Solicitation ref. 19FR6325R0001.pdf

NSN 7540-01-152-8064 STANDARD FORM 33 (REV 9-97)

PREVIOUS EDITION NOT USABLE Prescribed by GSA

SOLICITATION, OFFER AND AWARD

1. THIS CONTRACT IS A RATED ORDER

UNDER DPAS (15 CFR 350)

RATING PAGE OF PAGES

2. CONTRACT (Proc. Inst. Ident.) NO.

3. SOLICITATION NO.

19FR6325R0001

4. TYPE OF SOLICITATION

[ ] SEALED BID (IFB)

[x] NEGOTIATED (RFP)

5. DATE ISSUED

October 22, 2024

6. REQUISITION/PURCHASE NO.

7. ISSUED BY CODE 8. ADDRESS OFFER TO (If other than item 7)

Contracts Office, A M-8 American Embassy 2 Avenue Gabriel 75008 Paris, France Phone: (33) 1 43122409 Fax: (33) 1 42661194

NOTE: In sealed bid solicitation "offer" and "offeror mean "bid" and "Bidder".

SOLICITATION

9. Sealed offers in original and 1 copy for furnishing the supplies or services in the Schedule will be received at the place specified, in the depository located in 18, Ave.

Gabriel, 75008 Paris (France) until 16:00 local time Nov 20, 2024.

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

10. FOR INFORMATION

CALL:

A. NAME

Ms. Dominique Mazier or Ms. Una O’Dwyer

B. TELEPHONE (NO COLLECT

CALLS) AREA CODE NUMBER EXT

(33) 143122487

(33) 143122435

C. E-MAIL ADDRESS

MazierD@state.gov ODwyerUM@state.gov

11. TABLE OF CONTENTS

(x) SEC. DESCRIPTION PAGE(S) (x) SEC. DESCRIPTION PAGE(S)

PART I - THE SCHEDULE PART II - CONTRACT CLAUSES

X A SOLICITATION/CONTRACT FORM 1 X I CONTRACT CLAUSES 38-59

X B SUPPLIES OR SERVICE AND PRICES/COSTS 2-6 PART III - LIST OF DOCUMENTS, EXHIBITS, AND OTHER ATTACH.

X C DESCRIPTION/SPECS/WORK STATEMENT 7-25 X J LIST OF ATTACHMENTS 60

X D PACKAGING AND MARKETING 26 PART IV - REPRESENTATIONS AND INSTRUCTIONS

X E INSPECTION AND ACCEPTANCE 27-28 X K REPRESENTATIONS, CERTIFICATIONS, AND 61-82

X F DELIVERIES OR PERFORMANCE 29-30 OTHER STATEMENTS OF OFFERORS

X G CONTRACT ADMINISTRATION 31-33 X L INSTRS., COND., AND NOTICES TO OFFERORS 83-90

X H SPECIAL CONTRACT REQUIREMENTS 34-37 X M EVALUATION FACTORS FOR AWARD 91-93

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

12. In compliance with the above, the undersigned agrees, if this offer is accepted within calendar days (120 calendar days unless a different period is inserted by the offer) from the date for receipt of offers specified above, to furnish any or all items upon which prices are offered at the price set opposite each item, delivered at the designated point(s), within the time specified in the schedule.

13. DISCOUNT FOR PROMPT PAYMENT SEE 14

(See section I, Clause No 52.232-8)

10 CALENDAR DAYS

20 CALENDAR DAYS

30 CALENDAR DAYS

CALENDAR DAYS

14. ACKNOWLEDGMENT OF AMENDMENTS AMENDMENT NO. DATE AMENDMENT NO. DATE

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

15A. NAME CODE FACILITY 16. NAME AND TITLE OF PERSON AUTHORIZED

AND

ADDRESS

OF

OFFEROR

TO SIGN OFFER (Type or print)

15B. TELEPHONE NO. (Include area code)

15C. CHECK IF REMITTANCE ADDRESS [ ]

IS DIFFERENT FROM ABOVE - ENTER SUCH

ADDRESS

17. SIGNATURE 18. OFFER DATE

AWARD (To be completed by Government)

19. ACCEPTED AS TO ITEM NUMBERED

20. AMOUNT 21. ACCOUNTING AND APPROPRIATION

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

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

23. SUBMIT INVOICES TO ADDRESS SHOWN IN

(4 copies unless otherwise specified)

ITEM

G.2.1

24. ADMINISTRATION BY (If other than Item 7) CODE 25. PAYMENT WILL BE MADE BY CODE

American Embassy Attn: FMO Voucher/DBO 2, Avenue Gabriel 75382 Paris Cedex 08

26. NAME OF CONTRACTING OFFICER (Type of print)

27. UNITED STATES OF AMERICA 28. AWARD DATE

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

Health and Life Insurance Solicitation ref. 19FR6325R0001

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SECTION B – SERVICES AND PRICES

PRICES - HEALTH INSURANCE AND DISABILITY AND DEATH BENEFITS

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.

B.1. HEALTH INSURANCE SERVICES

The Contractor shall provide health insurance services, including medical, maternity, disability, and death benefits, for locally employed staff of the U. S. Mission in France and their eligible dependents as described in Section C and the Attachments in Section J. Locally Employed Staff (LES) shall be French, American or third country nationals as well as Personal Service Contractors (PSCs, or PSAs if hired under a Personal Services Agreement) employed by the U. S. Government. Individuals entitled to coverage under this contract are described in the following categories:

Official Residence Employees (ORE) and categories C and D are included under this contract;

the contractor shall bill the Chief of Mission separately for ORE employee insurance at the rates specified below and in the attachments. Individuals covered under categories C and D will be billed directly for the rates cited in the attachments. See Section G for billing procedures.

Category A consists of:

Employees and their eligible dependents, i.e., spouses, PACS as well as children up to 18 years of age, or up to 25 years of age if still enrolled full-time in an educational institution, affiliated with the French Social Security system. A dependent is an adult person who is acknowledged as a legal dependent on the employee’s income tax report or recognized by the French Social Security as a dependent by inclusion in the insured employee’s social security card.

Category B consists of:

Employees and their eligible dependents not affiliated with the French Social Security system, (i.e., U.S. Social Security system) for whom this insurance is the only health benefits coverage.

Category C consists of:

Retirees, former employees who left employment due to a reduction in force and their eligible dependents, eligible dependents of deceased employees affiliated with the French Social Security system and employees on none paid status for extended sick leave or parental leave.

Portability is also available to any employees who have been terminated by the employer (for any other reason than for grave misconduct “faute lourde”) and are entitled to unemployment benefits.

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Category D consists of:

Retirees under the Civil Service Retirement (or U.S. Social Security) system, former employees who left employment due to a reduction in force and their eligible dependents and eligible dependents of deceased employees not affiliated with the French Social Security system, Health insurance services with at a specific rate are also available to employees on none paid status for extended sick leave or parental leave.

The above categories characterize the main groups in this contract, but Attachments A and A-1 contain the separate contract line items (CLINS) and their prices fill-ins. Each CLIN shall be filled but the total amount of premiums for the duration of the contract period is calculated taking into consideration Embassy Employees covered by the health insurance only (CLINS 1001 ; 2001 ; 3001 and 4001 in Attachment A).

All the premium prices by category shall appear on the contract as the insurance premiums are determined mutually for all the categories.

B.2 PRICES

B.2.1 PREMIUMS AND COST SHARING:

The premiums to be paid for the above categories shall be provided for each CLIN in Attachments A and A-1. The percentage levels of coverage for the specifications are described in Section C for two levels of coverage, a basic option offering minimum percentage levels of coverage and a high option offering greater percentage levels of coverage. Premium costs are attributable as follows:

Category A. Premium costs for the basic option are shared between the employer and the employee, the employer contribution being 2/3 of the premium and the employee contribution being 1/3. This cost sharing by the employer is applicable only to the employees of this category. Eligible dependents are responsible for their own premium payments. The difference in cost between the high option and low option premiums are payable entirely by the insured. The estimated contract total amount is based on the total amount of premiums for the Embassy Employees only during the performance of the contract.

Category B. For employees under the U.S. Social Security system, the premium is fully paid by the employee. The difference in cost between the high option and low option premiums are payable entirely by the insured.

Category C. Premium costs for both the basic option and the high option are fully payable by the insured. Employees benefitting from the portability do not pay anything as the premium costs for this category is included in the general cost of the contract.

Category D. Premium costs for both the basic option and the high option are fully payable by the insured.

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NOTE 1: Premiums will vary for employees and their eligible dependents who are affiliated with the French Social Security in the Alsace-Lorraine region, due to different French Social Security rates in effect in this region of France. Additional CLINS have been created to allow for this divergence and are included in Attachment A.

NOTE 2: Premiums shall be priced for each category and CLIN as described in this solicitation and in accordance with Attachment A. A temporary change of status for an employee e.g. an employee on maternity leave or on leave without pay, shall not permit any change to the agreed upon premium except as outlined in this contract.

B.2.2 PRICES/PREMIUMS FOR MEDICAL COVERAGE OF CATEGORIES A & B

Medical benefits for the Basic Option are described in Section C.2. Employee and Dependent Maximum Health Services Benefits. If a conflict results between the French attachment and the English-written specifications in Section C, the English version will control in compliance with FAR 52.225-14. Additional benefits for the High Option premiums are specifically outlined in bold italics and involve increased percentage levels of coverage as follows but may also involve additional specifications as described in Section C.2. The additional cost for the High Option premiums shall be fully payable by the employee regardless of category. The premium amounts submitted in Attachment A shall reflect total costs for premiums, including the aggregate of the employee and employer premiums. The estimated total of the premium rates in local currency are as follows:

The offeror shall submit a breakdown of prices provided under Attachment A of Section J to complete the following.

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12-month Estimated Contract Price for Medical Coverage:

Total Estimated Contract Price including taxes for Medical Coverage: _____ ___ Euros (€)

Note: Please refer to Attachment A-1 to provide Prices/Premiums for Medical coverage of Categories C & D.

B.3 PRICES/CONTRIBUTIONS FOR DISABILITY AND DEATH BENEFITS FOR CATEGORIES A

AND B (PRÉVOYANCE)

In addition to medical insurance the contractor is also tasked with providing Disability and Death Benefits (Prévoyance) for employees in categories A and B regardless of what medical benefits option they have chosen. As with the medical insurance, the employees may choose between a Basic or a High Option for minimum or increased benefits in the event of disability and death. The contributions for Category A will be calculated in percentage of gross salary and for Category B a flat rate shall be applied as well as a percentage of gross salary. If a conflict results between the French contract and the English-written specifications in Section C, the English version will control in compliance with FAR 52.225-14.

CLIN Category

Estimated

Number of

Premiums*

Montly rate per

Premium in Euros (€) including all taxes

Total Amount for twelve months in

Euros (€) including all taxes

Category A - Employees Affiliated to French Social Security

1001 A-1 Basic Option-Employees affiliated to Social Security (Actif Régime Sécurité Sociale Option de Base) 378

Category A - Employees Affiliated to French Social Security

2001 A-2 High Option-Employees affiliated to Social Security (Actif Régime Sécurité Sociale Option de Haute) 189

Category A - Employees Affiliated to French Social Security

3001 A-3 Basic Option-Employees affiliated to Alsace Social Security (Actif Régime Alsace Option de Base) 5

Category A - Employees Affiliated to French Social Security

4001 A-4 High Option-Employees affiliated to Alsace Social Security (Actif Régime Alsace Option de Haute) 4

Category B - Employees not Affiliated to French Social Security

5001 B-1 Basic Option-Employees not-affiliated to Social Security (Actif NON Sécurité Sociale Option de Base) 1

Category B - Employees not Affiliated to French Social Security

6001 B-2 High Option-Employees not-affiliated to Social Security (Actif NON Sécurité Sociale Option de Base) 0

Total estimated amount in Euros (€) for twelve months of Medical Coverage for Employees only**

* estimated number of premiums does not include any riders

** does not include any premium for Riders

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The offeror shall complete the following price list with the relevant percentages and prices:

12-Month Estimated Contract Price for Prévoyance Insurance:

Total Estimated Contract Price including taxes for Prévoyance Insurance: _________ Euros (€)

B.3. 7 GRAND ESTIMATED TOTAL INCLUDING TAXES FOR MEDICAL AND PRÉVOYANCE

INSURANCES FOR A TWELVE-MONTH CONTRACT PERIOD: _________ __Euros (€)

B.4 ADMINISTRATIVE RETENTION AMOUNTS AND ECONOMIC PRICE ADJUSTMENT

This is a firm-fixed unit price contract, and no administrative retention amount nor economic price adjustment shall apply for the performance period of twelve months.

B.5 MINIMUM AND MAXIMUM AMOUNTS

During the twelve months of the contract, and during any additional option period that might be exercised, the United States Government (USG) shall place orders totaling a minimum of ten

(10) Employees. This reflects the contract minimum guarantee for each period of performance.

The amount of all orders, for base and all option shall not exceed five hundred (500) employees. This reflects the contract maximum.

CLIN Category

Estimated

Number of

Employees

Percentage of tranche A

Percentage of tranche B

Permanent and partial

Disability (Invalidité permanente partielle et invalidité permanente totale)

Death (Décès) Total Amount for twelve months in € including all taxes*

Category A - Employees Affiliated to French Social Security

Basic Option-Employees affiliated to Social Security

PASS ceiling 2023 in €

P001 Employees 383 - % of PMSS** € 0.00 - % - %

High Option-Employees affiliated to Social Security

P002 Employees 193 - % of tranche A - % of Tranche B - % - %

Category B - Employees Non-Affiliated to French Social Security

Basic Option-Employees non-affiliated to Social Security

P003 Employees 1 - % of PMSS** - % - %

High Option-Employees non-affiliated to Social Security

P004 Employees 0 - % of tranche A - % of tranche B - % - %

Total estimated amount for twelve months of Death and Disability Coverage

*amount shall remain unchanged throughout the whole period of contract.

** PMSS - Social Security ceiling

Total estimated pay roll for one month (August 2024):

Basic: 1,423,545.00 €

High: 408,900.00 €

Employees non-affiliated to Social Security estimated yearly gross salary: 38,000.00 €

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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 the Locally Employed Staff (LES) in France employed by the U.S. Mission to France. The Government has determined that the mandatory practice by employers in France is to provide health insurance protection for their employees to supplement the benefits provided by the French Social Security system (Categories A and C herein) or to provide full health insurance coverage (Categories B and D); that the cost of such insurance protection is usually borne by both the employee and the employer, except in the case herein of Categories C and D (retirees and their eligible dependents or survivors), and that such health insurance protection is representative of locally mandatory compensation practice; therefore, the Government will adopt such locally mandatory practice as part of its compensation plan for locally employed staff. The specific health benefit coverage under this contract is set forth in Section C and in the Attachments of Section J.

C.1.2 Definitions:

• Auxiliary Medical Professional – Accredited medical personnel, other than a physician or Doctor of Medicine, registered with the FSS, e.g., registered nurses etc.

• Beneficiary - For death benefits under the terms of this contract, the beneficiary shall be the designated recipient of any benefits to which the deceased is entitled. Normally, the beneficiary shall be the surviving spouse and/or family members of the deceased. A Designation of Beneficiary form shall be completed by each employee and submitted to the Contractor within a period of two weeks from the effective date of the contract or from the entry on duty date of a new employee.

• FMO – Financial Management Office or the paying office for the U.S. Government.

• CADRE – Executive or management level employee

• Contracting Officer's Representative (COR) - Contracting Officer’s Representative. For this contract, the COR shall be the Human Resources Supervisor of the U.S. Embassy.

• Consommation Medicale Totale (CMT) - Total Medical Consumption - This index, published at the end of each calendar year by the National Institute for Statistics and Economic Studies (INSEE), is used as a reference by insurance companies to determine the percentage of increase for insurance premiums that is justifiable based on a national actuarial study.

• Contributory Insurance - Insurance for which the employee pays a part of the premium.

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• Conventioned - When applied to a medical doctor, paramedical practitioner, or dentist, or to a hospital, clinic or other establishment for medical services, this adjective indicates that the individual or institution abides by the conventioned tariffs, specific fee-for-service rates established by the National Health Service and used as a basis for reimbursement for medical services by the French Social Security system. This term has been superseded by DPTM for physicians but still applicable to hospitals and clinics.

• Daily rate - A daily charge (“Forfait Journalier”) claimed by hospitals and clinics, set by national decree, to cover expenses for food, linens, building maintenance, use of equipment and supplies, in-patient pharmaceuticals and dressings/bandages. This daily rate is charged by the hospital in addition to other specific charges.

• Dependent - Any minor child who depends on an insured employee for subsistence up to the age of 18 years if not a student and up to the age of 25 years when enrolled full-time in an educational institution. The spouse of an insured employee who depends on the employee for (partial) subsistence. An adult person who is acknowledged as a legal dependent on the employee’s income tax report or recognized by the French Social Security as a dependent by inclusion in the insured employee’s social security card.

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

• DPTM (previously OPTAM): Mastered Tariffication Practice Program (“Dispositif de Pratique Tarifaire Maitrisée”), a new convention for medical professionals which allows them to invoice freely within an annualized overrun envelope. DPTM agree to cap their average overrun of their fees to 100 % of the Conventioned tariff. Signatories to DPTM are not further subject to a reimbursement ceiling under the law. Non-DPTM practitioners are capped by law at maximum reimbursement rate of the Ticket Moderator plus 100% of the Conventioned tariff and reimbursement must be at least 20% less that the reimbursement for DPTM practitioner for the same service.

• Employee - A locally employed staff (LES) of the U.S. Government, whether French, locally-resident American, or third country national, hired as a Personal Services Contractor (PSC,or PSA (under a Personal Services Agreement)) or as a Foreign Service National (FSN), or as an employee of an Official Residence (ORE).

• Employer

– 1. The United States Government for all categories of employees cited above other than the ORE.

– 2. Chief of Mission for the ORE.

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• Forfait journalier - A daily charge (daily rate) claimed by hospitals and clinics, set by national decree, to cover expenses for food, linens, building maintenance, use of equipment and supplies, in-patient pharmaceuticals and dressings/bandages. This daily rate is charged by the hospital in addition to other specific charges.

• French Social Security Monthly Ceiling (PMSS or Plafond Mensuel de la Sécurité Sociale) - The monthly ceiling of the French Social Security system is set annually by decree by the Ministry of Finance. This monthly ceiling represents a median monthly income index established to determine the percentage of benefits of all types (health, disability, retirement, death, family allowances) to which a citizen or affiliate with the French Social Security is entitled, based on a comparison of the individual’s monthly income and the median monthly index, a hypothetical monthly income.

• 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 injury.

• Illness - A deterioration of an individual’s health resulting from a viral, bacteriological, genetic predisposition, or other external or internal cause, so certified by a medical authority. Illness in this contract excludes occupational diseases resulting from exposure to elements in the workplace.

• In-patient treatment - Treatment administered to a hospital patient.

• Liability rate: Another term for the Conventioned tariff used in labor law.

• Maximum Benefit - The total amount that will be paid to any one employee for injury or disease, or alternately the total reimbursement amount for medical services separately defined in section C.2. of this contract. The maximum benefit payable under the terms of this contract shall never exceed actual costs paid for medical/dental services

• Minimum Benefit - The minimum amount of reimbursement that will be paid to any one employee for injury or disease, or alternately, the minimum reimbursement for medical services separately defined in section C.2 of this contract.

• Maison de Repos – Convalescence Home

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• Non-conventioned - When applied to a medical doctor, paramedical practitioner or dentist, or to a hospital, clinic or other establishment for medical services, this adjective indicates that the individual or institution does not abide by the conventioned tariff, specific fee-for-service rates established by the national health service and used as a basis for reimbursement for medical services by the French Social Security system. These individuals or institutions constitute the private sector of the medical services industry in France and generally charge rates or fees-for-service that are higher than the conventioned tariff. This term has been superseded by DPTM for physicians but still applicable to hospital and clinics.

• Ordinary and Necessary Treatment - A diagnostic test or medical treatment which is usually performed in the community where the individual is being treated.

• Out-patient - An out-patient receives treatment at a hospital, clinic, or doctor’s office but does not remain overnight.

• Paramedical - A medical service provider who is accredited and specially trained in specific functions but who does not have generalist medical training such as a physician. Examples are accredited midwives, laboratory technicians, ambulance or firefighter emergency personnel, physical therapists, nurses, speech therapists.

• 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.

• Prévoyance: Insurance coverage for disability and death benefits.

• Prise en charge - A written document guarantee that services provided to an individual will be covered or reimbursed by a third party. The third party in this contract will be the Contractor who will provide an insurance coverage document (“prise en charge”) prior to the hospitalization of an insured individual.

• Self-pay - As used in this contract, self-pay indicates that the premium for medical insurance will be paid fully by the insured without employer or former employer contributions.

• Surgical procedure - Any invasive medical procedure by manual or instrument operation, whether scalpel or laser technology, undertaken for diagnosis or treatment of a diseased or injured patient.

• Tarif Convention (Conventioned tariff) - Charges established by the national health service for specific medical or paramedical or dental treatment. Each medical or paramedical branch may sign, through its union, a national convention or agreement with the French Social Security system. Fees paid to medical, paramedical, or dental practitioners or establishments will be partially reimbursed to those affiliated with the French Social Security based on the conventioned tariff for each service. Signatories to such conventions are conventioned medical service providers, i.e., adhere to the national health system’s fees for service.

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• Ticket modérateur - The difference between the Social Security reimbursement rate and the conventioned tariff is called the “ticket modérateur”. The fees-for-service established for the national health system and identified as tariff “conventions” are generally not reimbursed 100% by the French Social Security system. The difference is herein described.

C.2. EMPLOYEE AND DEPENDENT MAXIMUM HEALTH SERVICES BENEFITS:

The benefits described in each subsection of C.2 describe the benefits package under the BASIC OPTION and the HIGH OPTION. The differences between the Basic Option and the High Option are summarized in Section C. Any other additional benefits covered under increased percentage levels for the High Option are described in bold italic font and are available to employees already enrolled in the Basic Option for a supplementary premium payment. All itemized descriptions for CATEGORIES A and C pertain to complementary insurance since the members of these categories are under the French Social Security system. For CATEGORY A and C members, the Contractor shall provide Basic Option benefits to supplement French Social Security reimbursements as long as the treatment is reimbursable by French Social Security and has been prescribed by duly accredited physicians, hospitals or clinics. All itemized descriptions for CATEGORY B and D pertain to full Basic Option insurance coverage up to the maximum amount described for each itemized description, as long as the medical treatment has been prescribed by duly accredited physicians, hospitals or clinics and such medical treatment would normally be reimbursable by the French Social Security system. Members of CATEGORY B and D are NOT affiliated with the French Social Security system.

C.2.1. INPATIENT AND OUT-PATIENT HOSPITALIZATION, EMERGENCY ROOM TREATMENT,

SURGERY AND ANESTHESIOLOGY

Upon the written request by the insured, the Contractor shall provide a guarantee of insurance coverage (“prise en charge”) to the hospital or clinic prior to actual hospitalization except in emergency cases. Hospitalization, whether inpatient or outpatient services, in-patient or out-patient surgery and anesthesiology, emergency room, including paramedical care and related expenses during hospitalization and surgery, shall be reimbursed as follows:

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Category A & C:

Low Option:

• In the conventioned sector at 100% of the conventioned tariff, for surgery;

• In the non-conventioned sector, at 200% of the conventioned tariff, for surgery;

• Consultation fees in cases of surgery

• DPTM: TM+120% of the conventioned tariff

• Non-DPTM physician: TM+100% of the conventioned tariff

• Daily Rate (forfait journalier): shall be fully covered.

Not covered: single room accommodation and any elective or cosmetic surgery.

High Option:

• In the conventioned sector, at 100% of the conventioned tariff for surgery.

• In the non-conventioned sector, at 300% of the conventioned tariff for surgery.

• Physician consultation fees, in case of surgery:

• DPTM- TM+120% of the conventioned tariff Non-DPTM: TM+280%

(Single accommodation shall be covered up to an amount not to exceed 2.20% of the PMSS per day).

Not covered: any elective or cosmetic surgery.

Category B & D:

Whether in the conventioned or non-conventioned sector, at 200% of the conventioned tariff for surgery:

Daily Rate (forfait journalier): shall be fully covered Not covered: single room accommodation and any elective or cosmetic surgery.

• Whether in the conventioned OR non-conventioned sector, at 300% of the conventioned tariff for surgery:

• Single room accommodation shall be covered up to an amount not to exceed 2.20% of PMSS per day.

Not covered: any elective or cosmetic surgery.

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C.2.2. DOCTOR VISITS, LABORATORY TESTS, MEDICAL PROSTHESES, X-RAYS

Category A&C:

Low Option:

Office visits for treatment by a physician, house calls (i.e. a physician’s visit to the patient’s home), and X-Rays shall be covered as follows:

DPTM: “Ticket modérateur” + 90% of the conventioned tariff.

Non-DPTM: “Ticket modérateur” + 70% of the conventioned tariff.

Registered nurse and laboratory tests shall be covered at 100% of the conventioned tariff.

Office visits for treatment by a physician, house calls (i.e. a physician’s visit to the patient’s home), and X-Rays shall be covered as follows:

DPTM: “Ticket modérateur” + 170% of the conventioned tariff.

Non-DPTM: “Ticket modérateur” + 170% of the conventioned tariff.

Registered nurse and laboratory tests shall be covered at 200% of the conventioned tariff.

Category B&D:

150% of the conventioned tariff.

Registered nurse shall be covered at 100% of the conventioned tariff.

300% of the conventioned tariff for doctor visits, medical prostheses, and X-Rays, and ;

200% of the conventioned tariff for laboratory tests.

Registered nurse shall be covered at 300% of the conventioned tariff.

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C.2.3. PHARMACEUTICALS/PRESCRIPTION DRUGS

Whether Basic or High option: Reimbursement shall not exceed 100% of the “ticket modérateur”.

Category B&D:

Whether Basic or High option: Reimbursement shall not exceed 100% of the conventioned tariff.

C.2.4. MATERNITY/OBSTETRICS

Employees are eligible for the following maternity benefits after one full year of continued employment with the U.S. Government.

• Normal or Caesarian delivery - The Contractor shall pay a fixed amount birth premium equivalent to 10% of the Monthly Ceiling of Social Security (PMSS) to cover expenses related to childbirth and obstetric care provided by a physician or accredited midwife.

This payment is either payable to the mother or to her legal spouse. It will be paid concurrently to both parents if both are employed by the U.S. Government.

• Miscarriage - The Contractor shall reimburse up to 100% of the conventioned tariff.

• Stillborn birth - The Contractor shall pay a fixed amount birth premium equivalent to 10% of the Monthly Ceiling of Social Security (PMSS) to cover expenses related to childbirth and obstetric care provided by a physician or accredited midwife, as long as the deceased infant has been registered with the official authorities.

High Option:

The Contractor shall pay a fixed amount birth premium equivalent to 15% of the Monthly Ceiling of Social Security (PMSS) to cover expenses related to childbirth and obstetric care provided by a physician or accredited midwife for a normal delivery or for a stillborn birth, as long as in the latter case the deceased infant has been registered with the official authorities.

Whether Basic or High option, reimbursement shall be:

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• Normal or Caesarian delivery - The Contractor shall pay an amount of a minimum of 915€, for all expenses related to childbirth and obstetric care provided by a physician or accredited midwife in a normal delivery. Reimbursement shall not exceed a maximum of 2,287€, payable by the Contractor upon presentation of actual costs incurred and paid by the insured.

• Miscarriage - The Contractor shall reimburse 150% of the conventioned tariff.

• Stillborn birth - The Contractor shall pay a fixed amount not to exceed 1,524€ to cover expenses related to childbirth and obstetric care provided by a physician or accredited midwife as long as the deceased infant has been registered with the official authorities.

C.2.5. OPTOMETRIC OR OPTICIAN SERVICES

The Contractor will reimburse expenses related to optometric or optician services as follows:

(However, treatment, diagnosis, eye examinations and other ocular care provided by an M.D.

ophthalmologist shall be covered under the terms of C.2.2. Doctor Visits, as described above.)

Category A, B, C, D:

Low Option:

Reimbursement of expenses is limited over a two-year contract period to one pair of glasses, except in case of change in eyesight, and for children.

1. 100% Santé Basket:

• Expenses for the lenses and frames are covered within the limit of maximum fixed sale price (prices are established and published in the Social Security Code and include the French Social Security coverage).

2. Unrestricted basket:

• Single vision and progressive/multifocal lenses: A maximum of 250€ for lenses and a maximum of 100€ for the frame;

• Contact lenses: whether or not guarantee-reimbursed by the French Social Security system, reimbursement is limited to 5% of the Monthly Social Security Ceiling (PMSS) per year.

Reimbursement of expenses is limited over a two-year contract period to one pair of glasses, except in case of change in eyesight, and for children.

• Single vision lenses: A maximum of 550€ (including a maximum of 150€ for the frame);

Progressive/multifocal lenses: A maximum of 800€ (including a maximum of 150€ for the frame).

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• Contact lenses: whether guarantee-reimbursed by the French Social Security system, reimbursement is limited to10% for the Monthly Social Security Ceiling (PMSS) per year.

C.2.6. PHYSICAL THERAPY

Only post-surgical and/or physician-prescribed physical therapy normally reimbursable by the French Social Security system shall be reimbursed as follows:

Low Option:

Category A&C:

• 100% of the conventioned tariff.

Category B&D:

• 150% of the conventioned tariff.

High Option:

Category A, B, C, D:

• 200 % of the conventioned tariff.

C.2.7. PSYCHIATRIC TREATMENT

Psychiatrist-prescribed hospitalization in a psychiatric ward of a general hospital or in a psychiatric hospital or clinic shall be reimbursed based on the terms for C. 2.1. (Hospitalization).

Category A&C:

• DPTM: 100% of the conventioned tariff.

Non-DPTM: 80% of the conventioned tariff.

Whether Basic or High option, costs for treatment by a conventioned M.D. psychiatrist shall be reimbursed at 150% of the conventioned tariff.

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C.2.8. AMBULANCE SERVICE

The Contractor shall reimburse costs for ambulance service (“Secteur convention”) when it is prescribed by a physician or in cases of emergency and when such service is normally reimbursable by the French Social Security system.

No coverage for the non-conventioned sector.

Category A, B, C, D:

Whether Basic or High Option, at 100% of the conventioned tariff.

C.2.9. HEARING AIDS

The terms of Hearing Aids pertain only to appliances used to correct a hearing deficiency.

Costs for treatment by a physician for ear infections, hearing problems and other ear-related medical treatments based on the terms of C.2.2.

Whether Basic or High option, at 100% of the conventioned tariff.

Effective as of 01/01/2021:

Whether Basic or High option,

1. 100% Santé Basket:

• Expenses for the hearing aids are covered within the limit of maximum fixed sale price (prices are established and published in the Social Security Code and include the French Social Security coverage)

2. Unrestricted basket:

• 100% of the conventioned tariff (within the limit of 1700€ for each ear every four years

– including French Social Security reimbursement)

Whether Basic or High option, at 150% of the conventioned tariff.

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C.2.10. DENTAL TREATMENT

For category A, C:

Costs for dental treatment and dental prostheses per person, per annum, shall not exceed the Monthly French Social Security Ceiling (PMSS) in any given year.

For category B, D: Only costs for dental prostheses per person, per annum, shall not exceed the Monthly French Social Security Ceiling (PMSS) in any given year.

Category A, B, C, D

• Dentist visits: Treatment by a Doctor of Dental Surgery or a periodontist (“Secteur Conventioné”), to remedy dental cavities or other dental or periodontal disease as well as for prophylactic treatment and dental X-ray is covered as follows:

100% of the conventioned tariff.

200% of the conventioned tariff.

Dental Prostheses

1. 100% Santé Basket: Expenses for the prostheses are entirely reimbursed in the limit of maximum fixed sale price (includes the French Social Security reimbursement)

2. Reasonable expenses basket: 100% of the conventioned tariff per prostheses (in the limit of maximum prices).

3. Unrestricted basket: 100% of the conventioned tariff per prostheses.

300% of the conventioned tariff per prosthesis.

• Orthodontics: Costs for orthodontic appliances and orthodontic treatment for a child - if the treatment has started before the age of 16 are reimbursed as follows:

Category A & C:

100% of the conventioned tariff.

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Category A, B,C,D:

200% of the conventioned tariff.

• Emergency Dental Surgery

Emergency, accident-related dental surgery shall be reimbursed as follows:

Category A, B, C, D:

Low Option:

100% of the conventioned tariff.

300% of the conventioned tariff.

C.2.11. EXPENSES INCURRED OUT-OF-COUNTRY

Expenses incurred out-of-country for medical expenses - emergency medical and/or surgical expenses, including anesthesiology, ambulance service, surgeon’s fees, and hospitalization in a semi-private room – shall be reimbursed in accordance with European Union or other bilateral or multilateral medical services totalization agreements to which France is signatory.

Reimbursement shall not exceed the actual total of expenses incurred. In the event of medical expenses incurred out-of-country in a state that has no such totalization or exchange agreement to which France is signatory, or in a country that is not reimbursable by the French Social Security system, there shall be no reimbursement under this contract.

Category A & C:

100% of the conventioned tariff.

C.2.12.

Reserved

C.2.13. DIRECT PAYMENT CARD (CARTE TIERS PAYANT).

The Contractor shall provide all members of categories A and C, a “Carte Tiers Payant” for usage in conjunction with the French Social Security reimbursement system.

C. 2.14. HEALTH SERVICES AND TREATMENTS EXCLUDED FROM THIS CONTRACT:

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The following medical/health services or treatments are excluded from the benefits allowable under the terms and conditions of this contract.

1. Cosmetic or plastic surgery or hair transplants for esthetic effect unless such surgery qualifies as plastic reconstructive surgery after an accident or required due to a congenital malformation and is recommended by a surgeon. To be included as a benefit under C.2.1.

Hospitalization and C.2.2. Surgery above, the plastic surgery (reconstructive surgery only) must be approved for reimbursement by the French Social Security system for Category A insured.

For Category B insured, the surgery must be approved by the Contractor’s medical consultant.

2. Physical therapy or massages are excluded unless the treatment meets the criteria in C.2.6.

Physical Therapy above.

3. Thermal water cures, thalassotherapy, rest cures and “maison de repos” - except following a surgical procedure - are excluded from the terms of this contract.

4. Pedicures and other treatments of the foot, unless by prescription from an accredited M.D.

podiatrist, are excluded from this contract.

5. Weight control clinics, special diets and weight-loss clubs or camps are excluded from the terms of this contract.

6. Detoxification clinics for drug or alcohol addiction are excluded from this contract unless (a) treatment at such a clinic as an in-patient is prescribed by an M.D. and (b) in-patient clinical treatment at the facility is approvable for reimbursement by the French Social Security. If these two conditions are met, reimbursement under the terms of this contract shall conform to C.2.1.

Hospitalization, as described above. However, no daily indemnity shall be paid to Category B insured for detoxification treatment.

7. Acupuncture treatments shall not be covered under the terms of this contract.

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PART II – DISABILITY AND DEATH BENEFITS INSURANCE

C. 3. EMPLOYEE DISABILITY AND DEATH BENEFITS INSURANCE (PRÉVOYANCE)

These benefits are available only to employees currently on the U.S. Government payroll.

Disability insurance benefits under this contract shall not be payable when the disability results from an occupation-related illness or injury (“accident du travail”). This benefit does not apply to dependent family members, to survivors of the employee or to retired employees.

Employees who were separated and were receiving disability benefits from the contractor will continue to receive such benefits.

C.3.1 DISABILITY

Low Option:

Category A:

After an illness or non-occupational accident resulting in permanent total or partial disability, the Contractor shall pay a fixed amount which shall be prorated depending on the degree of permanent disability (N): such sum shall not exceed the annual Social Security ceiling (PASS), nor shall such sum be less than 10% of the official disability rate.

From 10% to 50%: N/2 x PASS. Above 50%: N x PASS

Category B:

Permanent Partial or Total Disability:

After to an accident or illness, the Contractor will pay a maximum of 15,245€. The exact amount of the fixed payment will depend on (a) evaluation of the degree of disability by the Contractor’s medical consultant and (b) the fixed amount payment rate established by the French Social Security system for that degree of disability.

Temporary Disability:

The contractor will make a monthly payment of 365€ in the following cases:

• Accident or injury: from the date of the occurrence for a period not to exceed 24 months.

• Illness requiring hospitalization for more than two days, from the first day of disability from work for a period not to exceed 12 months.

• Illness without hospitalization, beginning after 60 calendar days of disability from work for a period not to exceed 12 consecutive months. Payment will resume if the employee returns to work and is disabled again without incurring a new 60 days waiting period.

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High Option :

In addition to the basic option, a supplementary benefit may be granted to the employees, if a minimum number of them voluntarily enroll. The premium for this option shall be fully paid by the employee. Once enrolled, employees will not be authorized to cancel, except in case of resignation or retirement.

Temporary Disability with Medical Discharge:

After to an illness or an accident, the Contractor shall pay a daily indemnity. This benefit is only payable to active employees under the age of 70 and does not apply to family members or retirees.

Category A:

Once all the employee’s sick leave has been used, the Contractor shall pay a daily indemnity equal to 75% of the employee’s daily net salary including reimbursement from the French Social Security. These payments are made as long as the French Social Security benefits are paid, up to the 1095th day (or max 3 years) of the medical discharge, but without exceeding the retirement date at the 70th birthday, or up to the date at which the permanent partial or total disability is recognized by the French Social Security as stated below

Category B:

Once all the employee’s sick leave and annual leave has been used, the Contractor shall pay an indemnity equal to 75% of the employee’s daily net salary less the daily indemnity as established in the basic option in C.3.1. for Category B, above.

Permanent (Partial or Total) Disability:

An employee not eligible for immediate retirement benefits will receive compensation at the end of each quarter once the status of permanent (partial or total) disability is recognized. This compensation shall be calculated as follows:

• First Level of Disability - Permanent Partial Disability

Category A: The contractor shall pay compensation equal to 45% of the employee’s daily net salary less the amount for disability paid by the French Social Security System. This payment shall be made for as long as the disability status lasts, even in case of an eventual return to work.

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Category B: The Contractor shall pay compensation equal to 45% of the employee’s daily net salary less the amount paid by the contractor in C. 3 above, Category B until the employee resumes duties.

• Second and Third Levels of Disability - Permanent Total Disability

Category A: For an employee whose disability prevents him or her from working, the Contractor shall pay a compensation equal to 75% of the employee’s daily net salary less the amount for disability paid by the French Social Security

Category B: The Contractor shall pay compensation equal to 75% of the employee’s daily net salary less the daily indemnity as established in C.3.1. for Category B, above, until the US Civil Commission establishes the disability retirement date.

C.3.2 DEATH BENEFITS:

Death benefits are payable only to dependents or other designated beneficiaries if the employee was on the payroll at the time of death by accident or illness. This benefit does not apply to former employees of the US Government, dependent family members or retirees.

Category A & B:

The death benefits after illness or accident payable to the deceased’s spouse, legal heirs, and/or other designated beneficiary shall be equal to the official annual applicable ceiling of the French Social Security system as published on January 1st of the year of death. The death benefit payment shall be payable by the Contractor within 30 days of the death once all documentation has been provided.

The Contractor shall pay to the entitled survivors or beneficiaries, death benefits equal to 100% of the Social Security Annual Ceiling.

a. When the deceased employee is single, the Contractor shall pay to the entitled survivors or beneficiaries, death benefits equal to 100% of the employee’s annual net salary.

b. When the deceased employee is married, the Contractor shall pay to the entitled survivors or beneficiaries, death benefits equal to 150% of the employee’s annual net salary.

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C.4 ELIGIBLE PARTICIPANTS:

The employees, former employees and eligible dependents under the terms and conditions of this contract are the following:

- All current active locally employed staff of the United States Government, including third country nationals and American employees locally employed under the terms of the Rockefeller Amendment, employed by the United States Government for the U. S. Mission to France and paid under the local compensation plan, the Official Residence Employees (ORE) whose names shall be provided as a separate attachment upon award of contract. It shall be understood by the Contractor that in addition to the insured employees, whether under Category A (for employees affiliated with the French Social Security system) or under Category B (for employees under the U.S. Civil Service Retirement system, or the U.S. Social Security System), employed by the U.S. Mission to France and paid under the local compensation plan, the following groups shall be eligible under identical terms and conditions and premium rates as described herein and billable separately from this contract:

Category C and D shall comprise retired employees of the Embassy, Consulates, APP’s, FSTO, USOECD or USUNESCO and dependents or survivors of deceased employees, or former employees who left employment with the U.S. Government for reasons other than cause or misconduct (in each case whether affiliated with the French Social Security system or not).

Category C and D insured shall pay the full premium for (former) employee and eligible dependents without employer (U.S. Government) contribution toward premiums.

C.5. TERM OF ELIGIBILITY

Each current active employee is eligible for health benefits under this contract upon award and thereafter during the performance period of this contract. An employee is considered active (on the payroll) whenever such employee is on paid annual or sick leave. In the event that an individual employee accrues one full pay period (70 hours of accumulated leave without pay (LWOP), that employee shall henceforth be in a self-pay status under the terms of this contract, i.e., without employer contributions.

C.6 PERIOD OF INELIGIBILITY

Employees are not entitled to Health and Disability and Death benefits during any period of employment thereafter for which premiums are not paid.