Solicitation 19SA7021R0004.pdf

Life and Medical Cover for LES Solicitation No. 19SA7021R0004 Embassy of the United States of America, Riyadh Page 2 of 91

SOLICITATION

DOCUMENT

The Embassy of United States of America, Riyadh, Saudi Arabia Contracting and Procurement office

Life and Medical Insurance Coverage for Locally Employed Staff

SOLICITATION No. 19SA7021R0004

Embassy of the United States of America P.O. Box 94309 Riyadh 11693 Kingdom of Saudi Arabia

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11. SCHEDULE

(Include applicable Federal, State and local taxes)

ITEM NO.

(a)

SUPPLIES/SERVICES

(b)

QUANTITY

(c)

UNIT

(d)

UNIT PRICE

(e)

AMOUNT

(f)

1 The Contractor shall provide Life and Medical coverage to the Locally Employed Staff employees mission-wide (Saudi Arabia) of the Government of the United States of America for the period of five (5) years as described in Sections B & C and Exhibit - J. The Groups of employees who shall be provided these services are listed in section C.1.2 and C.2.2

1.00 SV

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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 Kingdom of Saudi Arabia as described in Section C and the Exhibits in Section J. The groups of employees who shall be provided this insurance are listed in C.1.4 (medical) and C.2.3 (life). This insurance shall be provided in accordance with Section C and the Exhibits in Section J.

B.1.1. Official Residence Expense (ORE) Staff and United Embassy Recreation Association (USERA) 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), United Embassy Recreation Association (USERA) at the rates specified below. See Section G for billing procedures.

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.

NOTE: Details listed in Clause 52.229-11 and 52.22912 (Section I and K)

B.2. PRICES

B.2.1 Value Added Tax.

The Contractor shall include VAT as a separate charge on the Invoice and as a separate line item in Section B, FOR HEALTH INSURANCE ONLY

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 for the health insurance services as specified in Section C are as follows:

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Value Added Tax (VAT) for Base Year SAR: ___________________________

B.2.3. Grand Total Base Year (Including VAT) SAR: ____________________________

Value Added Tax (VAT for First Option Year SAR: ___________________________

B.2.4. Grand Total for First Option Year (Including VAT) SAR: _________________________

Category Estimated Number of Employees Rate per Employee Bi-Weekly Total

a. Single Employees ( Self Only) 210

b. Family Plan 1,830

Bi-Weekly Rates per Employee

B.2.3. Base Year of Contract

c. Subtotal (a + b)

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

Category Estimated Number of Employees Rate per Employee Bi-Weekly Total

a. Single Employees ( Self Only) 231

b. Family Plan 2014

Bi-Weekly Rates per Employee

B.2.4. First Option Year of Contract

c. Subtotal (a + b)

d. Total Price for First Option Year (c x 26)

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Value Added Tax (VAT for Second Option Year SAR: ___________________________

B.2.5. Grand Total for Second Option Year (Including VAT) SAR: _______________________

Value Added Tax (VAT for Third Option Year SAR: ___________________________

B.2.6. Grand Total for Third Option Year (Including VAT) SAR: _______________________

Category Estimated Number of Employees Rate per Employee Bi-Weekly Total

a. Single Employees ( Self Only) 279

b. Family Plan 2436

Bi-Weekly Rates per Employee

B.2.6. Third Option Year of Contract

c. Subtotal (a + b)

d. Total Price for Third Option Year (c x 26)

Category Estimated Number of Employees Rate per Employee Bi-Weekly Total

a. Single Employees ( Self Only) 254

b. Family Plan 2215

Bi-Weekly Rates per Employee

B.2.5. Second Option Year of Contract

d. Total Price for Second Option Year (c x 26)

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Value Added Tax (VAT for Fourth Option Year SAR: ___________________________

B.2.7. Grand Total for Fourth Option Year (Including VAT) SAR: _______________________

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 one (1) employee 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 three thousand employees (3,000). This reflects the contract maximum.”

B.2.8. Grand Total of Base plus All Option Years

Base Year Total

First Option Year Total

Second Option Year Total

Third Option Year Total

Fourth Option Year Total

Grand Total of Base plus All Option Years

Category Estimated Number of Employees Rate per Employee Bi-Weekly Total

a. Single Employees ( Self Only) 307

b. Family Plan 2680

Bi-Weekly Rates per Employee

B.2.7. Fourth Option Year of Contract

d. Total Price for Fourth Option Year (c x 26)

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B.3 ADMINISTRATIVE RETENTION AMOUNTS

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

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

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

B.3.2 Bi-Weekly Retention Amounts per separate premium paid per single employee and per family plan.

Period of Performance Single Employees (Self Only) Family Plan

Base Period

First Option Year

Second Option Year

Third Option Year

Fourth Option Year

B.4. ECONOMIC PRICE ADJUSTMENT-HEALTH INSURANCE PREMIUMS

B.4.1. Premium Adjustment Based on Experience - For health insurance, prices may be adjusted upward or downward based on the experience rating of the Mission(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, ie per line item. The retention amount is not subject to adjustment. The Government reserves the right to have an independent third party review the balance sheet and claims and make recommendations regarding the appropriateness of the requested adjustment. Any adjustment shall be subject to mutual agreement of the parties and

Embassy of the United States of America, Riyadh Page 10 of 91 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.4.2. Premium Adjustment Based on Laws - The rates may also be adjusted during the performance period of the contract as a result of laws enacted by the host Government, if such change in the laws has a direct impact on the cost to the Contractor to perform this contract at the contracted rate. In that event, the Contracting Officer may enter into negotiations with the Contractor to modify the contract to adjust the premium rate. The Contractor agrees to provide all documentation necessary to support any requested adjustment.

B.4.2.1 Employee Pool – This clause is only in effect if the Contractor included details in its offer regarding a pooling arrangement, of which this contract is a part.

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

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PART II: PRICE - GROUP LIFE INSURANCE

B.5. GROUP LIFE INSURANCE SERVICES

The Contractor shall provide the Group Life Insurance services described herein to employees of the Government of the United States of America in Kingdom of Saudi Arabia. The groups of employees who shall be provided this insurance are listed in C.2.3. This insurance shall be provided in accordance with Section C and the Exhibits in Section J.

B.5.1. Official Residence Expense (ORE) Staff and United Embassy Recreation Association (USERA) 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), United Embassy Recreation Association (USERA) at the rates specified below. See Section G for billing procedures.

B.6. GROUP LIFE INSURANCE RATES

This is a fixed-price with economic-price- adjustment-requirements type contract under which the Government will issue firm-fixed price task orders. The fixed prices/premium rates the amount of life insurance coverage for each employee is SAR 290,000 to provide life insurance, accidental death and dismemberment and partial and total disability coverage are as follows:

Type of Insurance Estimated Number of

Emplyees Rate per Emplyee Bi-Weekly Total

a. Basic Life

b. Accidental Death & Dismemberment

c. Partial & Total Disability Coverage

Bi-Weekly Rates per Employee

B.6.1. Base Year of Contract

d. Subtotal (a + b + c)

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

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Type of Insurance Estimated Number of

Emplyees Rate per Employee Bi-Weekly Total

a. Basic Life

b. Accidental Death & Dismemberment

c. Partial & Total Disability Coverage

Bi-Weekly Rates per Employee

B.6.4. Third Option Year of Contract

d. Subtotal (a + b + c)

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

Type of Insurance Estimated Number of

Emplyees Rate per Employee Bi-Weekly Total

a. Basic Life

b. Accidental Death & Dismemberment

c. Partial & Total Disability Coverage

Bi-Weekly Rates per Employee

B.6.3. Second Option Year of Contract

d. Subtotal (a + b + c)

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

Type of Insurance Estimated Number of

Eployees Rate per Employee Bi-Weekly Total

a. Basic Life

b. Accidental Death & Dismemberment

c. Partial & Total Disability Coverage

Bi-Weekly Rates per Employee

B.6.2. First Option Year of Contract

d. Subtotal (a + b + c)

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

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B.6.6. Grand Total of Base plus All Option Years

Base Year Total

First Option Year Total

Second Option Year Total

Third Option Year Total

Fourth Option Year Total

Grand Total of Base plus All Option Years

Type of Insurance Estimated Number of

Emplyees Rate per Employee Bi-Weekly Total

a. Basic Life

b. Accidental Death & Dismemberment

c. Partial & Total Disability Coverage

Bi-Weekly Rates per Employee

B.6.5. Fourth Option Year of Contract

d. Subtotal (a + b + c)

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

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B.7. ADMINISTRATIVE RETENTION AMOUNTS

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

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

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

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

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

Period of Performance Basic Life Accidental Death and

Dismemberment Partial and Total

Disability Coverage

Base Period

First Option Year

Second Option Year

Third Option Year

Fourth Option Year

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

B.8.1. Premium Adjustment Based on Experience: For life insurance, prices may be adjusted upward or downward based on the experience rating of the Mission(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. The information shall be provided per type of premium, ie per line item. The retention amount is not subject to adjustment. The Government reserves the right to select an independent third party to review the

Embassy of the United States of America, Riyadh Page 15 of 91 balance sheet and claims and make recommendations regarding the appropriateness of the requested adjustment. Any adjustment shall be subject to mutual agreement of the parties and shall result in a written modification to the contract. Mutually agreed to adjustments shall be effective thirty days after complete information is received by the Government. Any failure to reach agreement under this clause shall be subject to the procedures in the Disputes clause.

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

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SECTION C

DESCRIPTION/SPECIFICATION/WORK STATEMENT

PART I - HEALTH INSURANCE

C.1. HEALTH INSURANCE SERVICES

The Government of the United States of America requires Health Insurance coverage for its employees as further described in C.1.1 in Riyadh, Dhahran and Jeddah, Kingdom of Saudi Arabia. The Government has determined that the prevailing practice by employers in Saudi Arabia is to provide for their employee’s health insurance protection and that the cost of such insurance protection is usually borne solely by the employer. The USG will pay 100% of the premium cost for the employee and their covered dependents. Premium will be based on the number of individuals covered (i.e. self only, self plus one or family). Health insurance protection will be representative of locally prevailing compensation practice as further described in C.1.2. The specific health benefit coverage under this contract is set forth in Section C and the Exhibits in Section J.

The Contractor shall insure that health care under this contract does not exclude HIV/AIDS care, unless exclusion has been authorized by GTM/OE/CM.

The health benefits under this contract are as follows. Reimbursement of covered expenses is limited to the stated percentages of reasonable and customary costs.

Reimbursements or payments shall be made for the following covered benefits, subject to reasonable and customary costs in the locality where treatment was provided C.1.1 Employee and Dependent Health Services Benefits

Deductible (For Outpatient Treatment Expenses):

Employee is responsible for 20 percent per visit with a maximum of SAR 100 per visit for employees and dependents when visiting outpatient clinic physician including all consultations, lab tests, x-rays, medicines and other medical supplies as well as follow-up visits and referral for the same illness, and not for every procedure separately.

20 percent per visit with a maximum of SAR 100 as outlined above for medical services and expenses when not hospitalized such as laboratory tests and x-rays, prescription medicines, physical therapy, routine annual physical examinations, and inoculations.

The following are the maximum Physician’s Fees in relation to above. Employee is responsible for 20 percent up to the following maximums:

- General Practitioner: SAR 50

- Specialists (Registrar): SAR 100

- Specialist (Senior Registrar): SAR 200

- Consultant: SAR 300

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- Rare medical specialties such as cardiac and neurosurgery and vascular surgery and subspecialties standardized by the Saudi Commission for Health Specialties: SAR

C.1.1.1. Hospitalization (Treatment in the Hospital for Inpatient Care) Minimum Coverage – 100% 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. See Mental Health and Substance Abuse care (C.1.1.13) for details concerning inpatient psychiatric care.

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): Minimum Coverage - 100% Services provided for conditions that could lead to serious disability or death if not immediately treated, such as accidents or sudden illness.

C.1.1.3 Ambulance: Minimum Coverage – 100% (Emergencies); Minimum Coverage – 80% (Non-Emergencies) 100% reimbursement of ambulance service for emergencies and 80% minimum coverage for non-emergencies for 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.

C.1.1.4 Outpatient Services: Minimum Coverage - 80% 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

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- Diagnostic tests and diagnostic imaging

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: Minimum Coverage - Inpatient/Emergency: 100%; Outpatient: 80% 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.

C.1.1.6 Pediatric Services: Minimum Coverage - Inpatient/Emergency:

100%; Outpatient: 80% 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.

C.1.1.7 Prescription Drugs: Minimum Coverage - Inpatient/Emergency:

100%; Outpatient: 80% 100% reimbursement when hospitalized; 80% reimbursement and 20% deductible per visit with maximum of SAR100 per visit when not hospitalized, of the cost of medicines and drugs for which a prescription is legally required 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.

Expenses incurred for medicines, vitamins, cold remedies, etc., that are available over the counter without a prescription will not be reimbursed even if prescribed by a physician

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

Minimum Coverage - 80% 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.

C.1.1.9 Hearing Aids: Minimum Coverage – 80% Examinations and Treatment: 80% Minimum Coverage

Hearing Aid Apparatus: Limited to one apparatus per ear up to a maximum of SR 5,625 per covered individual per three-year period. 80% Minimum Coverage: with annual cap.

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C.1.1.10 Optical Care: Minimum Coverage – 80% Examinations and Treatment: 80% Minimum Coverage

Prescription lenses and frames, or contact lenses: Covered up to a maximum of SR 1,125 per covered individual every two years. 80% Minimum Coverage; with annual cap.

C.1.1.11 Dental Care: Minimum Coverage – 80% Examinations and Treatment: Dentist’s fees, x-rays, examinations and treatment, cleanings, fillings, extractions, false teeth, crowns, and bridges up to a maximum of SR 12,000 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 will be covered per covered individual up to a maximum of SR 9,000 lifetime limit. 80% Minimum Coverage; with contract lifetime cap.

C.1.1.12 Reproductive Health: Minimum Coverage - 80% 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).

C.1.1.13 Mental Health and Substance Abuse Care: Minimum Coverage - 50% 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 provided at a facility licensed for detoxification and rehabilitation.

C.1.1.14 Rehabilitative and Habilitative Services and Devices:

Minimum Coverage - 50% 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.

C.1.1.15 HIV/AIDS: 100% up to USD 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

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C.1.1.16 Catastrophic Coverage Additional coverage equal to SAR 500,000 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 Out-of-Country Medical Travel: 80% Reimbursement Transportation for out-of-country medical treatment will be a covered expense for covered employees 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.

C.1.1.19 180 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. This optional benefit is subject to availability of funds at post and no extensions are permitted.

C.1.1.20 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.

C.1.1.21 Excess Coverage

NOTE: Employee responsible for paying 100% of premium for Excess Coverage

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Additional coverage equal to SAR 500,000 per covered individual per contract year.

This excess coverage will be offered as an optional benefit to LE Staff. This can be used for any covered individual for any covered expense that exceeds annual maximum. LE Staff must pay 100% of the premium if they elect Excess Coverage. The premium for this additional coverage is a rider to be paid by the employee to the vender directly and USG will not be responsible for collecting of these premium payments.

C.1.1.22 Post-Unique Benefit: Corpse Repatriation to Home Country:

Maximum of SAR 10,000 during term of the policy.

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 under C.1.1.15, HIV/AIDS, and C.1.1.21 Excess Coverage is equivalent to SAR 500,000.

C.1.3 Exclusions and Limitations

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

C.1.4 Eligible Participants

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

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

-- 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.

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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 Saud Arabia 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.

Official Residence Expense (ORE) and Employee Association (EA) employees may be covered under a rider to the contract. The employing officer/EA, not the USG, is responsible for the employer's share of the premium costs for an ORE and EA employee.

C.1.4.1 Identification of Eligible Employees and Dependents: U.S.

Mission Saudi Arabia (Embassy Riyadh and two Consulate General Jeddah and Dhahran) 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.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. LE Staff with more than one legal spouse must select only one spouse for coverage. Tandem employees may be enrolled separately as individuals.

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.

Unmarried adult female daughter: an adult female daughter of an eligible employee is covered under the medical plan up until the age of 40, if unmarried and unemployed.

There is no limit on the number of children covered per employee. Parents, grandparents, siblings, and other relatives are not eligible dependents.

C.1.4.2 Location of Employment: The eligible employees covered by C.1.4.1 must be employed within the geographic boundaries of the Kingdom of Saudi Arabia by the U.S. Embassy in Riyadh and U.S. Consulates General in Jeddah and Dhahran.

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C.1.4.3 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 in Riyadh and Consulates General in Dhahran and Jeddah. All costs for coverage of United States Embassy Recreation Association (USERA) EAEs are the responsibility of the Employee Association, not the U.S. Government.

C.1.5 Eligibility

C.1.5.1 Term of Eligibility and Effective Date

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 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.1.5.2. Period of Ineligibility

Employees and their dependents are not entitled to health benefits during any period of employment for which premiums are not paid.

Additionally, employee's dependents are not entitled to health benefits during any period of employment during which the employee was not eligible to participate.

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

C.1.6 Brochure Requirement

C.1.6.1 The Contractor shall provide a document (brochure/pamphlet/other written document) in English and Arabic that sets forth a complete listing of the health insurance

Embassy of the United States of America, Riyadh Page 24 of 91 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.1.6.2 The Contractor shall provide the document described in C.1.6.1 to the COR not later than ten (10 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.1.6.3 The Contractor assumes full responsibility for ensuring that the document described in C.1.6.1 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 the Kingdom of Saudi Arabia. The Government has determined that the prevailing practice by employers in the Kingdom of Saudi Arabia is that group life insurance coverage is representative of locally prevailing compensation practice and that the cost of such insurance protection is usually borne solely by the employer. The USG will pay 100% of the premium cost for the employee and their covered dependents. Premium will be based on the number of individuals covered (i.e. self only, self plus one or family). 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.

The amount of life insurance coverage for each employee is SAR 290,000.

C.2.1.2 Amount of Accidental Death and Dismemberment Coverage.

The employee's estate or employee will receive full amount of the life insurance coverage C.2.1.1, in the event the employee is killed in an accident or dismembered.

C.2.1.3 Partial and Total Disability Coverage

In the event the employee is partially or totally disabled, the employee will receive partial and total disability coverage in accordance with compensation table provided in Saudi Arabian Laws.

C.2.2 Life Insurance Benefits Conditions and Limitations

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

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 the Kingdom of Saudi Arabia, 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); employed under the Local Compensation Plan (LCP)

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

(LCP)

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 the Kingdom of Saudi Arabia by the U.S. Embassy in Riyadh and U.S. Consulates General in Jeddah and Dhahran.

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 in Riyadh and Consulates General in Jeddah and Dhahran (see separate rider, Exhibit C). All costs for United States Embassy Recreation Association (USERA).

USERAs 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 60 prior to entering on duty with the U.S. Government will not be eligible for life insurance coverage.

C.2.4.2 Individuals not eligible for coverage under this contract are non-personal services contract personnel; employees working on a temporary basis; employees with an intermittent, seasonal, or WAE (when actually employed) schedule; and any other individual not falling within one of the categories of employees described in this clause.

C.2.5. Other Eligible Participants

The following additional categories of persons are covered by this insurance: Reserved

C.2.6 Eligibility and Effective Date

C.2.6.1. Term of Eligibility and Effective Date

Each current active eligible employee is enrolled for life insurance benefits and disability benefits under this contract upon award and thereafter during the performance

Embassy of the United States of America, Riyadh Page 27 of 91 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 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 and Arabic that sets forth a complete listing of the life insurance benefits to be provided under this contract. This brochure shall be provided in sufficient quantities so that each covered employee receives a copy. The Contractor shall furnish all copies of the brochures to the COR, who will ensure that appropriate distribution is made.

C.2.7.2. The document described in C.2.7.1 shall be provided to the COR not later than ten (10) 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.

C.3.0. DEFINITIONS

GTM/OE/CMD has authorized solicitation for both health and life insurance.

C.3.0 DEFINITIONS

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

COR Contracting Officer's Representative (COR) is the Human Resources Officer (HRO) or designee 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 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,, tandem employees may be enrolled separately as individuals.

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.

Unmarried adult female daughter: an adult female daughter of an eligible employee is covered under the medical plan up until the age of 40, if unmarried and unemployed.

Disability - Total and Permanent

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

Employee An individual employed by the U.S. Government, under a direct-hire appointment, personal services contract (PSC), or personal services agreement (PSA), as further defined in Section C.1.4 for health insurance and C.2.3 for life insurance. This may also include ORE Staff and USERA EAE, if this category of individual is listed as participating under a rider in C.1.4.3 for health insurance and C.2.3.3 for life insurance.

Employer The United States Government or in the case of ORE and USERA EAE employees, the Chief of Mission/Deputy Chief of Mission and the Employee Association, respectively.

GSO

General Services Officer in charge of the General Services Office at post. This officer is usually the Contracting Officer (CO) for this contract.

Hospital An institution established and operated for the care and treatment of sick and injured persons. It provides 24-hour nursing care and

Embassy of the United States of America, Riyadh Page 29 of 91 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.

Maximum Benefit

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

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

Surgical Procedure

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

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SECTION D

PACKAGING AND MARKING

(RESERVED)

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SECTION E

INSPECTION AND ACCEPTANCE

E.1. 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

This contract incorporates one or more clauses by reference, with the same force and effect as if they were given in full text. Upon request, the Contracting Officer will make their full text available. In addition, the full text of a clause may be accessed electronically at: Acquisition.gov this address is subject to change.

If the Federal Acquisition Regulation (FAR) is not available at the location indicated above, use the Department of State Acquisition website at e-CFR to see the links to the FAR. You may also use an Internet “search engine” (for example, Google, Yahoo or Excite) to obtain the latest location of the most current FAR.

The following Federal Acquisition Regulation clause(s) is/are incorporated by reference:

CLAUSE TITLE AND DATE

52.246-4 INSPECTION OF SERVICES - FIXED PRICE (AUG 1996)

E.2. QUALITY ASSURANCE AND SURVEILLANCE PLAN (QASP)

This plan is designed to provide an effective surveillance method to promote effective Contractor performance. The QASP provides a method for the Contracting Officer's Representative (COR) to monitor Contractor performance, advise the Contractor of unsatisfactory performance, and notify the Contracting Officer of continued unsatisfactory performance.