Solicitation 19EG3026R0001 GMC 2027.pdf

Health and Life Insurance Services Cover memo for Solicitation No. 19EG3026R0001 American Embassy Cairo, Egypt Page 1 of 2

U.S. Embassy Cairo 8 Kamal El-Din Salah Garden City, Cairo Date: May 19, 2026

Dear Prospective Offeror:

Subject: Request for Proposals number 19EG3026R0001 Health/Life Insurance Services

The Embassy of the United States of America invites you to submit a proposal for locally employed staff health and life insurance coverage. The Embassy encourages prospective offerors to offer off-the-shelf plans that meet at least the minimum benefit levels required in this solicitation.

The U.S. Government intends to award a contract/purchase order to the responsible company submitting an acceptable offer at the lowest price. We intend to award a contract/purchase order based on initial proposals, without holding discussions, although we may hold discussions with companies in the competitive range if there is a need to do so.

The Embassy intends to conduct a pre-proposal conference at the site, The pre-proposal conference will be held on Jun 09, 2026, at 10 a.m. (Cairo time) at the US Embassy in Cairo.

Prospective offerors should contact cairocontracts@state.gov with their IDs by Jun. 03, 2026, to arrange entry to the building.

Proposals are due by Jun 29, 2026, at 04:30 p.m. (Cairo time). No proposals will be accepted after this time. Proposals must be in English and incomplete proposals will not be accepted. Any questions related to the solicitation should be emailed to cairocontracts@state.gov by Jun 17, 2026, at 04:30 p.m. (Cairo time).

Your proposal must be submitted electronically to CairoGSOProcA@state.gov only. It is important to make sure the submission is made in specific size and format; in MS-Word 2007/2010 or MS-Excel 2007/2010 or Adobe Acrobat (pdf) file format. The file size must not exceed 30MB. If the file size should exceed the 30MB, the submission must be made in separate files and attached to separate emails with less than 30MB each.

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

1. SF-33

2. Section B, Pricing Schedule.

3. Section K, Representations and Certifications; and

4. Additional information as required in Section L.

5. Proof of SAM Registration

Offerors shall be registered in the SAM (System for Award Management) database at https://www.sam.gov prior to submittal of their offer/proposal as prescribed under FAR 4.1102.

Failure to be registered at time of proposal submission may deem the offeror’s proposal to be

SBU - CONTRACTING AND ACQUISITIONS

Health and Life Insurance Services Cover memo for Solicitation No. 19EG3026R0001 American Embassy Cairo, Egypt Page 2 of 2 considered non-responsible and no further consideration will be given. Therefore, offerors are highly encouraged to register immediately if they are interested in submitting a response to this requirement.

Sincerely, Jeffrey Watts Contracting Officer

Enclosure:

PAGE OF PAGESSOLICITATION, OFFER AND AWARD 1. THIS CONTRACT IS A RATED ORDER RATING

UNDER DPAS (15 CFR 700) 1 84

2. CONTRACT NUMBER 3. SOLICITATION NUMBER

19EG3026R0001

4. TYPE OF SOLICITATION

SEALED BID (IFB)

NEGOTIATED (RFP)

5. DATE ISSUED

05/19/2026

6. REQUISITION/PURCHASE NUMBER

PR15859167

7. ISSUED BY CODE

AMERICAN EMBASSY CAIRO

US EMBASSY CAIRO 8 KAMAL EL DIN SALAH, ATTN:

PROCUREMENT/CONTRACTING OFFICE

CAIRO 11519

EGYPT

EG300 8. ADDRESS OFFER TO (If other than item 7)

AMERICAN EMBASSY CAIRO

US EMBASSY CAIRO 8 KAMAL EL DIN SALAH, ATTN: PROCUREMENT (1901)

CAIRO 11519

EGYPT

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

SOLICITATION

9. Sealed offers in original and copies for furnishings the supplies or services in the Schedule will be received at the place specified in item 8, or if hand carried, in the depository located in until 04:30 local time 06/29/2026

(Hour) (Date) CAUTION - LATE Submissions, Modifications, and Withdrawals: See Section L, Provision No. 52.214-7 or 52.215-1. All offers are subject to all terms and conditions contained in this solicitation.

11. TABLE OF CONTENTS

(X) SEC. DESCRIPTION PAGE(S) (X) SEC. DESCRIPTION PAGE(S)

PART I - THE SCHEDULE PART II - CONTRACT CLAUSES

x A SOLICITATION/CONTRACT FORM 1 x I CONTRACT CLAUSES 38 x B SUPPLIES OR SERVICES AND PRICES/COSTS 2 PART III - LIST OF DOCUMENTS, EXHIBITS AND OTHER ATTACH.

x C DESCRIPTION/SPECS./WORK STATEMENT 15 x J LIST OF ATTACHMENTS 54 x D PACKAGING AND MARKING 29 PART IV - REPRESENTATIONS AND INSTRUCTIONS x E INSPECTION AND ACCEPTANCE 30 x F DELIVERIES OR PERFORMANCE 32 x K REPRESENTATIONS, CERTIFICATIONS AND OTHER

STATEMENTS OF OFFERORS 56

x G CONTRACT ADMINISTRATION DATA 33 x L INSTRUCTIONS, CONDITIONS, AND NOTICES TO OFFERORS 75 x H SPECIAL CONTRACT REQUIREMENTS 35 x M EVALUATION FACTORS FOR AWARD 82

OFFER (Must be fully completed by offeror) NOTE: Item 12 does not apply if the solicitation includes the provisions at 52.214-16, Minimum Bid Acceptance Period.

12. In compliance with the above, the undersigned agrees, if this offer is accepted within calendar days (60 calendar days unless a different period is inserted by the offeror) from the date for receipt of offers specified above, to furnish any or all items upon which prices are offered at the set opposite each item, delivered at the designated point(s), within the time specified in the schedule.

13. DISCOUNT FOR PROMPT PAYMENT

(See Section I, Clause No. 52.232-8)

10 CALENDAR DAYS (%) 20 CALENDAR DAYS (%) 30 CALENDAR DAYS (%) CALENDAR DAYS(%)

AMENDMENT NO. DATE AMENDMENT NO. DATE14. ACKNOWLEDGMENT OF AMENDMENTS

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

CODE FACILITY

15A. NAME AND

ADDRESS

OF OFFER-

OR

16. NAME AND THE TITLE OF PERSON AUTHORIZED TO SIGN OFFER

(Type or print)

15B. TELEPHONE NUMBER

AREA CODE NUMBER EXTENSION

15C. CHECK IF REMITTANCE ADDRESS IS

DIFFERENT FROM ABOVE - ENTER SUCH

ADDRESS IN SCHEDULE.

17. SIGNATURE 18. OFFER DATE

AWARD (To be completed by Government)

19. ACCEPTED AS TO ITEMS NUMBERED 20. AMOUNT 21. ACCOUNTING AND APPROPRIATION

22. AUTHORITY FOR USING OTHER THAN FULL AND OPEN COMPETITION:

10 U.S.C. 2304(c)( ) 41 U.S.C. 253(c)( )

23. SUBMIT INVOICES TO ADDRESS SHOWN IN ITEM

(4 copies unless otherwise specified)

25. PAYMENT WILL BE MADE BY CODE24. ADMINISTERED BY (If other than Item 7)

AMERICAN EMBASSY CAIRO

US EMBASSY CAIRO 8 KAMAL EL DIN SALAH, ATTN: PROCUREMENT/CONTRACTING

OFFICE

CAIRO 11519

EGYPT

AMERICAN EMBASSY COLOMBO

210 GALLE ROAD, ATTN: FMO-BILLING

COLOMBO

SRI LANKA

26. NAME OF CONTRACTING OFFICER (Type or print 27. UNITED STATES OF AMERICA

(Signature of Contracting Officer)

28. AWARD DATE

IMPORTANT - Award will be made on this Form, or on Standard Form 26, or by other authorized official written notice.

AUTHORIZED FOR LOCAL REPRODUCTION

Previous edition is unusable STANDARD FORM 33 (REV. 6/2014)

Prescribed by GSA - FAR (48 CFR) 53.214 (c)

B. TELEPHONE (NO COLLECT CALLS)10. FOR

INFORMATION

CALL:

A. NAME

Jeffrey Watts Hany B. Gerguis

AREA CODE NUMBER EXTENSION

C. E-MAIL ADDRESS

wattsjl@state.gov GerguisHB@state.gov

X

Health and Life Insurance Services Solicitation No. 19EG3026R0001 American Embassy Cairo, Egypt Page 2 of 84

SECTION B

PART I: PRICE – HEALTH INSURANCE

B.1. HEALTH INSURANCE SERVICES

The Contractor shall provide the Health Insurance services to employees of the Government of the United States of America in Egypt and their eligible dependents as described in Section C and the Exhibits in Section J. This insurance shall be provided in accordance with Section C and the exhibits in Section J.

B.1.1. Official Residence Expense (ORE) Staff and the American Employees Cooperative and Welfare Association (AECWA) employees are included under this contract only as a rider; the Contractor shall bill the Chief of Mission and Deputy Chief of Mission (for ORE Staff), and the AECWA employees at the rates specified below. See Section G for billing procedures.

Note that USG is not responsible, nor liable, for any riders.

B.1.2 Optional benefit coverage is included under this contract only as a rider at the rates specified below.

B.2. PRICES

B.2.1 Value Added Tax

The Government will not reimburse the Contractor for VAT under this contract. The Contractor shall not include a line for VAT on Invoices as the U.S. Embassy has a tax exemption certificate with the host government.

B.2.2 This is a fixed price with economic price adjustment requirements type contract under which will be issued firm, fixed-price task orders. The fixed prices/premium rates in Egyptian Pounds for the health insurance services as specified in Section C are as follows:

JAMES ZADROGA 9/11 VICTIMS HEALTH AND COMPENSATION ACT OF 2010

NOTICE: UNLESS A WAIVER OR EXCEPTION APPLIES, PAYMENTS

SUBSEQUENT TO THIS PROCUREMENT ARE SUBJECT TO AN EXCISE TAX OF

2% PERSUANT TO 26 U S C 5000C

American Embassy Cairo, Egypt Page 3 of 84

B.2.3 Base Year of Contract

Bi-Weekly Rates Per Employee Category Estimated Number of Employees Rate per Employee/Dependent

Bi-Weekly Total

a. Single Employees (Self Only)

b. Family Plan (Rate per each Dependent)

c. Subtotal (a +b) Total Price for Base Year (c x 26)

B.2.4 First Option Year of Contract

Category Estimated

Number of Employees

Rate per Employee/Dependent

Bi-Weekly Total

a. Single Employees (Self Only)

b. Family Plan (Rate per each Dependent)

c. Subtotal (a + b) Total Price for First Option Year (c x 26)

B.2.5 Second Option Year of Contract of Employees Rate per Employee/Dependent

Bi-Weekly Total

a. Single Employees (Self Only)

b. Family (Rate per

Total Price for Second Option Year (c x 26)

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B.2.6 Third Option Year of Contract of Employees Rate per Employee/Dependent

Bi-Weekly Total

a. Single Employees (Self Only)

b. Family (Rate per

Total Price for Third

B.2.7 Fourth Option Year of Contract

Bi-Weekly Rates Per Premium of Employees Rate per Employee/Dependent

Bi-Weekly Total

a. Single Employees (Self Only)

b. Family (Rate per

Total Price for Fourth

B.2.8 Six months extension (FAR 52.217-8)

Bi-Weekly Rates Per Premium of Employees Rate per Employee/Dependent

Bi-Weekly Total

a. Single Employees (Self Only)

b. Family (Rate per

Total Price for Fourth Option Year (c x 13)

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B.2.9 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 Six months extension (FAR 52.217-8)

Grand Total of Base plus All Option Years

MINIMUM AND MAXIMUM AMOUNTS

During the Base Year of the contract, and during the option year that might be exercised, the United States Government (USG) shall place orders totaling a minimum of EGP 100,000.00.

This reflects the contract minimum guarantee for each period of performance. The amount of all orders, for base and all option years shall not exceed EGP 2,000,000,000.00. This reflects the contract maximum.

B.3 Pricing for Rider CLINS

The firm fixed price/premium rates in Egyptian Pounds for the Rider CLINS are as follows and are to be paid 100% by the enrollee; these Rider CLINS will NOT be evaluated as part of the overall price evaluation:

B.3.1 Base Year for Rider CLINS:

No. Category Bi-Weekly Rates per Employee

1 Official Residence Expense (ORE) Staff and the American Employees Cooperative and Welfare Association (AECWA) and their Dependents

B.3.2 First Option Year for Rider CLINS:

B.3.3 Second Option Year for Rider CLINS:

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B.3.4 Third Option Year for Rider CLINS:

B.3.5 Fourth Option Year for Rider CLINS:

B.3.6 Six months extension (FAR 52.217-8) for Rider CLINS:

B.3.7. Grand Total of Base Plus All Option Years For Rider CLINS:

These Rider CLINS will NOT be evaluated as part of the overall price evaluation

No. Category Total

1 Base Year Total 2 First Option Year Total 3 Second Option Year Total 4 Third Option Year Total 5 Fourth Option Year Total 6 Six months extension (FAR 52.217-8)

GRAND TOTAL of BASE plus ALL OPTION YEARS of RIDER CLINS:

The remainder of this page is intentionally blank.

American Embassy Cairo, Egypt Page 7 of 84

B.4 ADMINISTRATIVE RETENTION AMOUNTS

B.4.1 If the Contractor requests a price adjustment under B.5 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 shall 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.4.2 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 Six months extension (FAR 52.217-8)

B.5. ECONOMIC PRICE ADJUSTMENT-HEALTH INSURANCE PREMIUMS

B.5.1. Premium Adjustment Based on Experience - For health insurance, prices may be adjusted upward or downward based on the experience rating of the Mission(s) covered by this contract, 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 Government may request an adjustment in premiums on an annual basis. Adjustments are not retroactive to previous contract terms. Before any such adjustment is made, the Contractor agrees to provide the Government a balance sheet showing three main components for the time period: (1) receipts (premiums received) minus the retention amount, (2) number of insurance plans and (3) claims paid. This information shall be provided per type of premium, i.e. per line item. The retention amount is not subject to adjustment. The Government reserves the right to have an independent third party

American Embassy Cairo, Egypt Page 8 of 84 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.5.2. 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.5.2.1 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 shall include in its proposal for adjustment, details setting forth how the pool impacts the request for equitable adjustment.

The remainder of this page is intentionally blank

American Embassy Cairo, Egypt Page 9 of 84

PART II: PRICE – GROUP LIFE INSURANCE

B.6. 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 Cairo, Egypt. 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.6.1. Official Residence Expense (ORE) Staff and Embassy Association Employees (EAE)

ORE Staff and EAE employees are included under this contract only as a rider; the Contractor shall bill the Chief of Mission and Deputy Chief of Mission (for ORE Staff), the Embassy Association (for EAEs) at the rates specified below. See Section G for billing procedures.

B.7. 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 per one thousand Egyptian Pounds of salary to provide life insurance, accidental death and dismemberment and partial and total disability coverage are as follows:

B.7.1. BASE YEAR OF CONTRACT

Type of Insurance Premium (per 1,000 of salary)

Estimated Payroll (Bi-weekly in Thousands)

Bi-Weekly Total

Basic Life Accidental Death & Dismemberment Partial and Total Disability Coverage

Subtotal

Total Price for Base Year (Subtotal x 26)

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B.7.2. FIRST OPTION YEAR OF CONTRACT

Estimated Payroll (Bi-weekly in Thousands)

Bi-Weekly Total

Basic Life Accidental Death & Dismemberment Partial and Total Disability Coverage

Total Price for Option Year 1 (Subtotal x 26)

B.7.3. SECOND OPTION YEAR OF CONTRACT

Estimated Payroll (Bi-weekly in Thousands)

Bi-Weekly Total

Basic Life Accidental Death & Dismemberment Partial and Total Disability Coverage

Total Price for Option Year 2 (Subtotal x 26)

B.7.4. THIRD OPTION YEAR OF CONTRACT

Estimated Payroll (Bi-weekly in Thousands)

Bi-Weekly Total

Basic Life Accidental Death & Dismemberment Partial and Total Disability Coverage

Subtotal

Total Price for Option Year 3 (Subtotal x 26)

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B.7.5. FOURTH OPTION YEAR OF CONTRACT

Estimated Payroll (Bi-weekly in Thousands)

Bi-Weekly Total

Basic Life Accidental Death & Dismemberment Partial and Total Disability Coverage

Total Price for Option Year 4 (Subtotal x 26)

B.7.6. Six months extension (FAR 52.217-8)

Estimated Payroll

(Bi-weekly in Thousands) Bi-Weekly

Total Basic Life Accidental Death & Dismemberment Partial and Total Disability Coverage

Total Price for the Six months extension (FAR 52.217-8) (Subtotal x 13)

B.7.7 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 Six months extension (FAR 52.217-8)

Grand Total of Base plus All Option Years

B.8 ADMINISTRATIVE RETENTION AMOUNTS

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B.8.1 If the Contractor requests a price adjustment under B.9 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.7. 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.8.2 sets forth the Retention amounts per premium paid for each category of premium and for each period of performance.

B.8.3 Retention Amounts per separate premium paid per employee

Period of Performance

Basic Life Accidental Death and Dismemberment

Partial and Total Disability Coverage

Base Period Option Year 1 Option Year 2 Option Year 3 Option Year 4 Six months extension

(FAR 52.217-8)

B.9 ECONOMIC PRICE ADJUSTMENT-LIFE INSURANCE PREMIUMS

B.9.1. 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.

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 select an independent third party to 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.9.2. 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

American Embassy Cairo, Egypt Page 13 of 84 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.10 PROFIT SHARING CREDIT

B.10.1. Health Insurance Premiums – Experience Rating Refund

1.Premiums :

1.1 Total Premium according to contract rate XXXX

1.2 Less R/I cost in excess of xxxxx XXXX

2.Claims :

Claims net of reinsurance recoveries (Inclusive suspended claims, IBNR and change is reserves)

XXXX

3.Expenses :

Retention – 25% of gross premium XXXX 4.Loss carry forward Losses carried forward from previous year XXXX 1-2-3-4 Balance XXXX ×50% Experience Rating Refund XXXX

B.10.1.1 Premiums:

1.1 Total premium according to the contract rate.

1.2 Less reinsurance premiums paid for risk in excess of the risk retention limit.

B.10.1.2 Claims:

2.1 Claims and Claims related expenses paid during the period.

2.2 Plus change in reserves as required by company standards.

2.2.1 Pending claims reserves for incurred and reported claims not yet paid.

2.2.2 Incurred but not reported claims.

2.3 Less reinsurance claims recoveries received for claims of xxxxx

B.10.1.3 Expenses:

Retention, fees and taxes – 25% of gross premium.

B.10.1.4 Loss carry forward from Previous year

B.10.2 Life Premiums – Experience Rating Refund

1.Premiums :

1.1 Total Premium according to contract rate XXXX

1.2 Less R/I cost in excess of xxxxx XXXX

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2.Claims :

Claims net of reinsurance recoveries (Inclusive suspended claims, IBNR and change is reserves)

XXXX

3.Expenses :

Retention – 20% of gross premium XXXX 4.Loss carry forward Losses carried forward from previous year XXXX 1-2-3-4 Balance XXXX ×50% Experience Rating Refund XXXX

B.10.2.1. Premiums:

1.1 Total premium according to the contract rate.

1.2 Less reinsurance premiums paid for risk in excess of the risk retention limit.

B.10.2.2. Claims:

2.1 Claims and Claims related expenses paid during the period.

2.2 Plus change in reserves as required by company standards.

2.2.1 Pending claims reserves for incurred and reported claims not yet paid.

2.2.2 Incurred but not reported claims.

2.3 Less reinsurance claims recoveries received for claims of EGP xxxxxx

B.10.2.3. Expenses:

Retention, fees and taxes – 20% of gross premium.

B.10.2.4 Loss carry forward from Previous year

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SECTION C

DESCRIPTION/SPECIFICATION/WORK STATEMENT

PART I - HEALTH INSURANCE

C.1. HEALTH INSURANCE SERVICE S

The Government of the United States of America requires Health Insurance coverage for its employees as further described in C.1.1in Egypt. The Government has determined that the prevailing practice by employers in Egypt is to provide for their employees health insurance protection and that the cost of such insurance protection is usually borne 100% by the employer.

Heath insurance protection will be representative of locally prevailing compensation. The specific health benefit coverage under this contract is set forth in Section C and the Exhibits in Section J.

The contractor shall ensure 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 Service Benefits

C.1.1.1 Hospitalization (Treatment in the Hospital for Inpatient Care):

Services and supplies provided during hospitalization including services provided by a licensed healthcare provider, bed, and board (semi-private accommodations), operating room, recovery room, intensive care, imaging and diagnostic testing, and general hospital nursing care, physical therapy, as well as drugs and medicines administered while in-patient. When private accommodations are provided, coverage will be limited to the cost of a semi-private room unless otherwise covered in an off the shelf plan.

100% Coverage

See Mental Health and Substance Abuse Care (below) for details concerning inpatient psychiatric care.

See Outpatient Services (below) for details concerning professional services.

C.1.1.2 Emergency Services (Trips to Emergency Room):

Services provided for conditions that could lead to serious disability or death if not immediately treated, such as accidents or sudden illness.

100% Coverage

C1.1.3 Ambulance:

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Professional ground transport to move a patient from the place where s/he is injured or becomes ill to the nearest hospital able to provide treatment or to move a patient from one medical facility to another.

80% Minimum Coverage

C.1.1.4 Outpatient Services:

Services provided by a licensed healthcare provider on an ambulatory or outpatient basis (without being admitted to a hospital), including surgeon’s fees and other medical services provided at a hospital, clinic, doctor’s office, medical facility, etc. Examples include, but are not limited to:

- Annual physical examinations

- Specialist consultations and treatment, including second surgical opinion

- Minor surgical interventions

- Chemotherapy and radiation treatments

- Immunizations recommended by local authorities and/or the World Health Organization

- Diagnostic tests and diagnostic imaging

80% Minimum Coverage See Rehabilitative and Habilitative Services and Devices (below) for details concerning physical therapy.

See Mental Health and Substance Abuse Care (below) for details concerning psychiatric therapy.

C.1.1.5 Obstetric and Newborn Care: (Up to EGP 100,000)

Care and services that women receive during pregnancy (prenatal care), throughout labor, delivery and post-delivery, and outpatient care for newborn babies. Hospitalization during pregnancy and/or delivery will be reimbursed as inpatient care All other treatments will be considered outpatient services and will be reimbursed at that rate.

Inpatient: 100% Coverage; Outpatient: 80% Minimum Coverage

C.1.1.6 Pediatric Services:

Primary and preventive routine care services for covered dependent children, including, but not limited to: physical examinations, developmental assessments, laboratory tests, and immunizations recommended by local authorities and/or the World Health Organization.

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C.1.1.7 Prescription Drugs:

Medications prescribed by a licensed health care provider that are medically required.

Examples include, but are not limited to prescription antibiotics to treat an infection, medication used to treat an ongoing condition, such as high cholesterol, prophylaxis, contraceptive medication.

C.1.1.8 Preventive and Wellness Services and Chronic Disease Management:

Counseling or preventive care designed to prevent or detect medical conditions and care for chronic conditions such as asthma and diabetes. Examples include, but are not limited to:

physicals, immunizations, and cancer screenings.

80% Minimum Coverage

C.1.1.9 Hearing Aids: Minimum

Limited to one apparatus per ear. The maximum coverage is EGP 60,000 per covered individual per three-year period.

80% Minimum Coverage: with applicable cap.

C.1.1.10 Optical Care: Minimum Coverage – 80%

Examinations and Treatment: 80% Minimum Coverage

Prescription lenses and frames or contact lenses: The maximum coverage is EGP 10,000 per covered individual every two years.

80% Minimum Coverage; with applicable cap

C.1.1.11 Dental Care:

Examinations and Treatment: Dentist’s fees, x-rays, examinations and treatment, cleanings, fillings, extractions, false teeth, crowns, and bridges. The maximum coverage is EGP 15,000 per covered individual per contract year.

80% Minimum Coverage: with annual cap.

Orthodontia: Treatment is covered only if treatment begins before age 18, or if required as the result of an accident. A maximum of four years of orthodontia treatment

American Embassy Cairo, Egypt Page 18 of 84 will be covered per covered individual. The maximum coverage is EGP 50,000 lifetime limit.

80% Minimum Coverage, with contract lifetime cap

C.1.1.12 Reproductive Health: (Up to EGP 100,000)

Prescribed contraceptive devices, preventive care and routine examinations, voluntary sterilization, and diagnosis and treatment of conditions which may cause infertility. Assisted reproductive technology (ART), fertility treatments, and reversal of sterilization are not covered (see Exclusions to Coverage).

50% Minimum Coverage

C.1.1.13 RESERVED

C.1.1.14 Rehabilitative and Habilitative Services and Devices:

Rehabilitative services (e.g., recovering skills, such as speech therapy after a stroke or physical therapy after an accident) and habilitative services (e.g., developing skills, such as speech therapy for children, etc.) that help develop skills needed for everyday life. Devices to help gain or recover mental or physical skills lost due to injury, disability or a chronic condition, and devices needed for habilitative reasons.

50% Minimum Coverage

C.1.1.15 RESERVED

C.1.1.16 Catastrophic Coverage

Additional coverage equal to EGP 800,000.00 per covered individual per contract year.

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.1.1.17 Out-of-Country Medical Treatment:

Medical expenses incurred out-of-country will be covered at the same benefit levels and subject to the same total maximum annual limit as for medical expenses incurred in-country.

C.1.1.18 RESERVED

C.1.1.19 180 Day Coverage For Dependents After Employee’s Death:

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At the time of a covered employee’s death, his/her eligible dependents covered under post’s medical plan are eligible to continue receiving the same level of medical coverage for up to 180 days. This optional benefit is subject to availability of funds at post and no extensions are permitted.

C.1.1.20 RESERVED

C.1.1.21 RESERVED

C.1.2 Annual Maximum Limit

The maximum annual reimbursement per covered individual per contract year, not including expenses defined under Exclusions and Limitations (C.1.3) and C.1.1.16, Catastrophic Coverage, or those covered equivalent to EGP 800,000.00.

C.1.3 Exclusions and Limitations

There is no reimbursement for elective cosmetic surgery; spa cures; rejuvenation cures;

massage; exercise therapy; long-term rehabilitative therapy; non-medical hospital charges (e.g., telephone, television, etc.); home help, family help, or similar household assistance; fees of persons who are not certified health care providers; advanced reproductive technology (e.g., in-vitro fertilization, intra-cellular sperm injection, artificial insemination, microsurgical epididymal sperm aspiration, testicular sperm extraction, cryopreservation, etc.); or services or supplies which have not been prescribed or approved by a certified health care provider.

Exclusions to coverage may be amended if provided in an off-the-shelf plan and is the lowest-cost and technically acceptable.

Removal of any exclusions require prior authorization.

There is no reimbursement for expenses that will be reimbursed or paid directly under a host country medical program or workers' compensation program, the U.S. workers’ compensation program, or post’s LE Staff workers’ compensation program.

There is no coverage for expenses that will be reimbursed or paid directly under a host country medical program or workers' compensation program, the U.S. workers’ compensation program, or post’s LE Staff workers’ compensation program.

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

C.1.4 ELIGIBLE PARTICIPANTS

C.1.4.1 Identification of Eligible Employees and Dependents: U.S. Mission Cairo will provide a list of all eligible employees and dependents with relationship to employee

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(self/spouse/child) and DOB for each. Updates will be provided to add or remove individuals on a bi-weekly/monthly basis.

C.1.4.1.1 Definition of Dependents

C1.4.1.1.1 Spouse: a limit of one legal spouse as defined by local law per employee will be covered.

C.1.4.1.1.2 Children: a child is defined as the LE Staff’s natural, adopted, stepchild, or foster child. The child must be unmarried and financially dependent upon the LE Staff. A child will be covered until the end of the contract year in which s/he reaches age 26. An unmarried child determined to be incapable of self-support due to a physical or mental condition will continue to be eligible to participate in the medical plan as long as the condition persists, the child remains unmarried, and the LE Staff maintains coverage.

C.1.4.2 Eligible Employees: The employees eligible for the health insurance services include the following:

C.1.4.2.1 All current active employees of the United States Government, employed within the geographic boundaries of Egypt paid under the Local Compensation Plan, and certified by the Contracting Officer. Covered employees include

C.1.4.2.2 Foreign Service Nationals (FSNs) employed under direct hire appointments, Personal Services Agreements (PSAs) and Personal Services Contracts (PSCs).

C.1.4.2.3 Locally hired U.S. citizens employed under direct hire appointments, PSAs, and PSCs.

C.1.4.3 Location of Employment:

The eligible employees covered by C.1.4.1 must be employed within the geographic boundaries of Egypt by STATE, FAS, FAS/APHIS, DoD (DAO, OMC, COE, NAMRU-3, DeCA/Commissary), LOC, FCS, DEA, DHS (CBP and ICE), DOJ (Legat).

C.1.4.4 Participants and Benefits Covered Under a Rider

a. 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.

b. All current active employees of the Employee Association at Embassy Egypt (see separate rider, Exhibit C). All costs for AECWA employees (EAEs) are the responsibility of the Employee Association, not the U.S. Government.

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c. Optional excess coverage per above item C.1.1.19. If elected, all costs for excess coverage are the responsibility of the employee, not the U.S. Government

C.1.4.5 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, WAI (when actually employed) schedule; and any other individual not falling within on of the categories of employees described in this clause.

C.1.5 Other Eligible Participants

Covered dependents include the participating employee’s spouse and children. A limit of one legal spouse as defined by local law per employee is covered. An eligible child is defined as the employee’s natural child, adopted child, stepchild, or foster child. The child must be unmarried and financially dependent upon the LE Staff.

A child will be covered until the end of the contract year in which s/he reaches age 26. An unmarried child determined to be incapable of self-support due to a physical or mental condition will continue to be eligible to participate in the medical plan as long as the condition persists, the child remains unmarried, and the LE Staff maintains coverage.

There is no limit on the number of children covered per employee.

C.1.6 ELIGIBILITY

C.1.6.1 Term of Eligibility and Effective Date

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

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

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

C.1.7 Brochure Requirement

C.1.7.1 The Contractor shall provide a document (brochure/pamphlet/other written document) in English that sets forth a complete listing of the health insurance benefits to be provided under this contract. This brochure shall be provided in sufficient quantities so that each covered employee receives a copy. The Contractor shall furnish all copies of the brochures to the COR, who will ensure that appropriate distribution is made.

C.1.7.2 The Contractor shall provide the document described in C.1.7.1 to the COR not later than 15 Days after date of contract award. The Contractor shall provide additional brochures for new employees within ten (10) business days of the COR’s request.

C.1.7.3 The Contractor assumes full responsibility for ensuring that the document described in C.1.7.1 accurately reflects the requirements, coverage, and contract terms 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 document 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.

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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 Egypt. The Government has determined that the prevailing practice by employers in Egypt is that group life insurance coverage is representative of locally prevailing compensation practice and that the cost of such insurance protection is paid 100% by US Government. 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.

In case of natural death: 24 times the monthly basic salary.

C.2.1.2 Amount of Accidental Death and Dismemberment Coverage.

In case of accidental death: 48 times the monthly basic salary

C.2.1.3 Partial and Total Disability Coverage

A- Total Disability: In the event of an eligible employee becoming completely and permanently disabled due to bodily injury, work or non-work related diseases, the Contractor shall pay a lump sum benefit to the employee equal to 48 months of the employee’s last reported salary.

B- Partial Disability: In the event of an eligible employee becoming partially disabled due to bodily injury, work or non-work related diseases, the Contractor shall pay a lump sum benefit ranging from 20% up to 50% of the total disability benefit:

Loss of arm between shoulder and wrist 50% Loss of hand below wrist 50% Losses of four fingers and thumb 40% Loss of four fingers 35% Loss of whole thumb 25% Loss of whole index finger 20% Loss of whole middle finger 20% Loss of whole ring finger 20%

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Loss of whole little finger 20% Loss of leg at tip 50% Loss of leg between knee and hip 50% Los of leg below knee 35% Loss of one toe 20% Loss of an additional toe (each) 20% Loss of one eye 50% Deafness of both ears 50% Deafness of one ear 20%

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 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.

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:

1. Violating the law or in resisting detention or arrest.

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

3. 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 physical 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. Suicide will not be covered.

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 Egypt, paid under the Local Compensation Plan, and certified by the Contracting Officer. Covered employees include:

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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, PSAs, and 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 Egypt by:

STATE, FAS, FAS/APHIS, DoD (DAO, OMC, COE, NAMRU-3, DeCA/Commissary), LOC, FCS, DEA, DHS (CBP and ICE), DOJ (Legat).

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 Employee Association at

Embassy Cairo (see separate rider, Exhibit C). All costs for Embassy Cairo EAEs are the responsibility of the Employee Association, 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 65 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 nonpersonal services contract personnel; employees working on a temporary basis; employees with an intermittent, seasonal, or WAE (when actually employed) schedule; and any other individual not falling within one of the categories of employees described in this clause.

C.2.5. Other Eligible Participants

The following additional categories of persons are covered by this insurance. N/A.

C.2.6 Eligibility and Effective Date

C.2.6.1. Term of Eligibility and Effective Date

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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 insurance 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. The Contractor shall provide a document (brochure/pamphlet/other written document) in English 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 15 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. 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.

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C.3.0 DEFINITIONS

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

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

Contributory Insurance Insurance for which the employee contributes toward the premium.

Customary and Reasonable Treatment

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

Dependent 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 LE Staff’s natural, adopted, stepchild, or foster child. The child must be unmarried and financially dependent upon the LE Staff. A child will be covered until the end of the contract year in which s/he reaches age 26. An unmarried child determined to be incapable of self-support due to a physical or mental condition will continue to be eligible to participate in the medical plan as long as the condition persists, the child remains unmarried, and the LE Staff maintains coverage.

There is no limit on the number of children covered per employee.

Parents, grandparents, siblings, and other relatives are not eligible dependents.

Disability - Total and Permanent

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

Employee 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

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