Health__Life_Insurance_Mexico_Solicitation_Number_S-MX530-15-R-0025_.docx

SF-33

S-MX530-15-R-0025

SECTION B

SUPPLIES/SERVICES AND PRICES/COSTS

PART I – HEALTH INSURANCE

B.1. HEALTH INSURANCE SERVICES

B.1.1. The Contractor shall provide Health Insurance services to employees of the Government of the United States of America in Mexico City and U. S. Consulates 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. This insurance shall be provided in accordance with Section C and the Exhibits in Section J.

B.1.2. 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 Management/Principal Officer (for ORE Staff) separately, at the rates specified below. See Section G for billing procedures.

B.2. PRICES

B.2.1. VALUE ADDED TAX.

The Contractor shall include VAT as a separate charge on the Invoice and as a separate line item in Section B. VAT is not included in the CLIN rates. Instead, it will be priced as a separate Line Item in the contract and on Invoices. Local law dictates the portion of the contract price that is subject to VAT; this percentage is multiplied only against that portion. It is reflected for each performance period. The portions of the solicitation subject to VAT are all of the services and items to be provided by the Contractor as enlisted in Section B.2.3, through B.2.7 below.

B.2.2. FIXED PRICE

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

B.2.2.1. Offers and Payment in U.S. Dollars

U.S. firms are eligible to be paid in U.S. dollars. U.S. firms desiring to be paid in U.S. dollars should submit their officer in U.S. dollars. A U.S. firm is defined as a company which operates as a corporation incorporated under the laws of a state within the United States.

B.2.2.2. Foreign Firm

Any firm which is not a U.S. firm, is a foreign firm. Any firm that does not meet the definition of a U.S. firm shall submit its prices and receive payment in local currency.

B.2.3. BASE YEAR OF CONTRACT (12 month period)

As per paragraphs B.2.2.1, and B.2.2.2, above, insert currency: _______________

Bi-Weekly Rates per Employee:

Price for Base Year (Subtotal x 26): _____________

Value Added Tax (I.V.A.): _____________

Total Price for Base Year: _____________

B.2.4. FIRST OPTION YEAR OF THE CONTRACT (12 month period)

As per paragraphs B.2.2.1, and B.2.2.2, above, insert currency: _______________

Bi-Weekly Rates per Employee:

Price for First Option Year (Subtotal x 26): _____________

Value Added Tax (I.V.A.): _____________

Total Price for First Option Year: _____________

B.2.5. SECOND OPTION YEAR OF THE CONTRACT (12 month period)

As per paragraphs B.2.2.1, and B.2.2.2, above, insert currency: _______________

Bi-Weekly Rates per Employee:

Price for Second Option Year (Subtotal x 26):_____________

Value Added Tax (I.V.A.): _____________

Total Price for Second Option Year: _____________

B.2.6. THIRD OPTION YEAR OF THE CONTRACT (12 month period)

As per paragraphs B.2.2.1, and B.2.2.2, above, insert currency: _______________

Bi-Weekly Rates per Employee:

Price for Third Option Year (Subtotal x 26): _____________

Value Added Tax (I.V.A.): _____________

Total Price for Third Option Year: _____________

B.2.7. FOURTH OPTION YEAR OF THE CONTRACT (12 month period)

As per paragraphs B.2.2.1, and B.2.2.2, above, insert currency: _______________

Bi-Weekly Rates per Employee:

Price for Fourth Option Year (Subtotal x 26):_____________

Value Added Tax (I.V.A.): _____________

Total Price for Fourth Option Year: _____________

GRAND TOTAL BASE PERIOD PLUS OPTION YEARS: $__________________

B.2.8. DOCTOR AND SPECIALIST FEES:

For purposes of evaluation, please fill-in the fees below which are part of the premium amounts in B.2:

Insert the currency $_____________________

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.

B.3.2. 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.3.2.1, sets forth the retention amounts per premium paid for each category of premium and for each period of performance.

The following Note is to be deleted upon award.

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.

Bi-weekly Retention Amounts per separate premium paid per single employee and per family plan in Pesos, Mexican Currency.

Base Period

Option Year 1

Option Year 2

Option Year 3

Option Year 4

B.4. ECONOMIC PRICE ADJUSTMENT-HEALTH INSURANCE PREMIUMS

B.4.1. PREMIUM ADJUSTMENT BASED ON EXPERIENCE

Health insurance prices may be adjusted upward or downward based on the experience rating of the Mission(s) covered by this contract. No adjustment will be allowed during the first twelve months. After such time, the contractor or the Government may request an adjustment in premiums on an annual basis. Before any such adjustment is made, the contractor agrees to provide the Government a balance sheet showing two main components for the time period: (1) receipts (premiums received) minus the retention amount and (2) claims paid. The retention amount is not subject to adjustment. The Government reserves the right to have an independent third party review the balance sheet and make recommendations regarding the appropriateness of the requested adjustment. Any adjustment shall be subject to mutual agreement of the parties and shall result in a written modification to the contract. Any failure to reach agreement under this clause shall be subject to the procedures in the Disputes clause.

B.4.2. PREMIUM ADJUSTMENT BASED ON LAWS

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

B.4.2.1. Employee Pool

This clause is only in effect if the contractor included details in its offer regarding a pooling arrangement, of which this contract is a part.

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

PART II – 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 Mexico City and U.S. Consulates. 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.6. GROUP LIFE INSURANCE RATES

This is a fixed-price with economic-price- adjustment-requirements type contract under which the Government will issue firm-fixed price task orders. The fixed prices/premium rates in Pesos, Mexican Currency per one thousand of salary to provide life insurance, accidental death and dismemberment and partial and total disability coverage are as follows:

B.6.1. BASE YEAR OF THE CONTRACT (12 month period)

The pricing is to be based on the benefit levels stated in C.2.1.

As per paragraphs B.2.2.1, and B.2.2.2, above, insert currency: _______________

B.6.1.1. BI-WEEKLY RATES PER EMPLOYEE

a. Basic Life

b. Accidental Death & Dismemberment

c. Partial & Total Disability Coverage

d. Subtotal (a + b + c)

e. Total Price for Base Year (d x 26)

B.6.1.2. BI-WEEKLY RATES PER BODYGUARD

a. Basic Life

2.4905

b. Accidental Death & Dismemberment

.4010

c. Partial & Total Disability Coverage

d. Subtotal (a + b + c)

e. Total Price for Base Year (d x 26)

B.6.2. OPTION YEAR 1 OF THE CONTRACT (12 month period)

As per paragraphs B.2.2.1, and B.2.2.2, above, insert currency: _______________

B.6.2.1. BI-WEEKLY RATES PER EMPLOYEE

a. Basic Life

b. Accidental Death & Dismemberment

c. Partial & Total Disability Coverage

d. Subtotal (a + b + c)

e. Total Price for Option Year 1 (d x 26)

B.6.2.2. BI-WEEKLY RATES PER BODYGUARD

a. Basic Life

2.4905

b. Accidental Death & Dismemberment

.4010

c. Partial & Total Disability Coverage

d. Subtotal (a + b + c)

e. Total Price for Option Year 1 (d x 26)

B.6.3. OPTION YEAR 2 OF THE CONTRACT (12 month period)

As per paragraphs B.2.2.1, and B.2.2.2, above, insert currency: _______________

B.6.3.1. BI-WEEKLY RATES PER EMPLOYEE

a. Basic Life

b. Accidental Death & Dismemberment

c. Partial & Total Disability Coverage

d. Subtotal (a + b + c)

e. Total Price for Option Year 2 (d x 26)

B.6.3.2. BI-WEEKLY RATES PER BODYGUARD

a. Basic Life

2.4905

b. Accidental Death & Dismemberment

.4010

c. Partial & Total Disability Coverage

d. Subtotal (a + b + c)

e. Total Price for Option Year 2 (d x 26)

B.6.4. OPTION YEAR 3 OF THE CONTRACT (12 month period)

As per paragraphs B.2.2.1, and B.2.2.2, above, insert currency: _______________

B.6.4.1. BI-WEEKLY RATES PER EMPLOYEE

a. Basic Life

b. Accidental Death & Dismemberment

c. Partial & Total Disability Coverage

d. Subtotal (a + b + c)

e. Total Price for Option Year 3 (d x 26)

B.6.4.2. BI-WEEKLY RATES PER BODYGUARD

a. Basic Life

2.4905

b. Accidental Death & Dismemberment

.4010

c. Partial & Total Disability Coverage

d. Subtotal (a + b + c)

e. Total Price for Option Year 3 (d x 26)

B.6.5. OPTION YEAR 4 OF THE CONTRACT (12 month period)

As per paragraphs B.2.2.1, and B.2.2.2, above, insert currency: _______________

B.6.5.1. BI-WEEKLY RATES PER EMPLOYEE

a. Basic Life

b. Accidental Death & Dismemberment

c. Partial & Total Disability Coverage

d. Subtotal (a + b + c)

e. Total Price for Option Year 4 (d x 26)

B.6.5.2. BI-WEEKLY RATES PER BODYGUARD

a. Basic Life

2.4905

b. Accidental Death & Dismemberment

.4010

c. Partial & Total Disability Coverage

d. Subtotal (a + b + c)

e. Total Price for Option Year 4 (d x 26)

B.6.6. Grand Total of Base plus All Options Years:

The total pricing is to be based on the benefit levels stated in C.2.1.

Base Year Total

Option Year 1 Total

Option Year 2 Total

Option Year 3 Total

Option Year 4 Total

Grand Total of Base plus All Option Years:

B.7. ADMINISTRATIVE RETENTION AMOUNTS

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

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

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

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

B.7.2.(a) Retention Amounts per Separate Premium Paid per Employee based on the benefit levels stated in C.2.1:

Base Period

Option Year 1

Option Year 2

Option Year 3

Option Year 4

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

B.8.1. PREMIUM ADJUSTMENT BASED ON EXPERIENCE:

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

B.8.2. PREMIUM ADJUSTMENT BASED ON LAW:

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

SECTION C

DESCRIPTION/SPECIFICATION/WORK STATEMENT

PART I – HEALTH INSURANCE

C.1. HEALTH INSURANCE SERVICES

The Government of the United States of America in Mexico City Health Insurance coverage for its employees as further described in C.1.2, in Mexico, including American Consulates at Ciudad Juarez, Chihuahua; Guadalajara, Jalisco; Matamoros, Tamaulipas; Hermosillo, Sonora; Merida, Yucatan; Monterrey, Nuevo Leon; Nuevo Laredo, Tamaulipas; Tijuana, Baja California; and Nogales, Sonora; as well as Consular agencies at Acapulco, Guerrero; Cabo San Lucas, B.C.; Cancuún, Quintana Roo; Puerta Vallarta, Jalisco; Mazatlán, Sinaloa; Piedras Negras, Coahuila; Playa del Carmen, Quintana Roo; and San Miguel Allende, Guanajuato. The U.S. Government has determined that the prevailing practice by employers in Mexico 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 on a percentage cost basis. Health insurance protection will be representative of local 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 (SIDA) care.

Reimbursement of covered expenses is limited to the stated percentages Customary and Reasonable 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.

A. Premium Costs:

1) For active employees who are regularly scheduled to work 30 or more hours per week:

-the USG will pay 100% of the premium cost for employee and dependent coverage.

2) For eligible employees who are regularly scheduled to work less than 30 hours per week:

-The USG will pay a prorated share of the premium cost for employee and dependent coverage, based on the number of hours the employee is regularly scheduled to work.

B. Medical Coverage:

The Contractor will reimburse covered medical expenses incurred, subject to the stated limits within the contract. Payment will be for Customary and Reasonable Costs of covered benefits for services received as noted below. The medical treatment must be prescribed or provided by a physician or nurse licensed in Mexico, the United States, or in the country in which the treatment or prescription is received. All monetary amounts below are given in local currency unless otherwise noted. Coverage of expenses will be made in local currency.

C.1.1. Employee and Dependent Health Services Benefits

C.1.1.a. Maximum Coverage per Event: With the exception of expenses incurred under HIV/AIDS (SIDA), the Contractor will cover expenses up to a limit of $1,200,000.00 per covered individual per event for each Contract Year. All events will be considered as initial and/or new event as of the date the present contract is signed and in accordance with C.1.1.20. The Contractor will reimburse covered expenses described below for HIV/AIDS (SIDA) up to a separate annual limit of U. S. Dollars $10,000.00 per employee per event for each Contract year.

C.1.1.b. Deductible: $1,344.00 annual deductible per covered individual for each Contract year.

C.1.1.c. Co-Insurance for Customary and Reasonable Cost of Covered Benefits: Each covered individual will be reimbursed 86% of Customary and Reasonable Costs for services referenced below after payment of the deductible unless otherwise noted. The Co-insurance is subject to a maximum payment of $50,000.00. In the case of covered medical expenses incurred as the result of an accident, the co-insurance does not apply; the Contractor shall reimburse 100% after payment of the annual deductible. Any variations, individual maximum limits and/or deductibles are itemized below.

C.1.1.1. Hospitalization

a) 100% coverage of room and board expenses for a standard ward room or a semi-private room; coverage for a private room should not to exceed 100% of the cost of a semi-private room.

b) 100% coverage of in-patient hospital medical expenses including laboratory tests, radioactive, chemotherapy, x-rays, radioactive isotopes, electrocardiographs, or any other necessary diagnostic expense, blood transfusions, plasma, serum, or any other substances, customary nursing care, operating room expenses, intensive care, prescription medicines and items, physical therapy.

c) 100% coverage of expenses related to surgical procedures, including surgeon's fees, surgical assistance, and anesthesia.

C.1.1.2. Nursing Care

95% covered when not hospitalized for a maximum of 36 visits per year. See above item C.1.1.1, hospitalization for coverage when hospitalized.

C.1.1.3. Doctor’s Visits

95% coverage of doctor's visits when hospitalized, at a clinic, doctor’s office or at home; 95% coverage of specialist’s fees.

C.1.1.4. Outpatient Services

95% coverage for out-patient medical services and expenses when not hospitalized to include laboratory tests, x-rays, radioactive, chemotherapy, radioactive isotopes, electrocardiographs, or any other necessary diagnostic expense, blood transfusions, plasma, serum, or any other substances. See above item C.1.1.1, hospitalization for coverage when hospitalized.

C.1.1.5. Prescription Drugs and Medicines

95% coverage when not hospitalized, of the cost of medicines and drugs for which a prescription is legally required. See above item C.1.1.1, hospitalization for coverage when hospitalized. Should a Doctor or Physician prescribe medications, drugs and/or miscellaneous medical supplies normally prescribed for the treatment of one condition (i.e. heart illness) and is prescribed to treat a different condition (i.e. kidney illness) the cost shall be reimbursed. 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.1.1.6. Obstetrical Care

95% coverage of obstetrical medical care when hospitalized. The following maximums apply:

Note: Not covered are: pre- and post natal care, family planning or annual physical exams and immunizations.

C.1.1.7. Ambulance

100% coverage for local ground ambulance.

80% coverage for national air transportation.

Note: No coverage for international air transportation.

C.1.1.7. Emergency Room Visits

95% coverage of emergency visits.

C.1.1.8. Out of Country Coverage

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 in country. Reimbursement will be made at the same percentage rate and subject to the same annual maximum limit as for expenses incurred in country.

C.1.1.9. Opportunistic Infections

For employees only: 100% coverage for medications to suppress opportunistic infections, such as tuberculosis and toxoplasmosis for employees who have HIV/AIDS. For employee and employee's covered spouse: 100% coverage of 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. Annual maximum: $1,900,000.00 per covered individual per event for each Contract Year. This limit is in addition to the limit in C.1.1.a.

C.1.1.10. Physical Therapy

90% coverage of out-patient services.

C.1.1.11. Psychiatric Treatment

50% coverage. For medication see C.1.1.5, Prescription Drugs and Medicines.

C.1.1.12. Dental and Mouth

Only covered if medically necessary as the result of an accident. Coverage rates above apply.

C.1.1.13. Optical and Ophthalmologic Services

Only covered if medically necessary as the result of an accident. Coverage rates above apply.

C.1.1.14. Aesthetic or Plastic Surgery

Aesthetic treatment, cosmetic or plastic surgery; only if required as a re-constructive operation due to an accident or illness, coverage rates above apply.

C.1.1.15. Analysis/Tests

Any kind of analysis or test solicited by a doctor or a physician and performed with the intention of verifying possible diagnoses, will be covered even if the result is negative.

C.1.1.16. Congenital Malformations

Reimbursement of medical expenses spent to correct congenital malformations of an employee's child only if the employee’s child was born after the employee was hired by the United States Government. This includes illness contracted at the moment of birth and expenses incurred for asepsis and prophylaxis of the newborns. It is a requirement that newborns be enrolled under the current Health Insurance Plan within 30 days of birth.

C.1.1.17. Pre-Existing Conditions

Pre-existing conditions are covered under this contract for those employees and dependents covered under the previous Mission Health Insurance Plan and covered since the entry on duty date of employment. This means that all covered individuals, to include dependents will be reimbursed for the continuation of any treatment or any illness that the employee had before the award of this contract. This also includes congenital malformations of participants/dependents born prior to the award of this contract. In order for a pre-existing condition to be covered for a newly hired covered individual, he/she must be enrolled in the plan for a minimum of six (6) months. A newly hired employee may not submit a claim for a pre-existing condition until he/she has been working for the U.S. Government and enrolled in this plan for six (6) months.

C.1.1.18. Accidents and Emergencies

Treatment and hospitalization will be paid directly by the Contractor to the hospital, and the employee/family member shall not be obligated to provide immediate payment whether the contractor has an agreement with the hospital/physician or not.

C.1.1.19. Hearing Aid

Not covered.

C.1.1.20. Catastrophic Coverage

Not covered.

C.1.2. Conditions and Limitations

C.1.2.1. No coverage will be provided for elective cosmetic surgery; spa cures; rejuvenation cures; massage; exercise therapy; transplants; long term rehabilitative therapy; eyeglass frames and lenses; 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.

C.1.2.2. No coverage will be provided for expenses that will be reimbursed or paid directly under a host country medical program, the U.S. workers' compensation program, or any host country workers' compensation program.

C.1.2.3. No coverage will be provided for expenses related to an illness or injury that is a result of an unlawful action on the part of the patient; the *professional 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.

*”Professional” in this context denotes that the covered individual receives an income for the practice or performance of a sport.

C.1.2.4. Any expense not expressly excluded in Clause C.1.2., shall be covered and included in Clause C.1.1.

C.1.2.5. No coverage will be provided for round trip transportation expenses to travel out of country for medical treatment.

C.1.2.6. No coverage will be provided for expenses incurred after an employee leaves the service of the U. S. Mission.

C.1.2.7. Employees and their dependents are not covered after retirement.

C.1.3. Eligible Participants

C.1.3.1. Eligible Employees

Locally Employed (LE) Staff who are (1) working on a full-time or part-time basis under non-temporary direct-hire appointments, under Personal Services Agreements (PSAs) and Personal Services Contracts (PSCs) that are not time limited to less than one year and (2) paid under the terms of the Local Compensation Plan. The employees eligible for the group life insurance coverage include the following:

C.1.3.1.1. All current active employees of the United States Government, employed within the geographic boundaries of Mexico, 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, Personal Services Agreements (PSAs) and Personal Services Contracts (PSCs).

C.1.3.1.4. Currently there is no age limit for employees to be covered under this contract.

C.1.3.2. Location of Employment

The individuals covered by C.1.3, must be employed within the geographic boundaries of Mexico by:

American Battle Monument Commission (ABMC) Defense Attaché Office (DAO) Department of Agriculture Department of Commerce Department of Defense Department of Health and Human Services (DHHS) Department of Homeland Security (DHS) Department of Justice (DOJ) Department of State (DOS) Department of Treasury (DOT) Peace Corps Mexico United States Agency for International Development

C.1.3.3. Participants Covered Under a Rider

C.1.3.3.1. All current active employees of the Chief of Mission and the Deputy Chief of Mission assigned to their respective official Government residences and paid under an ORE account (see separate rider, Exhibit H). All costs for ORE employees are the responsibility of the employing officer, not the U.S. Government.

C.1.3.3.2. RESERVED.

C.1.4. Individuals Not Eligible for Coverage

Not eligible for coverage under this contract are non-personal services contract personnel; Peace Corps Personal Services Contractors as required by MS 743, employees working on a temporary basis; employees with an intermittent, seasonal, or WAE (when actually employed) schedule; Recreation Association employees; retired employees and any other individual not falling within one of the categories of employees described in this clause. Parents, grandparents, siblings, and other relatives are not eligible dependents.

C.1.5. Other Eligible Participants

Dependent Coverage: 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 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.

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. Alternatively, the employee may elect to have coverage cease if he/she prefers not to pay the premium

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 U. S. Government 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.1.6.3. Participation in the Plan

Participation in the plan ceases if the employee separates from the U.S. Government’s service. However, the employee as well as his/her dependents, will have the right to continue to pursue present claims, which were in progress at the time of the employee’s separation for 1) a period of 730 days from the first expense; or 2) payment is made up to the maximum coverage amount or 3) upon the termination of the services on behalf of the U.S. Government.

Separation from U.S. Government service due to the death of the employee does not cancel the coverage. In this case coverage for new claims will continue for the surviving spouse and /or dependents for a period for 90 days. Existing claims will continue to be valid for 1) a period of 730 days from the first expense; or 2) payment is made up to the maximum coverage amount; or 3) upon the termination of the services of the U.S. Government.

C.1.7. Brochure Requirements

C.1.7.1. Quantity and Language

The Contractor shall provide a document (brochure/pamphlet/other written document) in Spanish 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. Delivery

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. Contents

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. The brochure/pamphlet or other written document shall clearly describe an example of what the employee is responsible for paying after the co-insurance and deductible are applied to a claim submitted where customary and reasonable costs are used. 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 U.S. Government to notice any inaccuracies shall in no way limit, revise or otherwise affect the requirement under this contract for the Contractor to fully comply with all contract terms.

PART II – GROUP LIFE INSURANCE

C.2. GROUP LIFE INSURANCE

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

C.2.1. Group Life Insurance Coverage

The amount of group life insurance coverage is as follows:

C.2.1.1. Amount of Employee Life Insurance – Natural Death

The amount of life insurance coverage for each employee is based upon 100% of premium costs.

The amount of Natural Death Coverage is the employee’s estate or employee’s named beneficiary will receive an amount equal to twenty-eight (28) months of base salary in the event the employee dies of natural causes.

C.2.1.2. Amount of Accidental Death or Work Related Death Coverage

The employee's estate or employee will receive an amount equal to twenty-five (25) months’ basic salary, in the event the employee is killed in an accident or work related death.

C.2.1.3. Partial and Total Disability Coverage

The employee will receive an amount equal to twenty-eight (28) months’ of base salary when employment ends due to total disability. There is a six month waiting period before total disability may be declared. Treatment provided to the employee during the six-month waiting period must be provided by a physician who is not a family member and in accordance with the IMSS statement of permanent disability. The amount payable shall be paid in a single payment immediately after the six-month waiting period has elapsed. In the event of loss of limb or other body parts which obviously immediately totally disables an employee, the six-month period is waived. If the insured employee is incapable of collecting the insured amount, payment shall be made to his/her legal representative.

C.2.2. Life Insurance Benefits Conditions and Limitations

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

No benefit shall be payable under this contract if the employee's bodily injuries have been caused directly or indirectly and totally or partially by:

C.2.2.1. Suicide, if death occurs within the first six months of employment as LE Staff at U.S. Mission Mexico. If an employee dies within the fist six months due to suicide, the contractor shall return the respective mathematical reserve to the Government. If an employee dies after the fist six months of his/her employment with the U.S. Government due to suicide, it will be considered natural death.

C.2.2.2. Death is caused by participating in, practicing, or making use of military service, acts of war (except for terrorist attack), rebellion, revolution or insurrection.

C.2.2.3. Intentional criminal actions, violating the law or resisting detention or arrest in which the insured employee directly participates.

C.2.2.4. Participation in competitions involving the use of wheeled vehicles, horses, boats or water skis.

C.2.2.5. When the insured employee is receiving or has received disability benefits under this policy.

C.2.2.6. Death resulting from any aerial sports, skydiving, bullfighting, scuba diving or skin diving.

C.2.2.7. Death resulting from the professional practice of any sport. This does not apply to amateur competitions, even those offering cash or other prizes.

C.2.2.8. An accident resulting from the employee being under the influence of alcohol, drugs, or other toxic substance unless administered by a physician. Death as a result of a disease or mental infirmities and medical or surgical treatment thereof (except pyogenic infection due to an accidental cut or wound) shall be considered a natural and not an accidental death.

C.2.2.9. No benefits shall be payable if an employee's death or other insurance event was caused directly or indirectly by war. War shall be defined as declared or non-declared war or any martial operations or invasion, hostile acts of foreign powers, rebellion, riot, civil war, uprising, mutiny, operations by military or usurpatory authorities, martial law or state of siege or any other similar event or reason for declaring martial law or war. A terrorist attack shall not be considered war.

C.2.3. Eligible Participants

C.2.3.1. Eligible Employees

Locally Employed (LE) Staff who are (1) working on a full-time or part-time basis under non-temporary direct-hire appointments, under Personal Services Agreements (PSAs) and Personal Services Contracts (PSCs) that are not time limited to less than one year and (2) paid under the terms of the Local Compensation Plan. 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 Mexico, paid under the Local Compensation Plan, and certified by the Contracting Officer. Covered employees include:

C.2.3.1.2. Foreign Service Nationals (FSNs) employed under direct hire appointments, Personal Services Agreements (PSAs) and Personal Services Contracts (PSCs);

C.2.3.1.3. Locally hired U.S. citizens employed under direct hire appointments, Personal Services Agreements (PSAs) and Personal Services Contracts (PSCs).

C.2.3.2. Location of Employment

C.2.3.2. The individuals covered by C.2.3.1 must be employed within the geographic boundaries of Mexico by:

American Battle Monument Commission (ABMC) Defense Attaché Office (DAO) Department of Agriculture Department of Commerce Department of Defense Department of Health and Human Services (DHHS) Department of Homeland Security (DHS) Department of Justice (DOJ) Department of State (DOS) Department of Treasury (DOT) Peace Corps Mexico United States Agency for International Development

C.2.3.3. RESERVED

C.2.4. Individuals Not Eligible for Coverage

C.2.4.1. Age Limit

New employees who have reached the age of 75 prior to entering on duty with the U.S. Government will not be eligible for life insurance coverage.

C.2.4.2. Not eligible

Employees not eligible are LE Staff age 60 or older; working under temporary appointments; those working under a PSA or PSC that is time limited to less than one year; those with a When Actually Employed (WAE) workweek schedule; non-personal services contract personnel and their employees, supplied by an independent contractor licensed to do business in the Mexico who provide services to other local organizations as well as to the U.S. Mission; employees of USAID institutional contractors; and Peace Corps personal services contractors as indicated in MS 743.

C.2.4.3. Dependents and retirees

Dependents such as spouse and children and retirees are not covered under this Contract.

C.2.5. Reserved

C.2.6 Eligibility and Effective Date

C.2.6.1. Term of Eligibility and Effective Date

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

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

C.2.6.2. Period of Ineligibility

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

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

C.2.7. Brochure Requirement

C.2.7.1. Quantity and Language

The Contractor shall provide a document (brochure/pamphlet/other written document) in English and Spanish 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. Delivery

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.

C.2.7.3. Content

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

COR: Contracting Officer’s Representative (Post Human Resources Officer and/or FSN in charge.

Contributory: Insurance for which the employee/employer contributes toward the premium.

Co-Insurance: The percentage of the claim, after the deductible has been satisfied, which will be paid by the employee.

Currency: Premiums and benefits will be paid in local currency (Mexican Pesos).

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

Dependent: Insured dependents including the participating employee’s spouse and children. An eligible child is defined as the employee’s natural child, adopted child, stepchild, or foster child. See C.1.5, for further definition.

Deductible: The amount which will be ducted per person, per year, and which will be paid by the insured employee.

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

Employee: An individual employed by the U.S. Government, under a direct hire appointment, Personal Services Contract (PSC) or Personal Services Agreement (PSA) as further defined in C.1.3, for Health Insurance and C.2.3, Life Insurance. This may also include an ORE employee, if this category of individual is an eligible participant, as defined in C.1.3.3, for Health Insurance and C.2.3, for Life Insurance.

Employer: The United States Government or in the case of ORE, the Chief of Mission, the Deputy Chief of Mission and the Management Officers or the Principal Officers at each Consulate.

FMO/FMC: Financial Management Officer/Financial Management Center or the paying office for all U.S. Government agencies.

GSO: General Services Officer in charge at Post who 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 physician and 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, sickness or injury.

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

Miscarriage: The delivery of a dead child before the pregnancy is completed, due to abnormal pregnancy.

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 must be Board Certified in the specialty.

Salary: monthly salary is one-twelfth of the employee's annual basic salary, exclusive of premium pay, allowances, bonuses, or any other separate payments.

Surgical Procedure: Any invasive medical procedure by manual or instrument operation undertaken for diagnosis or treatment of a diseased, sick or injured 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 these addresses:

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 Dept. of State Acquisition Website at http://www.statebuy.state.gov/ to see the links to the FAR.