Solicitation 19GE5023R0033.pdf

SOLICITATION

DOCUMENT

LE Staff Health Insurance Services

U.S. Embassy Harare, Zimbabwe

Solicitation No. 19GE5023R0033

U.S. Consulate General Frankfurt Regional Procurement Support Office

Giessenerstrasse 30

60435 Frankfurt am Main, Germany

19GE5023R0033

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS

OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24 & 30

1. REQUISITION NUMBER

5. SOLICITATION NUMBER

19GE5023R0033

2. CONTRACT NO. 3. AWARD/EFFECTIVE DATE 4. ORDER NUMBER 6. SOLICITATION ISSUE

DATE

04/20/2023

7. FOR SOLICITATION

INFORMATION CALL:

a. NAME

Nadja U. Reinmueller

b. TELEPHONE NUMBER (No collect calls)

c. EMAIL ReinmuellerNU@state.gov

8. OFFER DUE DATE / LOCAL

TIME

CODE FRANK

AMERICAN CONSULATE GENERAL FRANKFURT

GIESSENER STRASSE 30

ATTN: RPSO

60435, FRANKFURT, GERMANY

9. ISSUED BY X UNRESTRICTED OR SET ASIDE: % FOR

SMALL BUSINESS

HUBZONE SMALL

BUSINESS

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

WOMEN-OWNED SMALL BUSINESS (WOSB)

ELIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM

EDWOSB

8(A)

NAICS:

SIZE STANDARD:

10. THE ACQUISITION IS

SEE

SCHEDULE

X

11. DELIVERY FOR FOB DESTINATION

UNLESS BLOCK IS MARKED

12. DISCOUNT TERMS

13a. THIS CONTRACT IS

RATED ORDER UNDER DPAS

(15 CFR 700)

13b. RATING

RFQ IFB X RFP

14. METHOD OF SOLICITATION

HARARCODE15. DELIVER TO

AMERICAN EMBASSY HARARE

172 HERBERT CHITEPO AVE

HARARE, ZIMBABWE

CODE OPEAQM16. ADMINISTERED BY

RPSO Frankfurt OPE/AQM/IP/RPSO Frankfurt Office of Acquisition (AQM) Frankfurt

FACILITY

CODE

CODE

Contact UEI:

Telephone No.

17a. CONTRACTOR/

OFFEROR

OPEAQMCODE18a. PAYMENT WILL BE MADE BY

AMERICAN EMBASSY HARARE

2 Lorraine Drive

ATTN: FINANCIAL MANAGEMENT OFFICE

HARARE, ZIMBABWE

17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN

OFFER SEE ADDENDUM

18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK BELOW IS

CHECKED

19. ITEM NO. 20. SCHEDULE OF SUPPLIES/SERVICES

(Use Reverse and/or Attach Additional Sheets as Necessary)

21. QUANTITY 22. UNIT 23. UNIT PRICE 24. AMOUNT

See Line Items Section

25. ACCOUNTING AND APPROPRIATION DATA 26. TOTAL AWARD AMOUNT (For Govt. Use Only)

X 27a. SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1, 52.212-4. FAR 52.212-3 AND 52.212-5 ARE ATTACHED. ADDENDA X ARE ARE NOT ATTACHED

27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA ARE ARE NOT ATTACHED

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN ____ COPIES TO

ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND DELIVER ALL ITEMS SET FORTH

OR OTHERWISE IDENTIFIED ABOVE AND ON ANY ADDITIONAL SHEETS SUBJECT TO THE

TERMS AND CONDITIONS SPECIFIED.

29. AWARD OF CONTRACT: REF. _____________________________ OFFER

DATED _________________ . YOUR OFFER ON SOLICITATION (BLOCK 5)

INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE SET FORTH HEREIN,

IS ACCEPTED AS TO ITEMS:

30a. SIGNATURE OF OFFEROR/CONTRACTOR 31a. UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER)

30b. NAME AND TITLE OF SIGNER (TYPE OR PRINT) 30c. DATE SIGNED 31b. NAME OF THE CONTRACTING OFFICER (TYPE OR PRINT) Nicolas Wilhelm

31c. DATE SIGNED 04/20/2023

AUTHORIZED FOR LOCAL REPRODUCTION

PREVIOUS EDITION IS NOT USABLE

STANDARD FORM 1449 (REV. 02/2012)

Prescribed by GSA - FAR (48 CFR) 53.212

CGFS // CGFS

19GE5023R0033

Line Item Summary

Solicitation Number:

19GE5023R0033

Contract Number: Title: Harare, Zimbabwe - LE Staff Health Insurance

Date of Solicitation:

04/20/2023

Line Item No.

Description Quantity Unit Unit Price Total Cost

001 BASE YEAR - LES Health Insurance inclusive of the following Sub CLINs:

0001A Single Employee (Self Only) 0001B Employee + 1 0001C Family Plan (Employee + 2) 0001D Family Plan (Employee + 3) 0001E Family Plan (Employee + 4) 0001F Family Plan (Employee + 5 and above) Type of Contract Pricing: FFP

Doc Ref No:

Delivery Date FOB:

0.00 EA

002 OPTION YEAR ONE - LES Health Insurance inclusive of the following Sub CLINs:

1001A Single Employee (Self Only) 1001B Employee + 1 1001C Family Plan (Employee + 2) 1001D Family Plan (Employee + 3) 1001E Family Plan (Employee + 4) 1001F Family Plan (Employee + 5 and above) Type of Contract Pricing: FFP

Doc Ref No:

Delivery Date FOB:

0.00 EA

003 OPTION YEAR TWO - LES Health Insurance inclusive of the following Sub CLINs:

2001A Single Employee (Self Only) 2001B Employee + 1 2001C Family Plan (Employee + 2) 2001D Family Plan (Employee + 3) 2001E Family Plan (Employee + 4) 2001F Family Plan (Employee + 5 and above) Type of Contract Pricing: FFP

Doc Ref No:

Delivery Date FOB:

0.00 EA

004 OPTION YEAR THREE - LES Health Insurance inclusive of the following Sub CLINs:

3001A Single Employee (Self Only) 3001B Employee + 1 3001C Family Plan (Employee + 2) 3001D Family Plan (Employee + 3) 3001E Family Plan (Employee + 4) 3001F Family Plan (Employee + 5 and above) Type of Contract Pricing: FFP

Doc Ref No:

Delivery Date FOB:

0.00 EA

005 OPTION YEAR FOUR - LES Health Insurance inclusive of the following Sub CLINs:

4001A Single Employee (Self Only) 4001B Employee + 1 4001C Family Plan (Employee + 2) 4001D Family Plan (Employee + 3) 4001E Family Plan (Employee + 4) 4001F Family Plan (Employee + 5 and above) Type of Contract Pricing: FFP

Doc Ref No:

Delivery Date FOB:

0.00 EA

19GE5023R0033 Harare, Zimbabwe

Locally Employed Staff Health Insurance Page 3 of 77

TABLE OF CONTENTS

Section 1 – The Schedule

• SF 1449 cover sheet

• Continuation To SF-1449, Prices, Block 23

• Continuation To SF-1449, Schedule Of Supplies / Services, Block 20 Description / Specifications / Work Statement

• Attachment 1 – Pricing Spreadsheet

• Attachment 2 – Contract Information / Experience Listing

• Attachment 3 – W-14 Certificate of Foreign Contracting Party

• Exhibit A – Employee Statistic

NOTE: Further contractor-provided attachments will be included after award

Section 2 – Contract Clauses

• Contract Clauses

• Addendum to Contract Clauses - FAR and DOSAR Clauses not Prescribed in Part 12

Section 3 – Solicitation Provisions

• Solicitation Provisions

• Addendum to Solicitation Provisions - FAR and DOSAR Provisions not Prescribed in Part 12

Section 4 – Evaluation Factors

• Evaluation Factors

• Addendum to Evaluation Factors - FAR and DOSAR Provisions not Prescribed in Part 12

Section 5 – Representations and Certifications

• Offeror Representations and Certifications

• Addendum to Offeror Representations and Certifications - FAR and DOSAR Provisions not Prescribed in Part 12

Locally Employed Staff Health Insurance Page 4 of 77

SECTION 1 – THE SCHEDULE

CONTINUATION TO SF-1449

PRICES – BLOCK 23

I BACKGROUND / SCOPE OF SERVICES

A. The Government of the United States of America requires Health Insurance for its Locally

Engaged Staff (LES) and their dependents in Harare, Zimbabwe.

The Contractor shall provide the Health Insurance services to employees of the Government of the United States of America in Harare, Zimbabwe, as described in Section 1.IV Specifications / Statement of Work and the Exhibit attached. The groups of employees who shall be provided this insurance are listed in Section 1.IV.C Eligible Participants.

This insurance shall be provided in accordance with Section 1.IV. and the Exhibit attached.

B. This is a fixed price with economic price adjustment requirements type contract under which annual firm, fixed-price task orders will be issued. The contract shall remain unfunded. The fixed prices / premium rates for the health insurance services as specified in Section 1.IV. are listed in Section 1.III.

C MINIMUM (Reference Section I, Clause 52.216-22(b))

During the term of this contract, the Government shall order, as a minimum, services in an amount of at least $5,000.00.

The Government makes no guarantee as to the number of orders or actual amount of services that will be requested above the guaranteed minimum of $5,000.00.

The maximum dollar value during the entire life of this contract is $24,000,000.00.

II ACRONYMS AND ABBREVIATIONS

Acronym Definition

CLIN Contract Line Item Number

Contractor Insurance Company

CO

Contracting Officer

COR

Contracting Officer Representative

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.

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Dependent Dependents are defined as the covered employee’s legal spouse as defined by law (limit one) and children (natural, adopted, stepchild, or foster children). 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.

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

Employer

The United States Government = USG

Employee Staff member of the US Embassy Harare

Employee plus one

Any eligible spouse or child of the Employee

FMO Financial Management Officer

Hospital An institution established and operated for the care and treatment of sick and injured persons. It provides 24-hour nursing care and has diagnostic, laboratory, treatment, and surgical facilities. Any institution which does not meet this definition is not considered a hospital.

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

LS

Lump Sum

PII

Personally Identifiable Information

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

QA

Quality Assurance

QC

Quality Control

QCP Quality Control Plan

QTY

Quantity

SOW

Statement of Work

Surgical Procedure

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

TBD

To be determined

USG

U.S. Government

ORE Official Residence Expense

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III PRICES

A.1 The contractor shall complete all work, including furnishing all labor, material, equipment and services, unless otherwise specified herein, required under this contract for the firm fixed unit prices indicated below and within the time specified herein. These individual prices shall include all labor, materials, profit, and, if applicable, value added tax (VAT).

Any costs not separately priced will be considered to be included in the individual prices as overhead or other indirect cost. No additional sums will be payable on account of any escalation in the cost of materials, equipment or labor, or because of the contractor's failure to properly estimate or accurately predict the cost or difficulty of achieving the results required by this contract. Nor will the contract price be adjusted on account of fluctuations in the currency exchange rates.

A.2 The currency shall be fixed and cannot be changed by modification to the contract.

A.3.1. Economic Price Adjustment, Premium Adjustment Based on Experience For health insurance, prices may be adjusted upward or downward based on the experience rating of the Mission covered by this contract, and it specifically excludes all riders in IV.C.3 No adjustment will be allowed during the first twelve months.

After such time, the contractor or the USG may request an adjustment in premiums on an annual basis to be effective per contract year. Adjustments are not retroactive to previous contract terms. Before any such adjustment is made, the contractor agrees to provide the USG a balance sheet showing three main components for the previous time period:

(1) receipts (premiums received),

(2) number of insurance policies and

(3) claims paid.

This information shall be provided per type of premium, i.e. per line item.

The USG reserves the right to have an independent third party review the balance sheet and claims and make recommendations regarding the appropriateness of the requested adjustment. Any adjustment shall be subject to mutual agreement of the parties and shall result in a written modification to the contract effective for the following option year. Any failure to reach agreement under this clause shall be subject to the procedures in the Disputes clause.

A.3.2.1. 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.

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A.3.2.2. 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.

B. VAT – if applicable, the contractor shall be responsible for paying to the appropriate authority the applicable rate of Value Added Tax (VAT). Offerors shall identify the VAT as a separate line item. The VAT shall also be a separate cost item on all invoices submitted against task orders under the resulting contract. The contractor will be reimbursed for VAT only up to the amount listed in each task order and upon presentation of proof that VAT has been paid to the host country government. If the contractor receives a VAT refund from the host government he shall re-pay the refund amount to the US Government.

C. Official Residence Expense (ORE) employees and Employee Association (EA) employees are included under this contract only as a rider. The Contractor shall bill the individual covered at the rates specified below. Please see Section 1,IV,C.3.

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

D. The contract will be issued in United States Dollar (USD). Offerors shall quote their prices in United States Dollar (USD).

The fixed prices / premium rates for the health insurance services as specified in Section IV are as follows:

E. Administrative Retention Amounts

If the Contractor requests a price adjustment under A.3, 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 Attachment 1 Pricing.

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. Attachment 1 Pricing sets forth the retention amounts per premium paid for each category of premium and for each period of performance.

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NOTE TO OFFEROR: Fill in the fixed monthly 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.

monthly retention amounts per separate premium paid per single employee, per Employee +1 and per family plan.

Period of Performance

Single Employees (Self Only) Employee + 1

Family Plan Employee + 2

Family Plan:

Employee + 3

Family Plan:

Employee + 4

Family Plan:

Employee + 5 and above

Base Year

Option Year

Option Year

Option Year

Option Year

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ATTACHMENT 001 – PRICES WILL BE INSERTED HERE

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CONTINUATION TO SF-1449

SCHEDULE OF SUPPLIES / SERVICES, BLOCK 20

DESCRIPTION / SPECIFICATIONS / WORK STATEMENT

IV SPECIFICATIONS

A. HEALTH INSURANCE SERVICES

The Government of the United States of America requires Health Insurance coverage for its employees as described herein.

-- Self-Only: 1 covered individual -- Self Plus One (two individuals) -- Family (three or more individuals)

B. EMPLOYEE & DEPENDENT HEALTH SERVICE BENEFITS

B.1. MANDATORY/REQUIRED BENEFITS

B.1.1 Hospitalization (Treatment in the Hospital for Inpatient Care):

100% Coverage

Services and supplies provided during hospitalization, including services provided by a licensed healthcare provider, bed & board (semi-private accommodations), operating room, recovery room, intensive care, imaging and diagnostic testing, 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.

See Mental Health and Substance Abuse care (B.1.13) for details concerning inpatient psychiatric care.

See Outpatient Services (B.1.4) for details concerning professional services.

B.1.2 Emergency Services (Trips to Emergency Room):

100% Coverage

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

B.1.3 Ambulance:

80% Minimum Coverage

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.

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B.1.4 Outpatient Services:

Services provided by a certified healthcare provider on an ambulatory or outpatient basis (without being admitted to a hospital), including surgeon’s fees and other medical services that may be provided in 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

See Rehabilitative and Habilitative Services and Devices (B.1.14) for details concerning physical therapy.

See Mental Health and Substance Abuse Care (B.1.13) for details concerning psychiatric therapy.

B.1.5 Obstetric and Newborn Care:

Inpatient: 100% Coverage

Outpatient: 80% Minimum Coverage

Care and services that women receive during pregnancy (prenatal care), throughout labor and delivery, and post-delivery, and outpatient care for newborn babies. Hospitalization during pregnancy and/or delivery will be covered as Hospitalization (treatment in the hospital for inpatient care). All other treatments will be considered Outpatient Services.

B.1.6 Pediatric Services:

Outpatient: 80% Minimum Coverage

Primary and preventive routine care services for covered dependent children, including, but not limited to:

physical examination, developmental assessment, laboratory tests, and immunizations recommended by local authorities or the World Health Organization.

B.1.7 Prescription Drugs:

Outpatient: 80% Minimum Coverage

Medications prescribed by a certified health care provider that are medically necessary. 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; or contraceptive medication.

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B.1.8 Preventive and Wellness 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 not limited to: physicals, immunization, and cancer screenings.

B.1.9 Hearing Aids:

Examinations and Treatment: 80% Minimum Coverage

Hearing Aid Apparatus: Limited to one apparatus per ear up to a maximum of USD 1,500 per covered individual per three-year period.

80% Minimum Coverage; with annual cap

B.1.10 Optical Care:

Examinations and Treatment: 80% Minimum Coverage

Prescription lenses and frames or contact lenses: Covered up to a maximum of USD 300 per covered individual every two years.

B.1.11 Dental Care:

Examinations and Treatment:

Dentist’s fees, x-rays, examinations and treatment, cleanings, fillings, extractions, false teeth, crowns, and bridges up to a maximum of USD 3,200 per covered individual per contract year.

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 will be covered per covered individual up to a maximum of USD 2,400 lifetime limit.

80% Minimum Coverage; with contract lifetime cap

B.1.12 Reproductive Health:

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 B.2 Exclusions to Coverage).

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B.1.13 Mental Health and Substance Abuse Care:

50% Minimum Coverage

Inpatient and outpatient care provided to evaluate, diagnose and treat a mental health condition or substance abuse disorder. This includes behavioral health treatment, counseling, and psychotherapy.

Services must be provided by a licensed psychiatrist, psychoanalyst, psychologist, or psychiatric social worker. Inpatient care for alcohol and substance abuse must be carried out at a facility licensed for detoxification and rehabilitation.

B.1.14 Rehabilitative and Habilitative Services and Devices:

50% Minimum Coverage

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) 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.

B.1.15 HIV/AIDS:

100% Coverage up to $10,000 per contract year per covered individual

Medications to suppress opportunistic infections (such as tuberculosis or toxoplasmosis for covered individuals who have HIV/AIDS). Brief courses of anti-retroviral drugs during childbirth to prevent the transmission of HIV/AIDS to the child. Generally, excludes medication for the long-term suppression of

HIV/AIDS through the combination of anti-retroviral drugs in locations with inadequate local healthcare infrastructures.

B.1.16 Out-of-Country Medical Treatment:

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

B.1.17 Out-of-Country Medical Travel:

Transportation for out-of-country medical treatment will be a covered expense for LE Staff and eligible family members. To be considered a covered expense, the attending certified health care provider must certify in advance that the treatment is medically necessary and unavailable locally. 80% of covered individual’s transportation expenses by the least expensive, appropriate means of transportation to the nearest city with adequate medical facilities will be covered. 80% of the transportation expenses of an attendant will also be covered, but only if the covered individual's attending certified health care provider certifies that an attendant for the patient is necessary, (e.g., a parent in the case of a patient who is a minor, or a family member to make medical decisions in the case of a patient who is unwell or unconscious). All coverage for transportation for out-of-country medical treatment is subject to the total maximum annual limit. Transportation to a neighboring country without the attending certified health care provider certifying that the treatment is medically necessary and unavailable locally will not be covered.

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B.1.18 180 Day Coverage For Dependents After Employee’s Death:

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.

B.1.19 Employee Assistance Program (EAP):

An Employee Assistance Program (EAP) is a voluntary, work-based program that offers free and confidential assessments, short-term counseling, referrals, and follow-up services to employees who have personal and/or work-related problems. This optional benefit is subject to availability of funds at post.

B.1.20 Excess Coverage:

Additional coverage equal to $68,000 per covered individual per contract year. This excess coverage will be offered as an optional benefit to LE Staff. LE Staff must pay 100% of the premium if they elect Excess

Coverage.

B.2 Exclusions to Coverage

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.

C. Eligible Participants

C.1. Eligibility

Each current active eligible employee and their eligible dependents are enrolled for health benefits under this contract upon award and thereafter during the performance period of this contract. Each new eligible employee and eligible dependents will be enrolled upon entering on duty with the United States

Government. An employee’s coverage for all services listed above, is effective immediately upon enrolment. There shall be no waiting period for any service for all employees. An employee is considered active ("on the rolls") whenever such employee is on approved leave, whether paid or unpaid.

To be eligible to participate in the medical plan, LE Staff must be:

• Paid under the terms of the Local Compensation Plan (LCP); and –

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• Under a non-temporary direct hire appointment, personal services agreement (PSA), or personal services contract (PSC); or

• Under a temporary direct hire appointment or PSA Fixed Term of one year or more.

Not eligible are those working under temporary appointments; those working under a PSC or PSA that is time limited to less than one year; non-personal services contract personnel and their employees, supplied by an independent contractor licensed to do business in Zimbabwe who provides services to other local organizations as well as to the U.S. Mission; employees working on an intermittent or When Actually Employed (WAE) schedule; employees of USAID institutional contractors; Peace Corps personal services contractors as indicated in MS 743; and Recreation Association employees.

Official Residence Expense (ORE) and Employee Association (EA) employees may be covered under a rider to the contract. Official Residence Expense (ORE) and Employee Association (EA) employees shall be invoiced on a separated invoice.

C.1.1. Periods 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.

C.2. Identification of Eligible Employees and Dependents:

U.S. Mission Harare, Zimbabwe will provide a list of all eligible employees and dependents with relationship to employee (self/spouse/child) and DOB for each. Updates will be provided to add or remove individuals on a bi-weekly/monthly basis.

C.2.1.1. Dependents:

LE Staff who are eligible to participate in the medical plan automatically confer coverage to eligible family members who meet the following criteria:

Legal spouse: one legal spouse as defined by local law may be covered. LE Staff with more than one legal spouse must select only one spouse for coverage.

In cases where LE Staff and their legal spouse both work for the mission and both are eligible to participate in the medical plan, one will be designated as the lead for purposes of the medical plan, and the other will be considered a legal spouse.

Dependent 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.

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C.2.2. Premium:

• Self-Only: 1 covered individual

• Self Plus One (two individuals)

• Family (three or more individuals)

Annual Maximum Limit

The maximum annual coverage per covered individual per contract year, not including expenses covered under Section B.1.15 HIV/AIDS benefits if selected by post, is $68,000.

C.2.3. Location of Employment:

The eligible employees covered by C.2.1. must be employed within the geographic boundaries of Zimbabwe by: U.S. Government agencies, e.g., Department of State, U.S. Agency for International Development (USAID), U.S. Department of Defense & U.S. Centers for Disease Control & Prevention

(CDC).

C.3. Participants Covered Under a Rider:

a. All current active ORE Staff personally employed by the Chief of Mission and the Deputy Chief of Mission and assigned to their respective official Government residences and paid under an ORE account. All costs for coverage of ORE Staff are the responsibility of the Chief of Mission and the Deputy Chief of Mission, not the U.S. Government.

b. All current active employees of the Employee Association at Embassy Harare. All costs for coverage of AEWRA are the responsibility of the Employee Association, not the U.S.

Government.

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

C.4. Brochure Requirement

C.4.1. The Contractor shall provide a digital and print document (brochure/pamphlet/other written document) in English that outlines:

• A complete listing of the health insurance benefits to be provided under this contract.

• Detailed instructions, including documents required, timeline for submission of claims, how and whom to submit claims for reimbursement of services paid out of pocket.

• Details of how to access the Employee Assistance Program, contact numbers / location for employee counselling.

• Instructions on how to access out of country medical travel and out of country medical benefits.

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.

The Contractor shall provide the document described above 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) business days of the COR’s request.

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The Contractor assumes full responsibility for ensuring that the document described above 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.

C.5. Service Requirements

C.5.1. Contract Management / Key Personnel The contractor must provide a point of contact for the Embassy who can communicate effectively regarding all contractual matters in English. This individual must have at least 2 years’ experience in the Zimbabwe or international insurance industry and working with contracts of similar size. The contractor must obtain COR approval before replacing this individual.

C.5.2. Claims And Appeals

The contractor must maintain a user-friendly system for employees to access their claims, submit and track claims, and a clear appeal process for any rejected claims. Customer satisfaction with this process must be included as an indicator in the quality assurance plan. Claims appeal shall not take more than 7 business days to resolve / provide feedback to the employee and Contracting Officer’s representative.

C.5.3.

Service providers shall be paid in United States Dollars for the duration of this contract.

C.5.4.

Service providers shall be paid in not more than 30 days.

C.5.5.

Contractor shall make reimbursements for services paid for out of pocket within 30 business days from submission of reimbursement claim in United States dollars.

C.5.6.

Contractor shall provide a dedicated 24-hour customer service facility to handle and customer enquiries and after-hours authorizations.

C.5.7.

Contractor shall provide a Preferred Provider Network (PPN) of service providers for the benefits listed in B.1.- B.2. in Zimbabwe Areas of coverage to include but not limited to Victoria Falls, Bulawayo, Gwanda, Gweru, Kwekwe, Kadoma, Chegutu, Norton, Marondera, Rusape, Mutare, Nyanga, Chipinge, Masvingo, Chiredzi, Bindura, Harare (CBD, Westgate, Avondale, Borrowdale, Ruwa, Waterfalls, Chitungwiza, Waterfalls, Avondale, Eastlea, Highlands/Chisipite and Greendale. The PPN shall be reviewed and updated bi-annually and shared with all employees.

C.5.8.

Contractor shall respond to medical aid enquiries within 24 hours of notification.

C.5.9.

Contractor will provide the Embassy regular monthly reports on claims submission, and other matters important to good overall management of the contract.

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V CONTRACT ADMINISTATIVE REQUIREMENTS AND PROCEDURES

V.1 Quality Assurance and Surveillance Plan (QASP)

This plan is designed to provide an effective surveillance method to promote effective contractor performance. The QASP provides a method for the Contracting Officer's Representative (COR) to monitor contractor performance, advise the contractor of unsatisfactory performance, and notify the Contracting Officer of continued unsatisfactory performance. The contractor, not the USG, is responsible for management and quality control to meet the terms of the contract. The role of the USG is to conduct quality assurance to ensure that contract standards are achieved.

Performance Objective Performance Threshold

Timely payment of benefits (within 30 calendar days)

No more than one (1) customer complaint is received per month.

Repeat customer complaints are not permitted for any services. If a repeat customer complaint is received for the same deficiency during the service period, the COR will contact the Contracting Officer for appropriate action under the Inspection clause.

No more than one (1) customer complaint is received per month.

V.1.1 Surveillance – The COR will receive and document all complaints from USG personnel regarding the services provided. If found valid, the COR will send the complaints to the contractor for corrective action.

V.1.2 Standard – The performance standard is that the USG receives no more than one (1) customer complaint per month. The COR shall notify the Contracting Officer of the complaints so that the Contracting Officer may take appropriate action to enforce the inspection clause (FAR 52.246-4, Inspection of Services – Fixed Price (AUG 1996) or the appropriate Inspection of Services clause), if any of the services exceed the standard.

V.1.3 Complaint Procedures

a. If USG personnel observe unacceptable services such as but not limited to lack of coordination during medical evacuation, extended referral periods, delays in receipt of payment, etc., they will immediately contact the COR.

b. The COR will complete appropriate documentation to record the complaint.

c. If the COR determines the complaint is invalid, the COR will advise the complainant. The COR will retain the annotated copy of the written complaint for his / her files.

d. If the COR determines the complaint is valid, the COR will inform the contractor and give the contractor additional time to correct the defect, if additional time is available. The COR shall determine how much time is reasonable.

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e. The COR shall, as a minimum, provide e-mail notification informing the contractor of any valid complaints.

f. If the contractor disagrees with the complaint and challenges the validity of the complaint, the contractor shall notify the COR by e-mail. The COR will review the matter to determine the validity of the complaint.

g. The COR will consider complaints as resolved unless notified otherwise by the complainant.

h. Repeat customer complaints are not permitted for any services. If a repeat customer complaint is received for the same deficiency during the service period, the COR will contact the Contracting Officer for appropriate action under the Inspection clause.

V.2 REPORTS AND OTHER DELIVERABLES

All reports and other deliverables required under this contract shall be delivered by email to the COR and mailed to the following address:

US Embassy Harare ATTN: Human Resources Officer

(Contact details to be provided in contract document)

NOTE: Any and all costs for the preparation, handling, mailing and submission of progress reports or any other required reports and documentation shall be included in the total price of each delivery order.

Description QTY Submission Date Deliver to and how:

Reference

C.4 Brochures (digital and print document)

As instructed by COR

Additional copies

30 days after contract award

Within 10 calendar days of the COR’s request

COR

by e-mail and hard copy

Medical Aid Cards for employee and Beneficiaries

As instructed by COR

Additional Copies for new hires or new dependents

30 days after contract award

Within 10 calendar days of COR’s request

COR

V.11.3 Invoice 1 monthly COR / Designated Billing Office

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V.4 Employee Claims Report 1 Monthly - no later than the 10th day of each month

COR

FAR

52.222-50 Trafficking in Persons and

FAR

52.222-56 Certification Regarding Trafficking in Persons & Compliance Plan.

In accordance with FAR 52.222- 50 Trafficking in Persons and FAR 52.222-56 Certification Regarding Trafficking in Persons Compliance Plan.

Provide a Trafficking in persons compliance plan

1 no later than 30 calendar days after award.

CO/COR,

by e-mail

V.3 Contractor Responsibility in Claims and Reimbursement to Claims

General – The contractor shall be responsible for all planning, estimating, programming, project management, scheduling, dispatching, supervision, and inspection of work. The contractor shall maintain his own reference library of technical reference works and local laws and regulations, including current tariffs and registries. The contractor shall treat the information provided by the Embassy concerning employees' personal data, medical information, and salaries as highly sensitive and not divulge any employee information to unauthorized persons.

The contractor shall establish procedures for handling medical insurance claims as follows:

a. Administrative Records

(1) The Contractor shall maintain medical insurance files for each covered employee and each covered dependent including receipts and proof of paid claims, requests for claim reimbursements, and accounting of paid benefits with balances of amounts remaining in the annual per person reimbursement ceiling.

(2) The Contractor shall provide the COR with the necessary claim forms for each type of benefit that can be claimed under the contract. These forms shall specify a list of documents required to be appended to each claim and otherwise provide instructions for claim filing.

(3) The Contractor shall use the English spelling of the employees' names in all transactions, including reimbursements.

(4) The Contractor shall process employee claim reimbursements to employees not later than two weeks after a claim is submitted.

b. Medical Insurance Claims – Settlement of medical insurance shall be completed as follows:

(1) All medical claims shall be submitted directly to the Contractor by employees, through an online platform provided by the contractor.

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(2) The Contractor shall date stamp and screen all claims submitted on the day of receipt.

If there are any missing documents or information thereby disallowing said claim to be payable, the Contractor shall notify the employee within two days, with a copy to the COR (if notification is written).

(3) The Contractor shall settle the claims no later than two weeks from the date the claim is submitted to the Contractor.

(4) Settlement shall be by EFT/Cash in the name of the employee for each claim submitted. Each reimbursement shall be in the same currency as the receipt. Each reimbursement shall be accompanied by a form or email providing details of the amount reimbursed with an explanation of deductions, if any.

V.4 Report Requirements The Contractor shall provide the following monthly report. The report shall be received by the COR no later than the 10th day of each month. The report shall report on the previous month's activities.

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

V.5 Miscellaneous Contractor Requirements

General. The Contractor shall take all such steps as are necessary, and obtain and pay for all permits, taxes and fees as are required by the Zimbabwean Government to establish and/or operate a commercial venture locally.

A contract with the U.S. Government conveys no special privileges or immunities to the Contractor. The Contractor is an independent commercial concern and not a part of the U.S.

mission. The Contractor's employees are not U.S. Government employees. Registration of this contract with the Zimbabwean Government, if required by law, will be the sole responsibility of the Contractor, and any fees, taxes, or other duties shall be payable by the Contractor without recourse to the Government of the amounts thereof.

Licenses and Local Laws. The Contractor shall possess all permits, licenses, and any other appointments required for the prosecution of work under this contract, all at no additional cost to the Government.

V.6 Erroneous Payment

If the USG becomes eligible for a refund of payment because of erroneous overpayment or other cause, the contractor shall refund the amounts or use them to offset future payments owed by the USG, whichever the USG prefers. The contractor shall refund any refunds not complete or discovered after the completion date of this contract.

V.7 Requiring Activity The requiring activity under this contract is the U.S. Embassy/Consulate.

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V.8 Physical and Information Security Requirements

The contractor shall be responsible for safeguarding all government information provided for contractor use. All material / documentation produced for the USG will be the sole property of the USG. The contractor shall not release any documents to anyone unless authorized by the USG. The following considerations shall be followed by the contractor and/or shall be incorporated into the design documents / shop drawings.

V.8.1 All documents received or generated under the contract are the property of the USG.

V.8.2 All documents shall be controlled and disseminated on a need-to-know basis. Reproduction and distribution is prohibited without express approval of the USG. All design documents generated shall be annotated as follows:

V.8.3 All documents shall be marked and handled in strict accordance with all applicable requirements and regulations. Proposed and actual contract documents shall only be disseminated on a strict need-to-know basis, and shall not be further disseminated without prior authorization from the USG.

V.8.4 Those receiving any type of proposed and / or actual contract documents shall be responsible for these materials while in their possession, or that of any of their subcontractors. They shall return all documents, including all copies, promptly upon demand by the USG.

V.9 Reserved

V.10 Laws And Regulations

V.10.1 Compliance Required – If the contractor has or will establish a local office, he shall, without additional expense to the USG, be responsible for complying with all laws, codes, ordinances, and regulations applicable to the performance of the work, including those of the host country, and with the lawful orders of any governmental authority having jurisdiction.

V.10.2 Labor, Health and Safety Laws and Customs – If the contractor has or will establish a local office, he shall comply with all local labor laws, regulations, customs and practices pertaining to labor, safety, and similar matters, to the extent that such compliance is not inconsistent with the requirements of this contract.

V.10.3 A contract with the USG conveys no special privileges or immunities to the contractor. The contractor is an independent commercial concern and not a part of the U.S. mission. The contractor's employees are not USG employees. Registration of this contract with the host country government, if required by law, will be the sole responsibility of the contractor, and any fees, taxes, or other duties shall be payable by the contractor without recourse to the USG of the amounts thereof.

V.10.4 The only items that the USG will consider for price adjustments are those that are mandated e.g. changes in the VAT rate (if applicable) or minimum hourly wage rate.

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V.11 Contract Administration Data

V.11.1 Authority of the Contracting Officer – All work shall be performed under the general direction of the Contracting Officer, who alone shall have the power to bind the Government and to exercise the rights, responsibilities, authorities and functions vested by the contract, except that the Contracting Officer and the Procurement Executive shall have the right to designate authorized representatives to act for the Contracting Officer, as specifically provided in the designation of that individual, such as the COR.

V.11.2 Government Personnel

Contracting Officer: Nicolas Wilhelm

Contract Administrator: Nadja Reinmüller E-mail address: ReinmuellerNU@state.gov

Contracting Officer's Representative (COR): Kupakwashe Mukumbi

V.11.3 Invoices, Review and Payment

Invoices shall be issued monthly to the COR and to the following address:

AMERICAN EMBASSY HARARE

2 LORRAINE DRIVE

ATTN: FINANCIAL MANAGEMENT OFFICE

HARARE, ZIMBABWE

E-mail : hararefmoinvoices@state.gov o Value Added Tax (VAT), if applicable, shall be a separate line item on each invoice.

o Each invoice shall include the items listed in Section 2, FAR 52.212-4 g.1.

o Payment shall be made in the currency the contractor specified in Section1.III.D Prices.

V.11.4 Advance Payment shall not be authorized under this contract.

V.11.5 Changes In Ownership – The contractor shall furnish the COR advance notification (90 calendar days prior to the effective date) of any disposition or the change in ownership or terms of lease of any facilities utilized by him for performance of any service under this contract.

V.12 Funding / Task Orders / Procedures

V.12.1 The contract remains unfunded; funding will be provided by issuing an annual task orders with possible modification for staffing changes. Each task order will contain the following information:

• Name of contractor

• Contract number mailto:ReinmuellerNU@state.gov

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• Date of purchase

• Task order number

• Name of person placing the order

• Quantity, unit price, and total price of each service / insurance rate

• VAT or other taxes as a separate item, if applicable

• COR and post points of contact, including e-mail addresses

• applicable contract clauses, either in reference or in full text if necessary

V.12.2 Only an RPSO Contracting Officer may place a written order.

V.12.3 Ordering Procedures – The Government shall issue annual funded task orders to cover all eligible employees and their dependents. No task order shall include any names or PII (personally identifiable information).