Attachment_A-1-Medical_Pricing-Categories_C_and_D.xlsx

XLSX spreadsheet 51 KB Posted Aug 16, 2017

Attached to: Health Insurance Services for U. S. Mission in France
Solicitation number: SFR63016R0011
Issued by: Department of State US Embassy Paris

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RFP Health Insurance

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File	Type	Posted
Attachment_F_-_Statistic_Report_of_Incumbent_Contractor-PREVOYANCE.pdf	PDF	Aug 16, 2017
Attachment_A-Medical_Pricing-Categories_A_and_B.xlsx	XLSX spreadsheet	Aug 16, 2017
Attachment_E-Staff_Statistics_-_Unclassified_Information.xls	XLS spreadsheet	Aug 16, 2017
Attachment_F_-_Statistic_Report_of_Incumbent_Contractor-HEALTH.pdf	PDF	Aug 16, 2017
Attachment_C-Prvoyance_Pricing.xlsx	XLSX spreadsheet	Aug 16, 2017
Attachment_B-1_Medical_Coverage_-_Social_Security_with_English_translation.xlsx	XLSX spreadsheet	Aug 16, 2017
Attachment_B-2_Medical_Coverage_-_CSR_with_English_Translation.xlsx	XLSX spreadsheet	Aug 16, 2017
RFP_Health_Insurance-Final.docx	DOCX document	Aug 16, 2017
Attachment_D-Prvoyance_Coverages_-_SS_and_CSR_w_Translation.xlsx	XLSX spreadsheet	Aug 16, 2017

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A-1 Health Prices-Rider Base Yr

ATTACHMENT A-1 - PRICES/PREMIUMS FOR MEDICAL COVERAGE
CLIN	Current Members of the U.S. Mission	Estimated Members	Premium per Month & per Member, €	Retention Amount per Mo, € per pers	Total / mo / pers	Total / Est mem / mo	Total Amount for one contract year, €	AG2R Category	Contract Value based on current members/Yr

Category C - Retirees, riffed employees, survivors and dependents Affiliated to French Social Security

	C-1-1 Basic Option-Retirees, survivors and dependents affiliated to Social Security (Retraité, ayant droit et ayant droit de salarié décédé Régime Sécurité Sociale Option de Base)
7001	Retirees (Cadres et Non-cadres), up to 69 years old	0	1	RB1
7002	Spouses	0	1
7003	Children	0	1
7004	Retirees (Cadres et Non-cadres), 70 to 80 years old	0	1	RB1
7005	Spouses	0	1
7006	Children	0	1
7016	Retirees (Cadres et Non-cadres), More than 81 years old	0	1	RB4
7017	Spouses	0	1
7018	Children	0	1
7019	Régime Alsace Retirees (Cadres et Non-cadres), up to 69 years old	0	1	RB5
7020	Spouses	0	1
7021	Children	0	1
7022	Régime Alsace Retirees (Cadres et Non-cadres), 70 to 80 years old	0	1	RB5
7023	Spouses	0	1
7024	Children	0	1
7034	Régime Alsace Retirees (Cadres et Non-cadres), More than 81 years old	0	1	RB8
7035	Spouses	0	1
7036	Children	0	1
	Exact number of Retirees per age category will be provided upon contract award

	C-1-2 Basic Option-Riffed employees, survivors and dependents affiliated to Social Security (Licencié, ayant droit et ayant droit de salarié décédé Régime Sécurité Sociale Option de Base)
8001	Former Employees (Cadres et Non-cadres)	1	1	LB1
8002	Spouses	0	1
8003	Children	0	1

	C-2-1 High Option-Retirees, survivors and dependents affiliated to Social Security (Retraité, ayant droit, ayant droit de salarié décédé Régime Sécurité Sociale Option de Haute)
9007	Retirees (Cadres et Non-cadres), up to 69 years old	38	1	RH1
9008	Spouses	13	1
9009	Children	4	1
9010	Retirees (Cadres et Non-cadres), 70 to 80 years old	33	1	RH2
9011	Spouses	7	1
9012	Children	1	1
9013	Retirees (Cadres et Non-cadres), More than 81 years old	16	1	RH3
9014	Spouses	4	1
9015	Children	0	1
9019	Régime Alsace Retirees (Cadres et Non-cadres), up to 69 years old	0	1	RH5
9020	Spouses	0	1
9021	Children	0	1
9022	Régime Alsace Retirees (Cadres et Non-cadres), 70 to 80 years old	0	1	RH5
9023	Spouses	0	1
9024	Children	0	1
9034	Régime Alsace Retirees (Cadres et Non-cadres), More than 81 years old	0	1	RH8
9035	Spouses	0	1
9036	Children	0	1

	C-2-2 High Option-Riffed employees, survivors and dependents affiliated to Social Security (Licencié, ayant droit, ayant droit de salarié décédé Régime Sécurité Sociale Option de Haute)
10001	Former Employees (Cadres et Non-cadres)	5	1	LH1
10002	Spouses	0	1
10003	Children	0	1

Category D - Retirees, riffed employees, survivors and dependents Non-Affiliated to French Social Security

	D-1-1 Basic Option-Retirees, survivors and dependents not affiliated to Social Security (Retraité, ayant droit et ayant droit de salarié décédé Non Sécurité Sociale Option Base)
11001	Retirees (Cadres et Non-cadres), up to 54 years old	0	1	RBA
11002	Spouses	0	1
11003	Children	0	1
11004	Retirees (Cadres et Non-cadres), 55 to 59 years old	0	1	RBA
11005	Spouses	0	1
11006	Children	0	1
11007	Retirees (Cadres et Non-cadres), 60 to 64 years old	0	1	RBA
11008	Spouses	0	1
11009	Children	0	1
11010	Retirees (Cadres et Non-cadres), 65 to 70 years old	0	1	RBA
11011	Spouses	0	1
11012	Children	0	1
11013	Retirees (Cadres et Non-cadres), 71 to 75 years old	0	1	RBB
11014	Spouses	0	1
11015	Children	0	1
11016	Retirees (Cadres et Non-cadres), 76 to 80 years old	0	1	RBC
11017	Spouses	0	1
11018	Children	0	1
11019	Retirees (Cadres et Non-cadres), More than 81 years old	0	1	RBD
11020	Spouses	0	1
11021	Children	0	1

	D-1-2 Basic Option-Riffed employees, survivors and dependents not affiliated to Social Security (Licencié, ayant droit et ayant droit de salarié décédé Non Sécurité Sociale Option Base)
12001	Former Employees (Cadres et Non-cadres)	0	1	LB3
12002	Spouses	0	1
12003	Children	0	1

	D-2-1 High Option-Retirees, survivors and dependents not affiliated to Social Security (Retraité, Ayant droit et ayant droit de salarié décédé NON Sécurité Sociale Option Haute)
13001	Retirees (Cadres et Non-cadres), up to 54 years old	0	1	RHA
13002	Spouses	0	1
13003	Children	0	1
13004	Retirees (Cadres et Non-cadres), 55 to 59 years old	0	1	RHA
13005	Spouses	0	1
13006	Children	0	1
13007	Retirees (Cadres et Non-cadres), 60 to 64 years old	3	1	RHA
13008	Spouses	0	1
13009	Children	0	1
13010	Retirees (Cadres et Non-cadres), 65 to 70 years old	1	1	RHA
13011	Spouses	0	1
13012	Children	0	1
13013	Retirees (Cadres et Non-cadres), 71 to 75 years old	1	1	RHB
13014	Spouses	0	1
13015	Children	0	1
13016	Retirees (Cadres et Non-cadres), 76 to 80 years old	2	1	RHC
13017	Spouses	0	1
13018	Children	0	1
13019	Retirees (Cadres et Non-cadres), More than 81 years old	1	1	RHD
13020	Spouses	0	1
13021	Children	0	1
	Exact number of Retirees per age category will be provided upon contract award

	D-3 High Option-Riffed employees, survivors and dependents not affiliated to Social Security (Licencié, Ayant droit et ayant droit de salarié décédé NON Sécurité Sociale Option Haute)
14001	Former Employees (Cadres et Non-cadres)	0	1	LH3
14002	Spouses	0	1
14003	Children	0	1

Rider C&D Base Year- Estimated Grand Total

Solicitation: S-FR630-17-R-0013 Attachment A-1 - Rider -Base Year Page: &P of &N

A-1 Health Prices-Rider Opt Y1

ATTACHMENT A-1 - PRICES/PREMIUMS FOR MEDICAL COVERAGE
CLIN	Current Members of the U.S. Mission	Estimated Members	Premium per Month & per Member, €	Retention Amount per Mo, € per pers	Total / mo / pers	Total / Est mem / mo	Total Amount for one contract year, €	AG2R Category	Contract Value based on current members/Yr

Category C - Retirees, riffed employees, survivors and dependents Affiliated to French Social Security

	C-1-1 Basic Option-Retirees, survivors and dependents affiliated to Social Security (Retraité, ayant droit et ayant droit de salarié décédé Régime Sécurité Sociale Option de Base)
7001	Retirees (Cadres et Non-cadres), up to 69 years old	0	1	RB1
7002	Spouses	0	1
7003	Children	0	1
7004	Retirees (Cadres et Non-cadres), 70 to 80 years old	0	1	RB1
7005	Spouses	0	1
7006	Children	0	1
7016	Retirees (Cadres et Non-cadres), More than 81 years old	0	1	RB4
7017	Spouses	0	1
7018	Children	0	1
7019	Régime Alsace Retirees (Cadres et Non-cadres), up to 69 years old	0	1	RB5
7020	Spouses	0	1
7021	Children	0	1
7022	Régime Alsace Retirees (Cadres et Non-cadres), 70 to 80 years old	0	1	RB5
7023	Spouses	0	1
7024	Children	0	1
7034	Régime Alsace Retirees (Cadres et Non-cadres), More than 81 years old	0	1	RB8
7035	Spouses	0	1
7036	Children	0	1
	Exact number of Retirees per age category will be provided upon contract award

	C-1-2 Basic Option-Riffed employees, survivors and dependents affiliated to Social Security (Licencié, ayant droit et ayant droit de salarié décédé Régime Sécurité Sociale Option de Base)
8001	Former Employees (Cadres et Non-cadres)	1	1	LB1
8002	Spouses	0	1
8003	Children	0	1

	C-2-1 High Option-Retirees, survivors and dependents affiliated to Social Security (Retraité, ayant droit, ayant droit de salarié décédé Régime Sécurité Sociale Option de Haute)
9007	Retirees (Cadres et Non-cadres), up to 69 years old	38	1	RH1
9008	Spouses	13	1
9009	Children	4	1
9010	Retirees (Cadres et Non-cadres), 70 to 80 years old	33	1	RH2
9011	Spouses	7	1
9012	Children	1	1
9013	Retirees (Cadres et Non-cadres), More than 81 years old	16	1	RH3
9014	Spouses	4	1
9015	Children	0	1
9019	Régime Alsace Retirees (Cadres et Non-cadres), up to 69 years old	0	1	RH5
9020	Spouses	0	1
9021	Children	0	1
9022	Régime Alsace Retirees (Cadres et Non-cadres), 70 to 80 years old	0	1	RH5
9023	Spouses	0	1
9024	Children	0	1
9034	Régime Alsace Retirees (Cadres et Non-cadres), More than 81 years old	0	1	RH8
9035	Spouses	0	1
9036	Children	0	1

	C-2-2 High Option-Riffed employees, survivors and dependents affiliated to Social Security (Licencié, ayant droit, ayant droit de salarié décédé Régime Sécurité Sociale Option de Haute)
10001	Former Employees (Cadres et Non-cadres)	5	1	LH1
10002	Spouses	0	1
10003	Children	0	1

Category D - Retirees, riffed employees, survivors and dependents Non-Affiliated to French Social Security

	D-1-1 Basic Option-Retirees, survivors and dependents not affiliated to Social Security (Retraité, ayant droit et ayant droit de salarié décédé Non Sécurité Sociale Option Base)
11001	Retirees (Cadres et Non-cadres), up to 54 years old	0	1	RBA
11002	Spouses	0	1
11003	Children	0	1
11004	Retirees (Cadres et Non-cadres), 55 to 59 years old	0	1	RBA
11005	Spouses	0	1
11006	Children	0	1
11007	Retirees (Cadres et Non-cadres), 60 to 64 years old	0	1	RBA
11008	Spouses	0	1
11009	Children	0	1
11010	Retirees (Cadres et Non-cadres), 65 to 70 years old	0	1	RBA
11011	Spouses	0	1
11012	Children	0	1
11013	Retirees (Cadres et Non-cadres), 71 to 75 years old	0	1	RBB
11014	Spouses	0	1
11015	Children	0	1
11016	Retirees (Cadres et Non-cadres), 76 to 80 years old	0	1	RBC
11017	Spouses	0	1
11018	Children	0	1
11019	Retirees (Cadres et Non-cadres), More than 81 years old	0	1	RBD
11020	Spouses	0	1
11021	Children	0	1

	D-1-2 Basic Option-Riffed employees, survivors and dependents not affiliated to Social Security (Licencié, ayant droit et ayant droit de salarié décédé Non Sécurité Sociale Option Base)
12001	Former Employees (Cadres et Non-cadres)	0	1	LB3
12002	Spouses	0	1
12003	Children	0	1

	D-2-1 High Option-Retirees, survivors and dependents not affiliated to Social Security (Retraité, Ayant droit et ayant droit de salarié décédé NON Sécurité Sociale Option Haute)
13001	Retirees (Cadres et Non-cadres), up to 54 years old	0	1	RHA
13002	Spouses	0	1
13003	Children	0	1
13004	Retirees (Cadres et Non-cadres), 55 to 59 years old	0	1	RHA
13005	Spouses	0	1
13006	Children	0	1
13007	Retirees (Cadres et Non-cadres), 60 to 64 years old	3	1	RHA
13008	Spouses	0	1
13009	Children	0	1
13010	Retirees (Cadres et Non-cadres), 65 to 70 years old	1	1	RHA
13011	Spouses	0	1
13012	Children	0	1
13013	Retirees (Cadres et Non-cadres), 71 to 75 years old	1	1	RHB
13014	Spouses	0	1
13015	Children	0	1
13016	Retirees (Cadres et Non-cadres), 76 to 80 years old	2	1	RHC
13017	Spouses	0	1
13018	Children	0	1
13019	Retirees (Cadres et Non-cadres), More than 81 years old	1	1	RHD
13020	Spouses	0	1
13021	Children	0	1
	Exact number of Retirees per age category will be provided upon contract award

	D-3 High Option-Riffed employees, survivors and dependents not affiliated to Social Security (Licencié, Ayant droit et ayant droit de salarié décédé NON Sécurité Sociale Option Haute)
14001	Former Employees (Cadres et Non-cadres)	0	1	LH3
14002	Spouses	0	1
14003	Children	0	1

Rider C&D Option Year 1 - Estimated Grand Total

Solicitation: S-FR630-17-R-0013 Attachment A-1 - Rider -Option Yr 1 Page: &P of &N

A-1 Health Prices-Rider Opt Y2

ATTACHMENT A-1 - PRICES/PREMIUMS FOR MEDICAL COVERAGE
CLIN	Current Members of the U.S. Mission	Estimated Members	Premium per Month & per Member, €	Retention Amount per Mo, € per pers	Total / mo / pers	Total / Est mem / mo	Total Amount for one contract year, €	AG2R Category	Contract Value based on current members/Yr

Category C - Retirees, riffed employees, survivors and dependents Affiliated to French Social Security

	C-1-1 Basic Option-Retirees, survivors and dependents affiliated to Social Security (Retraité, ayant droit et ayant droit de salarié décédé Régime Sécurité Sociale Option de Base)
7001	Retirees (Cadres et Non-cadres), up to 69 years old	0	1	RB1
7002	Spouses	0	1
7003	Children	0	1
7004	Retirees (Cadres et Non-cadres), 70 to 80 years old	0	1	RB1
7005	Spouses	0	1
7006	Children	0	1
7016	Retirees (Cadres et Non-cadres), More than 81 years old	0	1	RB4
7017	Spouses	0	1
7018	Children	0	1
7019	Régime Alsace Retirees (Cadres et Non-cadres), up to 69 years old	0	1	RB5
7020	Spouses	0	1
7021	Children	0	1
7022	Régime Alsace Retirees (Cadres et Non-cadres), 70 to 80 years old	0	1	RB5
7023	Spouses	0	1
7024	Children	0	1
7034	Régime Alsace Retirees (Cadres et Non-cadres), More than 81 years old	0	1	RB8
7035	Spouses	0	1
7036	Children	0	1
	Exact number of Retirees per age category will be provided upon contract award

	C-1-2 Basic Option-Riffed employees, survivors and dependents affiliated to Social Security (Licencié, ayant droit et ayant droit de salarié décédé Régime Sécurité Sociale Option de Base)
8001	Former Employees (Cadres et Non-cadres)	1	1	LB1
8002	Spouses	0	1
8003	Children	0	1

	C-2-1 High Option-Retirees, survivors and dependents affiliated to Social Security (Retraité, ayant droit, ayant droit de salarié décédé Régime Sécurité Sociale Option de Haute)
9007	Retirees (Cadres et Non-cadres), up to 69 years old	38	1	RH1
9008	Spouses	13	1
9009	Children	4	1
9010	Retirees (Cadres et Non-cadres), 70 to 80 years old	33	1	RH2
9011	Spouses	7	1
9012	Children	1	1
9013	Retirees (Cadres et Non-cadres), More than 81 years old	16	1	RH3
9014	Spouses	4	1
9015	Children	0	1
9019	Régime Alsace Retirees (Cadres et Non-cadres), up to 69 years old	0	1	RH5
9020	Spouses	0	1
9021	Children	0	1
9022	Régime Alsace Retirees (Cadres et Non-cadres), 70 to 80 years old	0	1	RH5
9023	Spouses	0	1
9024	Children	0	1
9034	Régime Alsace Retirees (Cadres et Non-cadres), More than 81 years old	0	1	RH8
9035	Spouses	0	1
9036	Children	0	1

	C-2-2 High Option-Riffed employees, survivors and dependents affiliated to Social Security (Licencié, ayant droit, ayant droit de salarié décédé Régime Sécurité Sociale Option de Haute)
10001	Former Employees (Cadres et Non-cadres)	5	1	LH1
10002	Spouses	0	1
10003	Children	0	1

Category D - Retirees, riffed employees, survivors and dependents Non-Affiliated to French Social Security

	D-1-1 Basic Option-Retirees, survivors and dependents not affiliated to Social Security (Retraité, ayant droit et ayant droit de salarié décédé Non Sécurité Sociale Option Base)
11001	Retirees (Cadres et Non-cadres), up to 54 years old	0	1	RBA
11002	Spouses	0	1
11003	Children	0	1
11004	Retirees (Cadres et Non-cadres), 55 to 59 years old	0	1	RBA
11005	Spouses	0	1
11006	Children	0	1
11007	Retirees (Cadres et Non-cadres), 60 to 64 years old	0	1	RBA
11008	Spouses	0	1
11009	Children	0	1
11010	Retirees (Cadres et Non-cadres), 65 to 70 years old	0	1	RBA
11011	Spouses	0	1
11012	Children	0	1
11013	Retirees (Cadres et Non-cadres), 71 to 75 years old	0	1	RBB
11014	Spouses	0	1
11015	Children	0	1
11016	Retirees (Cadres et Non-cadres), 76 to 80 years old	0	1	RBC
11017	Spouses	0	1
11018	Children	0	1
11019	Retirees (Cadres et Non-cadres), More than 81 years old	0	1	RBD
11020	Spouses	0	1
11021	Children	0	1

	D-1-2 Basic Option-Riffed employees, survivors and dependents not affiliated to Social Security (Licencié, ayant droit et ayant droit de salarié décédé Non Sécurité Sociale Option Base)
12001	Former Employees (Cadres et Non-cadres)	0	1	LB3
12002	Spouses	0	1
12003	Children	0	1

	D-2-1 High Option-Retirees, survivors and dependents not affiliated to Social Security (Retraité, Ayant droit et ayant droit de salarié décédé NON Sécurité Sociale Option Haute)
13001	Retirees (Cadres et Non-cadres), up to 54 years old	0	1	RHA
13002	Spouses	0	1
13003	Children	0	1
13004	Retirees (Cadres et Non-cadres), 55 to 59 years old	0	1	RHA
13005	Spouses	0	1
13006	Children	0	1
13007	Retirees (Cadres et Non-cadres), 60 to 64 years old	3	1	RHA
13008	Spouses	0	1
13009	Children	0	1
13010	Retirees (Cadres et Non-cadres), 65 to 70 years old	1	1	RHA
13011	Spouses	0	1
13012	Children	0	1
13013	Retirees (Cadres et Non-cadres), 71 to 75 years old	1	1	RHB
13014	Spouses	0	1
13015	Children	0	1
13016	Retirees (Cadres et Non-cadres), 76 to 80 years old	2	1	RHC
13017	Spouses	0	1
13018	Children	0	1
13019	Retirees (Cadres et Non-cadres), More than 81 years old	1	1	RHD
13020	Spouses	0	1
13021	Children	0	1
	Exact number of Retirees per age category will be provided upon contract award

	D-3 High Option-Riffed employees, survivors and dependents not affiliated to Social Security (Licencié, Ayant droit et ayant droit de salarié décédé NON Sécurité Sociale Option Haute)
14001	Former Employees (Cadres et Non-cadres)	0	1	LH3
14002	Spouses	0	1
14003	Children	0	1

Rider C&D Option Year 2 - Estimated Grand Total

Solicitation: S-FR630-17-R-0013 Attachment A-1 - Rider -Option Yr 2 Page: &P of &N

A-1 Health Prices-Rider Opt Y3

ATTACHMENT A-1 - PRICES/PREMIUMS FOR MEDICAL COVERAGE
CLIN	Current Members of the U.S. Mission	Estimated Members	Premium per Month & per Member, €	Retention Amount per Mo, € per pers	Total / mo / pers	Total / Est mem / mo	Total Amount for one contract year, €	AG2R Category	Contract Value based on current members/Yr

Category C - Retirees, riffed employees, survivors and dependents Affiliated to French Social Security

	C-1-1 Basic Option-Retirees, survivors and dependents affiliated to Social Security (Retraité, ayant droit et ayant droit de salarié décédé Régime Sécurité Sociale Option de Base)
7001	Retirees (Cadres et Non-cadres), up to 69 years old	0	1	RB1
7002	Spouses	0	1
7003	Children	0	1
7004	Retirees (Cadres et Non-cadres), 70 to 80 years old	0	1	RB1
7005	Spouses	0	1
7006	Children	0	1
7016	Retirees (Cadres et Non-cadres), More than 81 years old	0	1	RB4
7017	Spouses	0	1
7018	Children	0	1
7019	Régime Alsace Retirees (Cadres et Non-cadres), up to 69 years old	0	1	RB5
7020	Spouses	0	1
7021	Children	0	1
7022	Régime Alsace Retirees (Cadres et Non-cadres), 70 to 80 years old	0	1	RB5
7023	Spouses	0	1
7024	Children	0	1
7034	Régime Alsace Retirees (Cadres et Non-cadres), More than 81 years old	0	1	RB8
7035	Spouses	0	1
7036	Children	0	1
	Exact number of Retirees per age category will be provided upon contract award

	C-1-2 Basic Option-Riffed employees, survivors and dependents affiliated to Social Security (Licencié, ayant droit et ayant droit de salarié décédé Régime Sécurité Sociale Option de Base)
8001	Former Employees (Cadres et Non-cadres)	1	1	LB1
8002	Spouses	0	1
8003	Children	0	1

	C-2-1 High Option-Retirees, survivors and dependents affiliated to Social Security (Retraité, ayant droit, ayant droit de salarié décédé Régime Sécurité Sociale Option de Haute)
9007	Retirees (Cadres et Non-cadres), up to 69 years old	38	1	RH1
9008	Spouses	13	1
9009	Children	4	1
9010	Retirees (Cadres et Non-cadres), 70 to 80 years old	33	1	RH2
9011	Spouses	7	1
9012	Children	1	1
9013	Retirees (Cadres et Non-cadres), More than 81 years old	16	1	RH3
9014	Spouses	4	1
9015	Children	0	1
9019	Régime Alsace Retirees (Cadres et Non-cadres), up to 69 years old	0	1	RH5
9020	Spouses	0	1
9021	Children	0	1
9022	Régime Alsace Retirees (Cadres et Non-cadres), 70 to 80 years old	0	1	RH5
9023	Spouses	0	1
9024	Children	0	1
9034	Régime Alsace Retirees (Cadres et Non-cadres), More than 81 years old	0	1	RH8
9035	Spouses	0	1
9036	Children	0	1

	C-2-2 High Option-Riffed employees, survivors and dependents affiliated to Social Security (Licencié, ayant droit, ayant droit de salarié décédé Régime Sécurité Sociale Option de Haute)
10001	Former Employees (Cadres et Non-cadres)	5	1	LH1
10002	Spouses	0	1
10003	Children	0	1

Category D - Retirees, riffed employees, survivors and dependents Non-Affiliated to French Social Security

	D-1-1 Basic Option-Retirees, survivors and dependents not affiliated to Social Security (Retraité, ayant droit et ayant droit de salarié décédé Non Sécurité Sociale Option Base)
11001	Retirees (Cadres et Non-cadres), up to 54 years old	0	1	RBA
11002	Spouses	0	1
11003	Children	0	1
11004	Retirees (Cadres et Non-cadres), 55 to 59 years old	0	1	RBA
11005	Spouses	0	1
11006	Children	0	1
11007	Retirees (Cadres et Non-cadres), 60 to 64 years old	0	1	RBA
11008	Spouses	0	1
11009	Children	0	1
11010	Retirees (Cadres et Non-cadres), 65 to 70 years old	0	1	RBA
11011	Spouses	0	1
11012	Children	0	1
11013	Retirees (Cadres et Non-cadres), 71 to 75 years old	0	1	RBB
11014	Spouses	0	1
11015	Children	0	1
11016	Retirees (Cadres et Non-cadres), 76 to 80 years old	0	1	RBC
11017	Spouses	0	1
11018	Children	0	1
11019	Retirees (Cadres et Non-cadres), More than 81 years old	0	1	RBD
11020	Spouses	0	1
11021	Children	0	1

	D-1-2 Basic Option-Riffed employees, survivors and dependents not affiliated to Social Security (Licencié, ayant droit et ayant droit de salarié décédé Non Sécurité Sociale Option Base)
12001	Former Employees (Cadres et Non-cadres)	0	1	LB3
12002	Spouses	0	1
12003	Children	0	1

	D-2-1 High Option-Retirees, survivors and dependents not affiliated to Social Security (Retraité, Ayant droit et ayant droit de salarié décédé NON Sécurité Sociale Option Haute)
13001	Retirees (Cadres et Non-cadres), up to 54 years old	0	1	RHA
13002	Spouses	0	1
13003	Children	0	1
13004	Retirees (Cadres et Non-cadres), 55 to 59 years old	0	1	RHA
13005	Spouses	0	1
13006	Children	0	1
13007	Retirees (Cadres et Non-cadres), 60 to 64 years old	3	1	RHA
13008	Spouses	0	1
13009	Children	0	1
13010	Retirees (Cadres et Non-cadres), 65 to 70 years old	1	1	RHA
13011	Spouses	0	1
13012	Children	0	1
13013	Retirees (Cadres et Non-cadres), 71 to 75 years old	1	1	RHB
13014	Spouses	0	1
13015	Children	0	1
13016	Retirees (Cadres et Non-cadres), 76 to 80 years old	2	1	RHC
13017	Spouses	0	1
13018	Children	0	1
13019	Retirees (Cadres et Non-cadres), More than 81 years old	1	1	RHD
13020	Spouses	0	1
13021	Children	0	1
	Exact number of Retirees per age category will be provided upon contract award

	D-3 High Option-Riffed employees, survivors and dependents not affiliated to Social Security (Licencié, Ayant droit et ayant droit de salarié décédé NON Sécurité Sociale Option Haute)
14001	Former Employees (Cadres et Non-cadres)	0	1	LH3
14002	Spouses	0	1
14003	Children	0	1

Rider C&D Option Year 3 - Estimated Grand Total

Solicitation: S-FR630-17-R-0013 Attachment A-1 - Rider -Option Yr 3 Page: &P of &N

A-1 Health Prices-Rider Opt Y4

ATTACHMENT A-1 - PRICES/PREMIUMS FOR MEDICAL COVERAGE
CLIN	Current Members of the U.S. Mission	Estimated Members	Premium per Month & per Member, €	Retention Amount per Mo, € per pers	Total / mo / pers	Total / Est mem / mo	Total Amount for one contract year, €	AG2R Category	Contract Value based on current members/Yr

Category C - Retirees, riffed employees, survivors and dependents Affiliated to French Social Security

	C-1-1 Basic Option-Retirees, survivors and dependents affiliated to Social Security (Retraité, ayant droit et ayant droit de salarié décédé Régime Sécurité Sociale Option de Base)
7001	Retirees (Cadres et Non-cadres), up to 69 years old	0	1	RB1
7002	Spouses	0	1
7003	Children	0	1
7004	Retirees (Cadres et Non-cadres), 70 to 80 years old	0	1	RB1
7005	Spouses	0	1
7006	Children	0	1
7016	Retirees (Cadres et Non-cadres), More than 81 years old	0	1	RB4
7017	Spouses	0	1
7018	Children	0	1
7019	Régime Alsace Retirees (Cadres et Non-cadres), up to 69 years old	0	1	RB5
7020	Spouses	0	1
7021	Children	0	1
7022	Régime Alsace Retirees (Cadres et Non-cadres), 70 to 80 years old	0	1	RB5
7023	Spouses	0	1
7024	Children	0	1
7034	Régime Alsace Retirees (Cadres et Non-cadres), More than 81 years old	0	1	RB8
7035	Spouses	0	1
7036	Children	0	1
	Exact number of Retirees per age category will be provided upon contract award

	C-1-2 Basic Option-Riffed employees, survivors and dependents affiliated to Social Security (Licencié, ayant droit et ayant droit de salarié décédé Régime Sécurité Sociale Option de Base)
8001	Former Employees (Cadres et Non-cadres)	1	1	LB1
8002	Spouses	0	1
8003	Children	0	1

	C-2-1 High Option-Retirees, survivors and dependents affiliated to Social Security (Retraité, ayant droit, ayant droit de salarié décédé Régime Sécurité Sociale Option de Haute)
9007	Retirees (Cadres et Non-cadres), up to 69 years old	38	1	RH1
9008	Spouses	13	1
9009	Children	4	1
9010	Retirees (Cadres et Non-cadres), 70 to 80 years old	33	1	RH2
9011	Spouses	7	1
9012	Children	1	1
9013	Retirees (Cadres et Non-cadres), More than 81 years old	16	1	RH3
9014	Spouses	4	1
9015	Children	0	1
9019	Régime Alsace Retirees (Cadres et Non-cadres), up to 69 years old	0	1	RH5
9020	Spouses	0	1
9021	Children	0	1
9022	Régime Alsace Retirees (Cadres et Non-cadres), 70 to 80 years old	0	1	RH5
9023	Spouses	0	1
9024	Children	0	1
9034	Régime Alsace Retirees (Cadres et Non-cadres), More than 81 years old	0	1	RH8
9035	Spouses	0	1
9036	Children	0	1

	C-2-2 High Option-Riffed employees, survivors and dependents affiliated to Social Security (Licencié, ayant droit, ayant droit de salarié décédé Régime Sécurité Sociale Option de Haute)
10001	Former Employees (Cadres et Non-cadres)	5	1	LH1
10002	Spouses	0	1
10003	Children	0	1

Category D - Retirees, riffed employees, survivors and dependents Non-Affiliated to French Social Security

	D-1-1 Basic Option-Retirees, survivors and dependents not affiliated to Social Security (Retraité, ayant droit et ayant droit de salarié décédé Non Sécurité Sociale Option Base)
11001	Retirees (Cadres et Non-cadres), up to 54 years old	0	1	RBA
11002	Spouses	0	1
11003	Children	0	1
11004	Retirees (Cadres et Non-cadres), 55 to 59 years old	0	1	RBA
11005	Spouses	0	1
11006	Children	0	1
11007	Retirees (Cadres et Non-cadres), 60 to 64 years old	0	1	RBA
11008	Spouses	0	1
11009	Children	0	1
11010	Retirees (Cadres et Non-cadres), 65 to 70 years old	0	1	RBA
11011	Spouses	0	1
11012	Children	0	1
11013	Retirees (Cadres et Non-cadres), 71 to 75 years old	0	1	RBB
11014	Spouses	0	1
11015	Children	0	1
11016	Retirees (Cadres et Non-cadres), 76 to 80 years old	0	1	RBC
11017	Spouses	0	1
11018	Children	0	1
11019	Retirees (Cadres et Non-cadres), More than 81 years old	0	1	RBD
11020	Spouses	0	1
11021	Children	0	1

	D-1-2 Basic Option-Riffed employees, survivors and dependents not affiliated to Social Security (Licencié, ayant droit et ayant droit de salarié décédé Non Sécurité Sociale Option Base)
12001	Former Employees (Cadres et Non-cadres)	0	1	LB3
12002	Spouses	0	1
12003	Children	0	1

	D-2-1 High Option-Retirees, survivors and dependents not affiliated to Social Security (Retraité, Ayant droit et ayant droit de salarié décédé NON Sécurité Sociale Option Haute)
13001	Retirees (Cadres et Non-cadres), up to 54 years old	0	1	RHA
13002	Spouses	0	1
13003	Children	0	1
13004	Retirees (Cadres et Non-cadres), 55 to 59 years old	0	1	RHA
13005	Spouses	0	1
13006	Children	0	1
13007	Retirees (Cadres et Non-cadres), 60 to 64 years old	3	1	RHA
13008	Spouses	0	1
13009	Children	0	1
13010	Retirees (Cadres et Non-cadres), 65 to 70 years old	1	1	RHA
13011	Spouses	0	1
13012	Children	0	1
13013	Retirees (Cadres et Non-cadres), 71 to 75 years old	1	1	RHB
13014	Spouses	0	1
13015	Children	0	1
13016	Retirees (Cadres et Non-cadres), 76 to 80 years old	2	1	RHC
13017	Spouses	0	1
13018	Children	0	1
13019	Retirees (Cadres et Non-cadres), More than 81 years old	1	1	RHD
13020	Spouses	0	1
13021	Children	0	1
	Exact number of Retirees per age category will be provided upon contract award

	D-3 High Option-Riffed employees, survivors and dependents not affiliated to Social Security (Licencié, Ayant droit et ayant droit de salarié décédé NON Sécurité Sociale Option Haute)
14001	Former Employees (Cadres et Non-cadres)	0	1	LH3
14002	Spouses	0	1
14003	Children	0	1

Rider C&D Option Year 4 - Estimated Grand Total

Solicitation: S-FR630-17-R-0013 Attachment A-1 - Rider -Option Yr 4 Page: &P of &N

File details come from the government source that posted it. Updated Nov 14, 2017.