Amendment__8-SPA10016R0001_SolicitationExtension-Health_Insurance.pdf

SOLICITATION NO. SPA10016R0001 AMENDMENT NO. 0008

This Solicitation is amended as follows:

SECTION C

DESCRIPTION/SPECIFICATION/WORK STATEMENT

PART I - HEALTH INSURANCE

C.1. HEALTH INSURANCE SERVICES

The Government of the United States of America requires Health Insurance coverage for its employees as further described in C.1.2 in Paraguay. The Government has determined that the prevailing practice by employers in Paraguay is to provide for their employees health insurance protection and that the cost of such insurance protection is usually borne by both the employee (15%) and the employer on a (85%). Health insurance protection will be representative of locally prevailing compensation practice as further described in C.1.2. The specific health benefit coverage under this contract is set forth in Section C and the Exhibits in Section J.

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

C.1.1 Employee_and_Dependent_Health_Services_Benefits.

The insurance company will cover 100% of reasonable and customary costs of benefits and services received and referenced below subject to any stated limits or applicable maximums as noted below. The medical treatment must be prescribed or provided by a physician or nurse licensed in Paraguay, the United States, or in the country in which the treatment or prescription is received. Payment will be made in local currency.

C.1.1.1. Deductible: None

C.1.1.2. Hospitalization: 100% coverage of room and board for a standard ward room, semi-private room, or private room; disposable/expendable medical supplies, medicines and utilitarian materials. 100% coverage of hospital medical expenses including laboratory tests, x-rays, nursing care, operating room costs, intensive care, and prescription medicines.

C.1.1.3. Surgery - 100% coverage of all types of major or minor surgical operations, anesthesia, blood transfusions, medicines, disposable/expendable medical supplies, utilitarian materials.

C.1.1.4. Doctor Visits – 100% coverage of hospital and office calls and medical appointments; and professional services of general clinic specialists; excluding home visits. Use of physicians and professionals not included on the Contractor’s list of preferred providers would result in coverage in the amount the physicians of the Contractor's staff would receive.

C.1.1.5. Hospital Outpatient Services – 100% coverage of ambulatory services, studies, treatments, simple and specialized laboratory analysis, and diagnostic studies.

C.1.1.6. Prescription Drugs and medicines: – 100% coverage of the cost of medicines and drugs while hospitalized for which a prescription is legally required. Expenses incurred for medicines in ambulatory prescriptions, vitamins, cold remedies, etc., that are available over the counter without a prescription will not be reimbursed even if prescribed by a physician.

C.1.1.7. Obstetrical Care - 100% coverage when hospitalized for obstetrical medical care to include post-natal care and newborn care.

C.1.1.8. Family Planning: Not covered.

C.1.1.9. Ambulance Service - 100% coverage (extended to the entire territory of

Paraguay).

C.1.1.10. Expenses Incurred Out-of-Country – Not covered.

C.1.1.11. HIV/AIDS Treatment Coverage: 100% coverage for medications to suppress opportunistic infections, such as tuberculosis and toxoplasmosis for employees who have HIV/AIDS; as well as brief courses of anti-retroviral drugs during childbirth to prevent the transmission of HIV to the employee's child. This expanded coverage generally excludes medications for the long-term suppression of AIDS through the combination of anti-retroviral drugs at those posts with inadequate local healthcare infrastructures. A separate maximum limit per year of USD $10,000 per employee applies to this coverage.

C.1.1.12. Emergencies: 100% coverage of treatment, procedures and medicines received as the result of urgencies and emergencies.

C.1.1.13 Intensive Care: 100% coverage of intensive therapy and/or poly-trauma services, therapies, medicines, supplies and materials. Adults and children covered.

C.1.1.14 Specialized Cases: 100% coverage for treatment in specialized medical centers for burn cases or contagious diseases.

C.1.1.15. Laboratory, analysis and diagnosis: 100% coverage of analyses and test ordered by an approved physician, radiology and scans, xrays, etc. Medicines not covered.

C.1.1.16. Preventative Care: 100% coverage for annual preventative service to include:

physical examination, general analysis, xray and electrocardiogram. For females this includes a pap smear, bone densitometry and mammography, etc.

C.1.1.17. Physical Therapy - 100% coverage for services prescribed by a physician.

C.1.1.18. Psychiatric Treatment – Reserved (special fee).

C.1.1.19. Dental Service - 100% coverage of basic dental treatments.

C.1.1.20. Optical Service – 100% coverage of examinations and eye surgery. Prescriptions, frames and lenses are not covered.

C.1.1.21. Hearing Aids - Not covered.

C.1.1.22. NOTE: Procedures and disposable/expendable and materials/supplies for blood transfusions are covered at 100%, however, the provision of blood is not covered.

C.1.1.23. CONTRACTOR AND CONTRACTOR’S PERSONNEL KNOWLEDGE AND

EXPERIENCE IN THE WORK.

C.1.1.23.1. The Contractor shall have a minimum of two (2) years progressively responsible prior work experience in this business.

C.1.1.23.2. The Contractor shall have an office settled in the City of Asuncion properly registered under the laws of the republic of Paraguay.

C.1.1.23.3. The Contractor shall provide sufficient personnel possessing the skill, knowledge, education, training, etc. to perform the task described herein. Moreover, the Contractor shall assure that any required local licenses, permits, medical board certification etc. are obtained prior the Contractor personnel performing these services. The Contractor shall not hire off-duty Government employees who serve as inspector or Contracting Officer’s Representative (COR) in their Government position, or any other persons whose employment would result in conflict of interest

C.1.1.24. Exclusions or limitations: No coverage will be made for elective cosmetic surgery; spa cures; rejuvenation cures; massage; exercise therapy; long term rehabilitative therapy; non-medical hospital charges such as telephones or television, home help, family help, or similar household assistance; fees of persons who are not licensed physicians or nurses; or services or supplies which have not been prescribed or approved by a physician or nurse.

No coverage will be made for expenses that will be reimbursed or paid directly under a host country medical program, the U.S. workers' compensation program, or any Paraguayan workers' compensation program.

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

Any exclusion, exception or limitation to the services provided by the Contractor under the Contractor shall be clearly spelled out by the Contractor and provided to the Government and the Beneficiaries. Services not properly listed as called under this clause shall be considered as covered under the Contractor and must be covered by Contractor.

C.1.2. Health Benefits Conditions and Limitations

With the exception of expenses incurred under paragraph C.1.11 above, the Insurance company shall cover expenses up to a limit of (USD) [120,000] per individual, per event, per contract year.

The insurance company shall cover expenses described under paragraph C.1.1.11 of the plan up to a separate limit of (USD) [10,000] per employee per contract year.

No coverage for elective cosmetic surgery; spa cures; rejuvenation cures; massage; exercise therapy; long term rehabilitative therapy; non-medical hospital charges such as telephones or television; home help, family help, or similar household assistance; fees of persons who are not licensed physicians or nurses; or services or supplies which have not been prescribed or approved by a physician or nurse.

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

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

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

C.1.3 Eligible Participants

C.1.3.1 Eligible Employees.

The employees eligible for the health insurance services include the following:

C.1.3.1.1 All current active employees of the United States Government, employed within the geographic boundaries of Paraguay paid under the Local Compensation Plan, and certified by the Contracting Officer. Eligible employees are Locally Employed Staff who are (1) working on a full time or part time basis under non-temporary direct hire appointments or under personal services agreements/Contractors that are not time limited to less than one year and (2) paid under the terms of the Local Compensation Plan. Participation is mandatory.

C.1.3.2. Location of Employment.

The individuals covered by C.1.3.1 must be employed within the geographic boundaries of Paraguay by:

U.S. Department of State, U.S. Agency for International Development (USAID), Drug Enforcement Administration (DEA), Defense Attaché Office (DAO), Office of Defense Cooperation (ODC), Open Source Center (OSC) former Foreign Broadcast Information Service (FBIS), Peace Corps (PC), Department of Justice, Department of Treasury, Federal Bureau of Investigation, or

Any other USG Agency as certified by the CO.

C.1.3.3 RESERVED

C.1.4 Individuals Not Eligible for Coverage

Not eligible are those working under temporary appointments; those working under a PSA or PSC that is time limited to less than one year; non-personal services Contractor personnel and their employees, supplied by an independent Contractor licensed to do business in Paraguay who provides 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.

C.1.5. Other Eligible Participants.

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

C.1.5.1. Dependent Coverage: Expenses incurred by an enrolled employee's eligible dependents are covered under this plan. For the purposes of this plan, an employee's dependents are defined as the employee's legal spouse (limit one), economically dependent parents, and each unmarried, economically dependent child who primarily resides with the employee unless away at school.

Child is defined as the employee's natural child, adopted child, foster child, or stepchild. An eligible child will be covered until the end of the calendar year in which the child turns age 21.

There is no age limit for an eligible 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.

C.1.5.2. Special agreements between the Contractor and covered employee may be established to cover the following dependents based on an additional premium which will be paid in each case by the employee without charge to the U.S. Government.

a. Parents of the covered employee, who are not economically dependent.

b. Dependent children of the covered employee over twenty one (21) years old, single or married; no coverage for spouses.

c. Parents-in-law of the covered employee.

d. Brothers and sisters of the covered employee only, single and/or married.

e. Grandchildren of the beneficiary employee only, single and/or married.

C.1.5.3 Retired U.S. Government Employees: USG retirees shall have the option, upon a written request addressed to Contractor and cleared by the COR to be covered by the Contractor, at any time, by virtue of a private agreement signed between the Contractor and the retiree. All Retired employees covered by this clause must pay the total amount of the premium to the Contractor;

the Government shall not contribute to these premium payments. Retirees covered under this clause shall have all rights and benefits conceded to USG employees including coverage for spouses and the options stipulated above at same prices set for employees/beneficiary coverage.

C.1.6. Eligibility

C.1.6.1. Term of Eligibility and Effective Date

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

C.1.6.2. Period of Ineligibility.

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

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

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

During a period of extended (beyond one pay period) of Leave Without Pay or unpaid leave, the employee is responsible for the full cost of the insurance premiums (employee’s and the Government’s share) for self and dependents. The Mission will pay the premiums directly to the contractor, and will collect the full cost from the employee.

C.1.7. Brochure Requirement.

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

C.1.7.2. The contractor shall provide the document described in C.1.7.1 to the COR not later than 30 days after date of contract award. The Contractor shall provide additional brochures for new employees within ten (10) days of the COR’s request.

C.1.7.3. The contractor assumes full responsibility for ensuring that the document described in C.1.7.1 accurately reflects the requirements of the contract, as implemented by the contractor’s technical proposal. In all cases, the contract shall take precedence. Should the COR discover that the brochure contains inaccuracies, the contractor will be notified in writing;

however, failure on the part of the Government to notice any inaccuracies shall in no way limit, revise or otherwise affect the requirement under this contract for the contractor to fully comply with all contract terms.

C.2.0. This section C2 is RESERVED

C.3.0 Definitions

FMO The Financial Management Officer or the paying office for all U.S. Government Agencies except AID and Peace Corps.

COR Contracting Officer's Representative (COR) is the Human Resources Officer

(HRO) at post

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

Dependent The spouse, children under the age of twenty one (21) years old, if they are not married and are economically dependent (child is defined as the employee’s natural child, adopted child, stepchild, or foster child), as well as the parents of the employee, if economically dependent and/or living at the employee’s house.

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

Employee An individual employed by the U.S. Government, under a direct-hire appointment, personal services contract (PSC), or personal services agreement (PSA), as further defined in Section C.1.3 for health insurance.

Employer The United States Government.

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

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

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

Maximum Benefit The total amount that will be covered/paid to any one covered individual for covered medical expenses.

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

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

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

Except as provided herein, all terms and conditions of the document referenced in Item 9A or 10A, as heretofore changed, remains unchanged and in full force and effect.

NOTHING FOLLOWS