Health_and_Life_Insurance_Solicitation_SKU20017R0001.pdf

Health/Life Insurance - Uniform Contract Format

SKU200-17-R-0001

April 4, 2017 American Embassy Kuwait Zeyad I Qishawi

Kuwait City, Kuwait

April 4, 2017

Dear Prospective Offeror:

SUBJECT: Solicitation Number SKU200-17-R-0001 for Group Health & Life Insurance

Services for Locally Engaged Staff (LES) of the American Embassy Kuwait.

The Embassy of the United States of America invites you to submit a proposal for customized

Health & Group Life Insurance Services for: Locally Engaged Staff (LES) of the American

Embassy Kuwait.

The Embassy intends to conduct a pre-proposal conference, and all prospective offerors who have received a solicitation package are invited to attend. See Section L of the attached Request for Proposals (RFP).

Your proposal must be submitted either in a sealed envelope marked "Proposal SKU200-17-R-

0001 Enclosed" to American Embassy, attention the Contracting Officer or by Email to

KuwaitProcurement@state.gov on or before 1400 hours local time May 17, 2017. No proposal will be accepted after this time.

In order for a proposal to be considered, you must also complete and submit the following:

1. SF-33

2. Section B, Pricing Schedule

3. Section B, Retention Amounts in B.3 and B.7

3. Section K, Representations and Certifications;

4. Additional information as required in Section L.

Direct any questions regarding this solicitation in writing NO later than April 26, 2017 by email to KuwaitProcurement@state.gov .

Please note: proposals that contain more benefits (even if there is no increase in cost) or fewer benefits than those stated in the solicitation may be deemed technically unacceptable.

The U.S. Government intends to award a contract to the responsible company submitting an acceptable offer at the lowest price. We intend to award a contract based on initial proposals, without holding discussions, although we may hold discussions with companies in the competitive range if there is a need to do so.

Sincerely, Roberto Custodio

Contracting Officer mailto:KuwaitProcurement@state.gov mailto:KuwaitProcurement@state.gov

SOLICITATION, OFFER AND AWARD

1. THIS CONTRACT IS A RATED ORDER

UNDER DPAS (15 CFR 350)

RATING PAGE OF PAGES

1 | 87

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

3. SOLICITATION NO.

SKU200-17-R-0001

4. TYPE OF SOLICITATION

[ ] SEALED BID (IFB)

[x] NEGOTIATED (RFP)

5. DATE ISSUED

April 4, 2017

6. REQUISITION/PURCHASE NO.

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

Bayan, Al Masjid Al Aqsa St.

Kuwait

Phone: 965-2259-1234 Fax: 965-2259-1938

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

SOLICITATION

9. Sealed offers in original and 2 copies for furnishing the supplies or services in the Schedule will be received at the place specified, in the depository located in

American Embassy Front Gate until May 17, 2017, local time 1400.

(date) (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

ZEYAD I Qishawi

B. TELEPHONE (NO COLLECT

CALLS)

AREA CODE NUMBER EXT

965-2259-1234

C. E-MAIL ADDRESS

QishawiZI@state.gov

11. TABLE OF CONTENTS

(x) SEC. DESCRIPTION PAGE(S) (x) SEC. DESCRIPTION PAGE(S)

PART I - THE SCHEDULE PART II - CONTRACT CLAUSES

X A SOLICITATION/CONTRACT FORM 2 X I CONTRACT CLAUSES 44-56

X B SUPPLIES OR SERVICE AND PRICES/COSTS 3-16 PART III - LIST OF DOCUMENTS, EXHIBITS, AND OTHER ATTACH.

X C DESCRIPTION/SPECS/WORK STATEMENT 17-32 X J LIST OF ATTACHMENTS 57-62

X D PACKAGING AND MARKETING 33 PART IV - REPRESENTATIONS AND INSTRUCTIONS

X E INSPECTION AND ACCEPTANCE 34-35 X K REPRESENTATIONS, CERTIFICATIONS, AND 63-75

X F DELIVERIES OR PERFORMANCE 36 OTHER STATEMENTS OF OFFERORS

X G CONTRACT ADMINISTRATION 37-38 X L INSTRS., COND., AND NOTICES TO OFFERORS 76-83

X H SPECIAL CONTRACT REQUIREMENTS 39-43 X M EVALUATION FACTORS FOR AWARD 84-86

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

14. ACKNOWLEDGMENT OF

AMENDMENTS

AMENDMENT NO. DATE AMENDMENT NO. DATE

(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

17. SIGNATURE 18. OFFER DATE

AWARD (To be completed by Government)

19. ACCEPTED AS TO ITEM NUMBERED

20. AMOUNT

21. ACCOUNTING AND APPROPRIATION

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

American Embassy Kuwait – Budget Office

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.

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 Kuwait 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 and the Exhibits in

Section J.

B.1.1. Official Residence Expense (ORE) Staff and American Employee Welfare Association

Employees (AEWA) 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), and the American Employee

Welfare Association Employees (AEWA) 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. 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 fixed prices/premium rates for the health insurance services as specified in Section C are as follows:

B.2.3 Defense Base Act (DBA) Insurance: The Contractor shall provide workers’ compensation insurance in accordance with FAR 52.228-3 to employees assigned to this contract who are either United States citizens or direct hire. Total cost of DBA should be part of the Firm-Fixed-

Price for Base and options periods.

B.2.4. Base Year of Contract

Estimated start date September 1, 2017 – August 31, 2018

Bi-Weekly Rates per Employee

Category Estimated Number of

Employees

Rate per Employee Bi-Weekly Total

a. Single Employees (Self Only) 42 ……………….. ………………..

b. Family Plan 319 ……………….. ………………..

c. Subtotal (a + b) ………………..

d. Total Price (c x 26) ………………..

B.2.5. 1 st Option Year

Estimated start date September 1, 2018 – August 31, 2019

Bi-Weekly Rates per Employee

Category Estimated Number of

Employees

Rate per Employee Bi-Weekly Total

B.2.6. 2 nd

Option Year

Estimated start date September 1, 2019 – August 31, 2020

Bi-Weekly Rates per Employee

Category Estimated Number of

Employees

Rate per Employee Bi-Weekly Total

B.2.7. 3 rd

Option Year

Estimated start date September 1, 2020 – August 31, 2021

Bi-Weekly Rates per Employee

Category Estimated Number of

Employees

Rate per Employee Bi-Weekly Total

B.2.8. 4 th

Option Year

Estimated start date September 1, 2021 – August 31, 2022

Bi-Weekly Rates per Employee

Category Estimated Number of

Employees

Rate per Employee Bi-Weekly Total

B.2.9 Health Insurance - Grand Total of Base plus All Option Years

Duration

Amount

Base Year (d)

Option Year (d)

Total amount including all option years

B.3 ADMINISTRATIVE RETENTION AMOUNTS

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

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

NOTE TO OFFEROR: Fill in the fixed 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.

Period of Performance

Single Employees (Self Only)

Family Plan

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, (2) number of insurance plans and (3) claims paid. This 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 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

B.5. GROUP LIFE INSURANCE SERVICES

The Contractor shall provide the Group Life Insurance services described herein to employees of the Government of the United States of America in Kuwait. The groups of employees who shall be provided this insurance are listed in C.2.3. This insurance shall be provided in accordance with Section C and the Exhibits in Section J.

B.5.1. Official Residence Expense (ORE) Staff and American Employee Welfare Association

Employees (AEWA) 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 Employee Welfare

Association Employees (AEWA), at the rates specified below. See Section G for billing procedures.

B.6. GROUP LIFE INSURANCE RATES

This is a fixed-price with economic-price- adjustment-requirements type contract under which the Government will issue firm-fixed price task orders. The fixed prices/premium rates in Kuwaiti

Dinars per one thousands of salary to provide life insurance, accidental death and dismemberment and partial and total disability coverage are as follows:

B.6.1. - Base Year of Contract - Estimated start date September 1, 2017 – August 31, 2018

Bi-Weekly Rates per Employee Type of Insurance Premium

(per 1,000 of Salary)

Estimated Payroll

(Bi-Weekly in Thousands)

Bi-Weekly Total

a. Basic Life

KWD 200

b. Accidental Death &

Dismemberment

c. Partial & Total

Disability Coverage

d. Subtotal (a + b + c)

e. Total Price (d x 26)

B.6.2. – 1

Option Year - Estimated start date September 1, 2018 – August 31, 2019

Type of Insurance Premium

(per 1,000 of Salary)

Estimated Payroll

KWD 210

B.6.3. – 2

Option Year - Estimated start date September 1, 2019 – August 31, 2020

(per 1,000 of Salary)

Estimated Payroll

KWD 220

B.6.4. – 3

Option Year - Estimated start date September 1, 2020 – August 31, 2021

(per 1,000 of Salary)

Estimated Payroll

KWD 231

B.6.5. – 4

Option Year - Estimated start date September 1, 2021 – August 31, 2022

(per 1,000 of Salary)

Estimated Payroll

KWD 242

B.6.6. – Life Insurance - Grand Total of Base plus All Option Years

Amount

Base Year (d)

Total amount including all option years

B.6.7. – Life Insurance and Health Insurance - Grand Total of Base plus All Option Years

Health Insurance

(f)

Life Insurance

(g)

Total amount

Base Year

Option Year

Grand total amount for Life and Health insurance

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 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 Retention Amounts per Separate Premium Paid per Employee:

Period of Performance Basic Life Accidental Death and

Partial and Total

Base Period

First Option Year

Second Option Year

Third Option Year

Fourth Option Year

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 the State of Kuwait. The Government has determined that the prevailing practice by employers in the State of Kuwait 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. The USG pays 90% and employee 10%. 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, unless exclusion has been authorized by HR/OE/CM.

Post-Unique Benefits

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.

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

C.1.1 Employee and Dependent Health Services Benefits

C.1.1.1

Covered Benefit Description Employee Dependent

Hospitalization Coverage of room and board expenses for a semi-private room.

100% 100%

Coverage of room and board expenses for a private room, not to exceed

100% of the cost of a semi-private room

80% 80%

Coverage of hospital medical expenses including laboratory tests and x-rays, nursing care, operating room expenses, intensive care, and physical therapy

100% 100%

Coverage of land ambulance service 100% 100%

C.1.1.2

Professional Services and Treatment

Coverage of doctors’ and surgeons' fees incurred while hospitalized, at a hospital on an out-patient basis, at a clinic or doctor's office, or at home.

Coverage for medical services and expenses when not hospitalized such as laboratory tests and x-rays, physical therapy.

80% 80%

C.1.1.3

Prescription drugs and medicines

Coverage of expenses when hospitalized and

100% 100%

Coverage of expenses when not hospitalized, of the cost of medicines and drugs for which a prescription is legally required

80% 80%

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

0% 0%

C.1.1.4

HIV/AIDS Coverage of expenses for medications to suppress opportunistic infections, such as tuberculosis and toxoplasmosis for employees who have HIV/AIDS; as well as brief courses of anti-retroviral drugs during childbirth to prevent the transmission of HIV to the employee's child. This expanded coverage generally excludes medications for the long-term suppression of AIDS through the combination of anti-retroviral drugs at those posts with inadequate local healthcare infrastructures.

The maximum limit for expenses reimbursed under section C.1.1.4 is USD 10,000 or equivalent in Kuwait local currency (KD) per patient per contract year.

C.1.1.5

Obstetrical Care Coverage of expenses when hospitalized, and

100% 100%

Coverage of expenses when not hospitalized

100% 100%

Coverage of expenses for prenatal and postnatal care.

50% 50%

C.1.1.6

Family Planning Coverage of expenses of prescribed contraceptive devices and drugs, voluntary sterilization and diagnosis, and treatment of infertility, fertility drugs

100% 100%

Not covered is reversal of voluntary sterilization, infertility treatment after voluntary sterilization, genetic counseling, and assisted reproductive technology

C.1.1.7

Hearing Aids Coverage of expenses for the cost of a hearing aid apparatus and related examination. Limited to one apparatus per ear per patient in a three-year period.

C.1.1.8

Optical Care Coverage of expenses for eye examination and treatment and prescription eyeglass or contact lenses. Limited to two lenses per patient every two years

No coverage for eyeglass frames, non-prescription lenses, tinting or sunglasses.

C.1.1.9

Dental Care Coverage of expenses for dental services including dentists' fees, x-rays, examination and treatment, cleaning, fillings, extractions, false teeth, crowns, and bridges.

Orthodontia treatment is covered only if treatment begins before age 15, unless required as a result of an accident. A maximum of four years of orthodontia treatment per patient.

C.1.1.10

Psychiatric Treatment Coverage of expenses for customary and reasonable cost of psychiatric care when referred to a psychiatric care specialist for medical reasons.

C.1.1.11

Covered Benefit Description

Medical Expenses Incurred Out of

Country

Medical expenses incurred out of country will be covered for employees and/or dependents when:

(a) a life threatening condition 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. Reimbursement will be made at the same percentage rate and subject to the same annual maximum limit as for expenses incurred in country.

C.1.1.12

Transportation for Out of Country Medical

Treatment:

Transportation for out of country treatment is not a covered expense.

C.1.1.13

Expenses not covered Expenses will not be covered for elective cosmetic surgery; spa cures; rejuvenation cures; massage; exercise therapy; long term rehabilitative therapy; eyeglass frames; annual physical examination and inoculations, 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 or nurse.

No coverage will be made for expenses that will be reimbursed or paid directly under a host country medical program, the U.S. workers' compensation program, or post’s LES workers’ compensation program

No coverage will be made for expenses related to an illness or injury that is a result of an unlawful action on the part of the patient; the practice of a dangerous sport; excessive or illegal use of alcohol or drugs; a self- inflicted wound; or service in the armed forces of any country.

No coverage will be made for expenses incurred after an employee leaves the service of the U.S. Mission.

C.1.1.14

Maximum Annual Reimbursement

With the exception of expenses incurred under paragraph C.1.1.4 above, the Insurance

Company will reimburse covered expenses up to a limit of 53,200 KWD per family per contract year.

The insurance company will reimburse covered expenses described under paragraph C.1.1.4 of the plan up to a separate limit of USD 10,000 per employee per contract year

C.1.2

For catastrophic conditions, the annual aggregate maximum shall be 53,200 KWD per family for medical expenses. Catastrophic conditions shall be defined as major medical conditions occurring as a result of a single illness, accident, or closely related set of major illnesses (or conditions relating to a single accident) that exceed the standard maximum coverage limit.

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 the State of Kuwait 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 the State of Kuwait by:

U.S. Department of State

U.S. Foreign Commercial Service

U.S. Defense Attaché Office (DAO)

U.S. Office of Military Cooperation

U.S. Army Corps of Engineers

U.S. Department of Defense

U.S. Department of Homeland Security (U.S. Customs)

U.S. International Broadcasting Bureau – IBB

U.S. Department of Justice

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/Consulate Kuwait (see separate rider, Exhibit C). All costs for American

Employees Welfare Association (AEWA) are the responsibility of the Employee

Association, not the U.S. Government.

C.1.4 Individuals Not Eligible for Coverage

Not eligible are those working under temporary appointments; those working under a PSC or

PSA that is time limited to less than one year; non-personal services contract personnel and their employees, supplied by an independent contractor licensed to do business in Kuwaiti who provides services to other local organizations as well as to the U.S. Mission; employees of

USAID institutional contractors; Peace Corps personal services contractors as indicated in MS

743 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

Covered dependents include the participating employee’s spouse and children. A limit of one spouse per employee is covered. An eligible child is defined as the employee’s natural child, adopted child, stepchild, or foster child. The child must be unmarried, economically dependent upon the employee, and reside with the employee unless away at school. An eligible child will be covered until the end of the contract year in which he/she reaches age 18, or age 21 if in school. 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.

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.

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. BROCHURE REQUIREMENT

C.1.7.1. The Contractor shall provide a document (brochure/pamphlet/other written document) in 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.1.7.2. The Contractor shall provide the document described in C.1.7.1 to the

COR not later than thirty (30) 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.1.7.3. 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.

PART II: GROUP LIFE 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 the State of Kuwait. The Government has determined that the prevailing practice by employers in the State of Kuwait 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% premium cost.

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 and the Attachments in Section

J.

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 his or her basic salary excluding allowances, bonuses or other monetary benefits

Each employee is eligible for a face amount of coverage that is equal to 16 (sixteen) times his or her monthly basic salary, not to exceed KD: 74,000/-.

C.2.1.2 Amount of Accidental Death and Dismemberment Coverage.

The employee's estate or employee will receive an amount equal to16 (sixteen) times the amount of monthly basic salary, not to exceed KD: 74,000/-, in addition to the life insurance benefit in C.2.1.1, in the event the employee is killed in an accident

C.2.1.3 Partial and Total Disability Coverage

C.2.1.3. 1 Permanent Total Disability

If an employee becomes totally and permanently disabled from bodily injury or disease so as to be wholly prevented from performing any occupation for remuneration or profit, the insurance company will terminate the life insurance of such employee and in lieu of all other benefits in this policy, will pay the amount of life insurance that would have been applicable to said employee in sixty (60) equal payments commencing within three months from receipt of due proof of disability.

The amount of insurance applicable to this provision shall be the amount of insurance in force on the life of such employee on the date of commencement of total and permanent disability.

During the continuance of total and permanent disability, all installment payments under this provision shall be payable to the employee.

If the employee should die after due proof of the disability has been furnished to the insurance company, but before payment of any installments, the amount of insurance under this provision shall be paid to the employee’s beneficiary. If the employee should die while some installments remain unpaid, the remaining installments shall be paid in one sum to the beneficiary.

If the total and permanent disability should cease before all installments under this provision have been paid, the following conditions shall apply:

• No further installment payments shall be made;

• If the employee is eligible under this provision, he may be insured hereunder for the amount of group life insurance for which he is then eligible, less the total amount of payments made under this provision.

The insurance company shall have the right at any time during the first two (2) years following the commencement of installment payments and thereafter not more frequently than once a year, to require proof of continuance of total and permanent disability. In addition, the insurance company shall have the right to have a physician of its choice examine the employee at six-month intervals during the first two (2) years of the installment paying period and thereafter not more frequently than once a year. Failure to furnish such proof or to submit to the medical examination within ninety (90) days of the date of request shall immediately terminate all benefits.

No payments shall be made under provision if, at the date when payment would otherwise have been made, the amount of life insurance shall have been paid as a death claim.

C.2.1.3. 2 Permanent Partial Disability

If an employee becomes partially disabled, on a permanent basis, as a result of bodily injury or disease, the insurance company shall make a lump sum payment to the insured for that disability in accordance with the schedule of payments below:

Description Percentage of Life Benefit

Loss of arm between shoulder and wrist 50

Loss of hand below wrist 50

Loss of four fingers and thumbs 40

Loss of four fingers 35

Loss of whole thumb 25

Loss of whole index finger 10

Loss of whole middle finger 06

Loss of whole ring finger 05

Loss of whole little finger 04

Loss of leg at hip 50

Loss of leg between knee and hip 50

Loss of leg below knee 35

Loss of all toes 15

Loss of one eye 50

Deafness of both ears 50

Deafness of one ear 15

Loss great toe 05

Loss of other than great, if more than one toe lost, each 01

Payment shall not exceed a maximum of the life insurance amount.

In the event of subsequent death or total permanent disability of an insured employee, after payment has been made under this provision, the insurance company shall reimburse the amount of life insurance benefit that would have been payable prior to the partial disablement less the amount reimbursed for that partial disablement or any payment made under total permanent disability.

Partial disability on a permanent basis shall be deemed to be the complete and irrecoverable physical loss or loss of use of any part of the body specified in the schedule of payments above.

In the event of

• A partial loss of any part of the body specified above, a proportionately lower percentage of compensation shall be payable and,

• Permanent disablement by physical loss or loss of use not specified above, the percentage of compensation shall be assessed in proportion to the degree of disability as compared with the cases specified in the schedule of payments without reference to the profession or occupation of the insured.

C.2.2 Life Insurance Benefits Conditions and Limitations

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

The Insurance provided by the contractor will not cover any loss resulting from or caused directly or indirectly, wholly or partly by:

• Self-destruction or self-inflicted injury, while sane or insane; or

• Racing on wheels, horses, boats or

• Sky or skin diving: or

• The commission of or attempted commission of an assault or any unlawful act, or being engaged in any illegal activity; or

• Service, travel or flight in any kind of aircraft except as a fare-paying passenger in an aircraft operated on a regular schedule by an incorporated common carrier for passenger service over its established air route; or

For accidental death coverage, the following exclusion applies:

• Disease or bodily or mental infirmity, or medical or surgical treatment thereof, or hernia, ptomaine or bacterial infections except phylogenic infections of an through a visible wound accidentally sustained.

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 the State of Kuwait, 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 the State of Kuwait by:

U.S. Department of State

U.S. Foreign Commercial Service

U.S. Defense Attaché Office (DAO)

U.S. Office of Military Cooperation

U.S. Army Corps of Engineers

U.S. Department of Defense

U.S. Department of Homeland Security (U.S. Customs)

U.S. International Broadcasting Bureau – IBB

U.S. Department of Justice

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 All current active employees of the Employee Association at

Embassy/Consulate Kuwait (see separate rider, Exhibit C). All costs for American

Employee’s Welfare Association (AEWA) are the responsibility of the Employee

Association, not the U.S. Government.

C.2.4 Individuals Not Eligible for Coverage

C.2.4.1. New employees who have reached the age of 65 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 nonpersonal 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.2.5. Other Eligible Participants

The following additional categories of persons are covered by this insurance: None

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.

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.2.6.2. Period of Ineligibility

RESERVED

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 thirty (30) 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.3.0 DEFINITIONS

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

COR Contracting Officer's Representative (COR) is the Human

Resources Assistant, Dina Damati.

Contributory Insurance Insurance for which the employee contributes toward the premium.

Customary and Reasonable

Treatment

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

Dependent Dependents 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 and 21 if in school. 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.

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 (PSC), or personal services agreement (PSA), as further defined in

Section C.1.3 for health insurance and C.2.3 for life insurance.

This may also include ORE Staff, American Employees

Welfare Association (AEWA), and Peace Corp PSCs, if this category of individual is listed as participating under a rider in

C.1.3.3 for health insurance and C.2.3.3 for life insurance.

Employer The United States Government or in the case of ORE and

American Employees Welfare Association (AEWA) employees, the Chief of Mission/Deputy Chief of Mission and the Employee Association, respectively.

GSO General Services Officer in charge of the General Services

Office at post. This officer is usually the Contracting Officer

(CO) 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.

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. 52.252-2 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://www.acquisition.gov/far/ or http://farsite.hill.af.mil/vffara.htm

These addresses are subject to change. If the Federal Acquisition Regulation (FAR) is not available at the locations indicated above, use the Department of State Acquisition website at http://www.statebuy.state.gov/ to see the links to the FAR. You may also use an internet “search engine” (for example, Google, Yahoo, Excite) to obtain the latest location of the most current

FAR.

The following Federal Acquisition Regulation clause(s) is/are incorporated by reference:

CLAUSE TITLE AND DATE

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.

Performance Objective

PWS

Paragraph Performance Threshold

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 one

(1) customer complaint is 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.

http://www.acquisition.gov/far/ http://farsite.hill.af.mil/vffara.htm http://www.statebuy.state.gov/

E.2.2 Standard. The performance standard is that the Government receives no more than one

(1) 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 additional time to correct the defect, if additional time is available. The

COR shall determine how much time is reasonable.

(e) The COR shall, as a minimum, orally notify the Contractor of any valid complaints.

(f) If the Contractor disagrees with the complaint and challenges the validity of the complaint, the Contractor will notify the COR. The COR will review the matter to determine the validity of the complaint.

(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. 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

http://www.statebuy.state.gov/ to see the links to the FAR.