SID320-10-R-0078 Health Insurance Provider - Solicitation.docx

SOLICITATION, OFFER, AND AWARD

1. THIS CONTRACT IS A RATED ORDER UNDER DPAS (15 CFR 350)

RATING

2. CONTRACT NUMBER

3. SOLICITATION NUMBER

SOID320-10-R-0078

|X| NEGOTIATED (RFP)

5 August 2010

6. REQUISITION/PURCHASE NO.

Procurement Contracting Unit US Embassy Jakarta Jl. Merdeka Selatan No. 3 Jakarta 10110

NOTE: In sealed bid solicitations “offer” and “offeror” mean “bid” and “bidder”

SOLICITATION

9. Sealed offers in original and 1 copy for furnishing the supplies or services in the Schedule will be received at the place specified in Item 8, or if hand carried, in the depository located in PCU until 12 noon local time on (Friday) September 17, 2010.

CAUTION — Late Submissions, Modifications, and Withdrawals: See Section L, Provision No. 52.214-7 or 52.215-10. All offers are subject to terms and conditions contained in this solicitation.

INFORMATION CALL:

62-21

NUMBER

3435-9080

EXT.

delauderma2@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 (60 calendar days unless a different period is inserted by the offeror) 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.

10 CALENDAR DAYS

20 CALENDAR DAYS

30 CALENDAR DAYS

CALENDAR DAYS

AND

OFFER (Type or print)

OF

OFFEROR

AREA CODE

NUMBER

EXT.

ADDRESS IS DIFFERENT FROM ABOVE - ENTER SUCH ADDRESS IN SCHEDULE.

AWARD (To be completed by Government)

19. ACCEPTED AS TO ITEMS NUMBERED

20. AMOUNT

21. ACCOUNTING AND APPROPRIATION

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

23. SUBMIT INVOICES TO ADDRESS SHOWN IN (4 copies unless otherwise specified)

ITEM

26. NAME OF CONTRACTING OFFICER (Type or print)

MICHAEL DELAUDER

27. UNITED STATES OF AMERICA

(Signature of Contracting Officer)

28. AWARD DATE

IMPORTANT -- Award will be made on this Form, or on 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 – FAR (48 CFR) 53.214(c)

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 Indonesia 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.1.3 (medical). This insurance shall be provided in accordance with Section C and the Exhibits in Section J.

B.1.1. Official Residence Expense (ORE) Staff and Peace Corps Personal Service Contractors (PSCs) are included under this contract only as a rider; the Contractor shall bill the Chief of Mission, Deputy Chief of Mission and the Peace Corps for their PSCs, 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 local currency) 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:

Monthly Rates Per Employee:

B.2.2. FIRST OPTION YEAR OF THE CONTRACT:

Monthly Rates Per Employee:

Total price for Option Year 1 Including VAT: ____ __________

B.2.3. SECOND OPTION YEAR OF THE CONTRACT:

Monthly Rates Per Employee:

Total price for Option Year 2 Including VAT: _____ _________

B.2.4. THIRD OPTION YEAR OF THE CONTRACT:

Monthly Rates Per Employee:

Total price for Option Year 3 Including VAT: ___ __________

B.2.5. FOURTH OPTION YEAR OF THE CONTRACT:

Monthly Rates Per Employee:

Total Price for Option Year 4 Including VAT: __ _____________

GRAND TOTAL BASE PERIOD PLUS OPTION YEARS: ___ _______________

GRAND TOTAL BASE PERIOD PLUS OPTION YEARS

INCLUDING VAT : ____ ______________

B.3 ADMINISTRATIVE RETENTION AMOUNTS

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

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

B.3.2 sets forth the retention amounts per premium paid for each category of premium and for each period of performance.

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

B.3.2 Retention Amounts per separate premium paid per single employee and per family plan.

B.4. ECONOMIC PRICE ADJUSTMENT-HEALTH INSURANCE PREMIUMS

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

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

SECTION C

DESCRIPTION/SPECIFICATION/WORK STATEMENT

HEALTH INSURANCE

C.1. HEALTH INSURANCE SERVICES

The Government of the United States of America requires Health Insurance coverage for its employees as further described in C.1.2 in Indonesia. The Government has determined that the prevailing practice by employers in Indonesia is to provide for their employees health insurance protection and that the cost of such insurance protection is usually borne by the employer. Health insurance protection will be representative of locally prevailing compensation practice as further described in C.1.2. The specific health benefit coverage under this contract is set forth in Section C and the Exhibits in Section J.

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

C.1.1 Employee and Dependent Health Services Benefits

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

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

Per Person

C1.1.1. Hospitalization

1. Room and board expenses for a ward room or semi private.

2. Room and board for a private room

3. Hospital medical expenses including lab test & x-rays, nursing care, operating room cost, intensive care, prescription medicine, and physical therapy.

4. Professional services and treatment: Doctor’s and surgeon’s fees and inoculations

5. Ambulance service Room and board expenses Rp. 500,000

C.1.1.2. Outpatient:

1. Professional services and treatment: doctors' and surgeons' fees incurred at a hospital on an outpatient basis, at a clinic or doctor's office, or at home;

2. Specialist’s and physiotherapist’s fee;

3. Medical services & expenses when not hospitalized such as laboratory test and x-rays, routine annual physical examination, and inoculations.

4. Prescription medicines and drug for which prescription is legally required.

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

5. Pre-natal and post-natal care treatment which include obstetrical medical care, including treatment of complications of pregnancy;

6. Psychiatric treatment;

Annual maximum: Rp.10,000,000

C1.1.3 For active employees only : Full reimbursement of medications to suppress opportunistic infections, such as tuberculosis and toxoplasmosis for employees who have HIV AIDS; as well as brief course of anti retroviral drugs during childbirth to prevent the transmission of HIV to the employee's child. This expanded coverage generally excluded medications for the long-term suppression of AIDS through the combination of anti-retroviral drugs at those posts with inadequate local healthcare infrastructure. This expanded coverage does not apply to dependents or to retired employees.

Annual Maximum US$10,000.00

C.1.1.4. Obstetrical Care: reimbursement of

1. Normal Delivery:

Obstetrical medical care including delivery with or without forceps or vacuum. Any childbirth, not involving hospital confinement; the maternity benefit shall be equal to the actual charges by a Registered Medical Practitioner or Qualified Nurse relating to the maternity, but not to exceed the Normal Delivery benefit

Normal birth max benefit/confinement: Rp.6,000,000

2. Caesarean Surgical incision through the abdominal wall to extract a fetus when normal delivery can not be accomplished due complication such as toxemia, eclampsia and pre-eclampsia or other abnormality conditions raised due to pregnancy

C-Section max benefit/confinement: Rp.10,000000

3. Miscarriage Premature birth of a fetus due to a medical conditions or therapeutic abortion

Miscarriage max benefit/confinement: Rp.4,500,000

C.1.1.5. Annual Medical Check Up: Reimburses charges for one complete medical check-up per person per year, including any medically necessary laboratory or ancillary test incident thereto to specifically include pap-smears and mammograms for female employees or dependent

Annual maximum: Rp.1,100,000

C.1.1.6. Optical Care: Reimbursement of eye examination and treatment and prescription eyeglass or contact lenses provided one time per year or upon change of eye prescription determined at eye examination by a license optometrist or optician at widely recognized optical providers. Contact lens prescriptions are valid for 12 months to obtain contact lens replacement.

Annual maximum: Rp.1,000,000

C.1.1.7. Dental Service: reimbursement of:

fillings, extractions, x-rays, treatments of abscesses, root canal fillings, pins for cusp restorations.

2. Preventive Care Expenses for treatments rendered by a dentist in respect of scaling, polishing and prophylaxis.

Annual maximum for dental services: Rp.3,000,000

C.1.1.8 Medical expenses incurred out of country, will be covered for employees and dependents when:

(a) life threatening conditions 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

The reimbursement will be made at the same rate and subject to the same annual maximum limit as for expenses incurred in country

C.1.1.8. Transportation for Out of Country Medical Treatment:

Transportation for out of country treatment will be covered expenses for employees and dependents. The patient’s attending physician must certify in advance that the treatment is medically necessary and unavailable locally. Eighty percent (80%) of the patient’s transportation expenses by the least expensive, appropriate means of transportation to the nearest city with adequate medical facility will be reimbursed. Eighty percent (80%) of the transportation expenses of an attendant will 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 reimbursement for transportation expenses are subject to the annual maximum limit.

C.1.1.9 Annual Maximum Limit – The maximum annual reimbursement per patient per contract year, not including expenses covered under C.1.1.3 is Rp. 250,000,000

C.1.2 Health Benefits Conditions and Limitations.

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

There is no reimbursement for elective cosmetic or plastic surgery; spa cures; rejuvenation cures; massage; exercise therapy; long term rehabilitative therapy; eyeglass frames or non-prescription lenses; 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.

There is no reimbursement for treatment or surgery due to obesity or baldness. There is no reimbursement for expenses for treatment or surgery to promote or avoid pregnancy (e.g. birth control devices or drugs, fertility drugs, artificial insemination, in vitro fertilization and services of a surrogate mother, reversal of sterilization and non-life threatening abortion).

There is no reimbursement for expenses for or related to sex change surgery or any treatment related to gender identity or sexual dysfunction.

There is no reimbursement for expenses related to an illness or injury that is a result of an unlawful action on the part of the employee, injury or illness resulting from insurrection of war, declared or undeclared; the practice of a dangerous sport (e.g.: parachuting, deep sea diving, mountain climbing etc); excessive or illegal use of alcohol or drugs; suicide or attempted suicide or a self-inflicted wound; or service in the armed forces of any country.

There is no reimbursement for expenses resulting from injuries suffered by the participant while traveling in the following vehicles:

In air taxis or aircraft not operated by commercial line, legally authorized for the regular transportation of passengers, except when travelling in business of the Embassy/consulates.

As a driver or passenger in any automobile or any other vehicle, while taking part in safety, resistance, road or speed test, except when he/she is on trainee job purposes. Transportation aid/service.

No reimbursement will be made for expenses incurred after an employee leaves the service of the mission.

C.1.3 Eligible Participants

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

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

C.1.3.1.2. Locally Employee Staff (LES) employed under direct hire appointments, Personal Services Agreements (PSAs)/contracts that are not time limited to less than one year and Personal Services Contracts (PSCs);

C.1.3.1.3. Locally hired U.S. citizens employed under direct hire appointments, PSAs, and PSCs that are not limited to less than one year.

C.1.3.2 Location of Employment

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

C.1.3.3 Participants Covered Under a Rider

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

C.1.3.3.2 Employees of the Peace Corps Personal Service Contract employed under Personal Services Contracts. All costs for Peace Corps employees are the responsibility of the Peace Corps, not the U.S. Embassy.

C.1.4 Individuals Not Eligible for Coverage

Individuals not eligible for coverage under this contract are non-personal services contract personnel; employees working on a temporary basis; employees with an intermittent, seasonal, or WAE (when actually employed) schedule; and any other individual not falling within one of the categories of employees described in this clause.

C.1.5 Other Eligible Participants

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 spouse) and each unmarried, economically dependent child (limit three) 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 covered until the end of calendar year in which the child turns age 18, or in the case of a child is a full-time student until the end of the calendar year in which the child turns age 23. There is no age limit for an eligible child who is physically or mentally handicapped so as to be unable to life independently. Parents, grandparents, siblings, and other relatives are not eligible dependents.

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.

(1) For active employees who are regularly scheduled to work 30 or more hours per week, the USG will pay 100% of the premium cost for employee and dependent coverage.

(2) For active employees who are regularly scheduled to work less than 30 hours per week, the USG will pay the premium cost for employee coverage, based on the number of hours the employee is regularly scheduled to work. The employee will pay 100% of the premium cost for dependent coverage

(3) No coverage for retired employees

C.1.6.2. Period of Ineligibility.

Employees and their dependents are not entitled to health benefits during any period of employment for which premiums are not paid.

Additionally, employee's dependents are not entitled to health benefits during any period of employment during which the employee was not eligible to participate.

During a period of extended (beyond one pay period) of Leave Without Pay or unpaid leave, the employee is responsible for the full cost of the insurance premiums for self and dependents. The Mission will pay the premiums directly to the contractor, and will collect the full cost from the employee on a quarterly basis. Alternatively, the employee may elect to have coverage cease if that employee prefers not to pay the premium.

C.1.7. BROCHURE REQUIREMENT.

C.1.7.1. The contractor shall provide a document (brochure/pamphlet/other written document) in Indonesian that sets forth a complete listing of the health insurance benefits to be provided under this contract. The contractor is required to submit the brochure to the CO and the COR to ensure compatibility with the contract prior to printing. 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 draft document described in C.1.7.1 to the COR not later than 21 days after date of Contract Award to provide the ready-made documents within 14 days after approval of the draft. The Contractor shall provide additional brochures for new employees within ten (10) days of the COR’s request.

C.3.0 DEFINITIONS

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

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

Contributory Insurance for which the employee contributes toward the premium.

Dependent The legal spouse limited to one; the first legal spouse in the event of polygamy and children (limited to three) from 0 to 18 years of age. The children’s age limit may be extended to 23, provided that the child is still studying in a formal school. A school certificate to this effect must be produced.

Disability, Total and Permanent A physical or mental impairment which precludes the individual from performing ordinary motor or bodily functions and which requires separation from employment. If the impairment is the result of a previous impairment, it shall be considered a continuation of the prior impairment.

Employee An individual employed by the U.S. Government, under a direct-hire appointment, personal services contract, or personal services agreement, as further defined in Section C.1.3 for health insurance. This may also include an ORE Staff and/or Peace Corps Personal Service Contract employees if this category of individual is listed as participating under a rider in C.1.3. for health insurance.

Employer The United States Government or in the case of ORE and Peace Corps Personal Service Contracts (PSCs) the Chief of Mission/Deputy Chief of Mission and Peace Corps, respectively.

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

Hospital An institution established and operated for the care and treatment of sick and injured persons. It provides 24-hour nursing care and has diagnostic, laboratory, treatment, and surgical facilities. Any institution which does not meet this definition is not considered a hospital.

Hospital Patient An individual who has been admitted to a hospital, is assigned a bed, and is given diagnostic tests or receives treatment for a disease or an injury.

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

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

Physician An individual who has graduated from an accredited medical school and is licensed to practice medicine in the jurisdiction in which the contract is to be performed. If the individual is a medical specialist, then he or she is Board Certified in that specialty.

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

SECTION D

PACKAGING AND MARKING

(RESERVED)

SECTION E

INSPECTION AND ACCEPTANCE

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

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

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

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

FEDERAL ACQUISITION REGULATION (48 CFR CH. 1)

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

E.2. QUALITY ASSURANCE AND SURVEILLANCE PLAN (QASP)

This plan is designed to provide an effective surveillance method to promote effective contractor performance. The QASP provides a method for the Contracting Officer's Representative (COR) to monitor contractor performance, advise the contractor of unsatisfactory performance, and notify the Contracting Officer of continued unsatisfactory performance. The contractor, not the Government, is responsible for management and quality control to meet the terms of the contract. The role of the Government is to conduct quality assurance to ensure that contract standards are achieved.

Services.

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

C.1.0 thru C.3.0

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

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

E.2.2 Standard. The performance standard is that the Government receives no more than three (3) customer 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 a maximum of 10 working days to correct the defect. If the complaint is not addressed appropriately within 10 days, the COR will bring the issue up to the CO for appropriate contract action.

(e) The COR shall, as a minimum, orally notify the Contractor of any valid complaints within 10 working days of receipt of the complaints.

(f) If the Contractor disagrees with the complaint and challenges the validity of the complaint, the Contractor will notify the COR within 10 days of receipt of the complaint. The COR will review the matter to determine the validity of the complaint. If the COR determines complaint valid, the COR will notify the CO for appropriate contract action.

(g) The COR will consider complaints as resolved unless notified otherwise by the complaint.

(h) Repeat customer complaints are not permitted for any services. If a repeat customer complaint is received for the same deficiency during the service period, the COR will contact the Contracting Officer for appropriate action under the Inspection clause.

SECTION F

DELIVERIES OR PERFORMANCE

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

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

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

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

FEDERAL ACQUISITION REGULATION (48 CFR CH. 1)

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

F.2 PERIOD OF PERFORMANCE. The performance period of this contract is one year beginning 30 days after contract award with four one year options to renew.

F.3 OPTIONS

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

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

F.4 REPORTS AND OTHER DELIVERABLES

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

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 Officer.

G.2 COR DUTIES

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

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

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

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

G.3. Payment shall be made in Indonesian Rupiah.

G.4 SUBMISSION OF INVOICES AND PAYMENT

G.4.1. Invoices 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

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

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

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

G.4.5. Peace Corps Personal Service Contract (PSCs). The Peace Corps will make payment directly to the contractor for the entire premium amount of the employee, whether or not the employee is contributing to the premium amount.

G.5 REFUNDS TO THE GOVERNMENT

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

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

SECTION H

SPECIAL CONTRACT REQUIREMENTS

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

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

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

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

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

(1) The Contractor shall maintain medical insurance files for each covered employee and each covered dependent including receipts and proof of paid claims, requests for claim reimbursements, and accounting of paid benefits with balances of amounts remaining in the annual per person reimbursement ceiling.

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

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

(4) The Contractor shall notify the employee/participant that the employee/participant is due for reimbursement, provide details of the approved claim amounts, and transfer payments to the employees’ appointed bank account for claim reimbursement not later than ten working days after a claim is collected on Tuesday and Thursday each week.

(5) If employee/participant chooses to go to contractor’s medical institution provider, in which reimbursement will be made directly to the providers, the Contractor shall provide notification to the employee within ten working days whether said claims have been settled and in what amount.

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

(1) All medical claims shall be submitted directly to the Contractor by employees, through a drop box in the COR's office. The claims shall be picked up from the COR each Tuesday and Thursday. In the case that employee/participant uses contractor’s provider, the providers will submit allowable claims directly to the contractor and the employees are obliged to settle the difference prior to leaving the entity.

(2) The Contractor shall date stamp and screen all claims submitted on the day of receipt. If there are any missing documents or information thereby disallowing said claim to be payable, if the participant receives benefits or medical treatment not covered by the contract or in excess of the benefit levels provided under the contract (excess claims), the Contractor shall notify the employee within two days, with a copy to the COR (if notification is written).

(3) The contractor shall settle the claims no later than ten working days from the date the claim is submitted to the Contractor.

(4) Settlement shall be paid to the employees’ appointed bank account in full amount without additional charge to the employee for administration/transfer fee. Each check transaction shall be accompanied by clear notification providing details of the amount reimbursed and an explanation of deductions, if any.

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

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

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

(b) Report of amounts due to the contractor by the employee. The report will list all amounts due to the contractor, including name of the employee, date of event, description of event, amounts due to contractor and copies of notification letters to the employee to settle the overdue amounts that result from receipt of benefits or medical treatment not covered by the contract or in excess of the benefit levels provided under the contract (excess claims).

H.6. MISCELLANEOUS CONTRACTOR REQUIREMENTS

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

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

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

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

SECTION I

CONTRACT CLAUSES

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

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

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

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

FEDERAL ACQUISITION REGULATION (48 CFR CH. 1)