LES_Health_Insurance_-_Solicitation_Package.pdf

United States Department of State

Date: January 19, 2017

U.S. Embassy Pristina, Kosovo

Address: Nazim Kikmet 30

10000 Pristina, Republic of Kosovo

Dear Prospective Offeror:

SUBJECT: Solicitation Number SKV42017R0003, Health Insurance Services

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

The Embassy intends to conduct a pre-proposal conference for this requirement, all prospective offerors who have received and read the solicitation package and intend to submit a proposal, may attend the pre-proposal conference.

See Section L.8 of the attached solicitation package for instructions on how to attend.

A pre-proposal conference has been scheduled for February 1 st , 2017 at 10:00 am, at the U.S. Embassy Pristina, in the Management Conference Room. If you plan to attend, we must receive your request by January 30 th

Your proposal must be submitted in a sealed envelope marked "Proposal Enclosed" to Jim Landherr, Nazim

Hikmet 30, Pristina on or before February 22, 2017 @ 15:00. 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

4. Section K, Representations and Certifications;

5. Additional information as required in Section L.

Direct any questions regarding this solicitation in writing to Jim Landherr, Contracting Officer, questions must be written in English and may be sent to email PristinaProcurement@state.gov . You may also call +381 38 5959 3000 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, Jim Landherr

Contracting Officer mailto:PristinaProcurement@state.gov

SOLICITATION, OFFER AND AWARD

1. THIS CONTRACT IS A RATED ORDER

UNDER DPAS (15 CFR 350)

RATING PAGE OF PAGES

1 | 64

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

3. SOLICITATION NO.

SKV42017R0003

4. TYPE OF SOLICITATION

[ ] SEALED BID (IFB)

[x] NEGOTIATED (RFP)

5. DATE ISSUED

01/19/2017

6. REQUISITION/PURCHASE NO.

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

U.S. EMBASSY PRISTINA

Nazim Hikmet Nr 7, Pristina 10000, Kosovo

Phone: +3813859593000

U.S. EMBASSY PRISTINA

Nazim Hikmet Nr 7, Pristina 10000, Kosovo

Phone: +3813859593000

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

SOLICITATION

9. Sealed offers in original and 3 copies for furnishing the supplies or services in the Schedule will be received at the place specified, in the depository located in US EMBASSY PRISTINA until 15:00 local time February 22, 2017

(hour) (date)

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

Jim Landherr/Burim Buza

B. TELEPHONE (NO COLLECT

CALLS)

AREA CODE NUMBER EXT

+3813859593000

C. E-MAIL ADDRESS

PristinaProcurement@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 1 X I CONTRACT CLAUSES 29-39

X B SUPPLIES OR SERVICE AND PRICES/COSTS 2-11 PART III - LIST OF DOCUMENTS, EXHIBITS, AND OTHER ATTACH.

X C DESCRIPTION/SPECS/WORK STATEMENT 12-18 X J LIST OF ATTACHMENTS 40

X D PACKAGING AND MARKETING 19 PART IV - REPRESENTATIONS AND INSTRUCTIONS

X E INSPECTION AND ACCEPTANCE 19-20 X K REPRESENTATIONS, CERTIFICATIONS, AND 41-54

X F DELIVERIES OR PERFORMANCE 21-22 X OTHER STATEMENTS OF OFFERORS

X G CONTRACT ADMINISTRATION 23-24 X L INSTRS., COND., AND NOTICES TO OFFERORS 55-61

X H SPECIAL CONTRACT REQUIREMENTS 25-28 X M EVALUATION FACTORS FOR AWARD 62-64

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 inseted 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

26. NAME OF CONTRACTING OFFICER (Type or print)

27. UNITED STATES OF AMERICA

(Signature of Contracting Officer)

28. AWARD DATE

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 Kosovo as described in Section C and the Exhibits in Section J.

The groups of employees who shall be provided this insurance are listed in C.1.3 (medical).

This insurance shall be provided in accordance with Section C and the Exhibits in Section J.

B.1.1. Official Residence Expense (ORE) Staff and Embassy Association Employees (EAE) 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 Embassy Association (for EAEs) 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. BASE YEAR OF CONTRACT

Category of

Insured person

Biweekly Premium per insured person in EUR

BASE PLAN ALTERNATE

PLAN A

A - Employee ________EUR x 434 persons

= ______ EUR

__________EUR

x 150persons*

=_________ EUR

B - Spouse __________EUR x 298 persons*

=_________ EUR

__________EUR

x 100 persons*

=_________EUR

C - Minor children __________EUR x 554 persons*

= ________EUR

__________EUR

x 190persons*

=_________EUR

D - Eligible adult children __________EUR x 105 persons*

= _________EUR

__________EUR

x 15 persons*

=_________ EUR

TOTAL BIWEEKLY

PREMIUMS

=_________EUR

= _________EUR

TOTAL ESTIMATED

PRICE FOR

BASE YEAR

__________x 26 biweekly periods

=__________EUR

___________x 26

=____________EUR

B.2.4. First Option Year of Contract

Insured person

A - Employee ________EUR x 434 persons

= ______ EUR

__________EUR

x 150persons*

=_________ EUR

B - Spouse __________EUR x 298 persons*

=_________ EUR

__________EUR

x 100 persons*

=_________EUR

C - Minor children __________EUR x 554 persons*

= ________EUR

__________EUR

x 190persons*

=_________EUR

D - Eligible adult children __________EUR x 105 persons*

= _________EUR

__________EUR

x 15 persons*

=_________ EUR

PRICE FOR

BASE YEAR

__________x 26

B.2.5. Second Option Year of Contract

Insured person

A - Employee ________EUR x 434 persons

= ______ EUR

__________EUR

x 150persons*

=_________ EUR

B - Spouse __________EUR x 298 persons*

=_________ EUR

__________EUR

x 100 persons*

=_________EUR

C - Minor children __________EUR x 554 persons*

= ________EUR

__________EUR

x 190persons*

=_________EUR

D - Eligible adult children __________EUR x 105 persons*

= _________EUR

__________EUR

x 15 persons*

=_________ EUR

PRICE FOR

BASE YEAR

__________x 26

B.2.6. Third Option Year of Contract

A - Employee ________EUR x 434 persons

= ______ EUR

__________EUR

x 150persons*

=_________ EUR

B - Spouse __________EUR x 298 persons*

=_________ EUR

__________EUR

x 100 persons*

=_________EUR

C - Minor children __________EUR x 554 persons*

= ________EUR

__________EUR

x 190persons*

=_________EUR

D - Eligible adult children __________EUR x 105 persons*

= _________EUR

__________EUR

x 15 persons*

=_________ EUR

PRICE FOR

BASE YEAR

__________x 26

B.2.7. Fourth Option Year of Contract

A - Employee ________EUR x 434 persons

= ______ EUR

__________EUR

x 150persons*

=_________ EUR

B - Spouse __________EUR x 298 persons*

=_________ EUR

__________EUR

x 100 persons*

=_________EUR

C - Minor children __________EUR x 554 persons*

= ________EUR

__________EUR

x 190persons*

=_________EUR

D - Eligible adult children __________EUR x 105 persons*

= _________EUR

__________EUR

x 15 persons*

=_________ EUR

PRICE FOR

BASE YEAR

__________x 26

B.2.8. Grand Total of Base plus All Option Years

Base Year Total

First Option Year Total

Second Option Year Total

Third Option Year Total

Fourth Option Year Total

Grand Total of Base plus All Option Years

B.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 Base Plan

Alternate Plan A

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.

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.

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 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, regardless of number of work hours: The USG will pay 100% of the premium cost for employee coverage. The USG will pay 65% of the premium cost and the employee will pay 35% of the premium cost for 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/CM.

C.1.1 Employee and Dependent Health Services Benefits

C.1.1.1. Hospitalization: 100% coverage of room and board expenses for a semi-private room. Coverage of room and board expenses for a private room, not to exceed 100% of the cost of a semi-private room.100% coverage of hospital medical expenses including laboratory tests and x-rays, nursing care, operating room expenses, intensive care, and physical therapy.80% coverage of ambulance service.90% coverage of anesthesia.90% coverage of surgical assistants.

C.1.1.2 Professional Services and Treatment: 90% coverage of doctor and surgeon fees incurred while hospitalized, at a hospital on an out-patient basis, at a clinic or doctor's office, or at home; 90% coverage of medical services and expenses when not hospitalized such as laboratory tests, x-rays and prescription medicines.80% coverage for routine annual physical examinations.50% coverage for inoculations annually. 70% coverage for physical therapy. 50% coverage for psychiatric therapy up to 700 Euros maximum.

C.1.1.3. Prescription Drugs and Medicines: 90% coverage of expenses when hospitalized and 90% coverage of expenses when not hospitalized, of the cost of medicines and drugs for which a prescription is legally required. Expenses incurred for medicines, vitamins, cold remedies, etc., that are available over the counter without a prescription will not be reimbursed even if prescribed by a physician.

C.1.1.4 For Employees Only: 100% coverage of expenses for medications to suppress opportunistic infections, such as tuberculosis and toxoplasmosis for covered individuals who have HIV/AIDS; as well as brief courses of anti-retroviral drugs during childbirth to prevent the transmission of HIV to the 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 9050 Euros per patient per contract year.

C.1.1.5 Obstetrical Care: Coverage of all obstetrical care is subject to an overall maximum of 2500 Euros per occurrence.100% coverage of expenses when hospitalized.

90% coverage of prenatal and postnatal care.

C.1.1.6 Family Planning: Family planning expenses are not covered.

C.1.1.7 Hearing Aids: 70% coverage of the cost of a hearing aid apparatus and related examination up to 370 Euros annually.

C.1.1.8 Optical Care: 90% coverage of expenses for eye examination, treatment and prescription. 60% coverage for frames. 90% coverage for prescription eyeglass or contact lenses up to 160 Euros maximum annually. Reimbursement for frames may not exceed 100 Euros annually. In addition, coverage of both frames and lenses is subject to an overall maximum of

160 Euros annually. No coverage of expenses for nonprescription lenses, or tinting.

C.1.1.9 Dental Care: 90% coverage of expenses for dental services including dentist fees, x-rays, examination and treatment, cleaning, fillings, and extractions.90% coverage of expenses for dental services related to false teeth, crowns, and bridges.

90% of Orthodontia treatment is covered only if treatment begins before age 15, unless required as the result of an accident. A maximum of four years of orthodontia treatment will be covered per patient. Coverage of all dental care is subject to an overall maximum of 650 Euros annually.

C.1.1.10 Psychiatric Treatment: 50% reimbursement up to 700Euros annually.

C.1.1.11 Medical Expenses Incurred Out of Country:

Territorial scope of full coverage: In addition to Kosovo, medical expenses will be covered for enrolled employees and dependents if incurred in the following countries: Bosnia and

Herzegovina, Croatia, Slovenia, Serbia, Montenegro, Macedonia, Albania, and Turkey.

Reimbursement will be made at the same percentage rate and subject to the same annual maximum limits as for expenses incurred in country. Medical expenses incurred out of the territorial scope of full coverage will be covered for enrolled 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 within the territorial scope of full coverage. Reimbursement will be made at the same percentage rate and subject to the same annual maximum limits as for expenses incurred in country.

C.1.1.12 Transportation for Out of Country Treatment

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

C.1.1.13 Annual Maximum Limit for Base Plan - THE maximum annual reimbursement per patient per contract year, not including expenses covered under c.1.1.4, is 80,000EUR per patient per contract year or maximum, or:

C.1.1.1.4 Annual Maximum Limit for Alternate Plan A – THE maximum annual reimbursement per patient per contract year, not including expenses covered under c.1.1.4, is

150,000EUR per patient per contract year or maximum.

C.1.2 Health Benefits Conditions and Limitations.

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

Expenses will not be covered 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 coverage of expenses that will be reimbursed or paid directly under a host country medical program, the U.S. workers' compensation program, or any Kosovo worker’s compensation type program.

No coverage of 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 of expenses incurred after an employee leaves the service of the U.S. Mission.

For catastrophic conditions, the maximum annual coverage shall be 80,000 Euros per covered individual 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 Kosovo 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 Kosovo by:

- US EMBASSY PRISTINA, USAID, PEAC CORPS

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 in Pristina, Kosovo (see separate rider, Exhibit C). All costs for

EAEs are the responsibility of the Employee Association, not the U.S. Government.

C.1.4 Individuals Not Eligible for Coverage

Individuals not eligible for coverage under this contract are non-personal services contract personnel; employees working on a temporary basis; employees with an intermittent, seasonal, or

WAE (when actually employed) schedule; and any other individual not falling within one of the categories of employees described in this clause.

C.1.5 Other Eligible Participants

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 25 if a full time student. There is no age limit for a child who is physically or mentally handicapped so as to be unable to live independently. There is no limit on the number of children covered per employee.

C.1.6. Eligibility

C.1.6.1. Term of Eligibility and Effective Date

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

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

C.1.6.2. Period of Ineligibility

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

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

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

C.1.7. 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.

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

(HRO) at post.

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 Expenses incurred by a participating employee's enrolled eligible dependents are covered under this plan. For the purposes of this plan, an employee's dependents are defined as the employee's legal spouse

(limit one) 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 contract year in which the child turns age 19, or in the case of a child who is a full-time student, until the end of the contract year in which the child turns age 25. There is no age limit for an eligible child who is physically or mentally handicapped so as to be unable to live independently. There is no limit on the number of children covered per employee.

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 Eligible employees are Locally Employed Staff who are (1) working on a full time or part time basis under non-temporary direct hire appointments, personal services agreements, or personal services contracts and (2) paid under the terms of the Local Compensation Plan.

Not eligible are those working under temporary appointments; those working under a PSC or PSA that is time limited to less than one year; those with an intermittent, seasonal, or WAE (when actually employed) schedule;

non-personal 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; Peace Corps personal services contractors as indicated in MS 743; and Recreation Association employees.

Official Residence Expense (ORE), Employee Association (EA) employees and employees separated due to retirement 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

Employer The United States Government or in the case of ORE and EAE 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 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 http://www.acquisition.gov/far/ http://farsite.hill.af.mil/vffara.htm http://www.statebuy.state.gov/

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

http://www.statebuy.state.gov/ to see the links to the FAR. You may also use an internet “search

The following Federal Acquisition Regulation clauses are incorporated by reference:

52.242-15 STOP WORK ORDER (AUG 1989)

52.242-17 GOVERNMENT DELAY OF WORK (APR 1984)

F.2 PERIOD OF PERFORMANCE. The performance period of this contract is one year beginning on 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:

US Embassy Pristina

Nazim Himet, No 30

10 000 Pristina

SECTION G

CONTRACT ADMINISTRATION DATA

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

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

Contracting Officer and this authority is delegated in the designation.

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

G.2 COR DUTIES

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

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

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

G.2.4 The COR may not change the terms and conditions of the contract. While the

COR is authorized to provide the Contractor with updated listings of eligible employees and dependents, only the Contracting Officer may modify existing task orders or issue new task orders, reflecting these changes, since only the Contracting Officer can obligate funding and commit the Government.

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

G.4 SUBMISSION OF INVOICES AND PAYMENT

G.4.1. Invoices for U.S. Government employees shall be submitted in an original and three (3) copies to the following address (designated billing office only for the purpose of submitting invoices):

US Embassy Pristina

Attention FMO

Nazim Hikmet #30

10 000 Pristina

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.4.6. Peace Corps . Peace Corps 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 VALUE ADDED TAX

VALUE ADDED TAX (VAT). The Government will not reimburse the Contractor for VAT under this contract. The Contractor shall not include a line for VAT on Invoices as the U.S.

Embassy has a tax exemption certificate with the host government.

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 and Peace Corps 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.

(c) Payment of Life Insurance Benefits to Beneficiaries. The Contractor shall settle life insurance claims as follows:

(1) The Contractor shall provide forms for the designation of beneficiaries for the life insurance benefits to the COR. The COR shall have all enrolled eligible employees complete designation of beneficiary forms and keep them in their personnel folders, ORE staff folders, or EAE folders. Upon the death of an enrolled employee, the COR shall provide this form to the Contractor.

(2) The Contractor shall pay the employee's named beneficiary, legal heir, or estate the total amount of the claim within 60 days from the date the Contractor receives a completed dismemberment or death claim. Payment shall be computed on the basis of the coverage as defined in Section C.2.0 and its subparagraphs.

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

These reports shall report on the previous month's activities.

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

H.6. MISCELLANEOUS CONTRACTOR REQUIREMENTS

H.6.1. General. The Contractor shall take all such steps as are necessary, and obtain and pay for all permits, taxes and fees as are required by the Kosovo government to establish and/or operate a commercial venture locally. A contract with the U.S. Government conveys no special privileges or immunities to the Contractor. The Contractor is an independent commercial concern and not a part of the U.S. mission. The Contractor's employees are not U.S.

Government employees. Registration of this contract with the Kosovo government, if required by law, will be the sole responsibility of the Contractor, and any fees, taxes, or other duties shall be payable by the Contractor without recourse to the Government of the amounts thereof.

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

H.7 ERRONEOUS PAYMENTS. If the Government becomes eligible for a refund of payment because of erroneous overpayment or other cause, the Contractor shall refund the amounts or use them to offset future payments owed by the Government, whichever the

Government prefers. The Contractor shall refund any refunds not complete or discovered after the completion date of this contract.

H.8 REQUIRING ACTIVITY. The requiring activity under this contract is the U.S.

Embassy/Consulate.

SECTION I

CONTRACT CLAUSES

I.1. 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

http://www.statebuy.state.gov/ to see the links to the FAR. You may also use a network “search

The following Federal Acquisition Regulation clauses are incorporated by reference:

52.202-1 DEFINITIONS (NOV 2013)

52.203-3 GRATUITIES (APR 1984)

52.203-5 COVENANT AGAINST CONTINGENT FEES (MAY 2014)

52.203-6 RESTRICTIONS ON SUBCONTRACTOR SALES TO THE GOVERNMENT

(SEPT 2006)

52.203-7 ANTI-KICKBACK PROCEDURES (MAY 2014)

52.203-8 CANCELLATION, RESCISSION, AND RECOVERY OF FUNDS FOR

ILLEGAL OR IMPROPER ACTIVITY (MAY 2014)

52.203-10 PRICE OR FEE ADJUSTMENT FOR ILLEGAL OR IMPROPER ACTIVITY

(MAY 2014)

52.203-12 LIMITATION ON PAYMENTS TO INFLUENCE CERTAIN FEDERAL

TRANSACTIONS (OCT 2010)

52.203-17 CONTRACTOR EMPLOYEE WHISTLEBLOWER RIGHTS AND

REQUIREMENT TO INFORM EMPLOYEES OF WHISTLEBLOWER

RIGHTS (APR 2014)

52.204-4 PRINTED OR COPIED DOUBLE-SIDED ON POSTCONSUMER FIBER

CONTENT PAPER (MAY 2011)

52.204-10 REPORTING EXECUTIVE COMPENSATION AND FIRST-TIER

SUBCONTRACT AWARDS (OCT 2015)

52.204-12 DATA UNIVERSAL NUMBERING SYSTEM NUMBER MAINTENANCE

(DEC 2012)

52.204-13 SYSTEM FOR AWARD MANAGEMENT MAINTENANCE (JULY 2013)

52.204-18 COMMERCIAL LAND GOVERNMENT ENTITY CODE MAINTENANCE

(JUL 2016)

52.204-19 INCORPORATION BY REFERENCE OF REPRESENTATIONS AND

CERTIFICATIONS (DEC 2014)

52.209-6 PROTECTING THE GOVERNMENT’S INTEREST WHEN

SUBCONTRACTING WITH CONTRACTORS DEBARRED, SUSPENDED,

OR PROPOSED FOR DEBARMENT (OCT 2015)

52.209-9 UPDATES OF INFORMATION REGARDING RESPONSIBILITY MATTERS

(JULY 2013)

52.210-1 MARKET RESEARCH (APR 2011)

52.215-2 AUDIT AND RECORDS - NEGOTIATION (OCT 2010)

52.215-8 ORDER OF PRECEDENCE--UNIFORM CONTRACT FORMAT (OCT 1997)

52.215-11 PRICE REDUCTION FOR DEFECTIVE CERTIFIED COST OR PRICING

DATA – MODIFICATIONS (AUG 2011)

52.215-13 SUBCONTRACTOR CERTIFIED COST OR PRICING DATA -

MODIFICATIONS (OCT 2010)

52.215-21 REQUIREMENTS FOR COST OR PRICING DATA OR INFORMATION

OTHER THAN COST OR PRICING DATA--MODIFICATIONS (OCT 2010)

52.222-19 CHILD LABOR – COOPERATION WITH AUTHORITIES AND REMEDIES

(FEB 2016)

52…