Health Insurance Services Solicitation SKV420-12-R-0100.docx

LETTER TO PROSPECTIVE OFFERORS 9 November 2011

US Embassy Pristina Address:

Nazim Hikmet #30 10,000 Pristina Republic of Kosovo

Dear Prospective Offeror:

SUBJECT: Health Insurance Services, Solicitation Number SKV420-12-R-0100

The Embassy of the United States of America invites you to submit a proposal for customized health insurance services for locally engaged staff and family members.

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 in a sealed envelope marked "Proposal Enclosed" to the Todd Katschke, Nazim Hikmet #30, Pristina on or before 17:00 hrs of 9th of December 2011. No proposal will be accepted after this time.

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

Direct any questions regarding this solicitation to Dukagjin Basha, Procurement Supervisor, by letter or by telephone +381 38 5959 3213 during regular business hours.

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, Todd Katschke Contracting Officer

MODEL CONTRACT – SECTION A

SOLICITATION, OFFER AND AWARD

1. THIS CONTRACT IS A RATED ORDER

UNDER DPAS (15 CFR 7900)

1 | 65

2. CONTRACT NUMBER

3. SOLICITATION NUMBER

SKV420-12-R-0100

4. TYPE OF SOLICITATION

[ ] SEALED BID (IFB)

[ x ] NEGOTIATED (RFP)

5. DATE ISSUED

MM/DD/YYYY

11/09/2011

6. REQUISITION/PURCHASE NO.

7. ISSUED BY CODE

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

U.S. Embassy Pristina Nazim Hikmet 30 Pristina, Kosovo Phone: ++381 38 5959 3000 Fax: ++381 38 5959 3901

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 Bravo Gate of US Embassy Pristina until 1700 local time of 9 Dec 2011.

(hour) (date) CAUTION - LATE Submissions, Modifications, and Withdrawals: See Section L. Provision No. 52.215-1 Deviation. All offers are subject to all terms and conditions contained in this solicitation.

Dukagjin Basha, Procurement Supervisor B. TELEPHONE NO. (Include Area Code) (NO COLLECT CALLS) ++381 38 5959 3000, BashaDO@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 instead 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)

(The offeror acknowledges receipt of amendments to the solicitation for offerors and related documents numbered and dated):

FACILITY

16. NAME AND TITLE OF PERSON AUTHORIZED

AND

ADDRESS

OF

OFFEROR

TO SIGN OFFER (Type or print)

15B. TELEPHONE NO. (Include area code)

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

N/A

26. NAME OF CONTRACTING OFFICER (Type of print)

27. UNITED STATES OF AMERICA

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

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 Kosovo. The groups of employees who shall be provided this insurance are listed in C.1.1. 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 the Embassy Association (for EAEs) at the rates specified below 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 Embassy Association (for EAEs) at the rates specified below. See Section G for billing procedures.

B.2. PRICES

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

B.2.1. BASE YEAR OF CONTRACT:

Bi-Weekly Rates Per Employee:

Category of Insured person Biweekly Premium per insured person

PLAN A

ALTERNATE

PLAN B

x 350 persons* = amount Price x 160persons* = amount Price x 160 persons* = amount

x 250 persons* = amount Price x 100 persons* = amount Price x 100 persons* = amount

x 480 persons* = amount Price x 190persons* = amount Price x 190 persons* = amount

x 40 persons* = amount Price x 15 persons* = amount Price x 15 persons* = amount

TOTAL BIWEEKLY

PREMIUMS

= Total biweekly amount

= Total biweekly amount

= Total biweekly amount

TOTAL ESTIMATED

PRICE FOR

BASE YEAR

x 26 biweekly periods = Total

X x 26 biweekly periods = Total

Y x 26 biweekly periods = Total

Z

· The number of persons likely to enrol in each plan is estimated, for evaluation purposes only.

· For the Alternate Plans, quote the additional costs (the price difference) over the Base Plan.

· For the purpose of estimating numbers only, the cut-off age for minor children has been taken as 18 years.

Total Price for Base Year (Subtotal x 26): _______

B.2.2. FIRST OPTION YEAR OF THE CONTRACT:

Bi-Weekly Rates Per Employee:

Category of Insured person Biweekly Premium per insured person

PLAN A

ALTERNATE

PLAN B

x 350 persons* = amount Price x 160persons* = amount Price x 160 persons* = amount

x 250 persons* = amount Price x 100 persons* = amount Price x 100 persons* = amount

x 480 persons* = amount Price x 190persons* = amount Price x 190 persons* = amount

x 40 persons* = amount Price x 15 persons* = amount Price x 15 persons* = amount

TOTAL BIWEEKLY

PREMIUMS

= Total biweekly amount

= Total biweekly amount

= Total biweekly amount

TOTAL ESTIMATED

PRICE FOR

BASE YEAR

x 26 biweekly periods = Total

X x 26 biweekly periods = Total

Y x 26 biweekly periods =

· For the purpose of estimating numbers only, the cut-off age for minor children has been taken as 18 years.

Total Price for Option Year 1 (Subtotal x 26): _______

B.2.3. SECOND OPTION YEAR OF THE CONTRACT:

Bi-Weekly Rates Per Employee:

Category of Insured person Biweekly Premium per insured person in EUR

PLAN A

ALTERNATE

PLAN B

x 350 persons* = amount Price x 160persons* = amount Price x 160 persons* = amount

x 250 persons* = amount Price x 100 persons* = amount Price x 100 persons* = amount

x 480 persons* = amount Price x 190persons* = amount Price x 190 persons* = amount

x 40 persons* = amount Price x 15 persons* = amount Price x 15 persons* = amount

TOTAL BIWEEKLY

PREMIUMS

= Total biweekly amount

= Total biweekly amount

= Total biweekly amount

TOTAL ESTIMATED

PRICE FOR

BASE YEAR

x 26 biweekly periods = Total

X x 26 biweekly periods = Total

Y x 26 biweekly periods =

· For the purpose of estimating numbers only, the cut-off age for minor children has been taken as 18 years.

Total Price for Option Year 2 (Subtotal x 26): _______

B.2.4. THIRD OPTION YEAR OF THE CONTRACT:

Bi-Weekly Rates Per Employee:

Category of Insured person Biweekly Premium

PLAN A

ALTERNATE

PLAN B

x 350 persons* = amount Price x 160persons* = amount Price x 160 persons* = amount

x 250 persons* = amount Price x 100 persons* = amount Price x 100 persons* = amount

x 480 persons* = amount Price x 190persons* = amount Price x 190 persons* = amount

x 40 persons* = amount Price x 15 persons* = amount Price x 15 persons* = amount

TOTAL BIWEEKLY

PREMIUMS

= Total biweekly amount

= Total biweekly amount

= Total biweekly amount

TOTAL ESTIMATED

PRICE FOR

BASE YEAR

x 26 biweekly periods = Total

X x 26 biweekly periods = Total

Y x 26 biweekly periods =

· For the purpose of estimating numbers only, the cut-off age for minor children has been taken as 18 years.

Total Price for Option Year 3 (Subtotal x 26): _______

B.2.5. FOURTH OPTION YEAR OF THE CONTRACT:

Bi-Weekly Rates Per Employee:

Category of Insured person Biweekly Premium

PLAN A

ALTERNATE

PLAN B

x 350 persons* = amount Price x 160persons* = amount Price x 160 persons* = amount

x 250 persons* = amount Price x 100 persons* = amount Price x 100 persons* = amount

x 480 persons* = amount Price x 190persons* = amount Price x 190 persons* = amount

x 40 persons* = amount Price x 15 persons* = amount Price x 15 persons* = amount

TOTAL BIWEEKLY

PREMIUMS

= Total biweekly amount

= Total biweekly amount

= Total biweekly amount

TOTAL ESTIMATED

PRICE FOR

BASE YEAR

x 26 biweekly periods = Total

X x 26 biweekly periods = Total

Y x 26 biweekly periods =

· For the purpose of estimating numbers only, the cut-off age for minor children has been taken as 18 years.

Total Price for Option Year 4 (Subtotal x 26): _______________

GRAND TOTAL BASE PERIOD PLUS 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 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 Retention Amounts per separate premium paid per single employee and per family member.

Base Plan

BASE YEAR

1ST OPTION YEAR

2ND OPTION YEAR

3RD OPTION YEAR

4TH OPTION YEAR

Alternate Plan A

BASE YEAR

1ST OPTION YEAR

2ND OPTION YEAR

3RD OPTION YEAR

4TH OPTION YEAR

Alternate Plan B

BASE YEAR

1ST OPTION YEAR

2ND OPTION YEAR

3RD OPTION YEAR

4TH 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. 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. Before any such adjustment is made, the contractor agrees to provide the Government a balance sheet showing two main components for the time period: (1) receipts (premiums received) minus the retention amount and (2) claims paid. The retention amount is not subject to adjustment. The Government reserves the right to have an independent third party review the balance sheet 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. 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.

SECTION C

DESCRIPTION/SPECIFICATION/WORK STATEMENT

HEALTH INSURANCE

C.1. HEALTH INSURANCE SERVICES

The Government of the United States of America requires Health Insurance coverage for its employees as further described in C.1.2 in Republic of Kosovo. The Government has determined that the prevailing practice by employers in Kosovo 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. For eligible employees who are regularly scheduled to work 40 or more hours per week: The USG will pay 75% and the employee will pay 25% of the premium cost for both employee and dependent coverage. 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/CMD.

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. 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.

A. Eligible Employees

Eligible employees are Locally Employed Staff who are (1)working on a full-time or part-time basis under non-temporary direct hire appointments or under personal services agreements/contracts (PSA/PSC) that are not time limited to less than one year and (2) paid under the terms of the Local Compensation Plan.

Not eligible are those working under temporary direct hire appointments; those working on When Actually Employed (WAE) schedules; those working under a PSC or PSA that is time limited to less than one year; nonpersonal services contract personnel and their employees, supplied by an independent contractor licensed to do business in Kosovo who provides services to other local organizations as well as to the U.S. Mission; employees of USAID institutional contractors; and Peace Corps personal services contractors as indicated in MS 743.

Official Residence Expense (ORE) and Employee Association (EA) employees may be covered under a rider to the contract. The employing officer/Employee Association, and not the USG, is responsible for the employer's share of the premium costs for an ORE/EA employee.

B. Dependent Coverage

Eligible employees elect to enroll their eligible dependents. For the purposes of this plan, an employee's dependents are defined as the employee's legal spouse (limit one) and unmarried, economically dependent children who primarily reside 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 contract year in which he/she reaches age 18, or age 25 if a full time student. There is no age limit for an eligible child who is physically or mentally handicapped so as to be unable to live independently. Parents, grandparents, siblings, and other relatives are not eligible dependents.

C. Premium Costs

a) For eligible employees who are regularly scheduled to work 40 or more hours per week: The USG will pay 75% and the employee will pay 25% of the premium cost for both employee and dependent coverage.

b) For eligible employees who are regularly scheduled to work less than 40 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.

c) During a period of leave without pay or unpaid leave beyond one pay period the employee is responsible for the full cost of premiums. The USG will pay the premium directly to the contractor, and will collect the full cost from the employee. Alternatively, the employee may elect to have coverage cease if he/she prefers not to pay the premium.

D. Medical Coverage

The health benefit plan shall comprise three parts:

1) The Base Plan for which enrollment is mandatory for all eligible employees and all eligible dependents.

2) Alternate Plan A for extended benefits, for which enrollment is optional for all eligible employees and all eligible dependents.

3) Alternate Plan B for extended benefits, for which enrollment is optional for all eligible employees and all eligible dependents.

An eligible employee and dependents may not be enrolled in more than one alternate plan.

Provided that an employee whose dependents have separate insurance through the spouse may enroll only himself/herself in one of the Alternate Plans.

Unless otherwise indicated, all terms and conditions set out below apply to both the Base Plan and the Alternate Plans.

Annual Maximum Reimbursement for Base Plan

Covered expenses are up to a limit of 11,000 Euro per covered individual per contract year.

Expenses incurred under section F of the plan are subject to a separate annual maximum limit of USD 10,000 per employee.

The USG will pay 75% and the employee will pay 25% of the premium cost for both employee and dependent coverage.

Alternate Plan A shall include the covered benefits detailed below for the Base Plan except where otherwise noted, and shall be reimbursed to the extent that they exceed the reimbursement percentages and limits in the Base Plan.

The reimbursed costs under Alternate Plan A shall not exceed EUR50,000 per person per insured year. Alternate Plan A is intended for those employees who can not afford more than the Base Plan offers, but cannot afford Alternate Plan B.

The professional fees during hospitalization are reimbursed at the rate of 85%

Alternate Plan B shall include the covered benefits detailed below for the Base Plan except where otherwise noted, and shall be reimbursed to the extent that they exceed the reimbursement percentages and limits in the Base Plan. The reimbursed costs under Alternate Plan B shall not exceed EUR 100,000 per person per insured contract year.

The professional fees during hospitalization are reimbursed at the rate of 85%.

The alternate plans have the same covered benefits and exclusions as the Base Plan.

The insurance company will reimburse covered medical expenses incurred, subject to the stated limits. Payment will be made for reasonable and customary costs of covered benefits. The medical treatment must be prescribed or provided by a physician or nurse licensed in Kosovo or the United States or Europe.

Reimbursement of Covered Medical Expenses:

Hospitalization: 100% reimbursement of room and board for ward room or semi-private room. The cost of a private room will be reimbursed up to 85% of the cost of semi-private room. 100% reimbursement of hospital medical expenses including laboratory tests and x-rays, nursing care, operating room costs, intensive care, and prescription medicines. 90% reimbursement for ambulance.

Professional Services and Treatment: 85% reimbursement 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. 80% reimbursement for medical services and expenses when not hospitalized such as laboratory tests and x-rays, prescription medicines, routine annual physical examination, and inoculations.

Prescription drugs and medicines: 100% reimbursement of the cost of medicines and drugs for which a prescription is legally required when hospitalized and 80% reimbursement when not hospitalized. 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.

Obstetrical Care: 85% reimbursement of obstetrical related medical expenses including normal delivery, cesarean, prenatal and postnatal care.

Physical Therapy: 80% reimbursement

Psychiatric Treatment: 50% reimbursement. Reimbursement limited to 1,000.00 Euros per insured year.

Reimbursement psychiatric treatment is limited to Euro 1,000.00 per insured year

Optical Care: 70% reimbursement for eye examination and treatment and reimbursement of prescription eyeglass or contact lenses. 70% reimbursement with max of EUR 70.00 limited to one set of lens per patient every two year. No reimbursement for nonprescription lenses, frames or tinting.

Dental Care: 80% reimbursement per person of expenses for dental Services including dentists, fees, x-rays, examination and treatment, cleaning, fillings, extractions, false teeth, crowns, and bridges. Post may establish a limit.

The cost of Dento-facial orthodontia provided treatment is started before the patient is 15 years old (except in case of an accident) and treatment is limited to a period of four years. This restriction does not apply to orthodontics treatment, made necessary because of an accident.

The annual limit on reimbursements for dental care is Euro 450.00 per person.

Hearing Aids: 50% reimbursement of the cost of a hearing aid apparatus and related examination per year.

Limited to Euro 130.00 per hearing aid apparatus including the related medical examination.

E) Expenses not Covered

No reimbursement for elective cosmetic surgery; spa cures; rejuvenation cures; massage; exercise therapy; long term rehabilitative therapy; 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 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 LE Staff Workers compensation program.

No reimbursement 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.

F) For employees only: 100% reimbursement 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. The duration of this treatment is to be determined by the employee’s physician following WHO or CDC guidelines.

G) Annual Maximum Reimbursement

Covered expenses are up to a limit of 11,000 Euro per covered individual per contract year.

Expenses incurred under section F of the plan are subject to a separate annual maximum limit of USD 10,000 per employee.

H. Medical expenses incurred out of country

Medical expenses incurred out of country will be covered for employees and 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.

I. Transportation for out of country treatment

Transportation for out of country treatment will be a covered expense for employees and dependents. The patient’s attending physician must certify in advance that the treatment is medically necessary and unavailable locally. 80% of the patient’s transportation expenses by the least expensive, appropriate means of transportation to the nearest city with adequate medical facilities will be reimbursed.

80% of the transportation expenses of an attendant will be reimbursed if the patient’s attending physician certifies that an attendant for the patient is necessary, e.g., a parent in the case of a patient who is a minor or a family member to make medical decisions in the case of a patient who is unconscious. All reimbursements for transportation expenses are subject to the annual maximum limit.

a) The territorial scope of full coverage is limited to the territories of the following countries: Kosovo, Bosnia and Herzegovina, Croatia, Slovenia, Serbia, Montenegro, Macedonia, Albania and Turkey.

Any and all medical costs incurred in the United States of America shall be excluded from this contract.

Includes all medical services which are unavailable or unacceptable in-country Pre-Certification by the Contractor may be required. Out of country coverage is provided under the following conditions:

Upon prior approval of the insurers, the insured person may be treated out of country if the indicated medical services are unavailable or unacceptable. For this assessment Zagreb and Ljubljana will serve as a reference. The transportation fee will be reimburse in accordance with paragraph I and J.

During travel abroad, medical emergency treatments are covered if made necessary because of an acute illness or a covered accident.

J. Repatriation for medical reasons - organization and payment of transportation of an employee abroad to a hospital or to Kosovo, up to a ceiling of € 10.000 per event, all guarantees considered.

K. Preventive Care The following costs for preventive care shall be reimbursed:

a) Dental check-up - The cost of routine dental check-ups are reimbursed at 80%. This reimbursement will be taken into account for the maximum reimbursement indicated in point D above.

b) Medical check-up The cost of one routine check-up per insured person per insurance year will be reimbursed at 80%.

c) Immunizations are covered at 80%.

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 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 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 Albanian, Serbian and 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 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.

C.2.0 “Paragraph C.2 is Reserved”

C.3.0 DEFINITIONS

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

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

Contributory Insurance for which the employee contributes toward the premium.

Dependent For the purposes of this plan, an employee's dependents are defined as the employee's legal spouse (limit one) and unmarried, economically dependent children who primarily reside 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 contract year in which he/she reaches age 18, or age 25 if a full time student. There is no age limit for an eligible child who is physically or mentally handicapped so as to be unable to live independently. Parents, grandparents, siblings, and other relatives are not eligible dependents.

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

Employee An individual employed by the U.S. Government, under a direct-hire appointment, personal services contract, or personal services agreement, as further defined in Section C.1.3 for health insurance. This may also include ORE Staff, if this category of individual is listed as participating under a rider in C.1.3.3 for health insurance.

Employer The United States Government or in the case of ORE the Chief of Mission/Deputy Chief of Mission.

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

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

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

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

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

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

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

SECTION D

PACKAGING AND MARKING

(RESERVED)

SECTION E

INSPECTION AND ACCEPTANCE

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

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

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

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

FEDERAL ACQUISITION REGULATION (48 CFR CH. 1)

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

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

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

Services.

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

C.1.0 thru C.3.0

All required services are performed and no more than one 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.

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. 52.2522 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

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

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

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

FEDERAL ACQUISITION REGULATION (48 CFR CH. 1)

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

F.2 PERIOD OF PERFORMANCE. The period of performance of this contract is one year from the date of contracting officer signature with four one-year options to renew.

F.3 OPTIONS

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

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

F.4 REPORTS AND OTHER DELIVERABLES

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

SECTION G

CONTRACT ADMINISTRATION DATA

G.1. 652.242-70 CONTRACTING OFFICER’S REPRESENTATIVE (COR) (AUG 1999)

(a) The Contracting Officer may designate in writing one Government employee, by name or position title, to take action for the Contracting Officer under this contract. This designee shall be identified as a Contracting Officer’s Representative (COR). Such designation shall specify the scope and limitations of the authority so delegated; provided, that the designee shall not change the terms or conditions of the contract, unless the COR is a warranted Contracting Officer and this authority is delegated in the designation.

(b) The COR for this contract is the Human Resources Assistant.

G.2 COR DUTIES

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

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

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

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

G.3. Payment shall be made in Euro’s (€).

G.4 SUBMISSION OF INVOICES AND PAYMENT

Attention FMO Nazim Hikmet #30 10 000 Pristina Republic of Kosovo

G.4.2. Frequency of Payments. All funds under this contract will be obligated by issuance of task orders, as described in H.3. Each task order will fund a specific period of time and number of employees, and the task orders will be issued at the frequency described in H.3. All payments under this contract will be made at the conclusion of the period covered. Invoices may be submitted monthly with payments being made monthly by the Government.

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

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

G.4.5. EAE Staff. The Employee Association will make payment directly to the contractor for the entire premium amount of the EA employee, whether or not the EA employee is contributing to the premium amount.

G.5 REFUNDS TO THE GOVERNMENT

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

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

SECTION H

SPECIAL CONTRACT REQUIREMENTS

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

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

H.3 ORDERING PROCEDURES. The Government will issue a task order as soon as possible after contract award to identify all employees to be covered by the insurance described in this contract and the coverage selected by each employee, including dependents to be covered. The COR will make subsequent additions or deletions to this list in writing and provide the revised list to the Contractor. All such revisions shall be consolidated, and a new or modified task order will be issued by the Contracting Officer. If any changes have been made to the coverage listing, the Government anticipates issuance of a new task order on a six week (3 Pay Periods) basis (there will be 8 invoices based on six week basis and one/last invoice through the one year period based on 2 week basis). This new task order will include all changes made since the previous task order was issued and will include any increase or decrease in necessary funding. The changes to the list of eligible individuals will supersede the initial list provided under prior task orders without prejudice to the ineligibility clause. Task orders will indicate the effective date of employment, for purposes of calculating the premium due.

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

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

General. The Contractor shall be responsible for all planning, estimating, programming, project management, scheduling, dispatching, supervision, and inspection of work. The Contractor shall maintain his own reference library of technical reference works and local laws and regulations, including current tariffs and registries. The Contractor shall treat the information provided by the Embassy concerning employee' personal data, medical information, and salaries as highly sensitive and not divulge any employee information to unauthorized persons. The Contractor shall establish procedures for handling medical insurance claims as follows:

(a) Administrative Records.

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

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

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

(4) The Contractor shall send employee claim reimbursement checks to employees not later than two weeks after a claim is submitted.

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

(1) All medical claims shall be submitted directly to the Contractor by employees, through a drop box in the COR's office. The claims shall be picked up from the COR each Tuesday.

(2) The Contractor shall date stamp and screen all claims submitted on the day of receipt. If there are any missing documents or information thereby disallowing said claim to be payable, the Contractor shall notify the employee within two days, with a copy to the COR (if notification is written).

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

(4) Settlement shall be by issuance of checks in the name of the employee for each claim submitted. Each check shall be accompanied by a form providing details of the amount reimbursed with an explanation of deductions, if any.

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

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

Employee Claims Report. The report will list all claims paid by the Contractor to a claimant, including the name of the claimant, date claim is received by…