Jakarta_LES_Health_Insurance_2016_RFP_Section_B.docx

SECTION B (FOR OFFEROR USE)

PART I: PRICE - HEALTH INSURANCE

B.1. HEALTH INSURANCE SERVICES

The Contractor shall provide 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/or Consul General Surabaya (for ORE Staff), at the rates specified below. See Section G for billing procedures.

B.2. PRICES

B.2.1 VALUE ADDED TAX.

The Government will not reimburse the Contractor for VAT under this contract.

B.2.2 This is a firm fixed price with economic price adjustment requirements type contract under which will be issued as firm, fixed-price task orders. The fixed prices/premium rates for the health insurance services as specified in Section C are as follows:

B.2.3. Basic Year

Bi-Weekly Rates per Employee

e. Subtotal (a+b+c+d)

f. Total Price for Year Basic Year (e. x 26)

B.2.4. Option Year 1

Bi-Weekly Rates per Employee

e. Subtotal (a+b+c+d)

f. Total Price for Option Year 1 (e. x 26)

B.2.5. Option Year 2

Bi-Weekly Rates per Employee

e. Subtotal (a+b+c+d)

f. Total Price for Option Year 2 (e. x 26)

B.2.6. Option Year 3

Bi-Weekly Rates per Employee

e. Subtotal (a+b+c+d)

f. Total Price for Option Year 3 (e. x 26)

B.2.7. Option Year 4

Bi-Weekly Rates per Employee

e. Subtotal (a+b+c+d)

f. Total Price for Option Year 4 (e. x 26)

B.2.8 Grand Total of Base Plus All Option Years

Grand Total of Base plus All Option Years

Base Year Total

First Option Year Total

Second Option Year Total

Third Option Year Total

Fourth Option Year Total

Grand Total of Base plus All Option Years

B.2.9. OFFERS AND PAYMENT IN LOCAL CURRENCY

All offers and payments shall be in local currency only, Indonesian Rupiah (IDR/ Rp) in accordance with the Bank Indonesia Regulation No. 17/3/PBI/2015. This applies to all firms and there are no exceptions.

B.3 ADMINISTRATIVE RETENTION AMOUNTS

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

The retention amount is part of the premium and may include, but not be limited to, such costs as overhead and general and administrative costs. It will also include any profit. Essentially, it includes all costs except the actual portion of the premium intended to fund claims paid to the health care provider/claimant. B.3.2 sets forth the retention amounts per premium paid for each category of premium and for each period of performance.

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

B.3.2.1 Bi-Weekly Retention Amounts per separate premium paid per covered employee.

Base Period

First Option Year

Second Option Year

Third Option Year

Fourth Option Year

B.4. ECONOMIC PRICE ADJUSTMENT-HEALTH INSURANCE PREMIUMS

B.4.1. Premium Adjustment Based on Experience - For health insurance, prices may be adjusted upward or downward based on the experience rating of the Mission(s) covered by this contract, and it specifically excludes all riders in B.1.1. No adjustment will be allowed during the first twelve months. After such time, the Contractor or the Government may request an adjustment in premiums on an annual basis. Adjustments are not retroactive to previous contract terms. Before any such adjustment is made, the Contractor agrees to provide the Government a balance sheet showing three main components for the time period:

(1) receipts (premiums received) minus the retention amount; and

(2) distribution of insurance plans; and

(3) claims paid.

This information shall be provided per type of premium, i.e. per line item. The retention amount is not subject to adjustment. The Government reserves the right to have an independent third party review the balance sheet and claims and make recommendations regarding the appropriateness of the requested adjustment. Any adjustment shall be subject to mutual agreement of the parties and shall result in a written modification to the contract. Mutually agreed to adjustments shall be effective thirty days after complete information is received by the Government. Any failure to reach agreement under this clause shall be subject to the procedures in the Disputes clause.

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.

Page 2 of 67 RFQ: SID32016R0015: U.S Embassy Jakarta LES Health Insurance