Paramaribo_8_17_Amendment_Text.docx

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 Suriname. The Government has determined that the prevailing practice by employers in Suriname is to provide for their employees and retirees health insurance protection and that the cost of such insurance protection is usually borne by both the employee and the employer. For active employees: The USG will pay 90% of the premium cost for employee and dependent coverage and the employee will pay 10%. For retirees: The USG will pay 70% of the premium cost for retiree and dependent coverage and the retiree will pay 30%. 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.

The Contractor will provide an onsite customer service representative three hours per week at agreed upon times at US Embassy Paramaribo. Types of services to be provided will include but not be limited to: Claims processing, change of beneficiary, delivery of refund checks, guarantee letters and benefits advice and counseling for covered members.

C.1.1 Employee, Retiree, ORE, and Dependent Health Services Benefits

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

C.1.1.1. Hospitalization: Reasonable and customary costs of 100% room and board expenses for a private room; 100% of hospital medical expenses including laboratory tests and x-rays, nursing care, operating room costs, intensive care, prescription medicines, and physical therapy.

All insured over 12 years of age are covered for hospitalization in Class I; younger children will be hospitalized in the “Children’s” class.

Rooming-in on behalf of children up to 7 years of age: coverage is provided to a maximum of 10 days per policy year for one parent.

Expenses for hospitalization, nursing and additional costs in the various hospital classes, namely:

• For claimants until 12 years of age in the pediatric ward (class 3)

• For claimants from 12 years of age (class 1) Coverage of costs for clinical treatment by a specialist

Hospital out-patient services e.g. home care, only on indication of the specialist in attendance, shall be covered up to a maximum of 20 weeks per policy year.

Medical treatment in the Emergency Room (E.R) as well as urgent medical treatment by the physician on weekend duty. Expenses for Hospitalization in the lung asylum.