Cotonou_Health_and_Life_Ins_-_Sol_Approved.pdf

March 24, 2017

American Embassy Cotonou

Marina Avenue

01 BP 2012

Cotonou, Benin

Dear Prospective Offeror:

SUBJECT: Solicitation Number SBN150-17-R-0001, Health and Life Insurance Services.

The Embassy of the United States of America invites you to submit a proposal for customized Direct

Health and Life Insurance Services for the locally hired staff of the Mission.

The Embassy intends to conduct a pre-proposal conference, and all prospective offerors who have received a solicitation package are invited to attend. See Section L of the attached Request for Proposals

(RFP).

Your proposal must be submitted in a sealed envelope marked "Proposal Enclosed" to Sarah Kahnt, General Services Office, Marina Avenue, on or before 10:00am local time on April 28, 2017. This opportunity allows for electronics response at KahntSE@state.gov. Please submit your offer prior to the response date and time. No proposal will be accepted after this time.

In order for a proposal to be considered, you must also complete and submit the following:

1. SF-33

2. Section B, Pricing Schedule

3. Section B, Retention Amounts in B.3 and B.7

4. Section K, Representations and Certifications;

5. Additional information as required in Section L.

All contractors have to be registered in the SAM (System for Award Management) Database https://www.sam.gov prior to contract award pursuant to FAR provision 52.204-7. Therefore prospective offerors are encouraged to register prior to the submittal of proposals.

Direct any questions regarding this solicitation to Ayawo Agboto by letter or by telephone at

+22921367977 during regular business hours.

Please note: Proposals that contain more benefits (even if there is no increase in cost) or fewer benefits than those stated in the solicitation may be deemed technically unacceptable.

The U.S. Government intends to award a contract to the responsible company submitting an acceptable offer at the lowest price. We intend to award a contract based on initial proposals, without holding discussions, although we may hold discussions with companies in the competitive range if there is a need to do so.

Sincerely, Sarah E Kahnt

Contracting Officer https://www.sam.gov/

SECTION A - MODEL CONTRACT

SOLICITATION, OFFER AND AWARD

1. THIS CONTRACT IS A RATED ORDER

UNDER DPAS (15 CFR 350)

RATING PAGE OF PAGES

1 | 72

2. CONTRACT (Proc. Inst. Ident.) NO.

3. SOLICITATION NO.

SBN150-17-R-0001

4. TYPE OF SOLICITATION

[ ] SEALED BID (IFB)

[x] NEGOTIATED (RFP)

5. DATE ISSUED

03-24-2017

6. REQUISITION/PURCHASE NO.

7. ISSUED BY CODE 8. ADDRESS OFFER TO (If other than item 7)

American Embassy Cotonou

Marina Avenue

Phone: +229-21-300650 Fax:

General Services Officer

01 BP 2012, Cotonou Benin

COTONOUGSOBIDS@STATE.GOV

NOTE: In sealed bid solicitation "offer" and "offeror” mean "bid" and "bidder".

SOLICITATION

9. Sealed offers in original and 03 copies for furnishing the supplies or services in the Schedule will be received at the place specified, in the depository located in

Cotonou, Marina Avenue 01 BP 2012 RP until 10:00AM local time on 04-28-2017.

(hour) (date)

CAUTION - LATE Submissions, Modifications, and Withdrawals: See Section L. Provision No. 52.215-1. All offers are subject to all terms and conditions contained in this solicitation.

10. FOR

INFORMATION

CALL:

A. NAME

Ayawo Agboto

B. TELEPHONE (NO COLLECT

CALLS)

AREA CODE NUMBER EXT

+229 21 36 7977

C. E-MAIL ADDRESS

agbotoa@state.gov

11. TABLE OF CONTENTS

(x) SEC. DESCRIPTION PAGE(S) (x) SEC. DESCRIPTION PAGE(S)

PART I - THE SCHEDULE PART II - CONTRACT CLAUSES

X A SOLICITATION/CONTRACT FORM 1 X I CONTRACT CLAUSES 36 - 46

X B SUPPLIES OR SERVICE AND PRICES/COSTS 2 - 13 PART III - LIST OF DOCUMENTS, EXHIBITS, AND OTHER ATTACH.

X C DESCRIPTION/SPECS/WORK STATEMENT 14 - 24 X J LIST OF ATTACHMENTS 47 - 49

X D PACKAGING AND MARKETING 25 PART IV - REPRESENTATIONS AND INSTRUCTIONS

X E INSPECTION AND ACCEPTANCE 26 - 27 X K REPRESENTATIONS, CERTIFICATIONS, AND

X F DELIVERIES OR PERFORMANCE 28 - 29 OTHER STATEMENTS OF OFFERORS 50 - 61

X G CONTRACT ADMINISTRATION 39 - 31 X L INSTRS., COND., AND NOTICES TO OFFERORS 62 - 69

X H SPECIAL CONTRACT REQUIREMENTS 32- 35 X M EVALUATION FACTORS FOR AWARD 70 - 72

OFFER (Must be fully completed by offeror) NOTE: ITEM 12 does not apply if the solicitation includes the provisions at 52.214-16, Minimum Bid Acceptance Period.

12. In compliance with the above, the undersigned agrees, if this offer is accepted within calendar days (120 calendar days unless a different period is inserted by the offer) from the date for receipt of offers specified above, to furnish any or all items upon which prices are offered at the price set opposite each item, delivered at the designated point(s), within the time specified in the schedule.

13. DISCOUNT FOR PROMPT PAYMENT SEE 14

(See section I, Clause No 52.232-8)

10 CALENDAR

DAYS

20 CALENDAR DAYS

30 CALENDAR

DAYS

CALENDAR DAYS

14. ACKNOWLEDGMENT OF

AMENDMENTS

AMENDMENT NO. DATE AMENDMENT NO. DATE

(The offeror acknowledges receipt of amendments to the solicitation and related documents ) numbered and dated:

15A. NAME CODE FACILITY 16. NAME AND TITLE OF PERSON AUTHORIZED

AND

ADDRESS

OF

OFFEROR

TO SIGN OFFER (Type or print)

15B. TELEPHONE NO. (Include area code)

15C. CHECK IF REMITTANCE

ADDRESS [ ] IS DIFFERENT FROM

ABOVE - ENTER SUCH ADDRESS

17. SIGNATURE 18. OFFER DATE

AWARD (To be completed by Government)

19. ACCEPTED AS TO ITEM NUMBERED

20. AMOUNT 21. ACCOUNTING AND APPROPRIATION

22. AUTHORITY FOR USING OTHER THAN FULL AND OPEN COMPETITION:

[ ] 10 U.S.C. 2304(c)( ) [ ] 41 U.S.C. 253(c)( )

23. SUBMIT INVOICES TO ADDRESS SHOWN

IN

(4 copies unless otherwise specified)

ITEM

24. ADMINISTRATION BY (If other than Item 7)

CODE

25. PAYMENT WILL BE MADE BY CODE

26. NAME OF CONTRACTING OFFICER (Type or print)

27. UNITED STATES OF AMERICA

(Signature of Contracting Officer)

28. AWARD DATE

IMPORTANT - Award will be made on this form, or on the Standard Form 26, or by other authorized official written notice.

SECTION B

PART I: PRICE - HEALTH INSURANCE

B.1. HEALTH INSURANCE SERVICES

The Contractor shall provide the Health Insurance services to employees of the Government of the United States of America in Cotonou, Benin as described in Section C. The groups of employees who shall be provided this insurance are listed in C.1 (medical) and C.2 (life). This insurance shall be provided in accordance with Section C.

B.1.1. Official Residence Expense (ORE) Staff are included under this contract only as a rider;

the Contractor shall bill the Chief of Mission and Deputy Chief of Mission (for ORE Staff) at the rates specified below. See Section G for billing procedures.

B.2. PRICES

The prices are stated in _______________ currency (offeror to identify currency.)

All local offerors shall offer in XOF, CFA Francs.

B.2.1 VALUE ADDED TAX.

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

B.2.2 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:

Category

Estimated Number of Employees Rate per Employee Bi-Weekly Total

a. Single Employees ( Self Only) 20

b. Family Plan 156

Bi-Weekly Rates per Employee

B.2.3. Base Year of Contract

c. Subtotal (a + b)

d. Total Price for Base Year (c x 26)

Category

Estimated Number of Employees Rate per Employee Bi-Weekly Total

a. Single Employees ( Self Only) 20

b. Family Plan 156

Bi-Weekly Rates per Employee

B.2.5. Second Option Year of Contract

c. Subtotal (a + b)

d. Total Price for Second Option Year (c x 26)

Category

Estimated Number of Employees Rate per Employee Bi-Weekly Total

a. Single Employees ( Self Only) 20

b. Family Plan 156

Bi-Weekly Rates per Employee

B.2.4. First Option Year of Contract

c. Subtotal (a + b)

d. Total Price for First Option Year (c x 26)

Category

Estimated Number of Employees Rate per Employee Bi-Weekly Total

a. Single Employees ( Self Only) 20

b. Family Plan 156

Bi-Weekly Rates per Employee

B.2.7. Fourth Option Year of Contract

c. Subtotal (a + b)

d. Total Price for Fourth Option Year (c x 26)

Category

Estimated Number of Employees Rate per Employee Bi-Weekly Total

a. Single Employees ( Self Only) 20

b. Family Plan 156

Bi-Weekly Rates per Employee

B.2.6. Third Option Year of Contract

c. Subtotal (a + b)

d. Total Price for Third Option Year (c x 26)

B.2.8. Grand Total of Base plus All Option Years

Base Year Total

First Option Year Total

Second Option Year Total

Third Option Year Total

Fourth Option Year Total

Grand Total of Base plus All 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 bi-weekly 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 Bi-Weekly Retention Amounts per separate premium paid per single employee and per family plan.

Period of Performance Single Employees (Self Only) Family Plan

Base Period

First Option Year

Second Option Year

Third Option Year

Fourth Option Year

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(s) covered by this contract, and it specifically excludes all riders in B.1.1. 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. Adjustments are not retroactive to previous contract terms.

Before any such adjustment is made, the Contractor agrees to provide the Government a balance sheet showing three main components for the time period: (1) receipts (premiums received) minus the retention amount, (2) number of insurance plans and (3) claims paid. This information shall be provided per type of premium, i.e. per line item. The retention amount is not subject to adjustment. The Government reserves the right to have an independent third party review the balance sheet and claims and make recommendations regarding the appropriateness of the requested adjustment. Any adjustment shall be subject to mutual agreement of the parties and shall result in a written modification to the contract. Mutually agreed to adjustments shall be effective thirty days after complete information is received by the Government. Any failure to reach agreement under this clause shall be subject to the procedures in the Disputes clause.

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.

PART II: PRICE - GROUP LIFE INSURANCE

B.5. GROUP LIFE INSURANCE SERVICES

The Contractor shall provide the Group Life Insurance services described herein to employees of the Government of the United States of America in Cotonou, Benin. The groups of employees who shall be provided this insurance are listed in C.2.3. This insurance shall be provided in accordance with Section C.

B.5.1. Official Residence Expense (ORE) Staff are included under this contract only as a rider;

the Contractor shall bill the Chief of Mission and Deputy Chief of Mission (for ORE Staff) at the rates specified below. See Section G for billing procedures.

B.6. GROUP LIFE INSURANCE RATES

This is a fixed-price with economic-price- adjustment-requirements type contract under which the Government will issue firm-fixed price task orders. The fixed prices/premium rates are stated in _____________ (Offeror to identify currency) per one thousand of salary to provide life insurance, accidental death and dismemberment and partial and total disability coverage are as follows:

Type of Insurance

Premium

(per 1,000 of Salary)

Estimated Payroll

(Bi-Weekly in Thousands) Bi-Weekly Total

a. Basic Life 64,968

b. Accidental Death & Dismemberment 64,968

c. Partial & Total Disability Coverage 64,968

Bi-Weekly Rates per Employee

B.6.1. Base Year of Contract

d. Subtotal (a + b + c)

e. Total Price for Base Year (d x 26)

(per 1,000 of Salary)

Estimated Payroll

(Bi-Weekly in Thousands) Bi-Weekly Total

a. Basic Life 70,270

b. Accidental Death & Dismemberment 70,270

c. Partial & Total Disability Coverage 70,270

Bi-Weekly Rates per Employee

B.6.3. Second Option Year of Contract

d. Subtotal (a + b + c)

e. Total Price for Second Option Year (d x 26)

Type of Insurance

Premium

(per 1,000 of Salary)

Estimated Payroll

(Bi-Weekly in Thousands) Bi-Weekly Total

a. Basic Life 67,567

b. Accidental Death & Dismemberment 67,567

c. Partial & Total Disability Coverage 67,567

Bi-Weekly Rates per Employee

B.6.2. First Option Year of Contract

e. Total Price for First Option Year (d x 26)

(per 1,000 of Salary)

Estimated Payroll

(Bi-Weekly in Thousands) Bi-Weekly Total

a. Basic Life 76,004

b. Accidental Death & Dismemberment 76,004

c. Partial & Total Disability Coverage 76,004

Bi-Weekly Rates per Employee

B.6.5. Fourth Option Year of Contract

d. Subtotal (a + b + c)

e. Total Price for Fourth Option Year (d x 26)

Type of Insurance

Premium

(per 1,000 of Salary)

Estimated Payroll

(Bi-Weekly in Thousands) Bi-Weekly Total

a. Basic Life 73,081

b. Accidental Death & Dismemberment 73,081

c. Partial & Total Disability Coverage 73,081

Bi-Weekly Rates per Employee

B.6.4. Third Option Year of Contract

e. Total Price for Third Option Year (d x 26)

B.6.6. Grand Total of Base plus All Option Years

Base Year Total

First Option Year Total

Second Option Year Total

Third Option Year Total

Fourth Option Year Total

Grand Total of Base plus All Option Years

B.7 ADMINISTRATIVE RETENTION AMOUNTS

B.7.1 If the Contractor requests a price adjustment under B.8 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.6. 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 claimant.

B.7.2 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.7.2 Retention Amounts per Separate Premium Paid per Employee:

Period of Performance Basic Life

Accidental Death and

Dismemberment

Partial and Total

Disability Coverage

Base Period

First Option Year

Second Option Year

Third Option Year

Fourth Option Year

B.8 ECONOMIC PRICE ADJUSTMENT (EPA)-LIFE INSURANCE PREMIUMS

B.8.1. Premium Adjustment Based on Experience: For life insurance, prices may be adjusted upward or downward based on the experience rating of the Mission(s) covered by this contract, and it specifically excludes all riders in B.1.1. 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. Adjustments are not retroactive to previous contract terms.

Before any such adjustment is made, the Contractor agrees to provide the Government a balance sheet showing three main components for the time period: (1) receipts (premiums received) minus the retention amount, (2) number of insurance plans and (3) claims paid. The information shall be provided per type of premium, i.e. per line item. The retention amount is not subject to adjustment. The Government reserves the right to select an independent third party to review the balance sheet and claims and make recommendations regarding the appropriateness of the requested adjustment. Any adjustment shall be subject to mutual agreement of the parties and shall result in a written modification to the contract. Mutually agreed to adjustments shall be effective thirty days after complete information is received by the Government. Any failure to reach agreement under this clause shall be subject to the procedures in the Disputes clause.

B.8.2. Premium Adjustment Based on Law: 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 rate contracted for herein. 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.

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 in Republic of Benin. The Government has determined that the prevailing practice by employers in Benin 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 USG pays 90% and employee 10%. Health insurance protection will be representative of locally prevailing compensation practice. The specific health benefit coverage under this contract is set forth below.

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

The insurance company will reimburse covered medical expenses incurred, subject to the stated limits. Payment will be made for reasonable and customary expenses of covered benefits. The medical treatment must be prescribed or provided by a physician or nurse licensed in Benin, United States, or in the country in which the treatment or prescription is received.

C.1.1 Employee and Dependent Health Services Benefits

C.1.1.1. Hospitalization: 100% coverage of room and board expenses for a semi-private room. 90% coverage of room and board expenses for a private room, not to exceed

100% of the cost of a semi-private room. 90% coverage of hospital medical expenses including nursing care, operating room expenses, intensive care, and physical therapy. 100% coverage of laboratory tests and x-rays. 90% coverage of ambulance service.

Maximum amount of room and board expenses per day per individual up to 60,000 XOF.

C.1.1.2 Professional Services and Treatment: 90% coverage of doctors’ and surgeons’ fees incurred while hospitalized, at a hospital on an out-patient basis, at a clinic or doctor’s office, or at home. 100% coverage of medical services and expenses when not hospitalized such as laboratory tests and x-rays and routine annual physical examinations. 90% coverage of prescription medicines and inoculations. 90% coverage for physical therapy.

C.1.1.3. Prescription Drugs and Medicines: 90% coverage of expenses when hospitalized, and 90% coverage of expenses when not hospitalized, of the cost of medicines and drugs for which a prescription is legally required. 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 HIV/AIDS coverage (for employees and dependents): 100% coverage of expenses for medications to suppress opportunistic infections, such as tuberculosis and toxoplasmosis for employees who have HIV/AIDS. For employee and employee's covered spouse/partner: 100% coverage for brief courses of anti-retroviral drugs during childbirth to prevent the transmission of HIV to the employee’s child. This expanded coverage generally excludes medications for the long-term suppression of aids through the combination of anti-retroviral drugs at those posts with inadequate local healthcare infrastructures. This expanded coverage does not apply to retired employees.

The maximum limit for expenses reimbursed under section C.1.1.4 is 10,000 USD per individual per contract year.

C.1.1.5 Obstetrical Care: 90% coverage of expenses when hospitalized, and 90% coverage of expenses when not hospitalized, of obstetrical medical care including prenatal and postnatal care. 100% coverage for caesarean deliveries. 90% coverage for miscarriages.

C.1.1.6 Family Planning: Family planning expenses are not covered.

C.1.1.7 Hearing Aids: 40% coverage of the cost of a hearing aid apparatus and related examination. Limited to one apparatus per ear per patient in a three-year period.

C.1.1.8 Optical Care: 90% coverage of expenses for eye examination, treatment, and prescription. 100% coverage for frame up to 70,000 XOF. 80% coverage for lenses, limited to two lenses per patient every 18 months up to 112,900 XOF. No coverage of expenses for nonprescription lenses, or tinting.

C.1.1.9 Dental Care: 80% coverage of expenses for dental services including dentists’ fees, x-rays, examination and treatment, cleaning, fillings, and extractions. 80% coverage of expenses for dental services related to false teeth, crowns, and bridges.

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

C.1.1.10 Psychiatric Treatment: 50% coverage of expenses for psychiatric treatment.

C.1.1.11 Medical Expenses Incurred Out of Country:

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. Covered expenses will be covered at the same percentage rate and subject to the same annual maximum limit as for expenses incurred in country.

C.1.1.12 Transportation for Out of Country Treatment

Transportation for out of country treatment is 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.1.1.13 For Catastrophic Conditions

The annual aggregate maximum shall be 100,000 XOF per covered individual for medical expenses. Catastrophic conditions shall be defined as major medical conditions occurring as a result of a single illness, accident, or closely related set of major illnesses (or conditions relating to a single accident) that exceed the standard maximum coverage limit stated in C.1.1.14 below.

C.1.1.14 Annual Maximum Limit – With the exception of the expenses incurred under paragraph C.1.1.4 above, the insurance company will reimburse covered expenses up to a limit of 13,800,000 XOF per individual per contract year.

The insurance company will reimburse covered expenses described under paragraph

C.1.1.4 of the plan up to a separate limit of 10,000 USD, per individual per contract year.

C.1.2 Health Benefits Conditions and Limitations.

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

C.1.2 Health Benefits Conditions and Limitations

Expenses will not be covered 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 coverage will be made for expenses that will be reimbursed or paid directly under a host country medical program or workers' compensation program; the U.S. workers’ compensation program; or any host country’s workers compensation program.

No coverage 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; a self-inflicted wound; or service in the armed forces of any country.

No coverage 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:

Eligible employees are LE Staff who are:

Working on a full time or part time basis under non-temporary direct hire appointments, personal services agreements, or personal services contracts and paid under the terms of the Local

Compensation Plan. Participation will be voluntary.

C.1.3.2 Participants Covered Under a Rider

Official Residence Expenses (ORE) employees may be covered under a rider to the contract. The employing officer, not the USG, is responsible for the employer’s share of the premium expenses for an ORE.

C.1.3.3 Dependent Coverage

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 legal spouse (limit one) and each unmarried, economically dependent child who primarily resides 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 calendar year in which the child turns age 20, or in the case of a child who is a full-time student, 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.

C.1.3.4 Location of Employment

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

U.S. Government agencies, e.g., Department of State, U.S. Agency for International

Development, Millennium Challenge Corporation, Department of Justice, Peace Corps etc.

C.1.4 Individuals Not Eligible for Coverage

Not eligible are those working under temporary appointments; those working under a PSC or

PSA that is time limited to less than one year; nonpersonal services contract personnel and their employees, supplied by an independent contractor licensed to do business in Benin who provides services to other local organizations as well as to the U.S. Mission; employees of USAID institutional contractors and Peace Corps personal services contractors as indicated in MS 743.

C.1.5 COVERAGE AFTER RETIREMENT

Retirees are not covered.

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 (LWP) 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 (LWP) 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 French 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 30 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

The Government of the United States of America requires group life insurance coverage for its employees in Republic of Benin. The Government has determined that the prevailing practice by employers in Republic of Benin is that group life insurance coverage is representative of locally prevailing compensation practice and that the cost of such insurance protection is usually borne by both the employee and the employer on a basis of U.S. Government pays 70% and employee 30%. Therefore, the Government desires to adopt such locally prevailing practice as part of its compensation plan for its employees. The specific group insurance coverage under this contract is set forth below.

C.2.1. Group Life Insurance Coverage

The amount of group life insurance coverage is as follows:

C.2.1.1 Amount of Employee Life Insurance.

Upon the employee’s natural death, an amount equal to one point seventy five (1.75) times the employee’s annual basic salary will be paid to the employee’s named beneficiaries or estate.

C.2.1.2 Amount of Accidental Death or Work related Death/Disability Coverage.

The employee's named beneficiaries or estate will receive an amount equal to Two (2) times the amount of annual basic salary in the event the employee is accidental killed or has work related death/disability.

C.2.1.3 Partial Disability and Total Disability Coverage

The employee's estate or employee will receive an amount equal to Fifty percent (50%) of the amount of annual basic salary, in the event the employee has total or partial disability.

C.2.1.4 Funeral Benefit

Not applicable.

C.2.2 Life Insurance Benefits Conditions and Limitations

Conditions and limitations on the entitlement to life insurance benefits under this contract are as

C.2.2.1 Employees are covered until age 60.

C.2.2.2 No benefits shall be payable if an employee’s death or other insurance event caused directly or indirectly by war. War shall be defined as declared or non-declared war or any martial operations on invasion, hostile acts of foreign powers, rebellion, riot, civil war, uprising, mutiny, operations by military or usurpatory authorities, martial laws or state of siege or any similar event or reason for declaring martial law or war. A terrorist attack shall not be considered war.

No benefit shall be payable under this contact if the employee’s bodily injuries have been caused directly or indirectly and totally or partially by:

C.2.2.2.1 Violation of law or in resisting detention or arrest.

C.2.2.2.2 Participation in competitions involving the use of wheeled vehicles, horses or water skis.

C.2.2.2.3 An accident resulting from the employee being under the influence of alcohol, drugs or other toxic substance unless administered by a physician. Death as a result of a disease or physical or mental infirmities and medical or surgical treatment thereof (except pyogenic infection due to an accidental cut or wound) shall be considered a natural and not an accidental death. Suicide will not be covered.

C.2.3. Eligible Participants

C.2.3.1 Eligible Employees.

Eligible employees are Locally Employed (LE) Staff who are (1) working on a full-time or part-time basis under non-temporary direct-hire appointments and under personal services agreements/contracts that are not time limited to less than one year and (2) paid under the terms of the Local Compensation Plan.

Employees are covered until age 60.

C.2.3.2 Location of Employment

C.2.3.2 The individuals covered by C.2.3.1 must be employed within the geographic boundaries of Benin by:

Department of State

U.S. Agency for International Development

Millennium Challenge Corporation

Department of Justice

Peace Corps

C.2.3.3 Participants Covered Under a Rider

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 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.2.4 Individuals Not Eligible for Coverage

C.2.4.1. Not eligible are LE Staff working under temporary appointments; those working under a PSA or PSC that is time limited to less than one year; those with a When

Actually Employed (WAE) workweek schedule; non-personal services contract personnel and their employees, supplied by an independent contractor licensed to do business in the Benin who provide services to other local organizations as well as to the U.S. Mission; employees of

USAID institutional contractors; and Peace Corps personal services contractors as indicated in

MS 743. Official Residence Expense (ORE) employees may be covered under a rider to the contract. The employing officer, not the USG, is responsible for the employer's share of the premium costs for an ORE employee.

C.2.4.2 Dependents are not covered. Retirees are not covered.

C.2.5 Eligibility and Effective Date

C.2.5.1. Term of Eligibility and Effective Date

Each current active eligible employee is enrolled for life insurance and disability 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 (LWP) 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.2.5.2. Period of Ineligibility

Employees are not entitled to life insurance and disability benefits hereunder during any period of employment for which premiums are not paid.

During a period of extended (beyond one pay period) of Leave Without Pay

(LWP) or unpaid leave, the employee is responsible for the full cost of the insurance premiums. 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.2.6. Brochure Requirement

C.2.6.1. The Contractor shall provide a document (brochure/pamphlet/other written document) in French that sets forth a complete listing of the life 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.2.6.2. The document described in C.2.7.1 shall be provided to the COR not later than 30 calendar days after date of contract award. The Contractor shall provide additional brochures for new employees within ten days of the COR’s request.

C.2.6.3. The Contractor assumes full responsibility for ensuring that the document described in C.2.7.1 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.

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

Government Agencies, except U.S. AID.

COR Contracting Officer's Representative (COR) is the Human Resources

Officer (HRO) at post.

Contributory Insurance Insurance for which the employee contributes toward the premium.

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

Dependent Health Insurance: an employee's dependents are defined as the employee's legal spouse (limit one) and each unmarried, economically dependent child who primarily resides 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 calendar year in which the child turns age 20, or in the case of a child who is a full-time student, 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

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 (PSC), or personal services agreement (PSA), as further defined in Section C.1.3 for health insurance and C.2.3 for life insurance. This may also include ORE Staff, 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 for 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 (CO) 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.

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

Salary Monthly salary is one-twelve of the employee's annual basic, exclusive of premium pay, allowances, bonuses, or any other separate payments.

C.3.0 DEFINITIONS

SECTION D

PACKAGING AND MARKING

(RESERVED)

SECTION E

INSPECTION AND ACCEPTANCE

E.1. 52.252-2 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://www.acquisition.gov/far/ or http://farsite.hill.af.mil/vffara.htm

These addresses are subject to change. If the Federal Acquisition Regulation (FAR) is not available at the locations indicated above, use the Department of State Acquisition website at http://www.statebuy.state.gov/ to see the links to the FAR. You may also use an internet “search engine” (for example, Google, Yahoo, Excite) to obtain the latest location of the most current

FAR.

The following Federal Acquisition Regulation clause(s) is/are incorporated by reference:

CLAUSE TITLE AND DATE

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.

Performance Objective

PWS

Paragraph Performance Threshold

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 one

(1) 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.

http://www.acquisition.gov/far/ http://farsite.hill.af.mil/vffara.htm http://www.statebuy.state.gov/

E.2.2 Standard. The performance standard is that the Government receives no more than one

(1) customer complaint per month. The COR shall notify the Contracting Officer of the complaints so that the Contracting Officer may take appropriate action to enforce the inspection clause (FAR 52.246-4, Inspection of Services – Fixed Price (AUG 1996) or the appropriate

Inspection of Services clause), if any of the services exceed the standard.

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

http://www.statebuy.state.gov/ to see the links to the FAR. You may also use an internet “search

The following Federal Acquisition Regulation clauses are incorporated by reference:

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 July 1, 2017 with four (4) 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".

http://www.acquisition.gov/far/

F.4 REPORTS AND OTHER DELIVERABLES

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

General Services Office

01 BP 2012 RP

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 the Human Resources Specialist.

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 through the broker, 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 currency stated in B.2 and B.6.

G.4 SUBMISSION OF INVOICES AND PAYMENT

G.4.1. Invoices for U.S. Government employees shall be submitted in an original and three (3) copies to the following address (designated billing office only for the purpose of submitting invoices):

Financial Management Office

01 BP 2012 RP

G.4.2. Frequency of Payments. All funds under this contract will be obligated by issuance of task orders, as described in H.3.