Health_Insurance_ver22912.docx

SECTION A

(See SF-33 Attachment)

SECTION B

PART I PRICE - HEALTH INSURANCE

B.1. HEALTH INSURANCE SERVICES

The Contractor shall provide Health Insurance services described herein to Locally Employed Staff (LES) of the Government of the United States of America Mission in Bolivia. The groups of employees who shall be provided this insurance are listed in C.1.3. This insurance shall be provided in accordance with Section C and the Exhibits in Section J.

The Contractor shall ensure that health care under this contract does not exclude HIV/AIDS care, unless exclusion has been authorized by HR/OE/CMD.

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:

Annual Rates per Employee:

Family [footnoteRef:1] [1: The Family premium category covers all dependents under each Embassy employee. The difference between the number of Employees and the number of families is the estimated number of single employees.]

SUBTOTAL

Total Price for Base Year: _______

B.2.2. FIRST OPTION YEAR OF THE CONTRACT:

Annual Rates per Employee:

SUBTOTAL

Total Price for first Option Year: _______

B.2.3. SECOND OPTION YEAR OF THE CONTRACT:

Annual Rates per Employee:

Family [footnoteRef:2] [2: The Family premium category covers all dependents under each Embassy employee. The difference between the number of Employees and the number of families is the estimated number of single employees.]

SUBTOTAL

Total Price for Second Option Year: _______

B.2.4. THIRD OPTION YEAR OF THE CONTRACT:

Annual Rates per Employee:

SUBTOTAL

Total Price for Third Option Year: _______

B.2.5. FOURTH OPTION YEAR OF THE CONTRACT:

Annual Rates per Employee:

SUBTOTAL

Total Price for Fourth Option Year: _______

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 Retention Amounts per separate premium paid per employee and per family.

Period of Performance

Employee

Family

Base Period

Option Year 1

Option Year 2

Option Year 3

Option Year 4

B.4. ECONOMIC PRICE ADJUSTMENT-HEALTH INSURANCE PREMIUMS

B.4.1. Premium Adjustment based on Experience - For health insurance, prices may be adjusted upward or downward based on the experience rating of the Mission covered by this contract. No adjustment will be allowed during the first twelve months. After such time, the contractor or the Government may request an adjustment in premiums on an annual basis. Before any such adjustment is made, the contractor agrees to provide the Government a balance sheet showing two main components for the time period: (1) receipts (premiums received) minus the retention amount and (2) claims paid. The retention amount is not subject to adjustment. The Government reserves the right to have an independent third party review the balance sheet 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. Any failure to reach agreement under this clause shall be subject to the procedures in the Disputes clause.

B.4.2. Premium Adjustment Based on Laws - The rates may also be adjusted during the performance period of the contract as a result of laws enacted by the host Government, if such change in the laws has a direct impact on the cost to the contractor to perform this contract at the contracted rate. In that event, the Contracting Officer may enter into negotiations with the Contractor to modify the contract to adjust the premium rate. The contractor agrees to provide all documentation necessary to support any requested adjustment.

B.4.2.1 Employee Pool – This clause is only in effect if the contractor included details in its offer regarding a pooling arrangement, of which this contract is a part.

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

SECTION C

DESCRIPTION/SPECIFICATION/WORK STATEMENT

PART I - HEALTH INSURANCE

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 Bolivia. The Government has determined that the prevailing practice by employers in Bolivia is to provide for their employees health insurance protection and that the cost of such insurance protection is usually borne by the employer. 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 ensure that health care under this contract does not exclude HIV/AIDS care, unless exclusion has been authorized by HR/OE/CMD.

C.1.1 Employee and Dependent Health Services Benefits

The health benefits under this contract are as follows. Reimbursement of covered expenses is limited to the stated percentages of reasonable and customary costs. Proposals that contain more benefits (even if there is no increase in cost) or fewer benefits than stated in the solicitation may be deemed technically unacceptable.

Reimbursements or payments shall be made for the following covered benefits, subject to reasonable and customary costs in the locality where treatment was provided.

Dependent Employee

C.1.1.1. Hospitalization 100% 100%

Reimbursement of room and board expenses for a ward room or semi-private room and reimbursement of hospital medical expenses including:

· Hospital ward, room, and intensive care accommodation fees.

· General nursing care, meals, and special diets.

· Private duty nursing care, if recommended by the attending physician.

· Companion bed, in cases where children under the age of twelve (12) years require hospitalization.

· Laboratory services.

· X-ray and other imaging services, including Magnetic Resonance Imaging (MRI), diagnostic ultrasonography (ECHO), and radioisotope imaging studies.

· Therapeutic radiology services.

· Electrocardiograph (EKG), electroencephalograph (EEG), and electromyography (EMG) services, to include static and stress EKGs and ambulatory EKG monitoring and testing, and tomographies.

· Intra-venous therapy services.

· Blood and blood products transfusion services.

· The policy shall only cover the cost of blood and transfusion services, when blood is obtained from hospitals and/or clinic blood banks and/or family members/relatives of patients undergoing surgery or medical treatment. In the event that blood is procured and/or obtained in any other way, the Contractor shall not be required to honor the reimbursement claim for blood and blood products transfusion services, as for the sale of blood is strictly prohibited by Bolivian law.

· Pharmacy services and medications prescribed by a physician, including those that suppress opportunistic infections, such as tuberculosis and toxoplasmosis.

· Respiratory therapy services including oxygen and mechanically assisted ventilation services.

· Physical therapy services.

· Orthopedic services including plastering, splinting, traction, bandaging, and crutches.

Letter of Guarantee: When surgery or medical treatment requires hospitalization, the Contractor shall submit a Letter of Guarantee to the hospital/clinic involved. The Letter of Guarantee will allow the patient (insured and/or covered family member) to be released from the hospital/clinic. Upon request of a Letter of Guarantee, the Contractor shall ensure that such letter is provided to the requestor in a period not to exceed twenty-four (24) hours.

C.1.1.2. Surgery 100% 100%

Reimbursement of surgical professional fees, including surgeon, anesthesiologist, surgical nurse, surgical assistants, and other professionals as deemed necessary for the surgery, by the attending surgeon as well as:

· Hospital surgical services, including operating room fees, recuperation room fees, and anesthesia fees.

· Laser surgery, including but not limited to eye surgery for cataracts, appendix surgery, vesicle surgery, prostate surgery, and others.

· All medical appliances, devices, and supplies required for an effective surgery and/or medical treatment, including iron lung, temporary and permanent cardiac pacemakers, prostheses (cardiac valves, artificial joints, artificial limbs, intra-ocular lenses, breast, etc.), and wheel chairs.

C.1.1.3. Doctor Visits 100% 100%

Reimbursement of medical professional fees, including those of the attending physician and consultant physicians incurred while hospitalized, at a hospital on an out-patient basis, at a clinic, or doctor’s office.

80% 80%

Reimbursement for medical services and expenses when not hospitalized such as laboratory tests and x-rays and doctor's hospital and office visit.

C.1.1.4. Prescription Drugs 100% 100%

Reimbursement when patient is hospitalized and

80% 80%

Reimbursement when not hospitalized, of the cost of medicines and drugs for which a prescription is legally required. Including those that suppress opportunistic infections, such as tuberculosis and toxoplasmosis.

Expenses incurred for vitamins and cold remedies that are available over the counter without a prescription will not be reimbursed even if prescribed by a physician.

C.1.1.5. Maternity

This category covers all expenses resulting from a normal pregnancy and childbirth (whether be a single baby, twins, triplets, etc.), without complications such as: hospitalization, labor, medical services for the newborn(s) from birth and all other related expenses.

Also covers provisions for brief courses of anti-retroviral drugs during childbirth to prevent the transmission of HIV to the employee and/or covered family member’s child. Duration of treatment is to be determined by the employee and/or covered family member’s personal physician.

IMPORTANT NOTES:

(i) All pregnancy and childbirth expenses such as office and home doctor’s visits, pre and post natal consultations, lab tests, ultrasound, genetic screening procedures (amniocentesis or chorionic villous sampling) for females who will deliver on or after their 35th birthday, well baby check-ups, preventive and acute care visits of the newborn, immunizations, etc., must be reimbursed under the out-patient care benefits.

(ii) All medical expenses resulting from complications that may arise as a consequence of a pregnancy and childbirth not considered normal such as: Cesarean, extra-uterine or ectopic pregnancy, normal or catastrophic expenses for premature delivery, incubator and related expenses, illnesses of the newborn, perinatal conditions or any other complications during the pregnancy or childbirth, are subject to the annual maximum coverage of the in-patient or out-patient care benefits as they correspond.

(iii) Complications of newborns, aside from Cesarean delivery, shall be covered at eighty percent (80%) up to US$5,000.00 per born child.

C.1.1.6. Hospital Outpatient Services 80% 80%

Reimbursement for:

· An annual physical examination is authorized for the employee and his/her covered family members which includes: physical exams, lab tests (general blood and urine tests), chest X-ray, PAP smear for women eighteen (18) years and older, EKG for members forty (40) years and older, mammography for women forty (40) years and older, fecal occult blood testing for members forty (40) years and older, and Prostate Specific Antigen (PSA) testing for men forty (40) years and older.

· Active and passive immunizations against the following diseases: poliomyelitis, measles, chicken pox, mumps, rubella, tuberculosis, diphtheria, tetanus, whooping cough, rabies, hepatitis A, hepatitis B, yellow fever, hemophilus influenza B (HIB), typhoid fever, influenza, pneumonia and meningitis.

· All medical care, expenses and treatment for patients suffering diabetes, including but not limited to insulin shots, syringes, creams for facial scars and others, shall be covered.

· Treatment for genital herpes, venereal lymphograniloma and acuminata condyloma, syphilis, gonorrhea, Chlamydia and others.

· All medical expenses and treatment for disorders related to menopause shall be covered under this contract.

· Evaluation, prevention, and medical treatment of osteoporosis are authorized, including hormone testing and hormone replacement therapy.

· Examination and evaluation of moles as a preventive measure is authorized.

For employees only: 100% reimbursement for medications to suppress opportunistic infections, such as tuberculosis and toxoplasmosis for employees who have HIV/AIDS.

C.1.1.7. Optical Service 80% 80%

Reimbursement for eye examination and treatment, prescription eyeglass or contact lenses.

This category covers medical consultations for myopia, astigmatism, presbyopia, hypermetropia (all refraction problems in general), eyeglasses (lens and frames), contact lenses and transition/organic lenses, if prescribed by an ophthalmologist.

This benefit also covers an annual check-up, including a glaucoma test for the insured and/or covered family members over thirty nine (39) years of age.

Annual coverage for lenses and frames per patient:

· Replacement of optical frames, which cost shall not exceed US$100.00.

· Eyeglass lens prescriptions shall not exceed US$200.00 per annum.

· No reimbursement will be made for nonprescription lenses or tinting.

Ophthalmologic illnesses shall be covered under the out-patient coverage benefits category.

C.1.1.8 Dental Service 80% 80%

Reimbursement of dental services including dentists’ fees, x-rays, examination and treatment, cleaning, fillings, extractions, false teeth, crowns, and bridges.

This category also covers tooth extractions, pain and inflammatory treatment, simple and complex obtrusions, without restrictions of materials except for precious metals, tooth decay, cavities, root canal work, simple or multiple reticules, oral prophylaxis, fluoride treatments, gingivitis treatment, X-rays, two preventive annual check-ups per person (general exam, gum control and prophylaxis), and apicectomies.

· Dental sealants for insured members that are under twenty one-(21) years of age, and any other ordinary dentistry treatment.

· Orthodontia treatment is covered only if treatment begins before age 15, unless required as the result of an accident. A maximum of four (4) years of orthodontia treatment will be covered per patient.

Dental care related to accidental injury shall be covered under the in-patient or out-patient benefits, as determined

C.1.1.9. Physical Therapy 80% 80%

Reimbursement for physical therapy expenses is authorized.

C.1.1.10. Psychiatric Treatment 80% 80%

Reimbursement for psychiatric treatment is authorized.

C.1.1.11. Ambulance Service 100% 100%

Reimbursement of ambulance service for the transportation, within Bolivia, of a patient to a medical facility in case of an accident or when the patient’s illness requires evacuation.

This category covers transportation by ambulance or any other means of transportation, including airplane evacuation, depending on the seriousness of the illness or the place of the accident.

C.1.1.12. Hearing Aids: None.

C.1.1.13. Expenses Incurred Out-of-Country 80% 80%

Medical expenses incurred out of country will be covered for employees and dependents when:

(a) A life threatening condition occurs when the individual is out of the country and treatment is medically necessary before the individual returns home; or

(b) The individual’s attending physician certifies in advance that such treatment is medically necessary and unavailable locally.

In the instances cited in paragraphs (a) and (b) above, the insured must obtain prior approval from the Contractor. The request must be made through the Mission Human Resources Office in the Embassy, or the Human Resources Office in AID.

On the assumption that all medical facilities are available in Bolivia, and the insured and/or covered family members wish to undergo surgical or medical treatment outside of Bolivia, medical expenses will be reimbursed at the same percentage rate of "Arancel Medico Boliviano" and subject to the same annual maximum limit as for expenses incurred in country.

Transportation for out of country treatment will be a covered expense for employees and dependents. The patient’s attending physician must certify in advance that the treatment is medically necessary and unavailable locally. 80% of the patient’s transportation expenses by the least expensive, appropriate means of transportation to the nearest city with adequate medical facilities will be reimbursed. 80% of the transportation expenses of an attendant will be reimbursed if the patient’s attending physician certifies that an attendant for the patient is necessary, e.g., a parent in the case of a patient who is a minor or a family member to make medical decisions in the case of a patient who is unconscious. All reimbursements for transportation expenses are subject to the annual maximum limit.

C.1.1.14. Other Benefits 80% 80%

Pre-Existing Pregnancies. The policy shall cover ongoing pregnancies for both, female employees and/or the covered family members.

Pre-Existing Illnesses. The policy shall not exclude pre-existing illnesses of active employees on the rolls, and those of their covered family members.

U.S. Resident Hires. U.S. Resident hires shall be allowed to enroll in the aforementioned Insurance Plan, provided that they cover/pay their own premium charges at the same rate quoted in Section B, for FSN employees.

Catastrophic Illnesses. Catastrophic illnesses shall be independently considered, and shall be subject to the Stand-by policy.

C.1.1.15 Maximum Limits

The contractor will reimburse covered expenses up to a limit of US$ 12,500.00 per patient per year.

The contractor will reimburse HIV/AIDS covered expenses of the plan up to a separate annual limit of US$10,000.00 per employee.

Medical Fees. Medical fees and rates for medical expenses will not be subject to pre-established rates. Medical expenses will be covered up to the maximum coverage for each benefit. Payment of medical fees will be covered up to two (2) times the value of the Bolivian “Arancel Medico.” Flexibility shall prevail during particular cases when the medical fees are more than two (2) times the Bolivian “Arancel Medico.”

Optional Stand-By Policy. A stand-by policy to cover treatment and/or medical expenses for employees and/or covered family members up to four (4) times is established for three percent (3%) of the insured group, to provide coverage under Family Medical Assistance for any disease that exceeds the maximum insured capital. Premium payments for the optional stand-by policy will be done in accordance with the following schedule: US$800.00 for the 1st. time; US$1,200.00 for the 2nd time; US$1,600.00 for the 3rd time; and US$2,000.00 for the 4th time.

Should a stand-by policy be required more than once to cover treatment and/or medical expenses for the same employee and/or family member, the coverage shall be for the same illness and or medical treatment or others, as necessary.

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 will be made for elective cosmetic surgery, except for: Repair of accidental injuries; correction of congenital anomalies shall be covered only when they constitute a danger for the individual’s health; and reconstruction of breasts that were surgically removed.

Spa cures; rejuvenation cures; massage; exercise therapy; long term rehabilitative therapy; 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 will be made for expenses that will be reimbursed or paid directly under a host country medical program, the U.S. workers’ compensation program, or any Bolivia LE Staff workers’ compensation program.

No reimbursement will be made 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; or a self-inflicted wound; or service in the armed forces of any country, unless the individual and/or covered family member is officially assigned to the military or pre-military service.

No reimbursement will be made for expenses incurred after an employee leaves the service of the U.S. Mission, except in the case of retired employees who elect to continue coverage.

C.1.3 Eligible Participants

C.1.3.1 Eligible Employees - The employees eligible for the health insurance services include the following:

C.1.3.1.1 All current active employees of the United States Government, employed within the geographic boundaries of Bolivia paid under the Local Compensation Plan, and certified by the Contracting Officer. Covered employees include:

C.1.3.1.2. Locally Employees Staff (LES) employed under non-temporary direct hire appointments (full time and part time), Personal Services Agreements (PSAs) and Personal Services Contracts (PSCs);

C.1.3.1.3. Locally hired U.S. citizens employed under direct hire appointments, PSAs, and PSCs.

C.1.3.2 Location of Employment

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

· Department of State – DOS (ICASS, PROG, PAS, NAS and SY)

· Agency for International Development – AID

· Military Group – MILGP

· Peace Corp – PC

· Department of Defense / Defense Attaché Office – DOD/DAO

· Animal and Plant Health Inspection Service – APHIS

C.1.3.3 Participants Covered Under a Rider

C.1.3.3.1 All current active employees of the Chief of Mission and the Deputy Chief of Mission assigned to their respective official Government residences and paid under an Official Residence Employees (ORE) account (see separate rider, Exhibit B). All costs for ORE employees are the responsibility of the employing officer, not the U.S. Government.

C.1.3.3.2 Reserved.

C.1.4 Individuals Not Eligible for Coverage

Individuals not eligible for coverage under this contract are non-personal services contract personnel and their employees; employees working on a temporary basis; employees with an intermittent, seasonal, or WAE (When Actually Employed) schedule; employees of USAID institutional contractors: Peace Corps personal services contractors as indicated in MS 743, and any other individual not falling within one of the categories of employees described in this clause.

C.1.5. Other Eligible Participants

The following additional categories of persons are covered by this insurance:

Expenses incurred by an enrolled employee's eligible dependents are covered under this plan. For the purposes of this plan, an employee's dependents are defined as the employee's spouse (limit one) or permanent companion, and each unmarried, economically dependent child. 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 calendar year in which the child turns age 25. There is no age limit for an eligible child who is physically or mentally handicapped so as to be unable to live independently. There is no limit on the number of children covered per employee. Parents, grandparents, siblings, and other relatives are not eligible dependents.

Retired Employees. Employees who were covered under the medical insurance plan at the time of retirement may elect to continue coverage for themselves and their dependents after retirement. However, enrollment and total charges of premium costs and others, will be the retired employees' responsibility.

C.1.6. Eligibility

C.1.6.1. Term of Eligibility and Effective Date

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 be enrolled upon entering on duty with the United States Government. An employee is considered active ("on the rolls") whenever such employee is on approved leave, whether paid or unpaid.

During a period of Leave Without Pay or unpaid leave that is one pay period or less, coverage under the insurance contract will continue. The USG will pay the total premium cost to the contractor. The employee’s share of the premium will be collected through payroll deduction in that or the subsequent pay period.

C.1.6.2. 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 (beyond one pay period) of Leave Without Pay or unpaid leave, 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 that employee prefers not to pay the premium.

C.1.7. Brochure Requirement.

C.1.7.1. The contractor shall provide a document (brochure/pamphlet/other written document) in Spanish that sets forth a complete listing of the health insurance benefits to be provided under this contract. This brochure shall be provided in sufficient quantities so that each covered employee receives a copy. The contractor shall furnish all copies of the brochures to the COR, who will ensure that appropriate distribution is made.

C.1.7.2. The contractor shall provide the document described in C.1.7.1 to the COR not later than 60 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.1.7.3. The contractor assumes full responsibility for ensuring that the document described in C.1.7.1 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.

PART II GROUP LIFE INSURANCE

C.2.0 GROUP LIFE INSURANCE

(RESERVED)

C.3.0 DEFINITIONS

FMO The Financial Management Officer (FMO) or the paying office for all U.S. Government Agencies except AID.

COR Contracting Officer's Representative (Human Resources Staff at post).

Contributory Insurance for which the employee contributes toward the premium.

Dependent The Spouse or permanent companion of the employee. Unmarried children of the employee, beginning at birth until their twenty fifth (25th) birthday.

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.

Employee An individual employed by the U.S. Government, under a direct-hire appointment, personal services contract, or personal services agreement, as further defined in Section C.1.3 for health insurance and C.2.3 for life insurance. This may also include ORE Staff, EAE and Peace Corp PSCs, if this category of individual is listed as participating under a rider in C.1.3.3 for health insurance and C.2.3.3 or life insurance.

Employer The United States Government or in the case of ORE, the Chief of Mission/Deputy Chief of Mission, respectively.

GSO General Services Officer in charge of the General Services Office at post. This officer is usually the Contracting Officer for this contract.

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.

Maximum Benefit The total amount that will be paid to any one covered individual for covered medical expenses or life insurance/disability benefit.

Customary and Reasonable Treatment - A diagnostic test or medical treatment which is usually performed in the community where the individual is being treated.

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.

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

SECTION D

PACKAGING AND MARKING

(RESERVED)

SECTION E

INSPECTION AND ACCEPTANCE

E.1. 52.2522 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

This contract incorporates the following clauses by reference, with the same force and effect as if they were given in full text. Upon request, the Contracting Officer will make their full text available. Also, the full text of a clause may be accessed electronically at this address:

http://acqusition.gov/far/index.html or, http://farsite.hill.af.mil/search.htm

These addresses are subject to change. If the Federal Acquisition Regulation (FAR) is not available at the locations indicated above, use the Dept. of State Acquisition Website at http://www.statebuy.state.gov to see the links to the FAR. You may also use a network “search engine” (e.g., Yahoo, Excite, Alta Vista, etc.) to obtain the latest location of the most current FAR.

FEDERAL ACQUISITION REGULATION (48 CFR CH. 1)

52.246-4 Inspection of Services - Fixed Price (AUG 1996)

E.2. 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 Government, is responsible for management and quality control to meet the terms of the contract. The role of the Government is to conduct quality assurance to ensure that contract standards are achieved.

Services.

Performs all the insurance services set forth in the performance work statement (PWS)

C.1.0 thru C.3.0

All required services are performed and no more than three (3) customer complaint is received per month.

E.2.1 Surveillance. The COR will receive and document all complaints from Government personnel regarding the services provided. If appropriate, the COR will send the complaints to the Contractor for corrective action.

E.2.2 Standard. The performance standard is that the Government receives no more than three (3) customer complaints 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.

E.2.3 Procedures

(a) If any Government personnel observe unacceptable services, either incomplete work or required services not being performed, they should 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, orally notify the Contractor of any valid complaints.

(f) If the Contractor disagrees with the complaint and challenges the validity of the complaint, the Contractor will notify the COR. 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 complaint.

(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.

SECTION F

DELIVERIES OR PERFORMANCE

F.1. 52.2522 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

This contract incorporates the following clauses by reference, with the same force and effect as if they were given in full text. Upon request, the Contracting Officer will make their full text available. Also, the full text of a clause may be accessed electronically at this address:

http://acqusition.gov/far/index.html or, http://farsite.hill.af.mil/search.htm

These addresses are subject to change. If the Federal Acquisition Regulation (FAR) is not available at the locations indicated above, use the Dept. of State Acquisition Website at http://www.statebuy.state.gov to see the links to the FAR. You may also use a network “search engine” (e.g., Yahoo, Excite, Alta Vista, etc.) to obtain the latest location of the most current FAR.

FEDERAL ACQUISITION REGULATION (48 CFR CH. 1)

52.242-15 Stop Work Order (AUG 1989) 52.242-17 Government Delay of Work (APR 1984)

F.2 PERIOD OF PERFORMANCE. The performance period of this contract is one year beginning on June 1st, 2012 with four one-year options to renew.

F.3 OPTIONS

(a) The Government may extend this contract in accordance with the option clause at Section I, clause I.2, FAR Clauses Incorporated by Full Text (FAR 52.217-9, Option to Extend the Term of the Contract), which also specifies the total potential duration of the contract.

(b) The Government may exercise the option set forth at Section I, "FAR 52.217-8, Option to Extend Services".

F.4 REPORTS AND OTHER DELIVERABLES

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

U.S. Embassy Human Resources Office

Av. Arce # 2780, San Jorge La Paz, Bolivia

SECTION G

CONTRACT ADMINISTRATION DATA

G.1. 652.242-70 CONTRACTING OFFICER’S REPRESENTATIVE (COR) (AUG 1999)

(a) The Contracting Officer may designate in writing one Government employee, by name or position title, to take action for the Contracting Officer under this contract. This designee shall be identified as a Contracting Officer’s Representative (COR). Such designation shall specify the scope and limitations of the authority so delegated; provided, that the designee shall not change the terms or conditions of the contract, unless the COR is a warranted Contracting Officer and this authority is delegated in the designation.

(b) The COR for this contract is Ms. Luz Karina Romero Jaldin, from the Human Resources Office.

G.2 COR DUTIES

G.2.1 The COR is responsible for inspection and acceptance of services. These duties include review of Contractor invoices, including the supporting documentation required by the contract. The COR may provide technical advice, substantive guidance, inspections, invoice approval, and other purposes as deemed necessary under the contract.

G.2.2 In addition, the COR shall maintain updated list of employees and dependents insured, which will supersede the initial list provided under this contract and as reported to the insurer without prejudice to the ineligibility clause.

G.2.3. The COR has the additional responsibility of maintaining the eligible listing of employees and dependents for insurance coverage.

G.2.4 The COR may not change the terms and conditions of the contract. While the COR is authorized to provide the Contractor with updated listings of eligible employees and dependents, only the Contracting Officer may modify existing task orders or issue new task orders, reflecting these changes, since only the Contracting Officer can obligate funding and commit the Government.

G.3. Payment shall be made in United States Dollars (US$). Payment of insurance benefits and reimbursement claims by the Contractor to the claimant shall be made in Bolivianos.

G.4 SUBMISSION OF INVOICES AND PAYMENT

G.4.1. Invoices for U.S. Government employees shall be submitted in an original and one (1) copy to the following address (designated billing office only for the purpose of submitting invoices):

United States Embassy, Financial Management Office, Av. Arce # 2780 - San Jorge, La Paz, Bolivia.

G.4.2. Frequency of Payments. All funds under this contract will be obligated by issuance of task orders, as described in H.3. Each task order will fund a specific period of time and number of employees, and the task orders will be issued at the frequency described in H.3. Contractor may submit invoices semi-annually for payment to be made at the beginning of the month for which insurance coverage is provided in accordance with FAR 32.404.\

G.4.3. U.S. Government Employees. The Government shall make payments directly to the contractor for all Government employees, whether or not the employee is contributing to the premium amount.

G.4.4 ORE Staff. The Chief of Mission and/or Deputy Chief of Mission will make payment directly to the contractor for the entire premium amount of the ORE staff, whether or not the ORE employee is contributing to the premium amount.

G.4.5. Reserved.

G.5 REFUNDS TO THE GOVERNMENT

If at any time during performance of the contract the Government finds that the contractor has been overpaid because the number of employees and/or dependents covered has decreased, the Contracting Officer may either allow that overpayment to be credited to the Government’s account or require that the contractor refund the overpayment. If the Contracting Officer requests a refund, the contractor shall make that refund to the Government within ten calendar days of receipt of the request.

G.6 The contractor shall show Value Added Tax (VAT-IVA) as a separate item on invoices submitted for payment.

Note: U.S. Government offices/agencies, such as STATE, AID, and others, shall independently process payment of premium rates due to the Contractor.

SECTION H

SPECIAL CONTRACT REQUIREMENTS

H.1 SECURITY. On occasion, a Contractor employee may require entry into U.S. Government-owned or -operated facilities. If so, the Contractor should be prepared to provide the necessary identification to permit escorted access within that facility.

H.2 STANDARDS OF CONDUCT. The Contractor shall maintain satisfactory standards of employee competency, conduct, cleanliness, appearance, and integrity and shall be responsible for taking such disciplinary action with respect to employees as may be necessary. Each Contractor employee is to adhere to standards that reflect credit on themselves, their employer, and the United States Government.

H.3 ORDERING PROCEDURES. The Government will issue a task order as soon as possible after contract award to identify all employees to be covered by the insurance described in this contract and the coverage selected by each employee, including dependents to be covered. The COR will make subsequent additions or deletions to this list in writing and provide the revised list to the Contractor. All such revisions shall be consolidated, and a new or modified task order will be issued by the Contracting Officer. If any changes have been made to the coverage listing, the Government anticipates issuance of a new task order on a semi-annual basis (6 months). This new task order will include all changes made since the previous task order was issued and will include any increase or decrease in necessary funding. The changes to the list of eligible individuals will supersede the initial list provided under prior task orders without prejudice to the ineligibility clause. Task orders will indicate the effective date of employment, for purposes of calculating the premium due.

H.3.1. The ORE staff, under separate riders is not included under the task orders issued by the Contracting Officer. Because their coverage is under a rider, their employer is responsible for directly interacting with the contractor to order any coverage for their employees. When contacted by the employer, the contractor shall advise the employer of the paperwork and payment that will be necessary to order coverage for the identified individuals. Because more than one employer may have ORE staff, the contractor may be contacted by more than one employer (typically the Chief of Mission and Deputy Chief of Mission).

H.4. CONTRACTOR RESPONSIBILITY IN CLAIMS AND REIMBURSEMENT TO CLAIMANTS

(1) The Contractor shall maintain medical insurance files for each covered employee and each covered dependent 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 person reimbursement ceiling.

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

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

(4) The Contractor shall send employee claim reimbursement checks to employees not later than two weeks fifteen (15) calendar days after a claim is submitted.

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

(1) All medical claims shall be submitted directly to the Contractor by employees, through a Representative of the Contractor working at the Chancery and AID buildings and regional offices of the contractor in Cochabamba, Santa Cruz, and Trinidad. The claims shall be received and processed each Tuesday and Thursday at the Chancery building and each Wednesday and Friday at the AID building and regional offices throughout the week.

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

(3) The contractor shall settle the claims no later than two weeks (fourteen -14 calendar days), from the date the claim is submitted to the Contractor.

(4) Settlement shall be by issuance of checks in the name of the employee for each claim submitted in excess of US$150.00 (or its equivalent in Bolivianos). Each check shall be accompanied by a form providing details of the amount reimbursed with an explanation of deductions, if any.

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

(c) Reserved.

H.5. REPORT REQUIREMENTS. The Contractor shall provide the following reports monthly. All reports must be received by the COR no later than the 10th day of each month. These reports shall report on the previous month's activities.

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

H.6. MISCELLANEOUS CONTRACTOR REQUIREMENTS

H.6.1.General. The Contractor shall take all such steps as are necessary, and obtain and pay for all permits, taxes and fees as are required by Bolivian government to establish and/or operate a commercial venture locally. A contract with the U.S. Government conveys no special privileges or immunities to the Contractor. The Contractor is an independent commercial concern and not a part of the U.S. mission. The Contractor's employees are not U.S. Government employees. Registration of this contract with the Bolivian government, if required by law, will be the sole responsibility of the Contractor, and any fees, taxes, or other duties shall be payable by the Contractor without recourse to the Government of the amounts thereof.

H.6.2. Licenses and Local Laws. The Contractor shall possess all permits, licenses, and any other appointments required for the prosecution of work under this contract, all at no additional cost to the Government. The Contractor shall perform this contract in accordance with local laws.

H.7 Erroneous Payments. If the Government becomes eligible for a refund of payment because of erroneous overpayment or other cause, the Contractor shall refund the amounts or use them to offset future payments owed by the Government, whichever the Government prefers. The Contractor shall refund any refunds not complete or discovered after the completion date of this contract.

H.8 Requiring Activity. The requiring activity under this contract is the U.S. Embassy in Bolivia.

SECTION I

CONTRACT CLAUSES

I.1. 52.2522 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

This contract incorporates the following clauses by reference, with the same force and effect as if they were given in full text. Upon request, the Contracting Officer will make their full text available. Also, the full text of a clause may be accessed electronically at this address:

http://acqusition.gov/far/index.html or, http://farsite.hill.af.mil/search.htm

These addresses are subject to change. If the Federal Acquisition Regulation (FAR) is not available at the locations indicated above, use the Dept. of State Acquisition Website at http://www.statebuy.gov/home.htm to see the links to the FAR. You may also use a network “search engine” (e.g., Yahoo, Excite, Alta Vista, etc.) to obtain the latest location of the most current FAR.

FEDERAL ACQUISITION REGULATION (48 CFR CH. 1)