Morocco_LES__Ins_2017_RFP_Solicitation_with_Amendment_4.pdf

SECTION B

PART I: PRICE - HEALTH INSURANCE

B.1 HEALTH INSURANCE SERVICES

The Contractor shall provide health insurance services to employees of the government of the

United States of America in Embassy Rabat, U.S. Consulate General Casablanca, as well as any other current and future agencies connected to the Embassy and as determined by the

Contracting Officer, as described in Section C and the Exhibits in Section J. The groups of employees who shall be provided this insurance are listed in C.1.3 (medical) and C.2.3 (life).

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

B.1.1 Official Residence Expense (ORE) Staff are included under this contract only as a rider;

the Contractor shall bill the Chief of Mission, Deputy Chief of Mission and Consulate General

(for ORE Staff), at the rates specified below. See Section G for billing procedures.

B.1.2 Retirees from U.S. Government service and their eligible family members are included under this contract only as a rider. They will pay their full premiums at the rates specified below.

See Section G for billing procedures.

B.1.3 Eligible Family Members (EFMs) of deceased employees are included under this contract only as a rider. They will pay their full premiums at the rates specified below. See Section G for billing procedures.

B.1.4 Tangier American Legation Museum (TALMS) are included under this contract only as a rider. The contractor shall bill the TALMS Director separately for TALMS staff, at the rates specified below. See Section G for billing procedures.

B.1.5 Embassy Community Association. The Embassy Community Association (ECA) is included under this contract only as a rider. They will pay their full premiums at the rates specified below. See Section G for billing procedures.

B.2 PRICES

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.2.1 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:

LES Health, Life, Disability and Work Accident Insurance US Embassy, Rabat, Morocco

Solicitation No. SMO550-17-R-0002

B.2.2 Base Year of Contract

Biweekly Rates per Employee

Category Estimated

Number of People

Rate per Person Bi-Weekly

Total

a. Employees 343

b. Family Members/Dependents 600

c. Subtotal (a+b) 943

d. Total Price for Base Year (ex26)

f. DEFENSE BASE ACT (DBA) INSURANCE

The Offeror shall include Defense Base Act (DBA) insurance premium costs covering all employees in the

DBA firm fixed price contract line items. The offeror shall obtain DBA insurance directly from any

Department of Labor approved providers at the DOL website at http://www.dol.gov/owcp/dlhwc/lscarrier.htm.

B.2.3 First Option Year of Contract of People

Rate per Person Bi-Weekly

Total

a. Employees (Self Only) 346

b. Family Members/Dependents 612

c. Subtotal (a+b) 958

d. Total Price for Base Year (ex26)

f. DEFENSE BASE ACT (DBA) INSURANCE

The Offeror shall include Defense Base Act (DBA) insurance premium costs covering all employees in the

DBA firm fixed price contract line items. The offeror shall obtain DBA insurance directly from any

Department of Labor approved providers at the DOL http://www.dol.gov/owcp/dlhwc/lscarrier.htm

LES Health, Life, Disability and Work Accident Insurance US Embassy, Rabat, Morocco

B.2.4 Second Option Year of Contract of People

Rate per Person Bi-Weekly

Total

a. Employees (Self Only) 350

b. Family Members/Dependents 624

c. Subtotal (a+b) 974

d. Total Price for Base Year (ex26)

f. DEFENSE BASE ACT (DBA) INSURANCE

The Offeror shall include Defense Base Act (DBA) insurance premium costs covering all employees in the

DBA firm fixed price contract line items. The offeror shall obtain DBA insurance directly from any

Department of Labor approved providers at the DOL

B.2.5 Third Option Year of Contract of People

Rate per Person Bi-Weekly

Total

a. Employees (Self Only) 354

b. Family Members/Dependents 637

c. Subtotal (a+b) 991

d. Total Price for Base Year (ex26)

f. DEFENSE BASE ACT (DBA) INSURANCE

The Offeror shall include Defense Base Act (DBA) insurance premium costs covering all employees in the

DBA firm fixed price contract line items. The offeror shall obtain DBA insurance directly from any

Department of Labor approved providers at the DOL

LES Health, Life, Disability and Work Accident Insurance US Embassy, Rabat, Morocco

B.2.6 Fourth Option Year of Contract of People

Rate per Person Bi-Weekly

Total

a. Employees (Self Only) 358

b. Family Members/Dependents 650

c. Subtotal (a+b) 1008

d. Total Price for Base Year (ex26)

f. DEFENSE BASE ACT (DBA) INSURANCE

The Offeror shall include Defense Base Act (DBA) insurance premium costs covering all employees in the

DBA firm fixed price contract line items. The offeror shall obtain DBA insurance directly from any

Department of Labor approved providers at the DOL

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

LES Health, Life, Disability and Work Accident Insurance US Embassy, Rabat, Morocco

B.3 ADMINISTRATIVE RETENTION AMOUNTS

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

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

NOTE TO OFFEROR: Fill in the fixed bi-weekly retention amounts for each period of performance and for each category of premium. This fixed amount must be expressed in the currency in which the premium amount is proposed. The fixed retention amount shall

NOT be expressed in terms of a percentage of the premium.

B.3.2.1 Bi-Weekly Retention Amounts per separate premium paid per single employee and per family plan.

Period of Performance Single Employees (Self Only) Family Plan

Base Period

First Option Year

Second Option Year

Third Option Year

Fourth Option Year

B.4 ECONOMIC PRICE ADJUSTMENT-HEALTH INSURANCE PREMIUMS

B.4.1. Premium Adjustment Based on Experience - For health insurance, prices may be adjusted upward or downward based on the experience rating of the Mission covered by this contract, and it specifically excludes all riders in B.1.1. No adjustment will be allowed during the first twelve months. After such time, the Contractor or the U.S. 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 U.S.

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.

LES Health, Life, Disability and Work Accident Insurance US Embassy, Rabat, Morocco

This information shall be provided per type of premium, i.e. per line item. The retention amount is not subject to adjustment. The U.S. 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

U.S. 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.

LES Health, Life, Disability and Work Accident Insurance US Embassy, Rabat, Morocco

PART II: PRICE - GROUP LIFE INSURANCE

B.5 GROUP LIFE INSURANCE SERVICES

The Contractor shall provide the Group Life Insurance services described herein to employees of the Government of the United States of America in Embassy Rabat, U.S. Consulate General

Casablanca, as well as other current and future agencies connected to the Embassy and as determined by the Contracting Officer. The groups of employees who shall be provided this insurance are listed in C.2.3. This insurance shall be provided in accordance with Section C and the Exhibits in Section J.

B.5.1. Official Residence Expense (ORE) Staff are included under this contract only as a rider;

the Contractor shall bill the Chief of Mission and Deputy Chief of Mission (for ORE Staff), at the rates specified below. See Section G for billing procedures.

B.5.2 Embassy Community Association (ECA) Employees are included under the work accident portion of this contract only as a rider; the contractor shall bill the Embassy Community

Association separately, at the rates specified below.

B.6 GROUP LIFE INSURANCE RATES

This is a fixed-price with economic-price-adjustment-requirements type contract under which the

U.S. Government will issue firm-fixed price task orders. The fixed prices/premium rates in

Dirham per one thousand of salary to provide basic life insurance, disability insurance and work accident insurance are as follows:

B.6.1 Base Year of Contract

Category Premium

(per 1,000 of Salary)

Estimated Payroll

(Bi-Weekly in

Thousands)

Bi-Weekly

Total*

a. Basic Life Insurance MAD 2,768.00

b. Work Accident Insurance MAD 3,135.00

c. Disability Insurance MAD 3,135.00

g. Total Price for Base Year (fx26)

* Bi-Weekly Total = Premium (per 1,000 of Salary) X Estimated Payroll (Bi-Weekly in Thousands)

LES Health, Life, Disability and Work Accident Insurance US Embassy, Rabat, Morocco

B.6.2 First Option Year of Contract

Estimated Payroll

(Bi-Weekly in

Thousands)

Bi-Weekly

Total*

a. Basic Life Insurance MAD 3050.00

b. Work Accident Insurance MAD 3,450.00

c. Disability Insurance MAD 3,450.00

g. Total Price for Base Year (fx26)

B.6.3 Second Option Year of Contract

Estimated Payroll

(Bi-Weekly in

Thousands)

Bi-Weekly

Total*

a. Basic Life Insurance MAD 3,350.00

b. Work Accident Insurance MAD 3,800.00

c. Disability Insurance MAD 3,800.00

B.6.4 Third Option Year of Contract

Estimated Payroll

(Bi-Weekly in

Thousands)

Bi-Weekly

Total*

a. Basic Life Insurance MAD 3680.00

b. Work Accident Insurance MAD 4,180.00

c. Disability Insurance MAD 4,180.00

LES Health, Life, Disability and Work Accident Insurance US Embassy, Rabat, Morocco

B.6.5 Fourth Option Year of Contract

Estimated Payroll

(Bi-Weekly in

Thousands)

Bi-Weekly

Total*

a. Basic Life Insurance MAD 4,050.00

b. Work Accident Insurance MAD 4,600.00

c. Disability Insurance MAD 4,600.00

B.7 ADMINISTRATIVE RETENTION AMOUNTS

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

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

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

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

B.6.6. 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

LES Health, Life, Disability and Work Accident Insurance US Embassy, Rabat, Morocco

B.7.2 Retention Amounts per Separate Premium Paid per Employee:

Period of Performance Basic Life

Accidental Death and

Dismemberment

Partial and Total Disability

Coverage

Base Period

First Option Year

Second Option Year

Third Option Year

Fourth Option Year

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

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

U.S. Government. Any failure to reach agreement under this clause shall be subject to the procedures in the Disputes clause.

B.8.2. Premium Adjustment Based on Law: The rates may also be adjusted during the performance period of the contract as a result of laws enacted by the host Government, if such change in the laws has a direct impact on the cost to the Contractor to perform this contract at the rate contracted for herein. In that event, the Contracting Officer may enter into negotiations with the Contractor to modify the contract to adjust the premium rate. The Contractor agrees to provide all documentation necessary to support any requested adjustment.

LES Health, Life, Disability and Work Accident Insurance US Embassy, Rabat, Morocco

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 in the Embassy Rabat, U.S. Consulate General

Casablanca, as well as other current and future agencies connected to the Embassy and as determined by the Contracting Officer. The U.S. Government has determined that the prevailing practice by employers in Morocco is to provide for their employees health insurance protection.

For active employees who are regularly scheduled to work part-time or full-time the U.S.

Government will pay 80% of the premium cost and the employee will pay 20% of the premium cost for employee and the U.S. Government will pay 80% of the premium cost and the employee will pay 20% 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

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. The insurance company will reimburse covered medical expenses incurred, subject to the stated limits. Payment will be made for reasonable and customary expenses of covered benefits. The medical treatment must be prescribed or provided by a physician or nurse licensed in Morocco, the United States, or in the country in which the treatment or prescription is received. Coverage of expenses will be made in Dirham (Morocco).

Deductible: None

LES Health, Life, Disability and Work Accident Insurance US Embassy, Rabat, Morocco

Dependent Employee

C.1.1.1. Hospitalization:

- Reimbursement of room and board expenses for a ward, 90% 90% semi-private, or private room.

- Reimbursement of hospital medical expenses including 90% 90% laboratory tests and x-rays, nursing care, operating room expenses, intensive care, and physical therapy.

- Reimbursement of ambulance service. 80% 80%

- Reimbursement of anesthesia. 95% 95%

- Reimbursement of surgical assistants 95% 95%

C.1.1.2. Professional Services and Treatment:

- Reimbursement of doctor’s, and surgeons, fees 85% 85% incurred while hospitalized at a hospital on an out patient basis, at a clinic or doctor’s office, or at home.

- Reimbursement of medical services and expenses when 85% 85% not hospitalized such as laboratory tests and x-rays, physical therapy, routine annual physical examinations, inoculations, and prescription medicines.

- Reimbursement of routine annual physical examinations. 90% 90%

- Reimbursement of inoculations annually 80% 80%

- Reimbursement of physical therapy 80% 80%

- Coverage for psychiatric therapy. 50% 50%

- Reimbursement of medical supplies such as blood stripes 80% 80% for diabetes, wheelchair, syringes, and orthopedic apparatus (shoes, built up soles, medical belts, neck brace).

C.1.1.3. Prescription Drugs and Medicines:

- Reimbursement of expenses when hospitalized 90% 90%

- Reimbursement of expenses when not hospitalized, 85% 85% of the cost of medicines and drugs for which a prescription is legally required. Expenses incurred

LES Health, Life, Disability and Work Accident Insurance US Embassy, Rabat, Morocco for medicines, vitamins, cold remedies, etc., that are available over the counter without prescription will not be reimbursed even if prescribed by a physician.

C.1.1.4. HIV/AIDS Coverage (for the employee only): 100%

- coverage of expenses for medications to suppress opportunistic infections, such as tuberculosis and toxoplasmosis for employees who have HIV/AIDS; as well as brief courses of anti-retroviral drugs during childbirth to prevent the transmission of HIV to the employee's child. This expanded coverage generally excludes medications for the long-term suppression of AIDS through the combination of anti-retroviral drugs at those posts with inadequate local healthcare infrastructures. This expanded coverage does not apply to dependents or to retired employees.

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

C.1.1.5. Obstetrical Care:

- Reimbursement of expenses up to a maximum 90% 90% of DH 5,450.00 when hospitalized and when not hospitalized, of obstetrical medical care including prenatal and postnatal care, normal delivery, caesarean and miscarriage.

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

C.1.1.7 Hearing Aids:

- Reimbursement of the cost of a hearing aid apparatus 80% 80% and related examination. Limited to one apparatus per ear per patient in a three-year period.

C.1.1.8 Optical Care:

- Reimbursement of frames up to a maximum of DH 970 80% 80% every two years.

- Reimbursement of prescription eyeglasses or contact 85% 85% lenses up to DH 1,275 every two years.

No coverage of expenses for nonprescription lenses, or tinting.

LES Health, Life, Disability and Work Accident Insurance US Embassy, Rabat, Morocco

C.1.1.9 Dental Care:

- Coverage of expenses for dental services including 90% 90% dentists' fees, x-rays, examination and treatment, cleaning, fillings, extractions and dental services related to false teeth, crowns and bridges up to DH 6,100 per patient per year.

- Reimbursement of expenses up to a maximum of 80% 80%

DH 9,788 per year for orthodontia treatment only if treatment begins before age 16, unless required as the result of an accident. A maximum of four years of orthodontia treatment will be covered per patient.

C.1.1.10 Psychiatric Treatment:

- Reimbursement of expenses for psychiatric treatment. 50% 50%

C.1.1.11 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.

C.1.1.12 Transportation for Out of Country Treatment:

- There is no coverage for round trip transportation expenses to travel out of country for medical treatment.

For catastrophic conditions, the annual aggregate maximum shall be DH 562,975 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.1.2 Expenses not covered:

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; transportation for out of country treatment, family planning, 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.

LES Health, Life, Disability and Work Accident Insurance US Embassy, Rabat, Morocco

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

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

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

Mission, except in the case of retired employees who elect to continue coverage.

C.1.3 Annual Maximum Limit

With the exception of expenses incurred under paragraph C.1.1.4 above, the Contractor will reimburse covered expenses up to a limit of 562,975 DH per individual per contract year.

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

C.1.4 Eligible Participants

C.1.4.1 Eligible Employees - Employees eligible for the health insurance services include the following:

C.1.4.1.1 All current active employees of the United States Government, employed within the geographic boundaries of Morocco paid under the Local Compensation Plan, and certified by the

Contracting Officer. Covered employees include:

C.1.4.1.2 Foreign Service Nationals (FSNs) 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 paid under the terms of the Local Compensation Plan and (2) working under temporary appointments; those working under a PSA or PSC that is time limited to less than one year and paid under the terms of the Local Compensation Plan. Participation will be voluntary.

C.1.4.1.3 Locally hired U.S. citizens employed under direct hire appointments, PSAs, and

PSCs.

C.1.4.2 Location of Employment

The individuals covered by C.1.3.1 must be employed within the geographic boundaries of

Morocco by:

U.S. Department of State, U.S. Agency for International Development, U.S. Consulate General, U.S. Office of Security Cooperation, U.S. Office of Legal Attaché, LES Health, Life, Disability and Work Accident Insurance US Embassy, Rabat, Morocco

U.S. Office of Export Control and Related Boarder Security, U.S. Drug Enforcement Agency, U.S. Defense Attaché Office, U.S. Department of Commerce, U.S. Department of Agriculture, U.S. Force Protection Detachment, U.S. Department of Justice, U.S. Department of Homeland Security, U.S. International Narcotic and Law Enforcement, U.S. Middle East Partnership Initiative, U.S. Millennium Challenge Cooperation, And any other U.S. Government entities who may establish a presence during the term of this contract.

C.1.4.3 Participants Covered Under a Rider

C.1.4.3.1 All current active employees of the Chief of Mission, the Deputy Chief of Mission and the American Consulate General assigned to their respective official Government residences and paid under an ORE account (see separate rider, Exhibit B) and Embassy Community

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

C.1.4.3.2 Retirees from U.S. Government service and their eligible family members are included under this contract only as a rider. The costs of each retiree are the responsibility of that retiree, not the U.S. Government.

C.1.4.3.3 Eligible family members (EFMs) of deceased employees are included under this contract only as a rider. The costs of each EFM are the responsibility of that EFM, not the U.S.

Government.

C.1.4.3.4 The Tangier American Legation Museum (TALMS) is included under this contract only as a rider. All costs of TALMS employees are the responsibility of TALMS, not the U.S.

C.1.5 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.

Also not eligible are those working under non-personal services contract personnel and their employees, supplied by an independent contractor licensed to do business in Morocco who provide services to other local organizations as well as to the U.S. Mission.

LES Health, Life, Disability and Work Accident Insurance US Embassy, Rabat, Morocco

C.1.6 Other Eligible Participants

Expenses incurred by an enrolled employee's 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 calendar year in which the child turns age 21, or in the case of a child who is a full-time student, until the end of the calendar year in which the child turns age 25. There is no age limit for an eligible child who is physically or mentally handicapped and unable to live independently. There is no limit on the number of children covered per employee. Parents, grandparents, siblings, and other relatives are not eligible dependents.

C.1.7 Eligibility

C.1.7.1 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 U.S Government 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.1.7.2 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.1.8 BROCHURE REQUIREMENT

C.1.8.1 The Contractor shall provide a document (such as a brochure, pamphlet or other written document) in French (with an English language translation for contract files) and Arabic that sets

LES Health, Life, Disability and Work Accident Insurance US Embassy, Rabat, Morocco 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.1.8.2 The Contractor shall provide the document described in C.1.7.1 to the COR not later than 21 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.1.8.3 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.

LES Health, Life, Disability and Work Accident Insurance US Embassy, Rabat, Morocco

PART II: GROUP LIFE INSURANCE

C.2 GROUP LIFE INSURANCE

The Government of the United States of America requires group life insurance coverage for its employees, as further described in C.2.2, for the U.S. Embassy Rabat, U.S. Consulate General

Casablanca, as well as other current and future agencies connected to the Mission such as determined by the Contracting Officer. The U.S. Government has determined that the prevailing practice by employers in Morocco is to provide group life insurance coverage and that the cost of such insurance protection is typically borne by both the employee (15%) and the employer

(85%); disability insurance is typically borne by the employee (25%) and the employer (75%, and the work accident insurance is borne entirely by the employer. Therefore, the U.S.

Government desires to adopt the locally prevailing practice as part of its compensation plan for its employees as further described in C.2.2. The specific group insurance coverage under this contract is set forth in this part of Section C and the Attachments in Section J.

C.2.1 Group Life Insurance Coverage

The amount of group life insurance coverage is as follows:

C.2.1.1 Amount of Employee Life Insurance.

The amount of life insurance coverage for each employee is based upon the basic salary of the individual. Each employee is eligible for a face amount of coverage that is equal to a number of months times his or her last reported basic salary as described below:

Married employee’s base payment 130% of annual base salary

Additional per child 30% of annual base salary

Maximum benefit 310% of annual base salary

Single employee’s base payment 100% of annual base salary

Additional per child 30% of annual base salary

Maximum benefit 280% of annual base salary

C.2.1.2 “Reserved”.

LES Health, Life, Disability and Work Accident Insurance US Embassy, Rabat, Morocco

C.2.1.3 Partial and Total Disability Coverage:

Non-Work Related Injuries and Illnesses:

The contractor shall pay daily indemnities in the amount of 50 percent of total salary, excluding meal & transportation, from the 31 st day of accident/injury until recovery or for a maximum of 1 year (365 calendar days), whichever is first.

In addition, the employee will receive injury from the Moroccan social security (CNSS) 66.7 percent of salary to a maximum of DH 6,000.00 per month beginning the 1st and up to the 365 th day of illness.

After the 1 year maximum has been reached and the employee still has not recovered, the benefit from the private insurance company will be reduced to 40 percent of salary until retirement age.

C.2.1.4 Amount of Coverage – Work Accident Insurance:

Work Related Injuries and Illnesses:

The contractor shall pay daily indemnities in the amount of two-thirds of the employee’s daily total salary, excluding meal & transportation, from the 2nd day of the accident for all injuries which occur during work hours and during the commute on a direct route to and from work, until recovery. The Contractor shall provide the insurance-issued guarantee of payment within 24 hours of the work related injury notification and will pay the full amount of the clinic/hospital fees.

In case of a permanent disability, the annual annuity is equal to the annual income multiplied by the rate of incapacity.

C.2.2 Life Insurance Benefits Conditions and Limitations

There is no reimbursement for death occurring as a result of suicide, 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 services in the armed forces of any country.

C.2.3 Eligible Participants:

C.2.3.1 Eligible Employees. The employees eligible for the group life insurance coverage include the following:

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

C.2.3.1.2 Foreign Service Nationals (FSNs) employed under direct hire appointments, Personal

Services Agreements (PSAs) and Personal Services Contracts (PSCs);

LES Health, Life, Disability and Work Accident Insurance US Embassy, Rabat, Morocco

C.2.3.1.3 Locally hired U.S. citizens employed under direct hire appointments, PSAs, and PSCs.

C.2.3.2 Location of Employment

The individuals covered by C.2.3.1 must be employed within the geographic boundaries of

Morocco by:

U.S. Department of State, U.S. Agency for International Development, U.S. Consulate General, U.S. Office of Security Cooperation, U.S. Office of Legal Attaché, U.S. Office of Export Control and Related Boarder Security, U.S. Drug Enforcement Agency, U.S. Defense Attaché Office, U.S. Department of Commerce, U.S. Department of Agriculture, U.S. Force Protection Detachment, U.S. Department of Justice, U.S. Department of Homeland Security, U.S. International Narcotic and Law Enforcement, U.S. Middle East Partnership Initiative, U.S. Millennium Challenge Cooperation, And any other U.S. Government entities who may establish a presence during the term of this contract.

C.2.3.3 Participants Covered Under a Rider

C.2.3.3.1 All current active employees of the Chief of Mission and the Deputy Chief of Mission assigned to their respective official Government residences and paid under an ORE account (see separate rider, Exhibit B). All costs for ORE employees are the responsibility of the employing officer, not the U.S. Government.

C.2.3.3.2 All current active employees of the Embassy Community Association (ECA). All costs for ECA employees are the responsibilities of the ECA, not the U.S. Government.

C.2.4 Individuals Not Eligible for Coverage

C.2.4.1 New employees who have reached the age of 60 prior to entering on duty with the U.S.

Government will not be eligible for life insurance coverage.

C.2.4.2 Individuals not eligible for coverage under this contract are non-personal services contract 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.

LES Health, Life, Disability and Work Accident Insurance US Embassy, Rabat, Morocco

C.2.5 Other Eligible Participants

None.

C.2.6 Eligibility and Effective Date

C.2.6.1 Term of Eligibility and Effective Date

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

C.2.6.2. Period of Ineligibility

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

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 U.S.G 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.

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

C.2.7 BROCHURE REQUIREMENT

C.2.7.1 The Contractor shall provide a document (such as a brochure, pamphlet or other written document) in French (with an English language translation for contract files) and Arabic that sets forth a complete listing of the life insurance benefits to be provided under this contract. This brochure shall be provided in sufficient quantities so that each covered employee receives a copy. The Contractor shall furnish all copies of the brochures to the COR, who will ensure that appropriate distribution is made.

C.2.7.2 The document described in C.2.7.1 shall be provided to the COR not later than 30 days after date of contract award. The Contractor shall provide additional brochures for new employees within ten days of the COR’s request.

LES Health, Life, Disability and Work Accident Insurance US Embassy, Rabat, Morocco

C.2.7.3 The Contractor assumes full responsibility for ensuring that the document described in

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

C.3 DEFINITIONS

FMO The Financial Management Officer or the paying office for all U.S.

Government Agencies except USAID.

COR Contracting Officer's Representative is the Human Resources Officer at the

U.S. Embassy Rabat.

Contributory Insurance for which the employee contributes toward the premium.

Customary and A diagonostic test or medical treatment which is usually performed in the

Reasonable community where the individual is being treated.

Treatment

Dependent Employee’s spouse and unmarried dependent children up to age 21 (25 if full time students and 100% dependent on employee).

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

Employee An individual employed by the U.S. Government, under a direct-hire appointment, personal services contract (PSC), or personal services agreement (PSA), as further defined in Section C.1.3 for health insurance and

C.2.3 for life insurance. This may also include an ORE Staff.

Employer The United States Government or in the case of ORE, the Chief of Mission, Deputy Chief of Mission and the American Consulate General.

GSO General Services Officer in charge of the General Services Office at the U.S.

Embassy Rabat. 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.

LES Health, Life, Disability and Work Accident Insurance US Embassy, Rabat, Morocco

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

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

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

Board Certified in that specialty.

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

C.4 Work Requirement

The contractor shall provide a qualified work force capable of providing the services specified in the Contract. Personnel must be available in Casablanca, Rabat and Tangier to assist with claims submissions. Specifically, a contact person must be designated in each city. These points of contact are considered essential personnel and their names should be included in the Contractor’s offer along with an address and phone number for each office in each city. These people will be required to be on the premises of the U.S. Embassy Rabat, the U.S. Consulate General

Casablanca for 4 hours one day each week and at the Tangier American Legation Museum

(TALMS) in Tangier for 2 hours a day every two weeks. The time and day will be determined upon contract award.

KEY PERSONNEL:

1. The Contractor shall assign the following key personnel to this contract:

Position/Function Name Contact Information

2. During the first 90 days of performance, the Contractor shall make no substitutions of key personnel unless the substitution is required due to illness, death, or termination of employment.

The Contractor shall notify the Contracting Officer within 15 calendar days after the occurrence of any of these events and provide the information required below to the Contracting Officer at least 15 days before making any permanent substitutions.

3. The Contractor shall provide a detailed explanation of the circumstances requiring the proposed substitution, a complete resume for the proposed substitute, and any additional information requested by the Contracting Officer. The proposed substitute shall possess qualifications comparable to the original key person and meet the minimum standards set forth in the contract. The Contracting Officer will notify the Contractor of its approval or disapproval of the substitution within 15 calendar days after receiving the required information. The U.S.

Government will modify the contract to reflect any changes in key personnel.

LES Health, Life, Disability and Work Accident Insurance US Embassy, Rabat, Morocco

SECTION D

PACKAGING AND MARKING

(RESERVED)

LES Health, Life, Disability and Work Accident Insurance US Embassy, Rabat, Morocco

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 thru C.4

All required services are performed and no more than ten

(10) customer complaint is received per month http://www.acquisition.gov/far/ http://farsite.hill.af.mil/vffara.htm http://www.statebuy.state.gov/

LES Health, Life, Disability and Work Accident Insurance US Embassy, Rabat, Morocco

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 ten

(10) customer complaints 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…