SBC-400-11-R-0005-A0004 Addendum.docx

SF-30 Continuation Box 14 L.4.3.2.2 is modified to allow Medical Aid Funds to participate in the solicitation.

L.8.1 is modified to set the date for the pre-proposal conference to March 15, 2012

B.2. PRICES

This is a fixed price with economic price adjustment requirements type contract under which will be issued firm, fixed-price task orders. The fixed prices/premium rates for the health insurance services as specified in Section C are as follows:

B.2.1. BASE YEAR OF CONTRACT:

Bi-Weekly Rates Per Employee:

Employee’s Dependents (additional cost per dependent)

SUBTOTAL

Total Price for Base Year (Subtotal x 26): _______

B.2.2. FIRST OPTION YEAR OF THE CONTRACT:

Bi-Weekly Rates Per Employee:

Employee’s Dependents

SUBTOTAL

Total Price for Option Year 1 (Subtotal x 26): _______

B.2.3. SECOND OPTION YEAR OF THE CONTRACT:

Bi-Weekly Rates Per Employee:

Employee’s Dependents

SUBTOTAL

Bi-Weekly Rates Per Employee:

Employee’s Dependent

SUBTOTAL

Total Price for Option Year 3 (Subtotal x 26): _______

B.2.5. FOURTH OPTION YEAR OF THE CONTRACT:

Bi-Weekly Rates Per Employee:

Employee’s Dependents

SUBTOTAL

Total Price for Option Year 4 (Subtotal x 26): _______________

GRAND TOTAL BASE PERIOD PLUS OPTION YEARS: __________________

B.3 ADMINISTRATIVE RETENTION AMOUNTS

B.3.1 If the Contractor requests a price adjustment under B.4 below, the Contractor must present cost experience data that includes the retention amount. For purposes of any economic price adjustment, this retention amount is a fixed amount that is a part of the premium amounts in B.2. This retention amount will not be adjusted for any reason.

The retention amount is part of the premium and may include, but not be limited to, such costs as overhead and general and administrative costs. It will also include any profit. Essentially, it includes all costs except the actual portion of the premium intended to fund claims paid to the health care provider/claimant. B.3.2 sets forth the retention amounts per premium paid for each category of premium and for each period of performance.

NOTE TO OFFEROR - Fill in the fixed retention amounts for each period of performance and for each category of premium. This fixed amount must be expressed in the currency in which the premium amount is proposed. The fixed retention amount shall NOT be expressed in terms of a percentage of the premium.

B.3.2.1 Retention Amounts per separate premium paid per single employee and per family plan.

Base Period

Option Year 1

Option Year 2

Option Year 3

Option Year 4

C.1. HEALTH INSURANCE SERVICES

The Government of the United States of America requires Health Insurance coverage for its employees as further described in C.1.2 in Botswana. The Government has determined that the prevailing practice by employers in Botswana is to provide for their employees health insurance protection and that the cost of such insurance protection is usually borne by both the employee and the employer on a basis of 60% of the premium paid for by employer and 40% of the premium paid for by the employee. For eligible employees who are regularly scheduled to work less than 30 hours per week: The USG will pay a prorated share of the premium cost for employee and dependent coverage, based on the number of hours the employee is regularly scheduled to work.

Health insurance protection will be representative of locally prevailing compensation practice as further described in C.1.2. The specific health benefit coverage under this contract is set forth in Section C and the Exhibits in Section J.

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

C.1.1.1. Hospitalization:

100% reimbursement of room and board for award room or semi-private room up to an annual maximum limit of P487,000. The cost of a private room will be reimbursed up to 100% limit of general ward or ICU (at agreed tariff) of the cost of a semi-private room. 100% reimbursement of hospital medical expenses including laboratory tests and x-rays, nursing care, operating room costs, intensive care, and prescription medicines up to annual maximum limit of P508,341. 100% coverage for ambulance.

C.1.1.2. Professional Services and Treatment:

100% reimbursement of doctors, and surgeons, fees incurred while hospitalized, at a hospital up to annual maximum limit of P887,000 on an out-patient basis, at a clinic or doctor's office, or at home Doctors Visit (Hospital and Office) P5,421 annual maximum limit. 100% reimbursement for medical services and expenses when not hospitalized such as laboratory tests and x-rays, prescription medicines, routine annual physical examination, and inoculations up to annual maximum limit of P39,471.

C.1.1.3. Prescription Drugs and Medicines:

100% reimbursement of the cost of medicines and drugs for which a prescription is legally required when hospitalized and 95% reimbursement up to annual maximum limit of P7,550 when not hospitalized. Chronic medications up to annual maximum limit of P42,000. Expenses incurred for medicines, vitamins, cold remedies, etc., that are available over the counter without a prescription will not be reimbursed even if prescribed by a physician.

C.1.1.4. Obstetrical Care:

100% reimbursement of obstetrical related medical expenses including prenatal and postnatal care . P7500 for normal delivery and P11000 for Caesarean up to annual maximum which is P887,000

C.1.1.5. Physical Therapy:

100% reimbursement up to annual maximum limit of P4973.

C.1.1.6. Psychiatric Treatment:

100% reimbursement up to P40,000 annual maximum limit local currency (pula).

C.1.1.7. Optical Care:

100% reimbursement for eye examination and treatment and prescription eyeglass or contact lenses, maximum amount of P100 for examination; P7,550 for prescription; P550 for frames and P1,050 for lenses. 50% reimbursement for lens per patient every year with maximum of 35 USD. No reimbursement for nonprescription lenses, or tinting.

C.1.1.8 Dental Care:

100% reimbursement up to P8,179 annual maximum limit local currency per person of expenses for dental Services including dentists, fees, x-rays, examination and treatment, cleaning, fillings, extractions, false teeth, crowns, and bridges.

C.1.1.9. Hearing Aids:

100% reimbursement of the cost of a hearing aid apparatus and related examination up to annual maximum limit of P5,400. Limited to one apparatus per ear per patient in a three-year period.

C.1.1.10. Alternative Treatment - Chiropractic, Homeopathic, Acupuncture and Traditional Healing, P2000 annual maximum limit.

C.1.1.11. Other Benefits (For Employees Only) 100% reimbursement for medications to suppress opportunistic infections, such as tuberculosis and toxoplasmosis for employees who have HIV/AIDS; as well as brief courses of anti-retroviral drugs during childbirth to prevent the transmission of HIV to the employee's child. The duration of this treatment is to be determined by the employee's physician following WHO or CDC guidelines.

C.1.1.12 Maximum Limits:

The USG will reimburse covered expenses up to a limit of P961,606 local currency per covered individual and dependents (combined) per contract year. Expenses incurred under section C.1.1.11 of the plan are subject to a separate annual maximum limit of USD 10,000 per employee.

C.1.2 Health Benefits Conditions and Limitations.

Conditions and limitations on the entitlement to health care under this contract are as follows:

No reimbursement for elective cosmetic surgery; spa cures; rejuvenation cures; massage; exercise therapy; long term rehabilitative therapy; non-medical hospital charges such as telephones or television; home help, family help, or similar household assistance; fees of persons who are not licensed physicians or nurses; or services or supplies which have not been prescribed or approved by a physician or nurse.

No reimbursement for expenses that will be reimbursed or paid directly under a host country medical program, the U.S. workers, compensation program, or a post's LE Staff Workers' compensation program.

No reimbursement for expenses related to an illness or injury that is a result of an unlawful action on the part of the patient; the practice of a dangerous sport; excessive or illegal use of alcohol or drugs; a self-inflicted wound; or service in the armed forces of any country.

There is reimbursement for medical expenses incurred outside of Botswana, though subject to the same maximum reimbursement rates (in foreign currency equivalents) described in C.1.1.1 through C.1.1.12 and C.1.2. There is no reimbursement for round trip transportation expenses to travel out of country for medical treatment.

C.1.3.2 Location of Employment

The individuals covered by C.1.3.1 must be employed within the geographic boundaries of Botswana by:

C.1.5 Other Eligible Participants Eligible employees may elect to enroll their eligible dependents. For the purposes of this plan, an employee's dependents are defined as the employee's legal spouse (limit one) and unmarried, economically dependent children who primarily reside with the employee unless away at school. Child is defined as the employee's natural child, adopted child, stepchild, or foster child. An eligible child will be covered until the end of the contract year in which he/she reaches age 20, or age 23 if a full time student. There is no age limit for an eligible child who is physically or mentally handicapped so as to be unable to live independently. Parents, grandparents, siblings, and other relatives are not eligible dependents. (Employees parents who are currently covered (31 employees) are authorized to be grandfathered into the plan.

C.3.0 DEFINITIONS

Dependent An employee's dependents are defined as the employee's legal spouse (limit one) and unmarried, economically dependent children who primarily reside with the employee unless away at school. Child is defined as the employee's natural child, adopted child, stepchild, or foster child. An eligible child will be covered until the end of the contract year in which he/she reaches age 20, or age 23 if a full time student. There is no age limit for an eligible child who is physically or mentally handicapped so as to be unable to live independently. Parents, grandparents, siblings, and other relatives are not eligible dependents.

(Employees parents who are currently covered (31 employees) are authorized to be grandfathered into the plan and considered dependents.

L.4.3.2.2 Licensing Information

The offeror shall include a notarized copy of the most current license/certificate/-accreditation, which demonstrates that the offeror is licensed/certified/accredited or otherwise authorized by the Government of Botswana or its agent (e.g., insurance commission, board) to provide health insurance coverage to persons (to include organizations, companies, groups) within the host country or be an accredited medical aid fund in Botswana . If the offeror is not licensed/certified/accredited or otherwise authorized by the government of Botswana it must demonstrate that it is licensed/certified/accredited by a government other than Botswana to provide health insurance for persons in Botswana and must demonstrate its capacity to provide health benefits in Botswana to meet the minimum requirements and other conditions set forth in this solicitation.

This section shall demonstrate that the offeror is licensed/certified/accredited through no less than the final day of the base performance period and that the offeror is eligible for renewal for the option periods. This section shall also summarize and describe any probationary, disciplinary or actions taken upon the offeror, which are in force or are about to be imposed upon the offeror by the government of Botswana or its agents.

Failure to demonstrate that the offeror is an authorized insurance company or medical aid fund permitted to write and administer health insurance policies in Botswana shall be grounds for rejection of the proposal.

Lesego Seema at +267-373-2338.