by submission of the offer that the representations and certifications currently posted electronically have been entered or updated within the last 12 months, are current, accurate, complete, and applicable to this solicitation.

B-6 Travel Costs

B.6 TRAVEL COSTS

Travel under this contract is generally defined as Contractor air and ground transportation, Contractor lodging, and Contractor meals and incidentals.

Except as otherwise provided herein, the Contractor shall be reimbursed its allowable, allocable, and reasonable actual incurred travel costs in accordance with FAR 31.205-46, including Item VI in the Final Rule of FAC 2005-38, dated December 10, 2009.

Travel must be directly related to and be required for performance of the contract. The Contractor should have a policy that requires its employees to use sound business judgment in both determining the need for travel, as well as in expending Contractor financial resources when travel is necessary. The following guidelines are provided to assist the Contractor in its compliance with contractual requirements to limit expense reimbursement to those costs that do not exceed DoS travel reimbursement guidelines. Travelers will not be reimbursed for excess costs caused by:

An indirect route as a matter of personal preference

Premature departure for personal reasons from a temporary location; or extending a stay for personal reasons.

In no event shall costs associated with employees commuting be reimbursable as a direct cost under this contract.

After task order award, travel must be authorized in advance by the Contracting Officer’s Representative. However, if travel costs are projected to exceed the estimated travel cost negotiated at base contract and task order award, the

Contractor shall obtain advance written authorization from the Contracting Officer.

If work under this contract will be performed at the Government site at the Department of State main building, 21st and Virginia Avenue, NW, Washington, DC 20520, or other State Annexes in the metropolitan Washington, DC area, daily commuting time and expenses between the Department of State site and some other location, such as a home office, shall not be allowable costs under this contract.

B .6.1 Use of Privately Owned vehicle Costs when using a privately owned vehicle for official travel are allowable provided that such costs do not exceed costs that would have resulted from use of other reasonable transportation methods (e.g., taxi, airplane, train). Reasonable associated costs, such as tolls and parking fees, are also generally allowable. The Contractor shall submit, as an attachment to its invoice, evidence to support the reasonableness of privately owned vehicle costs.

When travelling in a privately owned vehicle (POV) for official travel, the Contractor shall be reimbursed mileage costs at a rate that does not exceed the POV mileage rate established by the Internal Revenue Service.

B.6.2 Air Travel Air travel should be in coach class only, unless the contractor’s employee bears the cost of the difference between coach and first class. Travel should be planned as far in advance as possible to take advantage of discounted fares; especially if reasonable certainty exists that the event will take place. If more than one air carrier offers service, travel should be on the carrier that offers the lowest price. If a restricted fare is booked and the Contractor’s employee requires a change, a reasonable exchange fee may be claimed. Contractor’s employees are required to fly on U.S. flag carrier service under the Fly America Act, 49 USC Section 40118, which requires employees, consultants, contractors and any other persons traveling for the federal government outside the United States via commercial air to travel by U.S. flag air carriers, unless an exception to the Act applies. For additional information, refer to the Federal Travel Regulations and/or Comptroller General Decision B-138942, March 31, 1981.

B.6.3 Rental Cars Costs for car rentals for official travel are allowable provided that: such rentals are consistent with good business practice; such costs do not exceed costs that would have resulted from use of other reasonable transportation methods (e.g., taxi, airplane, train); and such costs do not exceed the actual cost of renting a compact automobile (maximum of one automobile for two Contractor personnel), unless extenuating circumstances (e.g., excess baggage) require other arrangements and subsequent Contracting Officer approval is obtained. Reasonable associated costs, such as tolls and parking fees, are also generally allowable. The use of rental cars, even if authorized, must be justified in writing by the traveler and attached to the voucher. Claims for rental car gasoline must be supported by original receipts.

B.6.4 Sustenance Employees on overnight travel status shall be reimbursed on a per diem basis. Specific per diem rates for different localities may be found at the General Services Administration web site, the specific citation for which is as follows:

http://www.gsa.gov/Portal/gsa/ep/contentView.doc

Per Diem is not intended to fully cover these expenses.

B.6.5 International Travel International travel is defined as outside of the United States. The United States is defined as the fifty states, Commonwealth of Puerto Rico, possessions of the United States, and the District of Columbia.

B.6.6 Passports and Visas Reimbursement may be permitted for actual visa fees for official travel; however, the expense for personal passports is not eligible as a direct cost under this contract. Visas are generally required in relation to a specific trip and therefore the cost is generally allowable as a direct cost for travel required under this contract.

Diplomatic passports may, in appropriate circumstances, be issued to government contractors (see 7 FAM 1391.5 or 7 FAM 1391.6).

A diplomatic passport is normally valid for five years or until the termination of the bearer’s diplomatic status, whichever comes first.

There is no fee for a diplomatic passport.

B.6.6 Receipts Except for per diem expenses, valid original receipts are required for all expenditures regardless of cost. If a receipt is not normally provided for the expense (metro, bus token, etc.), the certification signed by the traveler on the voucher will justify the expense.

Receipts submitted with the voucher should be originals indicating the name of the payee, date paid, amount, and the service rendered.

This includes the original Passenger Receipt Coupon of the airline ticket. If an electronic ticket is used, the boarding passes for each flight must be submitted with the travel voucher.

B.6.7 Travel Voucher Completion The contractor’s travel voucher must be submitted for reimbursement within 30 days after completion of travel. In addition, dates and times of each departure from residence or office, arrival at and the name of the place of temporary assignment, and arrival at the office or residence must be shown on the travel voucher. A certification signed by the traveler must be included on the travel voucher that states that the trip indicated was actually taken and that all expenses are accurate and correct.

B-7 CLIN STRUCTURE

CLIN 001 Services

CLIN 002 Travel

Section C - Descriptions/Specifications/Statement of Work

C-1 General Program Description and Requirements Overview

This RFP describes the policies governing the provision of health and accident coverage to Educational and Cultural Affairs Bureau (ECA) exchange program participants. The Accident and Sickness Program for Exchanges (ASPE) is a self-insured program designed to ensure the wellbeing of Bureau grantees while fulfilling programmatic goals as outlined in the grant and intended by the U. S. Department of State (STATE).

The Bureau has statutory authority to self-insure. Funds appropriated for exchange activities are used to pay covered expenses under the APSE. The Bureau has determined that to self-insure is the most cost-effective mechanism to ensure that exchange participants can successfully complete activities in support of STATE's mission.

The purpose of the ASPE is to provide for treatment of Sicknesses and medical emergencies. The ASPE is effective while grantees are outside their home countries, and is intended to meet the requirements of the J-I visa regulations that govern incoming exchange participants funded by the Bureau. The ASPE supports the programmatic goals of STATE’s grants and is therefore, invalid except when participating on a program funded by a STATE grant. Coverage under the ASPE shall not support a grantee, whose chronic or long-term illness precludes satisfactory completion of objectives outlined in STATE’s authorizing legislation. If it is determined that a grantee is unable to perform all objectives of the grant—both in the country of assignment and through subsequent contribution in the home country—with reasonable accommodation the exchange participant may be returned to his or her home country. If such a situation should arise, a participant shall return to his/her home country as soon as the attending physician indicates the patient's condition has stabilized and the patient has been released for travel. This policy statement refers to a grantee covered under this program as a "Covered Person". A Third Party Administrator (TPA) will administer the ASPE on behalf of STATE.

Enrollment and Claims Data Activity 2008 through 2011

Year Total grantees enrolled

Number of claims paid

Dollar value of

Claims paid

2008 30,228 10,478 $5,118,019.00

2009 29,339 13,352 $5,886,473.00

2010 33,913 15,928 $7,090,261.00

2011 36,157 15,779 $7,250,389.00

C.3 OBJECTIVES

C.3.1 Objective 1 – Program Management & Operational Support Services for Accident and Sickness Program for Exchanges (APSE)

The Contractor shall provide a program management plan for the services identified below:

Account Management, Brokerage, Case Management, Pre-Certification, Medical Evacuations/Repatriation, US and Foreign Claims processing and adjudication, Eligibility and enrollment, Customer Service, Member Communication, Financial management, FISMA Compliance, HIPAA Portability and Privacy Compliance, SAS 70 Type II compliant and Compliance with other applicable health and privacy laws and regulations, including state law as appropriate. Meetings, General Policy Statement Disclaimer, Reporting, and Administrative Support.

C.3.2 Deliverables

Program Management Support Services: Provide a self-insured program plan designed to ensure the wellbeing of Bureau grantees while fulfilling programmatic goals as outlined in the grant and intended by the U. S. The ASPE Program Management Plan (PMP) should be delivered to Department of State (STATE) 30 days after award. The plan must provide the methodology, guidance, and framework structure to implement the IIP/ASPE program & staffing management plan to support its varied exchange programs. Contractor’s responsibilities include managing timelines, systems, daily monitoring (by both State and Account Management) to ensure deliverables are met as defined by DoS and associated Bureaus. The PM must ensure all contractor labor categories are working properly and are provided with the support they require. A weekly Status Report of all the ASPE functions and labor category assignments, achievements and goals need to be delivered to the government on a weekly basis.

Project Management Support Services that starts with a framework for the PM, and staff that communicates task requests, decisions, and priorities and provides a Work Breakdown Structure (WBS) of program management plans. The Project Manager provides a detail project for the staff & DoS to ensure all requirements are being completed and that work being conducted adds quality assurance that is a clear understanding of the workflow and task obligations. Provides support for coordination of processes to ensure DoS benefits and requirements are provided in the manner designed for ASPE.

Account Management Support Services Plans. Dedicated staff for prompt ASPE US and Foreign medical claims adjudication and payment. Contractor must provide a plan for coordination of benefits, and payment of foreign claims in required foreign currency. The Account Management Plan (AMP) must be provided 30 days after award that shows methodology documentation to manage a commercial insurance policy which eligible dependents of covered exchange participants coming to the US can purchase, meeting the requirements of the J1 Visa Regulations established in the 22 CFR 62.14.

Brokerage Support Services &Plans. US nationwide preferred provider organization (PPO) with approval from ECA, and overseas medical provider network, US pharmacy Benefits Manager (PBM) with approval from ECA, and capable of shipping to International addresses. Brokerage: Provide insurance policies, US PPO Network, Pharmacy, and International provider relations, and medical evacuation, repatriation and assistance services ongoing during the contract period. A systematic and detailed program report should be delivered 30 days after award.

Case Management Support Services. Utilization review and case management. In-house quality assurance mechanisms. Case Management and Utilization Review: demonstrated review and action by registered nurse(s) on all cases that are of a serious physical or psychiatric nature and reporting of any cases that could become debilitating. Appropriate intervention shall occur as needed. Enrollee Appeals: Appeals by exchange participants for denied claims will be sent to the COR within ten (10) federal working days of receipt from the submitting party. Complete and Processable Claims: paid within ten (10) federal working days of receipt;

Explanation of Benefits sent to beneficiary or his/her designee.

Financial Management Support Services. Financial management plans for all Posts. Financial Management:

maintenance of a cost accounting system and fiscal reports provided on a quarterly basis. Check Batching:

batched and disbursed on a daily basis.

Case Specialist Support Services for Pre-Certification. Pre and existing compliance with all applicable health and privacy law and regulations, including state law where appropriate. Contractor must provide Enrollment Services to support ASPE. Deliver a compliance plan should be delivered to the government 30 days after award with other applicable health and privacy laws and regulations, including state law as appropriate.

Provide Enrollment Data: entered into the Contractor’s system for daily monitoring (by both State and Account Management). Case management must be observed and reviewed on a daily basis to see if file(s) was loaded by receiving a load confirmation system generated e-mail, inclusion of errors for all fields received and loaded. US and Foreign addresses will be required to be housed in the file and must be monitored on a daily basis with a weekly status report.

Medical Evaluations/Repatriation Services. Contractor must provide on-going metrics on consultations regarding and updates to the ASPE “General Policy Statement and Benefits”. The contractor must provide information guides on medical evacuations and repatriations of exchange participants to the US and outside the United States. Contractor must have General Policy Statement Disclaimer and consultative decision support reporting on a weekly basis. Member Communication: website and materials developed, produced, and distributed to programming agents, and updated as needed and recorded in status reports of activities and planned objectives on a weekly basis.

Medical Nurse Services – Contractor must be able to provide medical support services for treatment of sicknesses and medical emergencies on a daily basis. Medical nursing support must be able to meet the requirements of the J-I visa regulations that govern incoming exchange participants with the highest level of medical attention and provide the resources necessary by the Bureaus.

Claims Clerk Support - US and Foreign Claims Processing and Adjudication. Contractor must provide services for conversion of foreign medical claims to US coding standards and multilingual customer service as needed.

Manage Enrollment Data: entered into the Contractor’s system for daily monitoring (by both State and Account Management) to see if file was loaded by receiving a load confirmation system generated e-mail, inclusion of errors for all fields received and loaded. US and Foreign addresses will be required to be housed in the file. Set up a web site designed to allow secure access to health benefit plan and claim information. Create a brief tutorial that will teach DoS how to gain access to the ASPE website.

Customer Service Support Services. Contractor must provide cost containment solutions for individual claims and ensure appropriate Help-Desk Support. Telephone Inquiries: 24/7/365 average speed of answer to be no longer than 60 seconds. Any necessary follow-up acted upon within one (1) federal working day. Online email inquiries responded to within one (1) federal working day. Incomplete or Ineligible Claims: acknowledged within ten (10) federal working days by generation of a letter of explanation or request for further information.

Translator Services - Given the diverse ethnic and cultural background of State-sponsored exchange participants, the Contractor’s staff will provide resources and services that can converse and correspond with individuals in a culturally-sensitive and easily understood manner as needed. This support service must be provided as requested by all related ASPE personnel and customers. A weekly report on translator services will be required on a weekly basis and delivered to the government along with PM status reports.

Security & Compliance Officer – Contractor must propose and deliver document and service using a sound approach and plan for administering the security of Accident and Sickness Program for Exchanges (APSE).

Contractor must provide FISMA Specialist, HIPAA Specialist and SAS 70 Specialist to support Type II compliant. The Contractor must demonstrate that they have adequate controls and safeguards when they process data belonging to State. A weekly status report must be provided to the government.

Audits - Internal Claims Audit: The contractor must provide statistical report of all claims activity at the end of each working day. This report must include clerical and financial accuracy by bill line and/or procedure code within each claim with evidence of date of service, date received, processor, type of transaction. The contractor shall inform State of any irregularities discovered in a timely manner. Claims reports should be tracked by date of service, date paid, billed charges, amount allowed, member’s responsibility, total paid, CPT codes billed and, for denied claims, reason code for denial. This information must be tracked and documented on a daily basis and then rolled-up on weekly status reporting.

Report Writer & Required Reports. 30 days after award, the contractor should provide templates for Quarterly Reports, Semi-Annual Reports, and Annual Reports. The Contractor shall provide required reports, within the contract price, as DoS may request. State will ensure that any and all report data requests can be easily sorted and compiled by the Contractor’s report-generating system as well as data repositories DoS deems necessary.

Since ASPE documentation is vital due to the sensitivity and need of medical services, it’s vital that data and documents are kept current and accessible. The PM report should include all functional, systematic, program and status reporting on a weekly basis. The government will require ASPE literature, guides and training aides as well as updated information on the ASPE website. Compliance with other applicable law, regulations, and policies, and consultations and updates to the “General Policy Statement and Benefits” and other ASPE policy documents.

The Contractor shall be responsible for following developments in applicable healthcare and privacy law, regulations, and policy, and shall ensure ASPE’s ongoing compliance with such authorities, including informing State of potential compliance issues it detects that are outside of the Contractor’s control.

The Contractor shall consult with ECA and may offer suggestions to keep the ASPE “General Policy Statement and Benefits,” and other ASPE policy documents current in accordance with external regulatory changes. The contractor shall be required to comply with the most current version of the policy as approved and furnished by State.

The Contractor shall attend a meeting at the Bureau’s office in Washington, DC within 30 days after the award date. The contractor shall be prepared to present State with a transition plan to include:

Brief overview of company

Scope of transition and implementation tasks

Eligibility file transfer

File format

Initial file

ID cards

Contractual expectations for transition

Eligibility file transfer

Historical Data files

Final payment run

Canceled check file

Access to the online portal

Financial files as deliverables

Timeline for deliverables

Medical Evacuation/Repatriation

Benefit Guide

Clarifications/updates

Pharmacy

Reports

Program Communication and Training

Finalize timeline for “go live”

Contractor shall attend quarterly meetings in Washington, DC with the COR, and other State staff to review relevant administrative and policy-related program issues, including relevant claims trends, throughout the duration of the contract. Quarterly claims and financial reports will be prepared by the contractor and discussed at the meetings.

Contractor should expect at least one (1) annual site visit from the COR and other essential personnel associated with State.

The Contractor will need to comply with the ASPE policy statement that State issues. The current GPS can be found in Appendix 1. The GPS is a living document and subject to change as the exchange programs continue to evolve.

Claims received from individuals who do not appear on State-furnished enrollment roster should be reported to the COR no later than five (5) federal working days after receipt.

Case management activity: weekly summary, and monthly report—categorized by participant to include diagnosis, medical services rendered to date and cost information, and brief narrative provided by nurse manager documenting action taken, prognosis, if available, and proposed intervention.

The Contractor shall provide management reports to the COR as described below. In each case, only one copy shall be provided, unless otherwise specified. Reports can be e-mailed or downloadable from a secure Contractor website.

CURRENT “GENERAL POLICY STATEMENT AND BENEFITS”

Accident and Sickness Program for Exchanges (APSE) Bureau of Educational and Cultural Affairs US Department of State (DoS)

The DoS prescribes the policies governing the provision of health and accident coverage to Educational and Cultural Affairs Bureau (ECA) exchange program participants. The Accident and Sickness Program for Exchanges (ASPE) is a self-insured program designed to ensure the wellbeing of Bureau grantees while fulfilling programmatic goals as outlined in the grant and intended by the U. S. Department of

State (STATE). The Bureau has statutory authority to self-insure. Funds appropriated for exchange activities are used to pay covered expenses under the APSE. The Bureau has determined that to self-insure is the most cost-effective mechanism to ensure that exchange participants can successfully complete activities in support of STATE's mission. The government assumes that the contractor will complete these requirements and any dependencies that do not further this commitment are the responsibility of the contractor unless otherwise stated.

Section D - Packaging and Marking

D-001 DATA PACKAGING REQUIREMENTS 11/01/2008

(a) All unclassified data shall be prepared for shipment in accordance with best commercial practices.

(b) Classified reports, data, and documentation shall be prepared for shipment in accordance with the National Industrial Security Program Operating Manual (DOD 5220.22-M).

(end of clause)

Section E - Inspection and Acceptance

E-004 INSPECTION AND ACCEPTANCE (Services) 11/01/2008

Inspection and acceptance of the services to be provided hereunder shall be made by the Contracting Officer's Representative.

(end of clause)

Section F - Deliveries or Performance

52.242-15 Stop-Work Order (Aug 1989) 08/01/1989

(a) The Contracting Officer may, at any time, by written order to the Contractor, require the Contractor to stop all, or any part, of the work called for by this contract for a period of 90 days after the order is delivered to the Contractor, and for any further period to which the parties may agree. The order shall be specifically identified as a stop-work order issued under this clause. Upon receipt of the order, the Contractor shall immediately comply with its terms and take all reasonable steps to minimize the incurrence of costs allocable to the work covered by the order during the period of work stoppage. Within a period of 90 days after a stop-work is delivered to the Contractor, or within any extension of that period to which the parties shall have agreed, the Contracting Officer shall either--

(1) Cancel the stop-work order; or

(2) Terminate the work covered by the order as provided in the Default, or the Termination for Convenience of the Government, clause of this contract.

(b) If a stop-work order issued under this clause is canceled or the period of the order or any extension thereof expires, the Contractor shall resume work. The Contracting Officer shall make an equitable adjustment in the delivery schedule or contract price, or both, and the contract shall be modified, in writing, accordingly, if--

(1) The stop-work order results in an increase in the time required for, or in the Contractor's cost properly allocable to, the performance of any part of this contract; and

(2) The Contractor asserts its right to the adjustment within 30 days after the end of the period of work stoppage; provided, that, if the Contracting Officer decides the facts justify the action, the Contracting Officer may receive and act upon the claim submitted at any time before final payment under this contract.

(c) If a stop-work order is not canceled and the work covered by the order is terminated for the convenience of the Government, the Contracting Officer shall allow reasonable costs resulting from the stop-work order in arriving at the termination settlement.

(d) If a stop-work order is not canceled and the work covered by the order is terminated for default, the Contracting Officer shall allow, by equitable adjustment or otherwise, reasonable costs resulting from the stop-work order.

(End of clause)

52.242-17 Government Delay of Work (Apr 1984) 04/01/1984

(a) If the performance of all or any part of the work of this contract is delayed or interrupted (1) by an act of the Contracting Officer in the administration of this contract that is not expressly or impliedly authorized by this contract, or (2) by a failure of the Contracting Officer to act within the time specified in this contract, or within a reasonable time if not specified, an adjustment (excluding profit) shall be made for any increase in the cost of performance of this contract caused by the delay or interruption and the contract shall be modified in writing accordingly. Adjustment shall also be made in the delivery or performance dates and any other contractual term or condition affected by the delay or interruption. However, no adjustment shall be made under this clause for any delay or interruption to the extent that performance would have been delayed or interrupted by any other cause, including the fault or negligence of the Contractor, or for which an adjustment is provided or excluded under any other term or condition of this contract.

(b) A claim under this clause shall not be allowed-

(1) For any costs incurred more than 20 days before the Contractor shall have notified the Contracting Officer in writing of the act or failure to act involved; and

(2) Unless the claim, in an amount stated, is asserted in writing as soon as practicable after the termination of the delay or interruption, but not later than the day of final payment under the contract.

(End of clause)

F-1 Deliverables or Performance

SECTION F DELIVERABLES OR PERFORMANCE

F.1 Program Management & Operational Support Service for Accident and Sickness Program for Exchanges (APSE)

The contract support and purpose of the ASPE is to provide for treatment of Sicknesses and medical emergencies. The ASPE is effective while grantees are outside their home countries, and is intended to meet the requirements of the J-I visa regulations that govern incoming exchange participants funded by the Bureau.

The ASPE supports the programmatic goals of STATE’s grants and is therefore, invalid except when participating on a program funded by a STATE grant. Coverage under the ASPE shall not support a grantee, whose chronic or long-term illness precludes satisfactory completion of objectives outlined in STATE’s authorizing legislation. If it is determined that a grantee is unable to perform all objectives of the grant—both in the country of assignment and through subsequent contribution in the home country—with reasonable accommodation the exchange participant may be returned to his or her home country. If such a situation should arise, a participant shall return to his/her home country as soon as the attending physician indicates the patient's condition has stabilized and the patient has been released for travel. This policy statement refers to a grantee covered under this program as a "Covered Person". A Third Party Administrator (TPA) will administer the ASPE on behalf of STATE.

Provide a process that the Bureaus encourage participants to retain or obtain additional insurance for losses not covered under the program. While the Bureau does not recommend any one commercial insurance company over another, for the convenience of the participants the Bureau shall arrange additional Insurance—administered by the TPA.

Provide a Certificate of Health Care Coverage, when shown with a Valid Identification Card, is evidence of a Covered Person's personal coverage under the ASPE and of associated benefits. Anything contained in the Certificate is subject to the provisions, definitions, and exceptions in the General Policy Statement (GPS). The General Policy Statement is on file with State and available at any reasonable time. No changes in the ASPE or Benefits can be made except by the Bureau Executive Director, who will make such changes as might be required to address budget, policy, regulatory, or legislative mandates. The Certificate replaces all Certificates and policy statements, if any, previously issued to the Eligible Participants.

The contractor shall provide specific deliverables as shown below:

Program Management Support Services: Provide a self-insured program plan designed to ensure the well being of Bureau grantees while fulfilling programmatic goals as outlined in the grant and intended by the U. S. The ASPE Program Management Plan (PMP) should be delivered to Department of State (STATE) 30 days after award. The plan must provide the methodology, guidance, and framework structure to implement the IIP/ASPE program & staffing management plan to support its varied exchange programs. Contractor’s responsibilities include managing timelines, systems, daily monitoring (by both State and Account Management) to ensure deliverables are met as defined by DoS and associated Bureaus. The PM must ensure all contractor labor categories are working properly and are provided with the support they require. A weekly Status Report of all the ASPE functions and labor category assignments, achievements and goals need to be delivered to the government on a weekly basis.

Project Management Support Services that starts with a framework for the PM, and staff that communicates task requests, decisions, and priorities and provides a Work Breakdown Structure (WBS) of program management plans. The Project Manager provides a detail project for the staff & DoS to ensure all requirements are being completed and that work being conducted adds quality assurance that is a clear understanding of the workflow and task obligations. Provides support for coordination of processes to ensure DoS benefits and requirements are provided in the manner designed for ASPE.

Account Management Support Services Plans. Dedicated staff for prompt ASPE US and Foreign medical claims adjudication and payment. Contractor must provide a plan for coordination of benefits, and payment of foreign claims in required foreign currency. The Account Management Plan (AMP) must be provided 30 days after award that shows methodology documentation to manage a commercial insurance policy which eligible dependents of covered exchange participants coming to the US can purchase, meeting the requirements of the J1 Visa Regulations established in the 22 CFR 62.14.

Brokerage Support Services &Plans. US nationwide preferred provider organization (PPO) with approval from ECA, and overseas medical provider network, US pharmacy Benefits Manager (PBM) with approval from ECA, and capable of shipping to International addresses. Brokerage: Provide insurance policies, US PPO Network, Pharmacy, and International provider relations, and medical evacuation, repatriation and assistance services ongoing during the contract period. A systematic and detailed program report should be delivered 30 days after award.

Case Management Support Services. Utilization review and case management. In-house quality assurance mechanisms. Case Management and Utilization Review: demonstrated review and action by registered nurse(s) on all cases that are of a serious physical or psychiatric nature and reporting of any cases that could become debilitating.

Appropriate intervention shall occur as needed. Enrollee Appeals: Appeals by exchange participants for denied claims will be sent to the COR within ten (10) federal working days of receipt from the submitting party. Complete and Processable Claims: paid within ten (10) federal working days of receipt; Explanation of Benefits sent to beneficiary or his/her designee.

Financial Management Support Services. Financial management plans for all Posts. Financial Management: maintenance of a cost accounting system and fiscal reports provided on a quarterly basis. Check Batching: batched and disbursed on a daily basis.

Case Specialist Support Services for Pre-Certification. Pre and existing compliance with all applicable health and privacy law and regulations, including state law where appropriate. Contractor must provide Enrollment Services to support ASPE.