Solicitation 24R0008.pdf

19GE5024R0008

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS

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

1. REQUISITION NUMBER

5. SOLICITATION NUMBER

19GE5024R0008

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

DATE

03/26/2024

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

BRIDGCODE15. DELIVER TO

AMERICAN EMBASSY BRIDGETOWN

American Emb. Wildey Business Park, Wildey

ATTN: GSO

St Michael, BARBADOS 14006

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 BRIDGETOWN

American Embassy P.O. Box 302 ATTN: Financial Management Office Bridgetown, BARBADOS 1100

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 03/26/2024

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

Line Item Summary

Solicitation Number:

19GE5024R0008

Contract Number: Title: Bridgetown & St. Georges - Health & Life Insurance

Date of Solicitation:

03/26/2024

Line Item No.

Description Quantity Unit Unit Price Total Cost

001 BASE YEAR - LE Staff Health Insurance (estimate) inclusive of the following Sub CLINs:

0001A Single Employee (Self Only) 0001B Employee + 1 0001C Family Plan Type of Contract Pricing: FFP

Doc Ref No:

Delivery Date FOB:

0.00 EA $0.00 $0.00

002 BASE YEAR - LE Staff Life Insurance (estimate) inclusive of the following Sub CLINs:

0002A Basic Life 0002B Accidental Death and Dismemberment Type of Contract Pricing: FFP

Doc Ref No:

Delivery Date FOB:

0.00 EA $0.00 $0.00

003 OPTION YEAR ONE - LE Staff Health Insurance (estimate) inclusive of the following Sub CLINs:

1001A Single Employee (Self Only) 1001B Employee + 1 1001C Family Plan Type of Contract Pricing: FFP

Doc Ref No:

Delivery Date FOB:

0.00 EA $0.00 $0.00

004 OPTION YEAR ONE - LE Staff Life Insurance (estimate) inclusive of the following Sub CLINs:

1002A Basic Life 1002B Accidental Death and Dismemberment Type of Contract Pricing: FFP

Doc Ref No:

Delivery Date FOB:

0.00 EA $0.00 $0.00

005 OPTION YEAR TWO - LE Staff Health Insurance (estimate) inclusive of the following Sub CLINs:

2001A Single Employee (Self Only) 2001B Employee + 1 2001C Family Plan Type of Contract Pricing: FFP

Doc Ref No:

Delivery Date FOB:

0.00 EA $0.00 $0.00

006 OPTION YEAR TWO - LE Staff Life Insurance (estimate) inclusive of the following Sub CLINs:

2002A Basic Life 2002B Accidental Death and Dismemberment Type of Contract Pricing: FFP

Doc Ref No:

Delivery Date FOB:

0.00 EA $0.00 $0.00

007 OPTION YEAR THREE - LE Staff Health Insurance (estimate) inclusive of the following Sub CLINs:

3001A Single Employee (Self Only) 3001B Employee + 1 3001C Family Plan Type of Contract Pricing: FFP

Doc Ref No:

Delivery Date FOB:

0.00 EA $0.00 $0.00

Line Item Summary

Solicitation Number:

19GE5024R0008

Contract Number: Title: Bridgetown & St. Georges - Health & Life Insurance

Date of Solicitation:

03/26/2024

Line Item No.

Description Quantity Unit Unit Price Total Cost

008 OPTION YEAR THREE - LE Staff Life Insurance (estimate) inclusive of the following Sub CLINs:

3002A Basic Life 3002B Accidental Death and Dismemberment Type of Contract Pricing: FFP

Doc Ref No:

Delivery Date FOB:

0.00 EA $0.00 $0.00

009 OPTION YEAR FOUR - LE Staff Health Insurance (estimate) inclusive of the following Sub CLINs:

4001A Single Employee (Self Only) 4001B Employee + 1 4001C Family Plan Type of Contract Pricing: FFP

Doc Ref No:

Delivery Date FOB:

0.00 EA $0.00 $0.00

010 OPTION YEAR FOUR - LE Staff Life Insurance (estimate) inclusive of the following Sub CLINs:

4002A Basic Life 4002B Accidental Death and Dismemberment Type of Contract Pricing: FFP

Doc Ref No:

Delivery Date FOB:

0.00 EA $0.00 $0.00

19GE5024R0008 Bridgetown, Barbados and St. Georges, Grenada

Health and Life Insurance for LE Staff Page 4 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 – Prices

• Attachment 2 – Contract Information / Experience Listing

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

• Attachment 4 – Instructions for Form W-14

• Exhibit A – Employee Statistics

• Exhibit B – Salary Statistics

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

Health and Life Insurance for LE Staff Page 5 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 and Life Insurance for its Locally Employed Staff (LE Staff) and their dependents at the US Embassy Bridgetown, Barbados and St. Georges, Grenada.

The Contractor shall provide the Health and Life Insurance services to employees of the Government of the United States of America in Bridgetown, Barbados and St. Georges, Grenada, as described in Section 1.IV Specifications / Statememt of Work and the Exhibits 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 or equivalent in local currency.

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 or equivalent in local currency.

The maximum dollar value during the entire life of this contract is $4,900,000.00.

II ACRONYMS AND ABBREVIATIONS

Acronym Definition

CLIN Contract Line Item Number

Contractor Insurance Company

CO Contracting Officer

COR Contracting Officer Representative

Dependent Dependents include the participating employee’s legal spouse or domestic partner, to include same-sex domestic partners , as

Health and Life Insurance for LE Staff Page 6 of 77 certified by COM, and dependent children (defined as the LE Staff’s natural, adopted, stepchild, or foster child; any child of a recognized domestic partner shall be deemed a stepchild of the employee). A limit of one legal spouse or domestic partner is covered. An eligible child will be covered until the end of the contract year in which he/she reaches age 18, or under the age of 25, if a full-time student. There is no age limit for a child who is physically or mentally handicapped so as to be unable to live independently. There is no limit on the number of children covered per employee.

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

Employer The United States Government = USG

Employee Locally Employed Staff member of the US Embassy Bridgetown and US Embassy St. Georges

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

Health and Life Insurance for LE Staff Page 7 of 77

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

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.A.3.7.

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.

Health and Life Insurance for LE Staff Page 8 of 77

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.

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 – The Government will not reimburse the Contractor for VAT under this contract. The

Contractor shall not include a line for VAT on Invoices as the U.S. Embassy has a tax exemption certificate with the host government.

C. ORE employees of the Chief and Deputy of Mission who are paid under an ORE account and Employee Association (EA) employees are included under this contract only as a rider. Please see Section 1,IV,A.3.7.

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

D. Offeror, insert the currency of prices offered __Barbados Dollars__

The fixed prices / premium rates for the health insurance services as specified in Section IV are specified on pages 8 and 9:

Health and Life Insurance for LE Staff Page 9 of 77

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.

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.

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

ATTACHMENT 001 – PRICES WILL BE INSERTED HERE

Health and Life Insurance for LE Staff Page 10 of 77

ATTACHMENT 001 – PRICES WILL BE INSERTED HERE

Health and Life Insurance for LE Staff Page 11 of 77

CONTINUATION TO SF-1449

SCHEDULE OF SUPPLIES / SERVICES, BLOCK 20

DESCRIPTION / SPECIFICATIONS / WORK STATEMENT

IV SPECIFICATIONS / STATEMENT OF WORK

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)

A.1. EMPLOYEE & DEPENDENT HEALTH SERVICE BENEFITS

MANDATORY/REQUIRED BENEFITS

A.1.1. Hospitalization (treatment in the hospital for inpatient care):

Minimum Reimbursement Rate - 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 (below) for details concerning inpatient psychiatric care.

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

A.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.

A.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.

Health and Life Insurance for LE Staff Page 12 of 77

A.1.4. Outpatient Services:

80% Minimum Coverage

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 (below) for details concerning physical therapy.

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

A.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.

A.1.6. Pediatric Services:

Inpatient: 100% Coverage 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.

A.1.7. Prescription Drugs:

Inpatient: 100% Coverage 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.

Health and Life Insurance for LE Staff Page 13 of 77

A.1.8. Preventive and Wellness and Chronic Disease Management:

80% Minimum Coverage

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.

A.1.9. Hearing Aids:

Examinations and Treatment: 80% Minimum Coverage

Hearing Aid Apparatus: Limited to one apparatus per ear. The maximum coverage is USD 1,500 per covered individual per three-year period.

80% Minimum Coverage; with applicable cap.

A.1.10. Optical:

Examinations and Treatment: 80% Minimum Coverage

Prescription lenses and frames, or contact lenses: The maximum coverage is USD 300 per covered individual every two years.

80% Minimum Coverage; with applicable cap.

A.1.11. Dental:

Examinations and Treatment: Dentist’s fees, x-rays, examinations and treatment, cleanings, fillings, extractions, false teeth, crowns, and bridges. The maximum coverage is USD 3,200 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. The maximum coverage is USD 2,400 lifetime limit.

80% Minimum Coverage; with contract lifetime cap.

A.1.12. Reproductive Health:

80% Minimum Coverage

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 A.2. Exclusions to Coverage).

Health and Life Insurance for LE Staff Page 14 of 77

A.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.

A.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.

A.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 combination of anti-retroviral drugs in locations with inadequate local healthcare infrastructures.

A.1.16. Catastrophic Coverage:

Additional coverage equal to 135,000.00 Barbados Dollars 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.

A.1.17. 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.

A.1.18. 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

Health and Life Insurance for LE Staff Page 15 of 77 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.

A.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.

Note: The contractor will be responsible for handling all administrative work under this coverage.

Example: processing medical invoices, conclude credit medical service agreements with the current credit medical service providers for the LE staff.

A.3 Eligible Participants

A.3.1. Eligibility:

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.

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 Barbados or Grenada, 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.

Health and Life Insurance for LE Staff Page 16 of 77

A.3.2. 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.

A.3.3. Dependents:

A.3.3.1. Barbados specific Dependents definition is as follows:

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 or domestic partner (to include same-sex domestic partners, as certified by COM): one legal spouse as defined by local law or one domestic partner may be covered. LE Staff with more than one legal spouse or domestic partner must select only one individual for coverage.

In cases where LE Staff and their legal spouse or domestic partner 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 or domestic partner.

Dependent children: a child is defined as the LE Staff’s natural, adopted, stepchild, or foster child. Any child of a recognized domestic partner shall be deemed a stepchild of the employee. Children 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.

A.3.3.2. Grenada specific Dependents definition is as follows:

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.

Health and Life Insurance for LE Staff Page 17 of 77

A.3.4. Premium:

Premiums will be based on the number of individuals covered:

• 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 defined under Exclusions and Limitations (A.2.) and A.1.16, Catastrophic Coverage, or those covered under A.1.15, HIV/AIDS, is equivalent to BDS$135,000.

A.3.5. Identification of Eligible Employees and Dependents:

U.S. Mission in Bridgetown, Barbados 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 monthly basis.

A.3.6. Location of Employment:

The eligible employees covered by A.3. must be employed within the geographic boundaries of Barbados or Grenada by:

• Department of State (DOS)

• Agency for International Development (USAID)

• Presidents Emergency Plan for AIDS Relief (PEPFAR)

• U.S. Department of Defense (DOD)

• U.S. Department of Health and Human Services Centers for Disease Control (CDC).

• U.S. Department of Justice – Drug Enforcement Agency

• U.S. Department of Treasury - Internal Revenue Service

• U.S. Department of Homeland Security, and

• Any other U.S. Government agencies that may be represented at the U.S. Embassy in Barbados or Grenada.

A.3.7. Participants Covered Under a Rider:

• All ORE employees of the Chief and Deputy of Mission of the U.S. Mission to Bridgetown or Grenada who are paid under an ORE account.

Note: The employing officer may elect to enroll ORE staff in the Health Plan, but all associated costs are the responsibility of the employee & employing officer, not the U.S. Government.

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

A.4. Brochure Requirement

A.4.1. The Contractor shall provide a digital and print document (brochure/pamphlet/other written document) in English that sets forth a complete listing of the health insurance benefits to be provided

Health and Life Insurance for LE Staff Page 18 of 77 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.

A.4.2. The Contractor shall provide the document described in A.4.1 to the COR not later than 10 (ten) days after date of contract award. The Contractor shall provide additional brochures for new employees within ten (10) days of the COR’s request.

A.4.3. The Contractor assumes full responsibility for ensuring that the document described in A.4.1 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.

A.4.4 During the contract period, any changes regarding the information in the submitted documents/brochures will be updated and re-submitted as revised documents/brochures (i.e. changes to the list of approved institutes, etc.).

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B. GROUP LIFE INSURANCE SERVICES

The Government of the United States of America requires Group Life Insurance coverage for its employees at the US Embassy Bridgetown, Barbados and St. Georges, Grenada as described herein.

B.1. LIFE INSURANCE SERVICE BENEFITS

MANDATORY/REQUIRED BENEFITS

B.1.1. Death Benefit: The following benefit will be paid to the participant's named beneficiaries or estate upon the death of the participant as outlined below.

1. Natural Death: 24 times the monthly basic salary

2. Accidental Death: 24 times the monthly basic salary

3. Accidental Dismemberment: 25% - 100% of the accidental death benefit, depending on the loss.

If disbursement occurs, the benefit will be payable according to the following schedule of benefits. Only one benefit, the highest, will be paid if you suffer more than one loss in an accident. Loss of a hand means removal at or above the wrist joint. Loss of a foot means removal at or above the ankle joint. Loss of an eye means total loss of sight, which cannot be recovered.

Accidental Dismemberment Coverage Amount

Dismemberment Benefit - for Loss of Percent of Accidental Death Benefit

Sight of Both Eyes 100%

Both Hands or Both Feet 100%

One Hand and One Foot 100%

One Hand and sight of One Eye 100%

One Foot and Sight of One Eye 100%

Sight of One Eye 50%

One Hand or One Foot 50%

One Thumb and Any Finger on the Same Hand 25%

B.1.2. Disability Benefit:

1. Total Disability: Not Covered

2. Partial Disability: Not Covered

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B.1.3. Funeral Benefit:

Not applicable; funeral benefits are not payable under life insurance.

B.2. Conditions and limitations:

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

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

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

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

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

B.3. Eligible Participants

B.3.1. Eligibility:

Eligible employees are Locally Employed (LE) Staff who are

(1) working on a full-time or part-time basis under non-temporary direct-hire appointments and under personal services agreements/contracts that are not time limited to less than one year and

(2) paid under the terms of the Local Compensation Plan.

Not eligible are LE Staff working under temporary appointments; those working under a PSA or PSC that is time limited to less than one year; those with a When Actually Employed (WAE) workweek schedule;

non-personal services contract personnel and their employees, supplied by an independent contractor licensed to do business in the Barbados or Grenada who provide services to other local organizations as well as to the U.S. Mission; employees of USAID institutional contractors; and Peace Corps personal services contractors as indicated in MS 743.

Premium Costs: The USG will pay 100% of the premium costs.

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

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

B.3.2. Dependents are not covered.

B.3.3. Retirees are not covered.

Health and Life Insurance for LE Staff Page 21 of 77

B.3.4. Participants Covered Under a Rider:

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.

Note: The employing officer may elect to enroll ORE staff in the Life Plan, but all associated costs are the responsibility of the employing officer, not the U.S. Government.

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

B.3.5. Definitions:

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

Currency: premiums and benefits will be paid in Barbados Dollars.

B.4. Brochure Requirement

B.4.1. The Contractor shall provide a digital and print document (brochure/pamphlet/other written document) in English that sets forth a complete listing of the life insurance benefits to be provided under this contract. This brochure shall be provided in sufficient quantities so that each covered employee receives a copy. The Contractor shall furnish all copies of the brochures to the COR, who will ensure that appropriate distribution is made.

B.4.2. The Contractor shall provide the document described in B.4.1 to the COR not later than 10 (ten) days after date of contract award. The Contractor shall provide additional brochures for new employees within ten (10) days of the COR’s request.

B.4.3. The Contractor assumes full responsibility for ensuring that the document described in B.4.1 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.

B.4.4 During the contract period, any changes regarding the information in the submitted documents/brochures will be updated and re-submitted as revised documents/brochures (i.e. changes to the list of approved institutes, etc.).

Health and Life Insurance for LE Staff Page 22 of 77

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 21 calendar days)

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

No incorrectly denied claims

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.

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

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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 Bridgetown 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 A.4 and B.4.

Brochures (digital and print document)

As instructed by COR

Additional copies

10 days after contract award

Within 10 calendar days of the COR’s request

COR

by e-mail and hard copy

V.11.3 Invoice 1 Monthly (first day of the month)

COR /

Designated Billing Office

V.9 Management Plan – Final Version

1 No later than 15 calendar days after contract award

COR

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

COR

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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 reimbursement checks.

(4) The Contractor shall reimburse through EFT directly to the LE Staff bank account.

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 a drop box in the COR's office. The claims shall be picked up from the COR every week.

(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 direct deposit. Each deposit shall be accompanied by a form providing details of the amount reimbursed with an explanation of deductions, if any.

(5) The Contractor shall accept the employee's or dependent's choice to go for surgery to hospitals designated by the Contractor in order that the Contractor will pay the expenses directly to the hospitals.

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c. Payment of Life Insurance Benefits to Beneficiaries – The Contractor shall settle life insurance claims as follows:

(1) The Contractor shall provide forms for the designation of beneficiaries for the life insurance benefits to the COR. The COR shall have all enrolled eligible employees complete designation of beneficiary forms and keep them in their personnel folders, ORE staff folders, or EAE folders. Upon the death of an enrolled employee, the COR shall provide this form to the Contractor.

(2) The Contractor shall pay the employee's named beneficiary, legal heir, or estate the total amount of the claim within 60 days from the date the Contractor receives a completed dismemberment or death claim. Payment shall be computed on the basis of the coverage as defined in Section 1.IV.B and its subparagraphs.

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 Barbados or Grenada 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 Barbados or Grenada 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. The contractor shall perform this contract in accordance with local laws.

V.6 Erroneous Payment

If the USG becomes eligible for a refund of payment because of…