HEALTH_ _LIFE_INSURANCE_SOLICITATION_2015.doc

UNDER DPAS (15 CFR 350)

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

3. SOLICITATION NO.

SKE50015R0002

4. TYPE OF SOLICITATION

[ ] SEALED BID (IFB)

[x] NEGOTIATED (RFP)

5. DATE ISSUED

March 17,2015

6. REQUISITION/PURCHASE NO.

7. ISSUED BY CODE

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

AMERICAN EMBASSY NAIROBI

U.N. AVENUE GIGIRI; PO BOX 606,00621, ATTN: GSO-PROCUREMENT - 1901.0

NAIROBI KENYA

Phone: Fax:

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

SOLICITATION

9. Sealed offers in original and 5 copies for furnishing the supplies or services in the Schedule will be received at the place specified, in the depository located in the Embassy until April 16, 2015 local time 11:00 (hour).

(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

Judith Wambui Mulinge

B. TELEPHONE (NO COLLECT CALLS)

AREA CODE NUMBER EXT

254 203636849

C. E-MAIL ADDRESS

mulingejw@state.gov

11. TABLE OF CONTENTS

OTHER STATEMENTS OF OFFERORS

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

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 Kenya 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) and C.2.3 (life). This insurance shall be provided in accordance with Section C B.1.1.

Official Residence Expense (ORE) Staff, American Employees Association (AEA) and Peace Corps Personal Service Contracts (PSC) are included under this contract only as a rider; the Contractor shall bill the Chief of Mission and Deputy Chief of Mission (for ORE Staff), the American Employees Association (for AEA) and Peace Corps (for PSC) at the rates specified below. See Section G for billing procedures.

B.1.

HEALTH INSURANCE SERVICES

The Contractor shall provide Health Insurance services to employees of the Government of the United States of America in Kenya. The groups of employees who shall be provided this insurance are listed in C.1.2. This insurance shall be provided in accordance with Section C and the Exhibits in Section J.

B.2.

PRICES

B.2.1 VALUE ADDED TAX.

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

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

B.3

ADMINISTRATIVE RETENTION AMOUNTS

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

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

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

B.3.2.1 Bi-Weekly Retention Amounts per separate premium paid per single employee and per 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 the Mission(s) covered by this contract, and it specifically excludes all riders in B.1.1. No adjustment will be allowed during the first twelve months. After such time, the Contractor or the Government may request an adjustment in premiums on an annual basis. Adjustments are not retroactive to previous contract terms. Before any such adjustment is made, the Contractor agrees to provide the Government a balance sheet showing three main components for the time period: (1) receipts (premiums received) minus the retention amount, (2) number of insurance plans and (3) claims paid. This information shall be provided per type of premium, i.e. per line item. The retention amount is not subject to adjustment. The Government reserves the right to have an independent third party review the balance sheet and claims and make recommendations regarding the appropriateness of the requested adjustment. Any adjustment shall be subject to mutual agreement of the parties and shall result in a written modification to the contract. Mutually agreed to adjustments shall be effective thirty days after complete information is received by the Government. Any failure to reach agreement under this clause shall be subject to the procedures in the Disputes clause.

B.4.2.

Premium Adjustment Based on Laws - The rates may also be adjusted during the performance period of the contract as a result of laws enacted by the host Government, if such change in the laws has a direct impact on the cost to the Contractor to perform this contract at the contracted rate. In that event, the Contracting Officer may enter into negotiations with the Contractor to modify the contract to adjust the premium rate. The Contractor agrees to provide all documentation necessary to support any requested adjustment.

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

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

PART II: PRICE - GROUP LIFE INSURANCE

GROUP LIFE & GROUP DISABILITY INCOME INSURANCE

B.5.

GROUP LIFE & DISABILITY 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 Kenya. The groups of employees who shall be provided this insurance are listed in C.2.3. This insurance shall be provided in accordance with Section C.

B.5.1.

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

B.6.

GROUP LIFE & DISABILITY INCOME 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 Kenya Shilling per one thousand of salary to provide life insurance, accidental death and dismemberment and total disability coverage are as follows:

B.7

ADMINISTRATIVE RETENTION AMOUNTS

B.7.1 If the Contractor requests a price adjustment under B.8 below, the Contractor must present cost experience data that includes the retention amount. For purposes of any economic price adjustment, this retention amount is a fixed amount that is a part of the premium amounts in B.6. This retention amount will not be adjusted for any reason.

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

B.7.2 sets forth the retention amounts per premium paid for each category of premium and for each period of performance.

NOTE TO OFFEROR: Fill in the fixed quarterly 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 Quarterly Retention Amounts per Separate Premium Paid per Employee:

Base Period

Option Year 1

Option Year 2

Option Year 3

Option Year 4

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

B.8.1. Premium Adjustment Based on Experience: For life insurance, prices may be adjusted upward or downward based on the experience rating of the Mission(s) covered by this contract, and it specifically excludes all riders in B.1.1. No adjustment will be allowed during the first twelve months. After such time, the Contractor or the Government may request an adjustment in premiums on an annual basis. Adjustments are not retroactive to previous contract terms. Before any such adjustment is made, the Contractor agrees to provide the Government a balance sheet showing three main components for the time period: (1) receipts (premiums received) minus the retention amount, (2) number of insurance plans and (3) claims paid. The information shall be provided per type of premium, ie per line item. The retention amount is not subject to adjustment. The Government reserves the right to select an independent third party to review the balance sheet and claims and make recommendations regarding the appropriateness of the requested adjustment. Any adjustment shall be subject to mutual agreement of the parties and shall result in a written modification to the contract. Mutually agreed to adjustments shall be effective thirty days after complete information is received by the Government. Any failure to reach agreement under this clause shall be subject to the procedures in the Disputes clause.

B.8.2.

Premium Adjustment Based on Law: The rates may also be adjusted during the performance period of the contract as a result of laws enacted by the host Government, if such change in the laws has a direct impact on the cost to the Contractor to perform this contract at the rate contracted for herein. In that event, the Contracting Officer may enter into negotiations with the Contractor to modify the contract to adjust the premium rate. The Contractor agrees to provide all documentation necessary to support any requested adjustment.

SECTION C

DESCRIPTION/SPECIFICATION/WORK STATEMENT

PART I - HEALTH INSURANCE

C.1.

HEALTH INSURANCE SERVICES

The Government of the United States of America requires Health Insurance coverage for its employees as further described in C.1.2 in Kenya. The Government has determined that the prevailing practice by employers in Kenya is to provide for their employees health insurance protection and that the cost of such insurance protection is usually borne by both the employee and the employer: USG pays 90% and employee 10%. For eligible employees who are regularly scheduled to work less than 30 hours per week: The USG will pay a prorated share of the premium cost for employee and dependent coverage, based on the number of hours the employee is regularly scheduled to work.

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.

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.

( Spouse /Children)

The Cost shall include but is not limited to:

(a) Ward or semi-private room to include board for mothers accompanying sick children.

(b) Operating theatre fees and surgical expenses.

(c) All Doctors’, specialists’ and pathologists’ fees for visits and services rendered to the insured while confined in the hospital.

(d) All diagnostic tests and other charges of the hospital for services and supplies for treatment and care of the insured while confined in the hospital.

(e) All HIV/AIDS related treatment expenses. Provide HIV/AIDS cover that includes HIV testing, lab monitoring for CD4, viral load tests and hematology, biochemistry tests, ARV drugs, as well as drugs for Opportunistic Infections as appropriate.

(f) Obstetric-related expenses e.g. pregnancies, deliveries; normal and Caesarian Sections/maternity, ectopic pregnancies, miscarriages, ARV during child birth for E staff mothers.

(g) Well-baby care up to age 1.5 years consisting of primary vaccinations, growth and development monitoring, routine blood and urine tests, health education and nutrition, prevention and management of minor ailments, referral of sick babies to the pediatric casualty including HIV and Treatment Any of the following conditions but not limited to:

(a) Heart attack: The death of a portion of the heart muscle or damage to the heart due to inadequate blood supply to the relevant area.

(b) Cancer: A disease manifested by the presence of malignant tumor characterized by uncontrolled growth and spread of malignant cells, and the invasion of normal surrounding tissue.

(c) Coronary Artery Disease Surgery: The actual undergoing of bypass surgery (either saphenous vein internal mammary graft) for the treatment of coronary artery disease.

(d) Major Organ Transplant: The human-to-human organ transplant from a donor to the insured person of one or more of the following organs: Kidney, Heart, Lung, Liver, Pancreas or Bone Marrow: including expenses incurred by the donor during such a transplant.

(e) Paraplegia: The total and irreversible loss of the use of legs or arms.

(f) Kidney failure: End stage renal failure presenting as chronic irreversible failure of kidneys to function as a result of which regular renal dialysis must be instituted.

(g) Stroke: any cerebrovascular occurrence or accident which produces neurological sequelae lasting more than 24 successive hours and include infarction of brain tissue, hemorrhage, and remobilization from an extra cranial source. Evidence of permanent neurological deficit must be produced.

(h) Any medical condition that requires treatment in the High Dependency Unit (HDU) or Intensive Care Unit (I.C.U.)

(i) Follow up treatment in respect of any of the above.

(j) Any AIDS related disease that may be required on an emergency.

Surgery (out-patient): 90% at a hospital on an out-patient basis, at a doctors’ office or at home.

Doctor Visits (out-patient): 90% at a hospital on an out-patient basis, at a doctors’ office or at home.

Well-baby care up to age 1.5 years: 100% reimbursement consisting of primary vaccinations, growth and development monitoring, routine blood and urine tests, health education and nutrition, prevention and management of minor ailments, referral of sick babies to the pediatric urgent care, including HIV care and treatment.

Applicable

90% at a hospital on an out-patient basis, at a doctor’s office or at home. 90% reimbursement for laboratory tests.

The Cost shall include but is not limited to:

(1) All Doctors’, specialists’ and pathologists’ fees.

Fees of a registered graduate nurse (other than a close relative or one residing in the insurer’s home) for private duty nursing; nursing home and nursing attendance fees not to exceed 30 days in any one contract year;

(2) The following other services and supplies shall apply but not limited to:

(a) X-ray, laboratory, and physiotherapy charges (b) Drugs and medicines prescribed by a physician and dispensed by a licensed pharmacist. Expenses incurred for medicines, vitamins, cold remedies, etc., that are available over the counter without a prescription will not be reimbursed even if prescribed by a physician.

(c) Surgical dressings, casts, splints, trusses, braces and crutches.

(d) Artificial limbs and eyes when necessitated by accidental bodily injury or disease.

(e) Rental of wheelchair, hospital bed or iron lung, or purchase of hearing aids.

The Cost shall include but is not limited to:

- Consultant charges.

- X-rays, fillings

- Extracts of tooth or teeth

- Periodontics treatment

- Orthodontic treatment

- Crown and bridge

- Palliative treatment, scaling and polishing of teeth.

Psychological treatment and care which may/may not include medications, for psychiatric ailments. It may also include the services of a psychologist.

a) HIV/AIDs: A separate maximum limit applicable to the employee only will be included for the HIV/AIDs medications expanded coverage up to a maximum of 10,000 USD.

b) Catastrophic Coverage: 100% up to 1,400,000 KES reimbursement.

a) The Insurance company will reimburse covered expenses up to a limit of 3,000,000 KES per covered individual per year (for both in and out-patient).

b) A Separate maximum limit applicable to the employee only will be included for the HIV/AIDS medications expanded coverage is up to a maximum of local currency equivalent of USD 10,000

c) Catastrophic Coverage: 100% up to 1,400,000 KES reimbursement.

d) Dental Care: coverage maximum is up to 122,000 KES per family per contract year.

e) Optical Care: coverage maximum is up to 40,000 KES reimbursement for eye examination and treatment, up to 100,000 KES reimbursement for prescription lenses, up to 8,000 KES reimbursement for frames.

f) Hearing Aids: maximum one hearing aid apparatus every three years and related examination.

C.1.2 Health Benefits Conditions and Limitations.

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

Expenses not covered

a) No reimbursement for routine annual physical exams and inoculations

b) Family planning

c) Nursing care

d) Transportation for out of country treatment

e) Elective cosmetic surgery

f) Spa cures

g) Rejuvenation cures

h) Massage

i) Exercise therapy

j) Long term rehabilitative therapy

k) Non-medical hospital charges such as telephones or television; home help, family help, or similar household assistance

l) Fees of persons who are not licensed physicians or nurses; or services or supplies which have not been prescribed or approved by a physician or nurse.

m) No reimbursement for expenses that will be reimbursed or paid directly under a host country medical program, the U.S. workers' compensation program, or a post's employee Workers' compensation program.

n) No reimbursement for expenses related to an illness or injury that is a result of an unlawful action on the part of the patient.

o) The practice of a dangerous sport.

p) Excessive or illegal use of alcohol or drugs.

q) A self-inflicted wound while sane or insane (Children below 18years old are exempted)

r) Injuries sustained while in Service in the armed forces of any country.

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 Kenya paid under the Local Compensation Plan, and certified by the Contracting Officer. Covered employees include

C.1.3.1.2.

Foreign Service Nationals (FSNs) employed under direct hire appointments, Personal Services Agreements (PSAs) and Personal Services Contracts (PSCs);

C.1.3.1.3.

Locally hired U.S. citizens employed under direct hire appointments, PSAs, and PSCs.

C.1.3.2 Location of Employment

The individuals covered by C.1.3.1 must be employed within the geographic boundaries of Kenya by: Department of State, U.S. Agency for International Development.

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 B). All costs for ORE employees are the responsibility of the employing officer, not the U.S. Government.

C.1.3.3.2 All current active employees of the Employee Association at Embassy Nairobi (see separate rider, Exhibit C). All costs for American Employees Association (AEA) are the responsibility of the Employee Association, not the U.S. Government.

C.1.3.3.3 All Peace Corps Personal Service Contracts (PSC) at Embassy Nairobi (see separate rider, Exhibit D). All costs for Peace Corps Personal Service Contracts (PSC) are the responsibility of the Peace Corps, not the U.S. Government

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

The following additional categories of persons are covered by this insurance: An employee's dependents who are defined as the employee's legal spouse (limit one), and each unmarried, economically dependent child who primarily resides with the employee unless away at school.

Child is defined as the employee's natural child, adopted child, stepchild, or foster child. An eligible child will be covered until the end of the calendar year in which the child turns age 18, or in the case of a child who is a full-time student, until the end of the calendar year in which the child turns age 25. There is no age limit for an eligible child who is physically or mentally handicapped so as to be unable to live independently. There is no limit on the number of children covered per employee.

C.1.6.

Eligibility

C.1.6.1.

Term of Eligibility and Effective Date

Each current active eligible employee is enrolled for health benefits under this contract upon award and thereafter during the performance period of this contract. Each new eligible employee will be enrolled upon entering on duty with the United States Government. An employee is considered active ("on the rolls") whenever such employee is on approved leave, whether paid or unpaid.

During a period of Leave Without Pay (LWP) or unpaid leave that is one pay period or less, coverage under the insurance contract will continue. The USG will pay the total premium cost to the Contractor. The employee’s share of the premium will be collected through payroll deduction in that or the subsequent pay period.

C.1.6.2.

Period of Ineligibility.

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

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

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

C.1.7.

GENERAL REQUIREMENT

The Contractor shall provide (1) high level of individual attention to claims and close management oversight to monitor efficiently and accurately the Medical, Life and Disability insurance claims submitted for payment, and (2) monitor changes in staffing and payroll that affect premiums. The Contractor shall always take the greatest care to ensure prompt payment of claims (within ten (10) work-days of submission) and accurate monitoring of premiums. The Contractor shall also keep and provide the listed hospitals with an updated list of covered members at all times.

C.1.7.1. FORMS AND ISTRUCTIONS: The Contractor shall provide all forms necessary for employees and/or their dependents to apply for insurance coverage, designate beneficiaries if insurance, and forms for filling claims benefits covered under this insurance contract. This shall include but not be limited to application forms, designation of beneficiary forms, claims forms and instructions for completing the forms

C.1.7.1.1. Brochure Requirement: The Contractor shall provide a document (brochure/pamphlet/other written document) English that sets forth a complete listing of the health insurance benefits to be provided under this contract. This brochure shall be provided in sufficient quantities so that each covered employee receives a copy. The Contractor shall furnish all copies of the brochures to the COR, who will ensure that appropriate distribution is made.

C.1.7.1.2.

The Contractor shall provide the document described in C.1.7.1 to the COR not later than 14 days after date of contract award. The Contractor shall provide additional brochures for new employees within ten (10) days of the COR’s request.

C.1.7.1.3.

The Contractor assumes full responsibility for ensuring that the document described in C.1.7.1 accurately reflects the requirements of the contract, as implemented by the Contractor’s technical proposal. In all cases, the contract shall take precedence. Should the COR discover that the brochure contains inaccuracies, the Contractor will be notified in writing; however, failure on the part of the Government to notice any inaccuracies shall in no way limit, revise or otherwise affect the requirement under this contract for the Contractor to fully comply with all contract terms.

C.1.7.2. POINT OF CONTACT OF CONTRACTOR: The Contractor shall provide the name of a point of contact with which employees may contact to assist in filing or tracking claims filed against the insurance covered under this contract. The Contractor shall ensure prompt payment of claims (within ten (10) work-days of submission) and that claims decisions and payments are communicated promptly to both employee and COR C.1.7.3.

BRIEFINGS PROVIDED BY THE CONTRACTOR: The Contractor shall provide group briefings to employees, on insurance coverage as requested by the COR.

PART II: GROUP LIFE INSURANCE

GROUP LIFE & GROUP DISABILITY INCOME INSURANCE

C.2.0

GROUP LIFE INSURANCE

The Government of the United States of America requires group life insurance coverage for its employees, as further described in C.2.2, in Kenya. The Government has determined that the prevailing practice by employers in Kenya is that group life insurance coverage is representative of locally prevailing compensation practice and that the cost of such insurance protection is usually borne by the employer on a 100%.Therefore, the Government desires to adopt such locally prevailing practice as part of its compensation plan for its employees as further described in C.2.2. The specific group insurance coverage under this contract is set forth in this part of Section C.

C.2.0.1 Benefits

1. Death Benefit

2. Disability Benefit

3. Funeral Expense Benefit

C.2.1.

Group Life Insurance Coverage.

The amount of group life insurance coverage is as follows:

C.2.1.1

Amount of Employee Life Insurance.

The amount of life insurance coverage for each employee is based upon

Natural Death: Employee’s estate will receive 3 times basic annual salary at the time of death (Kenya Shillings)

C.2.1.2 Accidental or work related Death or Disability Coverage.

The employee's estate or employee will receive an amount equal to three (3) times the amount of annual basic salary at the time of death (Kenya Shillings

C.2.1.3

Total Disability Coverage

The employee will receive an amount of 28 months’ base salary (Kenya Shillings) C.2.1.4

Funeral Benefits

The contractor shall pay Kenya Shillings 50,020 at the time of death, payable within two working days

C.2.2

Life Insurance Benefits Conditions and Limitations.

Conditions and limitations on the entitlement to life & Disability income insurance benefits under this contract are as follows:

No benefits shall be payable if an employee's death or other insurance event was caused directly or indirectly by war. War shall be defined as declared or non-declared war or any martial operations or invasion, hostile acts of foreign powers, rebellion, riot, civil war, uprising, mutiny, operations by military or usurpatory authorities, martial law or state of siege or any other similar event or reason for declaring martial law or war. A terrorist attack shall not be considered war. No benefits shall be payable under this contract if the employee’s bodily injuries have been caused directly or indirectly and totally or partially by:

1. Self-inflicted wounds or wounds inflicted at the employee’s request, irrespective of the employee being sane or insane, excluding a suicide or attempted suicide after 2 years' continuous coverage under this or the Government's previous life insurance contract.

2. Violating the law or in resisting detention or arrest,

3. Participating in competitions involving the use of wheeled vehicles, horses, boats, or water skis.

4. Flying an airplane or any other aircraft as a passenger or otherwise, except as a passenger on an airplane operated by a passenger airline on a scheduled air service over an established passenger route.

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

C.2.3.

Eligible Participants.

C.2.3.1

Eligible Employees. The employees eligible for the group life insurance coverage include the following:

C.2.3.1.1 All current active employees of the United States Government, employed within the geographic boundaries of Kenya, paid under the Local Compensation Plan, and certified by the Contracting Officer. Covered employees include:

C.2.3.1.2.

Foreign Service Nationals (FSNs) employed under direct hire appointments, Personal Services Agreements (PSAs) and Personal Services Contracts (PSCs);

C.2.3.1.3.

Locally hired U.S. citizens employed under direct hire appointments, PSAs, and PSCs.

C.2.3.2 Location of Employment

C.2.3.2

The individuals covered by C.2.3.1 must be employed within the geographic boundaries of Kenya by: Department of State, U.S. Agency for International Development.

C.2.3.3 Participants Covered Under a Rider

C.2.3.3.1 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 B). All costs for ORE employees are the responsibility of the employing officer, not the U.S. Government.

C.2.3.3.2

RESERVED

C.2.4

Individuals Not Eligible for Coverage

C.2.4.1.

New employees who have reached the age of 60 prior to entering on duty with the U.S. Government will not be eligible for life insurance coverage.

C.2.4.2

Individuals not eligible for coverage under this contract are non-personal services contract/ Agreement 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.2.5.

RESERVED

C.2.6

Eligibility and Effective Date

C.2.6.1.

Term of Eligibility and Effective Date

Each current active eligible employee is enrolled for life insurance and disability benefits under this contract upon award and thereafter during the performance period of this contract. Each new eligible employee will be enrolled upon entering on duty with the United States Government. An employee is considered active ("on the rolls") whenever such employee is on approved leave, whether paid or unpaid.

C.2.6.2.

Period of Ineligibility

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

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

C.2.7.

Brochure Requirement

C.2.7.1.

The Contractor shall provide a document (brochure/pamphlet/other written document) in English that sets forth a complete listing of the life insurance benefits to be provided under this contract. This brochure shall be provided in sufficient quantities so that each covered employee receives a copy. The Contractor shall furnish all copies of the brochures to the COR, who will ensure that appropriate distribution is made.

C.2.7.2.

The document described in C.2.7.1 shall be provided to the COR not later than 14 days after date of contract award. The Contractor shall provide additional brochures for new employees within ten days of the COR’s request.

C.2.7.3.

The Contractor assumes full responsibility for ensuring that the document described in C.2.7.1 accurately reflects the requirements of the contract, as implemented by the Contractor’s technical proposal. In all cases, the contract shall take precedence. Should the COR discover that the brochure contains inaccuracies, the Contractor will be notified in writing; however, failure on the part of the Government to notice any inaccuracies shall in no way limit, revise or otherwise affect the requirement under this contract for the Contractor to fully comply with all contract terms.

C.2.8.

IMPORTANT PARTICULARS AND RECORDS:

(a) For a member to enroll for the Group Life and Disability Income Coverage, the Contractor shall provide application forms to be completed by new members. The member will provide the full name, date of birth, date of appointment, the annual basic salary, names of designated beneficiaries and any other information that may reasonably be required by the Contractor in connection with the Group Life & Disability Income Cover.

(b) Any updates in salary for any member shall be communicated to the contractor within 30 calendar days.

(C) The Contractor shall be expected to deliver the following:

(i) Application forms for new members

(ii) Information booklets

(iii) Member’s essential and reasonable records which may be requested for by the COR.

C.2.9.

HANDLING OF CLAIMS:

C.2.9.1. Life Insurance Coverage

(a) Upon notification of the death of a member by the COR, the Contractor shall pay a portion of the employee Life insurance benefit of an amount of KShs.100,000.00 within two working days. The Contactor shall thereafter provide any necessary forms to be completed by the beneficiary/ies or the COR. After receipt of all the completed and signed forms and/or any other necessary information, the Contractor shall pay the Life insurance benefit balance to the beneficiary within 60 calendar days.

(b) An eligible employee shall, subject to the laws and regulations governing such matters, on becoming a member, nominate the beneficiary who shall b e entitled to receive the Sum Assured and at any time thereafter alter any such nomination previously made, provided that notification is given in writing to the COR and Insurance. If there is no beneficiary living at the time of the member’s death, the member’s legal representatives shall be entitled to receive the sum assured.

C.2.9.2. Disability Income Insurance Coverage

(a) Upon notification by the COR of a member’s absence due to disability caused by illness or injury, the Contractor shall provide any necessary claim forms for completion by the COR and the member. After receipt of all the duly completed and signed forms and any other doctors’ reports on the disability, the Contractor shall start payment of the disability benefit. The Contractor shall be responsible to request for medical examination reports that may be necessary from time to time and any expenses for such reports shall be borne by the Contractor.

(b) No premiums will be payable in respect of a member who is receiving benefits.

C.20. Period of Disablement:

The period of disablement in respect of which benefit is payable shall not extend beyond the time when a member recovers from the effects of any illness or accident or beyond the period when the necessity for continuous medical attention shall have ceased. Benefit would be paid during disability caused by either accident or sickness for the specified benefit payment period or upon death of the member while still disabled. The COR, upon request by the Contractor, will notify them if a member is or continues to be disabled, and is not following any other occupation.

C.3.0 DEFINITIONS

Child is defined as the employee's natural child, adopted child, stepchild, or foster child. An eligible child will be covered until the end of the calendar year in which the child turns age 18, or in the case of a child who is a full-time student, until the end of the calendar year in which the child turns age 25. There is no age limit for an eligible child who is physically or mentally handicapped so as to be unable to live independently. There is no limit on the number of children covered per employee.

Out Patient- Medical and related services rendered by a hospital that do not entail hospitalization/admission

(1) While the insured is riding as a passenger within any mechanically propelled non-serial, public transport or conveyance operated by a common carrier which regularly dispatches for hire over an established route in a regular passenger service but not while, or inconsequence of, attempting to jump out of the conveyance;

(2) While the insured is riding as a passenger in a regular passenger elevator car (elevators in mines excluded); or

(3) In consequence of a burning of any home, theatre, hotel or other public building in which the insured is present at the commencement of the fire.

(4) Falling debris from construction sites etc.

SECTION D

PACKAGING AND MARKING

(RESERVED)

SECTION E

INSPECTION AND ACCEPTANCE

E.1.

52.252‑2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

This contract incorporates the following clauses by…