HEALTH AND LIFE INSURANCE Solicitation 1.31.08.doc

June 24, 2009

Dear Prospective Offeror:

SUBJECT: Solicitation Number S-CA5625-08-R-1037 for a Group Health Benefits and Life

Insurance Package

The Embassy of the United States of America invites you to submit a proposal for a customized Group Health Benefits and Life Insurance Package for Employees of the U.S. Embassy Ottawa and seven constituent posts in Halifax, Toronto, Montreal, Quebec City, Winnipeg, Calgary and Vancouver.

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 the Contracting Officer Michael St. Clair at United States Embassy, 207 Bank Street, Suite 418, Ottawa, Ontario, K2P 2N2 on or before August 20, 2009 at 4:00 pm. 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;

3.

Section K, Representations and Certifications;

4.

Important: Offerors must follow instructions for submitting proposals in accordance with Section L.

6.

Please indicate the currency your offer is presented in.

Direct any questions, in writing, regarding this solicitation to Michael St. Clair, Contracting Officer, “stclairm@state.gov” or Lori Fortin, Procurement Agent, “fortinla@state.gov” via letter or email.

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, Michael St. Clair Contracting Officer

UNDER DPAS (15 CFR 350)

1 | 91

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

3. SOLICITATION NO.

S-CA525-09-R-1037

4. TYPE OF SOLICITATION

[ ] SEALED BID (IFB)

[x] NEGOTIATED (RFP)

5. DATE ISSUED

June 24, 2009

6. REQUISITION/PURCHASE NO.

7. ISSUED BY CODE

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

United States Embassy

490 Sussex Drive

Ottawa, Ontario

K1N 1G8

Michael St. Clair United States Embassy 207 Bank Street

Suite 418

Ottawa, Ontario

K2P 2N2

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

SOLICITATION

9. Sealed offers in original and 3 copies for furnishing the supplies or services in the Schedule will be received at the place specified in box 8 above until August 20, 2009 local time 4:00 pm.

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

Michael St. Clair, Contracting Officer

B. TELEPHONE (NO COLLECT CALLS)

613- 688-5250

C. E-MAIL ADDRESS

stclairm@state.gov

11. TABLE OF CONTENTS

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

(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

AWARD (To be completed by Government)

19. ACCEPTED AS TO ITEM NUMBERED

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.

NSN 7540-01-152-8064

STANDARD FORM 33 (REV 9-97)

PREVIOUS EDITION NOT USABLE

Prescribed by GSA

SECTION B

PRICING

PART I

PRICE- HEALTH AND DENTAL INSURANCE

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 Canada as described in Section C and the Exhibits in Section J. The groups of employees who shall be provided this insurance are listed in C.1.5. This insurance shall be provided in accordance with Section C and the Exhibits in Section J.

Early retirees are eligible for health services only (exclusive of dental benefits) between the ages of 55 to 65 years. This applies to current employees as of the effective date of the contract. It does not apply to new hires.

B.1.1.

Official Residence Employees (ORE) are included under this contract only as a rider; the Contractor shall bill the Chief of Mission, Deputy Chief of Mission and Consuls General (for ORE Staff) separately, at the rates specified below. See Section G for billing procedures.

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 in Canadian dollars for the health insurance services as specified in Section C and Exhibit A of Section J are as follows:

B.2.1.

BASE YEAR OF CONTRACT (Health Insurance):

Bi-Weekly Rates per Employee:

Single Employees (Self only)

Family Plan

SUBTOTAL

Bi-Weekly Rates per Early Retirees:

Family Plan

SUBTOTAL

Bi-Weekly Rates per ORE Employees:

Family Plan

SUBTOTAL

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

B.2.2.

FIRST OPTION YEAR OF THE CONTRACT (Health Insurance):

Family Plan

SUBTOTAL

Family Plan

SUBTOTAL

Family Plan

SUBTOTAL

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

B.2.3.

SECOND OPTION YEAR OF THE CONTRACT (Health Insurance):

Family Plan

SUBTOTAL

Family Plan

SUBTOTAL

Family Plan

SUBTOTAL

Total Price for Option Year 2 (Subtotal x 26): _______

B.2.4.

THIRD OPTION YEAR OF THE CONTRACT (Health Insurance):

Single Employees

(Self only)

Family Plan

SUBTOTAL

Family Plan

SUBTOTAL

Single Employees

Family Plan

SUBTOTAL

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

B.2.5.

FOURTH OPTION YEAR OF THE CONTRACT (Health Insurance):

Single Employees

Family Plan

SUBTOTAL

Family Plan

SUBTOTAL

Single Employees

Family Plan

SUBTOTAL

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

HEALTH INSURANCE - 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 Health Insurance - Retention Amounts per separate premium paid per single employee and per family plan.

(Self Only) Family Plan

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 employees 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.

PRICE – DENTAL

B.5 DENTAL INSURANCE

The Contractor shall provide the Dental Insurance services to employees of the Government of the United States of America in Canada as described in Section C and the Exhibits in Section J. The groups of employees who shall be provided this insurance are listed in C.1.5. This insurance shall be provided in accordance with Section C and the Exhibits in Section J. Early Retirees are not eligible for dental insurance.

B.5.1.

Official Residence Employees (ORE) are included under this contract only as a rider; the Contractor shall bill the Chief of Mission, Deputy Chief of Mission and Consuls General (for ORE Staff) separately, at the rates specified below. See Section G for billing procedures B.6

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 in Canadian dollars for the dental insurance services as specified in Section C and Exhibit A of Section J are as follows:

B.6.1.

BASE YEAR OF CONTRACT (Dental):

Family Plan

SUBTOTAL

Family Plan

SUBTOTAL

B.6.2.

FIRST OPTION YEAR OF THE CONTRACT (Dental):

Family Plan

SUBTOTAL

Family Plan

SUBTOTAL

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

B.6.3.

SECOND OPTION YEAR OF THE CONTRACT (Dental):

Family Plan

SUBTOTAL

Family Plan

SUBTOTAL

Total Price for OptionYear 2 (Subtotal x 26): _______

B.6.4.

THIRD OPTION YEAR OF THE CONTRACT

(Dental):

Single Employees

Family Plan

SUBTOTAL

Single Employees

Family Plan

SUBTOTAL

B.6.5.

FOURTH OPTION YEAR OF THE CONTRACT (Dental):

Single Employees

Family Plan

SUBTOTAL

Single Employees

Family Plan

SUBTOTAL

DENTAL - GRAND TOTAL BASE PERIOD PLUS OPTION YEARS: __________________

B.7

B.7.1 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.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 DENTAL - Retention Amounts per separate premium paid per single employee and per family plan.

(Self Only) Family Plan

Base Period

Option Year 1

Option Year 2

Option Year 3

Option Year 4

B.8.

ECONOMIC PRICE ADJUSTMENT-DENTAL INSURANCE PREMIUMS

B.8.1.

Premium Adjustment based on Experience – For Dental insurance, prices may be adjusted upward or downward based on the experience rating of employees 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.8.2.

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.8.2.1 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.9

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 Canada. 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 and the Exhibits in Section J.

B.9.1.

Official Residence Employees (ORE) are included under this contract only as a rider; the Contractor shall bill the Chief of Mission, Deputy Chief of Mission and Consuls General (for ORE Staff) separately, at the rates specified below. See Section G for billing procedures

B.10

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 in Canadian Dollars per one thousand of salary to provide basic life insurance and accidental death and dismemberment insurance are as follows:

B.10.1.

BASE YEAR OF CONTRACT (Life Insurance):

Basic Life

17,976,658

Basic Life

12,265

Total Price for Base Year for Basic Life: __________x 26 = _____________

Accidental Death & Dismemberment

17,976,658

Accidental Death & Dismemberment

12,265

Total Price for Base Year for AD&D: __________x 26 = _____________ B.10.2.

FIRST OPTION YEAR OF CONTRACT (Life Insurance):

Basic Life

17,976,658

Basic Life

12,265

Total Price for Option Year 1 for Basic Life: __________x 26 = _____________

Accidental Death & Dismemberment

17,976,658

Accidental Death & Dismemberment

12,265

Total Price for Option Year 1 for AD&D: __________x 26 = _____________ B.10.3.

SECOND OPTION YEAR OF CONTRACT (Life Insurance):

Basic Life

17,976,658

Basic Life

12,265

Total Price for Option Year 2 for Basic Life: __________x 26 = _____________

Accidental Death & Dismemberment

17,976,658

Accidental Death & Dismemberment

12,265

Total Price for Option Year 2 for AD&D: __________x 26 = _____________

B.10.4. THIRD OPTION YEAR OF CONTRACT (Life Insurance):

Basic Life

17,976,658

Basic Life

12,265

Total Price for Option Year 3 for Basic Life: __________x 26 = _____________

Accidental Death & Dismemberment

17,976,658

Accidental Death & Dismemberment

12,265

Total Price for Option Year 3 for AD&D: __________x 26 = _____________ B.10.5.

FOURTH OPTION YEAR OF CONTRACT (Life Insurance):

Basic Life

17,976,658

Basic Life

12,265

Total Price for Option Year 4 for Basic Life: __________x 26 = _____________

Accidental Death & Dismemberment

17,976,658

Accidental Death & Dismemberment

12,265

Total Price for Option Year 4 for AD&D: __________x 26 = _____________

LIFE INSURANCE - GRAND TOTAL PRICE FOR ALL YEARS: __________________

B.11

B.11.1 If the Contractor requests a price adjustment under B.12 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.10. 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.11.2 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.11.2 LIFE INSURANCE - Retention Amounts per separate premium paid per employee

Base Period

Option Year 1

Option Year 2

Option Year 3

Option Year 4

B.12

ECONOMIC PRICE ADJUSTMENT-LIFE INSURANCE PREMIUMS

B.12.1.

Premium Adjustment Based on Experience - For life insurance, prices may be adjusted upward or downward based on the experience rating of employees 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 select an independent third party to 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.12.2. 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.

PART III

PRICE - GROUP LONG TERM DISABILITY INSURANCE (LTD)

B.13

GROUP LONG TERM DISABILITY INSURANCE SERVICES.

The Contractor shall provide the Group Long Term Disability Insurance Services described herein to employees of the Government of the United States of America in Canada. 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 and the Exhibits in Section J.

B.13.1. Official Residence Employees (ORE) are included under this contract only as a rider; the Contractor shall bill the Chief of Mission, Deputy Chief of Mission and Consuls General (for ORE Staff) separately, at the rates specified below. See Section G for billing procedures.

B.14

GROUP LONG TERM DISABILITY INSURANCE (LTD)

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 in Canadian dollars] per one thousand of salary to provide partial and total disability coverage are as follows:

B.14.1.

BASE YEAR OF CONTRACT (LTD):

Bi-Weekly Rates:

Category

LTD

Volumes

SUBTOTAL

B.14.2.

FIRST OPTION YEAR OF CONTRACT (LTD):

Category

LTD

SUBTOTAL

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

B.14.3.

SECOND OPTION YEAR OF CONTRACT (LTD):

Category

LTD

SUBTOTAL

Total Price for Option Year 2 (Subtotal x 26): _______

B.14.4.

THIRD OPTION YEAR OF CONTRACT (LTD):

Category

LTD

SUBTOTAL

B.14.5.

FOURTH OPTION YEAR OF CONTRACT (LTD):

Category

LTD

SUBTOTAL

GROUP LONG TERM DISABILITY INSURANCE (LTD) - GRAND TOTAL PRICE FOR ALL YEARS: __________________

B.15

B.15.1 If the Contractor requests a price adjustment under B.16 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.14. 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.15.2 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.15.2 Group Long Term Disability Insurance (LTD) - Retention Amounts per separate premium paid per employee

(Self Only) Family Plan

Base Period

Option Year 1

Option Year 2

Option Year 3

Option Year 4

B.16

ECONOMIC PRICE ADJUSTMENT- GROUP LONG TERM DISABILITY INSURANCE (LTD) PREMIUMS

B.16.1.

Premium Adjustment Based on Experience - Prices for Long Term Disability Insurance may be adjusted upward or downward based on the experience rating of employees covered by this contract. No adjustment will be allowed during the first 12 months of the contract. 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 receipts (premiums received), payments (claims paid), total retention paid (including taxes, commissions, etc.) and the difference between the amounts received and paid. The Government reserves the right to select an independent third party to 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.16.2. 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 & DENTAL INSURANCE

C.1.

HEALTH INSURANCE SERVICES

The Government of the United States of America requires health and dental insurance coverage protection for its employees in Canada as further described in C.1.5. The Government has determined that the prevailing practice by employers in Canada is to provide for their employees health (beyond what is provided by the provincial health care plans) and dental insurance coverage and that the cost of such supplemental insurance protection is usually borne by both the employee and the employer. The Government of the United States of America pays 85% and the employee pays 15% of the health and dental insurance coverage protection premiums. The health and dental insurance coverage protection will be representative of locally prevailing compensation practice as further described in C.1.2. through C.1.4. The specific health insurance and dental coverage under this contract is set forth in Section C and the Exhibits in Section J. The Contractor shall insure that health care under this contract does not exclude HIV/AIDS care.

C.1.1.

EMPLOYEE AND DEPENDENT HEALTH SERVICES BENEFITS.

The maximum health benefits for Employees and their dependents covered by this contract are described below in three categories of participants – Current Embassy Employees, Early Retirees, and ORE Employees. 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 costs) or fewer benefits than stated in the solicitation may be deemed technically unacceptable.

C.1.2.

CURRENT EMPLOYEES

C.1.2.1. HOSPITALIZATION: Upgrade to a semi-private hospital room. Employees will be paid the difference between the public ward allowance under the provincial health care plan and the semi-private charge for each day of confinement in a Licensed Hospital due to injury, disease, illness, mental disorder or pregnancy. Unlimited benefit. Reimbursable at 100%.

C.1.2.2.1 PRESCRIPTION DRUGS: Authorized charges via a pay direct drug card program is reimbursable at 80%. Unlimited benefit. Plan includes any eligible drug if medically necessary and reasonable and customary and not prohibited by a Government Sponsored plan in the province where the employee resides. Nicotine resine products are not covered. Compulsory generic substitution.

C.1.2.2.2 For employees only, 100% reimbursement for medications to suppress opportunistic infections, such as tuberculosis and toxoplasmosis for employees who have HIV/AIDS. For employee and employee’s covered spouse, 100% reimbursement for brief courses of anti-retroviaral 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 infrastructure.

C.1.2.3. MEDI-PACK: Medi-pack covers medically necessary expenses which are reasonable and customary and recommended and authorized by a legally licensed physician or surgeon, and which are not prohibited by provincial government sponsored plans. Benefits cannot exceed the difference between the actual cost of the charges and amounts that employees are entitled to apply for and receive under provincial health care plans. With the exception of the out-of-country expenses, reimbursement is at 80%. Medi-Pack includes:

C.1.2.3.1. Nursing Care: When ordered by a physician or surgeon legally licensed to practice medicine, the services of a registered nurse or registered nurse assistant in the home of the employee up to a maximum of $5,000 per calendar year. Reimbursable at 80%. From January 1st coincident with or next following the employee or the employee’s dependents 65th birthday, the maximum benefit is limited to $25,000 lifetime in all provinces.

C.1.2.3.2. Hospital Expenses and Supplies: Charges incurred for services furnished by a licensed Hospital and supplies which are obtained from an out-patient department of a licensed Hospital or surgical supply company (in the province of residence), while not confined to the Hospital.

C.1.2.3.3. Ambulance: For ambulance or other emergency service used to transport employees and/or their dependents from any place where injury, illness, or any other emergency medical situation occurs to the nearest hospital where adequate treatment can be obtained. Also, transportation from one hospital to another or from a hospital to home. Charges for the cost of one attendant if transportation is not provided via an ambulance. Reimbursable at 80%.

C.1.2.3.4. Aids, services and supplies: Purchase of approved braces, crutches, artificial limbs or eyes and prosthetic devices. An initial breast prosthesis following a mastectomy plus a replacement every two calendar years and two surgical brassieres per calendar year. Rental of a wheelchair, hospital bed or other approved durable equipment for temporary therapeutic use. Oxygen as ordered by a surgeon or physician. A maximum of one pair of custom made orthopedic shoes or orthotics per calendar year as prescribed by a podiatrist or physician. Two pairs of surgical stockings per calendar year. Hair pieces and wigs needed as a result of chemotherapy up to a lifetime maximum of $100.00. A lifetime maximum of $250.00 for wigs purchased due to a total loss of hair from Alopecia Totalis. Hearing aids and repairs to a maximum of $500 in four consecutive years. The purchase of an initial pair of frames and one corrective prosthetic lens for each eye that is prescribed after cataract surgery.

C.1.2.3.5. Accidental Dental: Treatment for an accidental blow to the mouth which is received within 12 months of the injury. Benefit is limited to amounts consistent with the current Dental Association Schedule of Fees for General Practitioners in the province of residence.

C.1.2.3.6. Vision Care: Vision care to a maximum benefit of $250.00 including eye exams, in any 24 consecutive months, reasonable and customary pricing. Reimbursable at 80%. Benefit includes frames, lenses, contact lenses and fitting of such eyewear and corrective laser eye surgery which has been recommended or approved by a legally licensed physician, surgeon, optometrist or ophthalmologist.

C.1.2.3.7. Clinical Psychology: Services of a legally licensed clinical psychologist up to an individual maximum of $1,000.00 per calendar year.

C.1.2.3.8. Diagnostic tests: Diagnostic tests, radium treatments and x-ray examinations, except for dental x-rays that are incurred in the Province or Territory of residence.

C1.2.3.9. Speech Therapy: Services of a qualified speech therapist up to an individual maximum of $1,000 per calendar year.

C.1.2.3.10. Referral Benefits: Services provided in Canada and the United States but outside the province of residence if not available in the province of residence and based on a written referral of a physician or surgeon who regularly attends the employee or dependent in the province of residence. These services must be approved in advance and are subject to a lifetime limit of $10,000:

a) Room and board in a licensed Hospital up to the hospital’s standard ward rate for each day of confinement;

b) Hospital services and supplies furnished by a licensed Hospital; and

c) Diagnosis and treatment by a physician or surgeon legally licensed to practice medicine.

C.1.2.3.11. Travel Assistance Benefit: Reimbursable at 100%. The following required services relating to a medical emergency, while away from the Province or Territory of residence for business or pleasure (but not for Health reasons):

1. Emergency medical assistance

2. Emergency medical payments

3. Telephone interpretation service

4. Medical evacuation

5. Assistance with lost documents or luggage

6. Return of dependent children, or a traveling companion

7. Visit of a family member

8. Transmission and retention of urgent messages

9. Help in contacting the nearest Canadian Embassy or Consulate

10. Assistance to transport remains in the event of death.

11. Return of a vehicle to plan member’s home or nearest rental agency.

C.1.2.3.12. Paramedical Services: Reimbursable at 80%. Laboratory tests and x-ray examinations recommended by a legally licensed chiropractor, osteopath, chiropodist or podiatrist. The maximum amount payable per classification of practitioner is limited to $500.00 per calendar year, per practitioner. Practitioners include Physiotherapists, Chiropractors, Osteopaths, Chiropodists or Podiatrists, Naturopaths, Masseurs and Acupuncturists.

C.1.2.4. Dental: Dental I and II – preventive is reimbursed at 100%, minor dental is reimbursed at 90% to a combined maximum of $1,500. per calendar year. Reimbursement for Dental III- major dental is limited to 50% reimbursement to a maximum of $1,500 per calendar year. Routine Dental exams limited to one per 12 consecutive months and two dental cleanings per 12 consecutive months.

NOTE: Dental I includes diagnostic services, preventive, minor restorative, minor surgical and anesthesia, and additional services.

Dental II includes periodontics, endodontics and major surgery.

Dental III includes dentures, bridgework and major restorative repair.

C.1.3.

EARLY RETIREES

Retirees in all provinces are eligible for the early retiree medical coverage beginning on his/her 55th birthday and ending upon his/her 65th birthday. New early retirees will pay 15% of the monthly premiums. Newly hired employees will not be eligible for early retiree benefits. These changes go into effect on the date the plan is revised and are not retroactive.

C.1.3.1. HOSPITALIZATION: Upgrade to a semi-private hospital room. Employees will be paid the difference between the public ward allowance under the provincial health care plans and the semi-private charge for each day of confinement in a Licensed Hospital due to injury, disease, illness, mental disorder or pregnancy. No deductible. Unlimited benefit. Reimbursable at 100%.

C.1.3.2.1 PRESCRIPTION DRUGS: Authorized charges via a drug card program are reimbursable at 80%. Unlimited benefit. Plan includes any eligible drug if medically necessary and reasonable and customary and is not prohibited by a Government Sponsored plan in the province or territory where the employee resides. Compulsory generic substitution.

C.1.3.2.2 For employees only, 100% reimbursement for medications to suppress opportunistic infections, such as tuberculosis and toxoplasmosis for employees who have HIV/AIDS. For employee and employee’s covered spouse, 100% reimbursement for brief courses of anti-retroviaral 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 infrastructure.

C.1.3.3. MEDI-PACK: Medi-pack covers medically necessary expenses which are reasonable and customary and recommended and authorized by a legally licensed physician or surgeon, and which are not prohibited by provincial government sponsored plans. Benefits cannot exceed the difference between the actual cost of the charges and amounts that employees are entitled to apply for and receive under provincial plans. With the exception of the out-of-country travel assistance, the benefits are 80% reimbursed. Medi-Pack includes:

C.1.3.3.1. Nursing Care: When ordered by a physician or surgeon legally licensed to practice medicine, the services of a registered nurse or registered nurse assistant in employee’s homes up to a maximum of $5,000 per calendar year. Reimbursable at 80%. From January 1st coincident with or next following the employee or the employee’s dependents 65th birthday, the maximum benefit is limited to $25,000 lifetime in all provinces.

C.1.3.3.2. Hospital Expenses and Supplies: Charges incurred for services furnished by a licensed Hospital and supplies (in the province of residence) which are obtained from an out-patient department of a licensed Hospital or surgical supply company (in the province of residence), while not confined to the Hospital.

C.1.3.3.3. Ambulance: For ambulance or other emergency service used to transport employees and/or their dependents from any place where injury, illness, or any other emergency medical situation occurs to the nearest hospital where adequate treatment can be obtained. Also, transportation from one hospital to another or from a hospital to home. Charges for the cost of one attendant if transportation is not provided via an ambulance. Reimbursable at 80%.

C.1.3.3.4. Aids, services and supplies: No deductible. Purchase of approved braces, crutches, artificial limbs or eyes and prosthetic devices. An initial breast prosthesis following a mastectomy plus a replacement every two calendar years and two surgical brassieres per calendar year. Rental of a wheelchair, hospital bed or other approved durable equipment for temporary therapeutic use. Oxygen as ordered by a surgeon or physician. A maximum of one pair of custom made orthopedic shoes or orthotics per calendar year as prescribed by a podiatrist or physician. Two pairs of surgical stockings per calendar year. Hair pieces and wigs needed as a result of chemotherapy up to a lifetime maximum of $100.00. A lifetime maximum of $250.00 for wigs purchased due to a total loss of hair from Alopecia Totalis. Hearing aids and repairs to a maximum of $500 in four consecutive years. The purchase of an initial pair of frames and one corrective prosthetic lens for each eye that is prescribed after cataract surgery.

C.1.3.3.5. Accidental Dental: Treatment for an accidental blow to the mouth which is received within 12 months of the injury. Benefit is limited to amounts consistent with the current Dental Association Schedule of Fees for General Practitioners in the province of residence.

C.1.3.3.6. Vision Care: Vision care to a maximum benefit of $250.00 including eye exams in any 24 consecutive months, reasonable and customary pricing. Reimbursable at 80%. Benefit includes frames, lenses or contact lenses and fitting of such eyewear and corrective laser eye surgery which has been recommended or approved by a legally licensed physician, surgeon, optometrist or ophthalmologist.

C.1.3.3.7. Clinical Psychology: Services of a legally licensed clinical psychologist up to an individual maximum of $1,000.00 per calendar year.

C.1.3.3.8. Diagnostic tests: Diagnostic tests, radium treatments and x-ray examinations, except for dental x-rays that are incurred in the Province or Territory of residence.

C.1.3.3.9. Speech Therapy: Services of a qualified speech therapist up to an individual maximum of $1,000 per calendar year.

C.1.3.3.10. Referral Benefits: Services provided in Canada and the United States but outside the province of residence if not available in the province of residence and based on a written referral of a physician or surgeon who regularly attends the employee or dependent in the province of residence. These services must be approved in advance and are subject to a lifetime limit of $10,000.

a) Room and board in a licensed Hospital up to the hospital’s standard ward rate for each day of confinement;

C.1.3.3.11. Travel Assistance Benefit: Reimbursable at 100% to a maximum of C$30,000 lifetime maximum. The following required services relating to a medical emergency, while away from the Province or Territory of residence for business or pleasure (but not for Health reasons):

C.1.3.3.12. Paramedical Services: Reimbursable at 80%. Laboratory tests and x-ray examinations recommended by a legally licensed chiropractor, osteopath, chiropodist or podiatrist. The maximum amount payable per classification of practitioner is limited to $500.00 per calendar year, per practitioner. Practitioners include Physiotherapists, Chiropractors, Osteopaths, Chiropodists or Podiatrists, Naturopaths, Masseurs and Acupuncturists.

C.1.4

ORE EMPLOYEES

C.1.4.1. HOSPITALIZATION: Upgrade to a semi-private hospital room. Employees will be paid the difference between the public ward allowance under the provincial health care plans and the semi-private charge for each day of confinement in a Licensed Hospital due to injury, disease, illness, mental disorder or pregnancy. Unlimited benefit. Reimbursable at 100%.

C.1.4.2.1 PRESCRIPTION DRUGS: Authorized charges via a pay direct drug card program is reimbursable at 80%. Unlimited benefit. Plan includes any eligible drug if medically necessary and reasonable and customary and not prohibited by a Government Sponsored plan in the province where the employee resides. Nicotine resine products are not covered. Compulsory generic substitution.

C.1.4.2.2 For employees only, 100% reimbursement for medications to suppress opportunistic infections, such as tuberculosis and toxoplasmosis for employees who have HIV/AIDS. For employee and employee’s covered spouse, 100% reimbursement for brief courses of anti-retroviaral 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 infrastructure.

C.1.4.3. MEDI-PACK: Medi-pack covers medically necessary expenses which are reasonable and customary and recommended and authorized by a legally licensed physician or surgeon, and which are not prohibited by provincial government sponsored plans. Benefits cannot exceed the difference between the actual cost of the charges and amounts that employees are entitled to apply for and receive under provincial plans. With the exception of the out-of-country travel assistance, these benefits are reimbursed at 80%. Medi-Pack includes:

C.1.4.2.1. Nursing Care: When ordered by a physician or surgeon legally licensed to practice medicine, the services of a registered nurse or registered nurse assistant in the home of the employee up to a maximum of $5,000 per calendar year. Reimbursable at 80%. From January 1st coincident with or next following the employee or the employee’s dependents 65th birthday, the maximum benefit is limited to $25,000 lifetime in all provinces.

C.1.4.2.2. Hospital Expenses and Supplies: Charges incurred for services furnished by a licensed Hospital and supplies (in the province of residence) which are obtained from an out-patient department of a licensed Hospital or surgical supply company, while not confined to the Hospital.

C.1.4.2.3. Ambulance: For ambulance or other emergency service used to transport employees and/or their dependents from any place where injury, illness, or any other emergency medical situation occurs to the nearest hospital where adequate treatment can be obtained. Also, transportation from one hospital to another, or from a hospital to home. Charges for the cost of one attendant if transportation is not provided via an ambulance. Reimbursable at 80%.

C.1.4.2.4. Aids, services and supplies: Purchase of approved braces, crutches, artificial limbs or eyes and prosthetic devices.