HL_Solicitation_Final.pdf

Health & Life Contract SPM070-17-R-0001

Table of Contents

B. SECTION B - PART I, PRICE - HEALTH INSURANCE

B.1. HEALTH INSURANCE SERVICES

B.2. PRICES

B.3. ADMINISTRATIVE RETENTION AMOUNTS

B.4. ECONOMIC PRICE ADJUSTMENT-HEALTH INSURANCE PREMIUMS

B.5. GROUP LIFE INSURANCE SERVICES

B.6. GROUP LIFE INSURANCE RATES

B.7. ADMINISTRATIVE RETENTION AMOUNTS

B.8. ECONOMIC PRICE ADJUSTMENT-LIFE INSURANCE PREMIUMS

C. SECTION C - DESCRIPTION/SPECIFICATION/WORK STATEMENT

PART I - HEALTH INSURANCE

C.1. HEALTH INSURANCE SERVICES

PART II GROUP LIFE INSURANCE

C.2. GROUP LIFE INSURANCE

C.3. DEFINITIONS

D. SECTION D - PACKAGING AND MARKING

E. SECTION E - INSPECTION AND ACCEPTANCE

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

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

F. SECTION F - DELIVERIES OR PERFORMANCE

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

F.2. PERIOD OF PERFORMANCE

F.3. OPTIONS

F.4. REPORTS AND OTHER DELIVERABLES

G. SECTION G - CONTRACT ADMINISTRATION DATA

G.1. 652.242-70 CONTRACTING OFFICER’S REPRESENTATIVE (COR) (AUG 1999)

G.2. COR DUTIES

G.3. PAYMENT SHALL BE MADE IN U.S. DOLLARS

G.4. SUBMISSION OF INVOICES AND PAYMENT

G.5. RESERVED

G.6. VALUE ADDED TAX (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

H. SECTION H - SPECIAL CONTRACT REQUIREMENTS

H.1. SECURITY

H.2. STANDARDS OF CONDUCT

H.3. ORDERING PROCEDURES

H.4. CONTRACTOR RESPONSIBILITY IN CLAIMS AND REIMBURSEMENT TO CLAIMANTS

H.5. REPORT REQUIREMENTS

H.6. MISCELLANEOUS CONTRACTOR REQUIREMENTS

H.7. ERRONEOUS PAYMENTS

H.8. REQUIRING ACTIVITY

I. SECTION I - CONTRACT CLAUSES

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

I.2. FAR CLAUSES INCORPORATED IN FULL TEXT

I.3. DEPARTMENT OF STATE ACQUISITION REGULATION (DOSAR)

J. SECTION J - LIST OF EXHIBITS/ATTACHMENTS

K. SECTION K - REPRESENTATIONS, CERTIFICATIONS, AND OTHER STATEMENTS OF OFFERORS

K.1. 52.203-2 CERTIFICATE OF INDEPENDENT PRICE DETERMINATION (APR 1985)

K.2. 52.203-11 CERTIFICATION AND DISCLOSURE REGARDING PAYMENTS TO INFLUENCE

CERTAIN FEDERAL TRANSACTIONS (SEP 2007)

K.3. 52.203-18 PROHIBITION ON CONTRACTING WITH ENTITIES THAT REQUIRE CERTAIN

INTERNAL CONFIDENTIALITY AGREEMENTS OR STATEMENTS – REPRESENTATION (JAN 2017)

K.4. 52.204-3 TAXPAYER IDENTIFICATION (OCT 1998)

K.5. 52.225-20 PROHIBITION ON CONDUCTING RESTRICTED BUSINESS OPERATIONS IN

SUDAN—CERTIFICATION (AUG 2009)

K.6. 52.204-8 ANNUAL REPRESENTATIONS AND CERTIFICATIONS DEC 2016

K.7. 52.209-5 CERTIFICATION REGARDING RESPONSIBILITY MATTERS (OCT 2015)

K.8. AUTHORIZED CONTRACT ADMINISTRATOR

K.9. 652.225-70 ARAB LEAGUE BOYCOTT OF ISRAEL (AUG 1999)

K.10. 52.209-2 PROHIBITION ON CONTRACTING WITH INVERTED DOMESTIC CORPORATIONS –

REPRESENTATIONS (MAY 2011)

K.11. 652.209-79 REPRESENTATION BY CORPORATION REGARDING AN UNPAID DELINQUENT

TAX LIABILITY OR A FELONY CRIMINAL CONVICTION UNDER ANY FEDERAL LAW (SEPT 2014)

(DEVIATION PER PIB 2014-21)

L. SECTION L - INSTRUCTIONS, CONDITIONS AND NOTICES TO OFFERORS

L.1. SUBMISSION OF OFFERS

L.2. SUMMARY OF INSTRUCTIONS. EACH PROPOSAL MUST CONSIST OF THE FOLLOWING SEPARATE

VOLUMES:

L.3. DELIVERY OF PROPOSALS AND EXCEPTIONS TO SOLICITATION

L.4. CONTENTS OF PROPOSALS

L.5. 52.252-1 SOLICITATION PROVISIONS INCORPORATED BY REFERENCE (FEB 1998)

L.6. SOLICITATION PROVISIONS INCLUDED IN FULL TEXT

L.7. 652.206-70 ADVOCATE FOR COMPETITION/OMBUDSMAN (FEB 2015)

L.8. PRE-PROPOSAL CONFERENCE

L.9. FINANCIAL STATEMENT

M. SECTION M - EVALUATION FACTORS FOR AWARD

M.1. EVALUATION OF PROPOSALS

M.2. OVERALL EVALUATION

M.3. AWARD SELECTION

M.4. FIXED PRICES

M.5. TECHNICAL EVALUATION. OFFERS WILL BE EVALUATED ON:

M.6. 52.217-5 EVALUATION OF OPTIONS (JUL 1990)

M.7. PRICE EVALUATION

M.8. SEPARATE CHARGES

M.9. AWARD WITHOUT DISCUSSIONS

B. SECTION B - PART I, PRICE - HEALTH INSURANCE

B.1. HEALTH INSURANCE SERVICES

The Contractor shall provide Health Insurance services to employees of the Government of the

United States of America in Panama as described in Section C and the Exhibits in Section J. The groups of employees who shall be provided this insurance are listed in C.1.3 (medical) and C.2.3

(life). This insurance shall be provided in accordance with Section C and the Exhibits in Section J.

B.1.1. Grandfathered Retirees and their dependents. Grandfathered Retirees and their dependents are included under this contract only as a rider; the Contractor shall bill the retirees separately, at the rates specified below. See Section G for billing procedures.

B.1.2. Official Residence Expense (ORE) Staff and American Employees Recreation Association

(AERA) Employees are included under this contract only as a rider; the Contractor shall bill the Chief of Mission and Deputy Chief of Mission (for ORE Staff), and the AERA (for

AERA employees) at the rates specified below. See Section G for billing procedures.

B.2. PRICES

B.2.1. 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.

B.2.2. This is a fixed price with economic price adjustment requirements type contract under which will be issued firm, fixed-price task orders. The fixed prices/premium rates for the health insurance services as specified in Section C are as follows:

B.2.3. BASE YEAR OF CONTRACT:

Category

Estimated Number of Employees Rate per Employee Bi-Weekly Total

a. Single Employees ( Self Only) 80

b. Family Plan 193

Bi-Weekly Rates per Employee

c. Subtotal (a + b)

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

B.2.4. FIRST OPTION YEAR OF THE CONTRACT:

B.2.5. SECOND OPTION YEAR OF THE CONTRACT:

B.2.6. THIRD OPTION YEAR OF THE CONTRACT:

of Employees Rate per Employee Bi-Weekly Total

a. Single Employees ( Self Only) 80

b. Family Plan 193

Bi-Weekly Rates per Employee

c. Subtotal (a + b)

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

Category

Estimated Number of Employees Rate per Employee Bi-Weekly Total

a. Single Employees ( Self Only) 80

b. Family Plan 193

Bi-Weekly Rates per Employee

c. Subtotal (a + b)

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

Category

Estimated Number of Employees Rate per Employee Bi-Weekly Total

a. Single Employees ( Self Only) 80

b. Family Plan 193

Bi-Weekly Rates per Employee

c. Subtotal (a + b)

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

B.2.7. FOURTH OPTION YEAR OF THE CONTRACT:

B.2.8. GRAND TOTAL BASE PERIOD PLUS OPTION YEARS

B.3. ADMINISTRATIVE RETENTION AMOUNTS

B.3.1. If the Contractor requests a price adjustment under B.4 below, the Contractor must present cost experience data that includes the retention amount. For purposes of any economic price adjustment, this retention amount is a fixed amount that is a part of the premium amounts in

B.2. This retention amount will not be adjusted for any reason.

The retention amount is part of the premium and may include, but not be limited to, such costs as overhead and general and administrative costs. It will also include any profit.

Essentially, it includes all costs except the actual portion of the premium intended to fund claims paid to the health care provider/claimant. B.3.2 sets forth the retention amounts per premium paid for each category of premium and for each period of performance.

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

of Employees Rate per Employee Bi-Weekly Total

a. Single Employees ( Self Only) 80

b. Family Plan 193

Bi-Weekly Rates per Employee

c. Subtotal (a + b)

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

Base Year Total

First Option Year Total

Second Option Year Total

Third Option Year Total

Fourth Option Year Total

Grand Total of Base plus All Option Years

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

Period of Performance Single Employees (Self Only) Family Plan

Base Period

First Option Year

Second Option Year

Third Option Year

Fourth Option Year

B.4. ECONOMIC PRICE ADJUSTMENT-HEALTH INSURANCE PREMIUMS

B.4.1. Premium Adjustment based on Experience - For health insurance, prices may be adjusted upward or downward based on the experience rating of the Mission(s) covered by this contract, and it specifically excludes all riders in B.1.1. No adjustment will be allowed during the first twelve months. After such time, the Contractor or the Government may request an adjustment in premiums on an annual basis. Adjustments are not retroactive to previous contract terms. Before any such adjustment is made, the Contractor agrees to provide the Government a balance sheet showing three main components for the time period: (1) receipts (premiums received) minus the retention amount, (2) number of insurance plans and (3) claims paid. This information shall be provided per type of premium, i.e. per line item. The retention amount is not subject to adjustment. The

Government reserves the right to have an independent third party review the balance sheet and claims and make recommendations regarding the appropriateness of the requested adjustment. Any adjustment shall be subject to mutual agreement of the parties and shall result in a written modification to the contract. Mutually agreed to adjustments shall be effective thirty days after complete information is received by the Government. Any failure to reach agreement under this clause shall be subject to the procedures in the Disputes clause.

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

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

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

PART II PRICE - GROUP LIFE INSURANCE

B.5. GROUP LIFE INSURANCE SERVICES

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

Section C and the Exhibits in Section J.

B.5.1. Official Residence Expense (ORE) Staff and American Employees Recreation Association

(AERA) Employees are included under this contract only as a rider; the Contractor shall bill the Chief of Mission and Deputy Chief of Mission (for ORE Staff), the AERA (for AERA employees) separately, at the rates specified below. See Section G for billing procedures.

B.6. GROUP LIFE INSURANCE RATES

This is a fixed-price with economic-price- adjustment-requirements type contract under which the

Government will issue firm-fixed price task orders. The fixed prices/premium rates US Dollar per thousand dollars of salary to provide life insurance, accidental death and dismemberment and partial and total disability coverage are as follows:

B.6.1. BASE YEAR OF CONTRACT

B.6.2. FIRST OPTION YEAR OF CONTRACT:

Type of Insurance

Premium

(per 1,000 of Salary)

Estimated Payroll

(Monthly in Thousands) Monthly Total

a. Basic Life $555.00

b. Accidental Death $555.00

c. Partial & Total Disability Coverage $555.00

Monthly Rates per Employee

d. Subtotal (a + b + c)

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

Type of Insurance

Premium

(per 1,000 of Salary)

Estimated Payroll

(Monthly in Thousands) Monthly Total

a. Basic Life $555.00

b. Accidental Death $555.00

c. Partial & Total Disability Coverage $555.00

Monthly Rates per Employee

d. Subtotal (a + b + c)

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

B.6.3. SECOND OPTION YEAR OF CONTRACT:

B.6.4. THIRD OPTION YEAR OF CONTRACT:

B.6.5. FOURTH OPTION YEAR OF CONTRACT:

Type of Insurance

Premium

(per 1,000 of Salary)

Estimated Payroll

(Monthly in Thousands) Monthly Total

a. Basic Life $555.00

b. Accidental Death $555.00

c. Partial & Total Disability Coverage $555.00

Monthly Rates per Employee

d. Subtotal (a + b + c)

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

Type of Insurance

Premium

(per 1,000 of Salary)

Estimated Payroll

(Monthly in Thousands) Monthly Total

a. Basic Life $555.00

b. Accidental Death $555.00

c. Partial & Total Disability Coverage $555.00

Monthly Rates per Employee

d. Subtotal (a + b + c)

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

Type of Insurance

Premium

(per 1,000 of Salary)

Estimated Payroll

(Monthly in Thousands) Monthly Total

a. Basic Life $555.00

b. Accidental Death $555.00

c. Partial & Total Disability Coverage $555.00

Monthly Rates per Employee

d. Subtotal (a + b + c)

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

B.6.6. GRAND TOTAL PRICE FOR ALL YEARS:

B.7. ADMINISTRATIVE RETENTION AMOUNTS

B.7.1. If the Contractor requests a price adjustment under B.8 below, the Contractor must present cost experience data that includes the retention amount. For purposes of any economic price adjustment, this retention amount is a fixed amount that is a part of the premium amounts in

B.6. This retention amount will not be adjusted for any reason.

The retention amount is part of the premium and may include, but not be limited to, such costs as overhead and general and administrative costs. It will also include any profit.

Essentially, it includes all costs except the actual portion of the premium intended to fund claims paid to the claimant.

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

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

B.7.2. Retention Amounts per separate premium paid per employee:

Period of Performance Basic Life

Accidental Death and

Dismemberment

Partial and Total

Disability Coverage

Base Period

First Option Year

Second Option Year

Third Option Year

Fourth Option Year

Base Year Total

First Option Year Total

Second Option Year Total

Third Option Year Total

Fourth Option Year Total

Grand Total of Base plus All Option Years

B.8. ECONOMIC PRICE ADJUSTMENT-LIFE INSURANCE PREMIUMS

B.8.1. Premium Adjustment Based on Experience - For life insurance, prices may be adjusted upward or downward based on the experience rating of the Mission(s) covered by this contract, and it specifically excludes all riders in B.1.1. No adjustment will be allowed during the first twelve months. After such time, the Contractor or the Government may request an adjustment in premiums on an annual basis. Adjustments are not retroactive to previous contract terms. Before any such adjustment is made, the Contractor agrees to provide the Government a balance sheet showing three main components for the time period: (1) receipts (premiums received) minus the retention amount, (2) number of insurance plans and (3) claims paid. The information shall be provided per type of premium, i.e. per line item. The retention amount is not subject to adjustment. The

Government reserves the right to select an independent third party to review the balance sheet and claims and make recommendations regarding the appropriateness of the requested adjustment. Any adjustment shall be subject to mutual agreement of the parties and shall result in a written modification to the contract. Mutually agreed to adjustments shall be effective thirty days after complete information is received by the Government. Any failure to reach agreement under this clause shall be subject to the procedures in the Disputes

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

C. 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 in Panama as further described in C.1.2. The Government has determined that the prevailing practice by employers in Panama is to provide health insurance protection for their employees, and that the cost of such insurance protection is usually borne by the employer as follows:

For eligible employees, regardless of number of work hours, the USG will pay 100% of the premium costs for employee and dependent coverage.

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

Unless specified below, the insurance company will pay 80% of medical expenses incurred.

Otherwise, the insurance company will reimburse covered medical expenses incurred, subject to the stated limits. Payment will be made for reasonable and customary expenses of covered benefits. The medical treatment must be prescribed or provided by a physician or nurse licensed in Panama, the

United States, or in the country in which the treatment or prescription is received. Coverage of expenses will be made in US Dollars (USD), unless otherwise stated.

Proposals that contain more benefits (even if there is no increase in cost) or fewer benefits than stated in the solicitation may be deemed technically unacceptable.

a) Deductible: 150 USD per year

In the case the deductible has not been covered when a pre-authorization is requested, the employee is entitled to pay the difference of the deductible that has not been covered to date, plus the percentage that needs to be paid by the insured (employee) for pre-authorized procedure

(e.g. laboratory, surgery, hospitalization, obstetrical coverage, dental care, etc.).

b) Reimbursement of Covered Medical Expenses

C.1.1.1 Hospitalization:

100% coverage of room and board expenses for a either a private or a semi-private room - no limit on length of stay.

80% coverage of hospital medical expenses including laboratory tests and x-rays, operating room expenses, intensive care, nursing care, and prescription medicines

100% coverage of anesthesia

50% coverage of surgical assistants

100% coverage of land ambulance service with a maximum of USD 360 per event

60% coverage of air transport with a maximum of USD 9,000 per event

100% coverage of emergency room services.

C.1.1.2 Professional Services and Treatment:

100% coverage of doctor’s, surgeon’s, and specialist’s fees incurred while hospitalized, at a clinic or doctor's office. Visits to a doctor’s office or a Specialist have a co-pay of $20 per visit.

80% coverage of medical services and expenses when not hospitalized, such as laboratory tests and x-rays

90% coverage for annual exams

60% coverage for immunizations

80% coverage for physical therapy

C.1.1.3 Prescription drugs and medicines:

80% coverage of the cost of medicines and drugs for which a prescription is legally required. Expenses incurred for medicines, vitamins, cold remedies, etc., that are available over the counter without a prescription will not be reimbursed even if prescribed by a physician.

C.1.1.4 HIV/AIDS coverage:

100% coverage of expenses for medications to suppress opportunistic infections, such as tuberculosis and toxoplasmosis for employees and dependents who have

HIV/AIDS; as well as brief courses of anti-retroviral drugs during childbirth to prevent the transmission of HIV to the 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.

C.1.1.5 Obstetrical Coverage:

Routine Delivery: 100% coverage

Cesarean: 100% coverage

Miscarriage: 100% coverage

80% coverage of expenses for prenatal and postnatal doctor visits.

C.1.1.6 Family Planning: Family planning expenses are not covered.

C.1.1.7 Psychiatric Treatment: 80% reimbursement.

C.1.1.8 Optical Care: 50% coverage of expenses for eye examination and treatment.

C.1.1.9 Dental Care:

50% coverage for minor restorative care

50% coverage for major restorative care

50% coverage for preventative care

Maximum of USD 600 per year for all dental expenses

Orthodontic expenses are not covered.

C.1.1.10 Hearing Aids: Hearing aids expenses are not covered.

C.1.1.11 Psychiatric Treatment: 80% coverage for psychiatric treatment up to USD60 per session and a maximum of 29 sessions per contract year.

C.1.1.12 Medical expenses incurred out of country:

Medical expenses incurred out of country will be covered for employees and dependents when (a) a life threatening condition occurs when the individual is out of the country and treatment is medically necessary before the individual returns home or (b) the individual’s attending physician certifies in advance that such treatment is medically necessary and unavailable locally. Coverage for medical expenses incurred out of country will be made at 80% and subject to the maximum limit as listed in paragraph C.1.1.14 below.

C.1.1.13 Transportation for Out of Country Treatment

Transportation for out of country treatment is not a covered expense.

C.1.1.14 Maximum Aggregate Reimbursement

With the exception of expenses incurred under paragraph C.1.1.4 above, the

Insurance Company will reimburse covered expenses up to an overall aggregate limit of USD 240,000 per covered individual per contract year.

The insurance company will reimburse covered expenses described under paragraph

C.1.1.4 of the plan up to a separate limit of USD 10,000 per covered individual per contract year.

C.1.2. Expenses not covered

Expenses will not be covered for elective cosmetic surgery; spa cures; rejuvenation cures; massage;

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 provided for expenses that will be reimbursed or paid directly under a host country medical program, the U.S. workers' compensation program, or any Panama workers' compensation type program.

No coverage of will be provided 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.

With the exception of retired employees covered under a rider in paragraph C.1.3.3. below, no coverage will be made for expenses incurred after an employee leaves the service of the U.S.

Mission.

C.1.3. Eligible Participants

C.1.3.1 Eligible employees:

C.1.3.1.1 Eligible employees are LE Staff who are: Working on a full time or part time basis under non-temporary direct hire appointments, personal services agreements, or personal services contracts and paid under the terms of the Local

Compensation Plan. Not eligible are those working under temporary appointments;

those working under a PSC or PSA that is time limited to less than one year; those with an intermittent, seasonal, or WAE (when actually employed) schedule; non-personal services contract personnel and their employees, supplied by an independent contractor licensed to do business in Panama 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.

Official Residence Expense (ORE), American Employees Recreation Association

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

C.1.3.1.2 For active and retired employees and their dependents, the following coverage is offered under a rider to the contract. Continued coverage of active and retired employees and their dependents as provided under previous plans, as detailed below in section C.1.3.3.3. Only those employees previously grandfathered will continue this coverage. Retired employees will be responsible for the full payment of premiums.

C.1.3.2 Location of Employment

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

Department of State

Department of Agriculture: APHIS, ARS, FAS

Department of Justice: DEA, LEGATT, OPDAT

Department of Homeland Security: ICE, CIS, CBP, USCG, TSA

Department of Defense: DAO, ODC, TAT, NCIS

Department of Commerce: FCS

Department of Treasury: IRS

Department of Transportation: FAA

Open Source Enterprise

U.S. Peace Corps

American Battle Monuments Commission

Any other USG agency as required.

C.1.3.3 Participants Covered Under a Rider:

C.1.3.3.1 All current active employees of the Chief of Mission and the Deputy

Chief of Mission assigned to their respective official Government residences and paid under an ORE account (see separate rider, Exhibit B). All costs for ORE employees are the responsibility of the employing officer, not the U.S. Government.

C.1.3.3.2 All current active employees of the American Employee Recreation

Association at U.S. Embassy Panama (see separate rider, Exhibit C). All costs for

AERA employees are the responsibility of the American Employee Recreation

Association, not the U.S. Government.

C.1.3.3.3 Special Coverage for Active and Retired Employees and Dependents:

For active and retired employees and dependents, the following coverage is offered under a rider to the contract. Continued coverage of active and retired employees and their spouses as provided under previous plans, as detailed below. Only those employees previously grandfathered will continue this coverage. Retired employees will be responsible for the full payment of premiums.

Eligibility for special coverage applies to LE Staff employees in the following categories:

From age 65 to age 80, retired employees who are not current full-time employees.

From age 67 to age 75, current employees enrolled before February 1, 1995.

From age 67 to age 70, current employees enrolled after February 1, 1995 and before

June 30, 2006.

Special Coverage:

Maximum Contract Lifetime Benefit USD $100,000

Annual Deductible USD $250

Accumulation Period Calendar Year

Co-Insurance (Active Employees) 80%/20%

Note: Retired employees are responsible for 100% of premium payments.

Retired employees enrolled before February 1, 1995, that have not reached 67 years old, are entitled to the benefits listed in C.1.1. until they reach 67 years old.

Unless eligible for coverage in accordance with this paragraph, retired employees and employees 67 years of age or older are not covered under the medical insurance plan at this time. An enrolled employee and his/her eligible and enrolled dependents may continue coverage until the end of the contract year in which the employee turns

67.

Retired Employee and Dependent Health Services:

HOSPITAL EXPENSES BENEFITS Max / Reimbursement %

- Room and Board – Daily $100.00 (80%)

Maximum 35 days $3,500.00 (80%)

- Intensive Care Unit – Daily $250.00 (80%

(Maximum 15 days) $3,750.00 (80%

- Hospital Services

Maximum per incapacity (Medical expenses) $750.00 Per day (80% Per day

Emergency per accident/illness $370.00 (80%) Per event

In case the insured needs Emergency room attention, due to an illness, a co-payment of

$20.00 will be charged.

- Ambulance Benefit $75.00 (80%) Per event

SURGICAL BENEFITS

- Maximum Surgeon’s Fee (per incapacity) $1,750.00 (80%)

- Anesthesiologist 50% (80%)

Max / Reimbursement %

ASSISTANT FEE

- Assistant Fee 50%

MATERNITY BENEFITS

- Normal Birth $750.00 (80%)

- Caesarian Extra-Uterine $1,500.00 (80%)

- Legal Miscarriage $450.00 (80%)

- High Risk Pregnancy $300.00 (80%)

COVERS (AFTER DEDUCTIBLE)

- Doctor’s Visits (home, office and hospitals) 80%

- Physical Therapy 80%

- Prescription Drugs 80%

- Laboratory and X Rays Fees 80%

- Psychiatric Treatment (Maximum 20 treatments) $30.00 (80%)

DENTAL SERVICES

- Dental Services 50%

Maximum of USD 600 per year for all dental expenses

Orthodontic expenses are not covered.

- OPTICAL CARE

50% coverage of expenses for eye examination and treatment

PROFESSIONAL SERVICES & TREATMENT

- Professional Services and Treatment: 80% reimbursement for medical services and expenses when not hospitalized, such as laboratory tests and x-rays, routine annual physical examination, and inoculations.

Note: Retired employees are responsible for 100% of premium payments.

C.1.4. Individuals Not Eligible for Coverage

Not eligible are those working under temporary direct hire appointments; those working on When

Actually Employed (WAE) schedules; 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 Panama 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 43.

C.1.5. Other Eligible Participants - Dependent Coverage:

Expenses incurred by an enrolled employee's eligible dependents are covered under this plan.

Enrollment of eligible dependents is voluntary. For the purposes of this plan, an employee's dependents are defined as the employee's legal spouse (limit one) 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, stepchild, or foster child. An eligible child will be covered until the end of the contract year in which the child turns age 18, or in the case of a child who is a full-time student, until the end of the contract year in which the child turns age

25. 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.

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

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.

During a period of leave without pay or unpaid leave beyond one pay period the employee is responsible for the full cost of premiums. The USG will pay the premium directly to the contractor and will collect the full cost from the employee. Alternatively, the employee may elect to have coverage cease if he/she prefers not to pay the premium.

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

C.1.7. Brochure Requirement

C.1.7.1 The contractor shall provide a document (brochure/pamphlet/other written document) in English and Spanish 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.

PART II GROUP LIFE INSURANCE

C.2. GROUP LIFE INSURANCE

The Government of the United States of America requires group life insurance coverage for its employees, as further described in C.2.2, in Panama. The Government has determined that the prevailing practice by employers in Panama is that group life insurance coverage is representative of locally prevailing compensation practice and that the cost of such insurance protection is usually borne by the employer. Therefore, the Government desires to adopt such locally prevailing practice as part of its compensation plan for its employees as further described in C.2.2. The specific group insurance coverage under this contract is set forth in this part of Section C and the Attachments in

Section J.

C.2.1. Group Life Insurance Coverage

The amount of group life insurance coverage is as follows:

C.2.1.1 Amount of Employee Basic Life insurance:

Natural Death: The participant's named beneficiaries or estate will receive an amount equal to twenty (20) times his or her basic monthly salary upon the death of the participant.

Funeral Benefit: USD 2,000.

C.2.1.2 Amount of Employee Accidental or work related Death insurance:

The participant's named beneficiaries or estate will receive an amount equal to twenty seven (27) times his or her basic monthly salary upon the death of the participant.

Funeral Benefit: USD 2,000.

C.2.1.3 Disability Benefit:

(1) Total Disability: In the event of permanent disability the employee is eligible for an amount of coverage equal to twenty (20) times his or her monthly basic salary.

(2) Partial Disability:

100% for loss of both arms or hands; both legs or feet; one arm or hand and one leg or foot; loss of vision in both eyes.

50% for the loss of one arm or hand; one leg or foot; loss of vision in one eye; total loss of speech or hearing. All percentages are based on the amount for natural death.

C.2.2. Life Insurance Benefits Conditions and Limitations

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

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 benefits shall be payable under this contract if the insurance event has been caused directly or indirectly and totally or partially by:

1. Self-inflicted wounds or wounds inflicted at the employee’s request, irrespective of the employee being sane or insane, except suicide. In case the insured dies due to suicide, coverage will be paid on the basis of natural death, provided that the employee has been under the insurance policy for a minimum of 18 months.

2. Violating the law or resisting detention or arrest.

3. Participating in competitions involving the use of wheeled vehicles, horses, boats, or water skis.

4. Flying an airplane or any other aircraft as a passenger or otherwise, except as a passenger on an airplane operated by a passenger airline on a scheduled air service over an established passenger route.

5. 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.

C.2.3. Eligible Participants

C.2.3.1 Eligible Employees: 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.

C.2.3.2 Location of Employment

The individuals covered by C.2.3.1 must be employed within the geographic boundaries of Panama by:

Department of State

Department of Agriculture: APHIS, ARS, FAS

Department of Justice: DEA, LEGATT, OPDAT

Department of Homeland Security: ICE, CIS, CBP, USCG, TSA

Department of Defense: DAO, ODC, TAT, NCIS

Department of Commerce: FCS

Department of Treasury: IRS

Department of Transportation: FAA

Open Source Enterprise

U.S. Peace Corps

American Battle Monuments Commission

Any other USG agency as required.

C.2.3.3 Participants Covered Under a Rider

C.2.3.3.1 All current active employees of the Chief of Mission and the Deputy

Chief of Mission assigned to their respective official Government residences and paid under an ORE account (see separate rider, Exhibit B). All costs for ORE employees are the responsibility of the employing officer, not the U.S. Government.

C.2.3.3.2 All current active employees of the American Employees Recreation

Association at the U.S. Embassy Panama (see separate rider, Exhibit C). All costs for AERA are the responsibility of the American Employee Recreation Association, not the U.S. Government.

C.2.4. Individuals Not Eligible for Coverage

C.2.4.1 New employees who have reached the age of 65 prior to entering on duty with the U.S. Government will not be eligible for life insurance coverage.

C.2.4.2 Not eligible are LE Staff working under temporary appointments, those working under a PSA or PSC that is limited to less than one year, those with a When

Actually Employed (WAE) workweek; non-personal services contract personnel and their employees, supplied by an independent contractor licensed to do business in Panama 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 and any other individual not falling within one of the categories of employees described in this

C.2.4.3 Retirees and dependents are not eligible.

C.2.5. Other Eligible Participants

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

None

C.2.6. Eligibility and Effective Date

C.2.6.1 Term of Eligibility and Effective Date

Each current active eligible employee is enrolled for life insurance and disability 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.2.6.2 Period of Ineligibility

Employees are not entitled to life insurance and disability benefits hereunder during any period of employment for which premiums are not paid.

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

C.2.7. Brochure Requirement

C.2.7.1 The contractor shall provide a document (brochure/pamphlet/other written document) in English and Spanish that sets forth a complete listing of the life insurance benefits to be provided under this contract. This brochure shall be provided in sufficient quantities so that each covered employee receives a copy.

The contractor shall furnish all copies of the brochures to the COR, who will ensure that appropriate distribution is made.

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

30 days after date of contract award. The contractor shall provide additional brochures for new employees within ten days of the COR’s request.

C.2.7.3 The contractor assumes full responsibility for ensuring that the document described in C.2.7.1 accurately reflects the requirements of the contract, as implemented by the contractor’s technical proposal. In all cases, the contract shall take precedence. Should the COR discover that the brochure contains inaccuracies, the contractor will be notified in writing; however, failure on the part of the Government to notice any inaccuracies shall in no way limit, revise or otherwise affect the requirement under this contract for the contractor to fully comply with all contract terms.

C.3. DEFINITIONS

FMO The Financial Management Officer (FMO) or the paying office for all

U.S. Government Agencies, except U.S. AID.

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

Assistant at post.

Contributory

Insurance

Insurance for which the employee contributes toward the premium.

Currency Premiums and benefits will be paid in US Dollars (USD).

Customary and

Reasonable

Treatment

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

Dependent Child is defined as the employee's natural child, adopted child, stepchild, or foster child. An eligible child will be covered until the end of the contract year in which the child turns age 18, or in the case of a child who is a full-time student, until the end of the contract year in which the child turns age 25. 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.

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 and C.2.3 for life insurance. This may also include ORE

Staff and AERA employees, if this category of individual is listed as participating under a rider in C.1.3.3 for health insurance and C.2.3.3 for life insurance.

Employer The United States Government or in the case of ORE and AERA employees, the Chief of Mission/Deputy Chief of Mission and the

American Employee Recreation Association, respectively.

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

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

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

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

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

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

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

D. SECTION D - PACKAGING AND MARKING

(RESERVED)

E. SECTION E - INSPECTION AND ACCEPTANCE

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

This contract incorporates the following clauses by reference, with the same force and effect as if they were given in full text. Upon request, the Contracting Officer will make their full text available. Also, the full text of a clause may be accessed electronically at this address:

http://acqusition.gov/far/index.html or, http://farsite.hill.af.mil/search.htm

These addresses are subject to change. If the Federal Acquisition Regulation (FAR) is not available at the locations indicated above, use the Dept. of State Acquisition Website at http://www.statebuy.state.gov to see the links to the FAR. You may also use a network “search engine” (e.g., Yahoo, Excite, Alta Vista, etc.) to obtain the latest location of the most current FAR.

FEDERAL ACQUISITION REGULATION (48 CFR CH. 1)

52.246-4 Inspection of Services - Fixed Price (AUG 1996)

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

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

Contracting Officer of continued unsatisfactory performance. The contractor, not the Government, is responsible for management and quality control to meet the terms of the contract. The role of the

Government is to conduct quality assurance to ensure that contract standards are achieved.

Performance Objective PWS Para Performance Threshold

Services.

Performs all the insurance services set forth in the performance work statement (PWS)

C.1.0 thru

C.3.0

All required services are performed and no more than one

(1) customer complaint is received per month

E.2.1. Surveillance. The COR will receive and document all complaints from Government personnel regarding the services provided. If appropriate, the COR will send the complaints to the Contractor for corrective action.

E.2.2. Standard. The performance standard is that the Government 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 http://acqusition.gov/far/index.html http://farsite.hill.af.mil/search.htm http://www.statebuy.state.gov/ 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.

E.2.3. Procedures

(a) If any Government personnel observe unacceptable services, either incomplete work or required services not being performed, they should 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, orally notify the Contractor of any valid complaints.

(f) If the Contractor disagrees with the complaint and challenges the validity of the complaint, the Contractor will notify the COR. 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 complaint.

(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

F. SECTION F - DELIVERIES OR PERFORMANCE

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

http://www.statebuy.state.gov to see the links to the FAR. You may also use a network “search engine” (e.g., Yahoo, Excite, Alta Vista, etc.) to obtain…