Version_2_Amendment_1.doc

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

1. CONTRACT ID CODE

PAGE OF PAGES

1 13

2. AMENDMENT/MODIFICATION NO.

3. EFFECTIVE DATE

02/02/2015

4. REQUISITION/PURCHASE REQ. NO.

5. PROJECT NO. (If applicable)

6.

ISSUED BY

CODE

7. ADMINISTERED BY (If other than Item 6) CODE

American Embassy

Contracting Office

Serrano, 75 – Box 27

28006 Madrid

8.

NAME AND ADDRESS OF CONTRACTOR (NO., street,city,county,State,and ZIP Code)

9a. AMENDMENT OF SOLICITATION NO.

S-SP500-15-R-0001

To all prospective offerors

9b. DATED (SEE ITEM 11)

January 12, 2015

10a. MODIFICATION OF CONTRACT/ORDER NO.

10b. DATED (SEE ITEM 13)

11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS

[ X ] The above numbered solicitation is amended as set forth in Item 14. The hour and date specified for receipt of Offers

[ ] is extended, [X] is not extended

Offers must acknowledge receipt of this amendment prior to the hour and date specified in the solicitation or as amended, by one of the following methods: (a) By completing Items 8 and 15, and returning _1_ copies of the amendment;(b) By acknowledging receipt of this amendment on each copy of the offer submitted; or(c) By separate letter or telegram which includes a reference to the solicitation and amendment numbers.

FAILURE OF YOUR ACKNOWLEDGMENT TO BE RECEIVED AT THE PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY RESULT IN REJECTION OF YOUR OFFER. If by virtue of this amendment you desire to change an offer already submitted, such change may be made by telegram or letter, provided each telegram or letter makes reference to the solicitation and this amendment, and is received prior to the opening hour and date specified.

12. ACCOUNTING AND APPROPRIATION DATA (If required)

13. THIS ITEM APPLIES ONLY TO MODIFICATIONS OF CONTRACTS/ORDERS,

IT MODIFIES THE CONTRACT/ORDER NO. AS DESCRIBED IN ITEM 14.

A. THIS CHANGE ORDER IS ISSUED PURSUANT TO: (Specify authority) THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE

CONTRACT ORDER NO. IN ITEM 10A.

B. THE ABOVE NUMBERED CONTRACT/ORDER IS MODIFIED TO REFLECT THE ADMINISTRATIVE CHANGES (such as changes in paying office, appropriation date, etc.) SET FORTH IN ITEM 14, PURSUANT TO THE AUTHORITY OF FAR 43.103(b)

C. THIS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO AUTHORITY OF:

D. OTHER (Specify type of modification and authority)

E. IMPORTANT: Contractor [ ] is not, [] is required to sign this document and return __ copies to the issuing office.

14. DESCRIPTION OF AMENDMENT/MODIFICATION (Organized by UCF section headings, including solicitation/contract subject matter where feasible.)

This amendment modifies original solicitation as follows:

1. Section C.1. HEALTH INSURANCE SERVICES is hereby amendeded to include Premium expenses by adding the following paragraph:

For active employees who are regularly scheduled to work 30 or more hours per week the U.S. Government will pay 90 % of the premium cost and the employee will pay 10 % of the premium cost. The U.S. Government will pay 75% of the premium cost and the employee will pay 25% for dependent coverage.

For active employees who are regularly scheduled to work less than 30 hours per week: the U.S. Government will pay a prorated share of the premium cost for employee and dependent coverage based on the number of hours is regularly scheduled to work.

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.

The hour and date specified for receipt of Offers is not extended. Offers must be received on or before February 11, 2015 at 17:30

15A. NAME AND TITLE OF SIGNER (Type or print)

16A. NAME OF CONTRACTING OFFICER

Richard C. Price

15B. NAME OF CONTRACTOR/OFFEROR

BY

(Signature of person authorized to sign)

BY

(Signature of Contracting Officer)

16C.DATE SIGNED

SF30

2. Under paragraph C.1.1., please delete the second paragraph in its entirety and substitute in lieu thereof the following:

Reimbursements or payments shall be made for the following covered benefits, subject to reasonable and customary costs in the locality where treatment was provided. There will be no grace period for receipt of any services for holders of this group policy.

Under the proposed medical insurance with free choice from list of participating health care professionals, the policy holder may receive the following services and care at no additional cost per service other than the monthly premium payments established in the contract except in those services where deductibles have been authorized in the solicitation.

The Contractor may offer reimbursable health insurance for those employees who elect to have that type of insurance at their own expense. The maximum reimbursement amount will be EU 150,000

3. Under paragraph C.1.6. Dental care, please replace it in its entirety and substitute in lieu thereof the following:

40% coverage of expenses for dental services including dentists' fees, x-rays, examination and treatment, cleaning, fillings, extractions, false teeth, crowns, and bridges.

Orthodontia treatment is covered only if treatment begins before age 15, unless required as the result of an accident. A maximum of four years of orthodontia treatment will be covered per patient.

4. Under Section C.3.0. Definition of ORE employee is included as follows:

ORE Employee: ORE stands for Official Residence Expenses. ORE employees work at Ambassador and Deputy Chief of Mission residences. These employees will be covered under a rider.

A revised section C is attached to this Amendment.

5. Section G.4.1 SUBMISSION OF INVOICES AND PAYMENT language is substituted. This section will read as follows:

G.4

SUBMISSION OF INVOICES AND PAYMENT

G.4.1.

Invoices for U.S. Government employees shall be submitted in an original and three (3) copies to the following address (designated billing office only for the purpose of submitting invoices):

Financial Management Officer

Contract number (This will be provided after award)

U.S. Embassy

Serrano, 75

28006 Madrid

CIF N4001548I

Electronic invoices can also be submitted to the following e-mail address:

MadridFMO.faturas@state.gov

6. Section H.4.(a)(4), H.4. (b)(4) language is substituted as follows:

H.4.

CONTRACTOR RESPONSIBILITY IN CLAIMS AND REIMBURSEMENT TO CLAIMANTS

General.

The Contractor shall be responsible for all planning, estimating, programming, project management, scheduling, dispatching, supervision, and inspection of work. The Contractor shall maintain his own reference library of technical reference works and local laws and regulations, including current tariffs and registries. The Contractor shall treat the information provided by the Embassy concerning employee' personal data, medical information, and salaries as highly sensitive and not divulge any employee information to unauthorized persons. The Contractor shall establish procedures for handling medical insurance claims as follows:

(a) Administrative Records

(1) The Contractor shall maintain medical insurance files for each covered employee and each covered dependent including receipts and proof of paid claims, requests for claim reimbursements, and accounting of paid benefits with balances of amounts remaining in the annual per person reimbursement ceiling.

(2) The Contractor shall provide the COR with the necessary claim forms for each type of benefit that can be claimed under the contract. These forms shall specify a list of documents required to be appended to each claim and otherwise provide instructions for claim filing.

(3) The Contractor shall use the English spelling of the employees' names in all transactions, including reimbursement checks.

(4) The Contractor shall provide employee claim reimbursement checks to the COR for disbursement to the employee not later than the Tuesday which is two weeks after the claim has been submitted. In case of Electronic Funds Transfer, proof of payment shall also be provided to the COR not later than the Tuesday which is two weeks after the claim has been submitted.

(b) Medical Insurance Claims. Settlement of medical insurance shall be completed as follows:

(1) All medical claims shall be submitted directly to the Contractor by employees, through a drop box in the COR's office. The claims shall be picked up from the COR each Tuesday.

(2) The Contractor shall date stamp and screen all claims submitted on the day of receipt. If there are any missing documents or information thereby disallowing said claim to be payable, the Contractor shall notify the employee within two days, with a copy to the COR (if notification is written).

(3) The Contractor shall settle the claims no later than two weeks from the date the claim is submitted to the Contractor.

(4) Settlement shall be by issuance of checks in the name of the employee for each claim submitted or via Electronic Funds Transfer to claimants provided bank account. Each reimbursement shall be accompanied by a form providing details of the amount reimbursed with an explanation of deductions, if any.

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

(c) Reserved

7. Language in Section L.4.2. is hereby substituted in lieu of the existing language. This section will read as follows:

L.4.2. Volume 2 -- Price Proposal and fill in Section B.

(a) Price proposal for the base year of health insurance;

(b) Price proposal for the option years; however, a price proposal for an option year with no proposal for the base year will not be considered, nor will a proposal for a base period which does not include a proposal for all optional periods for that same type of insurance.

8. Section L.4.3.1 (b) is hereby amended to add new language. This section will read as follows.

L.4.3.1 Management Approach

(a) Understanding of the Requirement

(i) The offeror must demonstrate that it understands the requirement set forth in Sections C, Parts I and/or II through Section J of the solicitation. The offeror must demonstrate a knowledge and familiarity in providing the insurance and services required in the aforementioned sections of the solicitation. For health insurance, if the proposal is for a health maintenance organization (HMO) or clinic type, describe the facilities and medical personnel that will be available. The offeror must also describe the pool of coverage in which the covered employees will be contained, and, a description of how the experience rating would be determined in regards to Section B.4.

(ii) Proposals shall contain only the benefit levels stated in Section C. Proposals offering benefit levels greater or less than those levels required in Section C may be rejected as unacceptable.

(b) Plan Administration

The offeror must demonstrate how it plans to perform the contract, especially as it relates to:

· Providing the insurance by providing a list of its network physicians/nurses and medical facilities.

· Maintaining adequate reserves to pay claims, including accounting procedures

· Administering and prompt payment of insured claims for reimbursement

· Procedures for reviewing claims (including where and how claims will be processed and settled)

· Description of the system for tracking utilization of services by claimants by diagnostic or other actuarial categories/profiles and comparing them against regional or national norms

· Availability of central point of contact and phone number for employees to call regarding claims or information

· Providing periodic reporting and accounting of financial results of the plan, including reporting formats

· Procedures and rates for converting from group insurance to individual insurance policies

· The overall management of the contract.

SECTION C

DESCRIPTION/SPECIFICATION/WORK STATEMENT

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 Spain. The Government has determined that the prevailing practice by employers in Spain is to provide for their employees health insurance protection and that the cost of such insurance protection is usually borne by both the employee and the employer:

For active employees who are regularly scheduled to work 30 or more hours per week the U.S. Government will pay 90 % of the premium cost and the employee will pay 10 % of the premium cost. The U.S. Government will pay 75% of the premium cost and the employee will pay 25% for dependent coverage.

For active employees who are regularly scheduled to work less than 30 hours per week: the U.S. Government will pay a prorated share of the premium cost for employee and dependent coverage based on the number of hours is regularly scheduled to work.

Employees who were covered under the medical insurance plan at the time of retirement may elect to continue coverage for themselves and their dependents. In this case, the retired employee will pay 100% of the premium cost for employee and dependent coverage.

There is no coverage for expenses that will be reimbursed or paid directly under a host country medical program or workers compensation program; or post’s LES workers compensation type program.

Health insurance protection will be representative of locally prevailing compensation practice as further described in C.1.1. The specific health benefit coverage under this contract is set forth in Section C and the Exhibits in Section J.

Post-Unique Benefits C.1.1 Employee and Dependent Health Services Benefits

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

Reimbursements or payments shall be made for the following covered benefits, subject to reasonable and customary costs in the locality where treatment was provided. There will be no grace period for receipt of any services for holders of this group policy.

Under the proposed medical insurance with free choice from list of participating health care professionals, the policy holder may receive the following services and care at no additional cost per service other than the monthly premium payments established in the contract except in those services where deductible has been authorized in the solicitation.

The Contractor may offer reimbursable health insurance for those employees who elect to have that type of insurance at their own expense. The maximum reimbursement amount will be EU 150,000 C.1.1.1. Hospitalization:

100% coverage of room and board expenses for a private room, not to exceed 100% of the cost of a semi-private room.

100% coverage of hospital medical expenses including laboratory tests and x-rays, nursing care, operating room expenses, intensive care, prescription medicines, and physical therapy.

100% coverage of ambulance service.

C.1.1.2. Professional Services and Treatment:

100% coverage of doctors’ and surgeons' fees incurred while hospitalized, at a hospital on an out-patient basis, at a clinic or doctor's office, or at home. 100% coverage of for medical services and expenses when not hospitalized such as laboratory tests and x-rays, physical therapy, routine annual physical examinations, and inoculations.

Prescription drugs and medicines are not covered under this plan.

C.1.1.3. Obstetrical Care:

100% coverage of expenses when hospitalized and 100% coverage of expenses when not hospitalized, of obstetrical medical care including prenatal care.

C.1.1.4. Hearing Aids:

100% coverage of expenses for related examination only. The hearing aid apparatus is not covered under this plan.

C.1.1.5. Optical Care:

100% coverage of expenses for eye examination and treatment only.

No coverage of expenses for eyeglass frames, lenses, nonprescription lenses, or tinting.

C.1.1.6. Dental Care:

40% coverage of expenses for dental services including dentists' fees, x-rays, examination and treatment, cleaning, fillings, extractions, false teeth, crowns, and bridges.

Orthodontia treatment is covered only if treatment begins before age 15, unless required as the result of an accident. A maximum of four years of orthodontia treatment will be covered per patient.

C.1.1.7. Psychiatric Treatment:

100% coverage of expenses for psychiatric treatment for up to 50 days.

C.1.1.8. 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. Reimbursement will be made at the same percentage rate and subject to the same annual maximum limit as for expenses incurred in country.

C.1.1.9. Transportation for Out of Country Medical Treatment:

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

C.1.1.10. Maximum Annual Coverage:

The insurance company will reimburse covered expenses up to a limit of Euro 150,000 per family per contract year.

C.1.2. Health Benefits Conditions and Limitations:

Conditions and limitations on the entitlement to health care under this contract are as follows:

Expenses will not be covered for prescription drugs and medicines, elective cosmetic surgery; spa cures; rejuvenation cures; massage; exercise therapy; long term rehabilitative therapy; eyeglass frames, lenses, nonprescription lenses, or tinting; orthodontia treatment; family planning (i.e., prescribed contraceptive devices and drugs, voluntary sterilization, and diagnosis and treatment of infertility, fertility drugs, reversal of voluntary sterilization, infertility treatment after voluntary sterilization, genetic counseling, and assisted reproductive technology), 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 Spanish LE Staff workers' compensation type program.

No coverage of 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; a self- inflicted wound; or service in the armed forces of any country.

No coverage of will be made for expenses incurred after an employee leaves the service of the U.S. Mission, except in the case of retired employees who elect to continue coverage.

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 Spain paid under the Local Compensation Plan, and certified by the Contracting Officer. Covered employees include

C.1.3.1.2.

Foreign Service Nationals (FSNs) employed under direct hire appointments, Personal Services Agreements (PSAs) and Personal Services Contracts (PSCs);

C.1.3.1.3.

Locally hired U.S. citizens employed under direct hire appointments, PSAs, and PSCs.

C.1.3.2 Location of Employment

The individuals covered by C.1.3.1 must be employed within the geographic boundaries of Spain by: Department of State, Department of Justice, Department of Agriculture, Department of Commerce, Department of Homeland Security, and Department of Defense.

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 D). All costs for ORE employees are the responsibility of the employing officer, not the U.S. Government.

C.1.3.3.2 Reserved.

C.1.4

Individuals Not Eligible for Coverage

Individuals not eligible for coverage under this contract are non-personal services contract personnel; Peace Corps Personal Services Contractors as required by MS 743; employees working on a temporary basis; employees with an intermittent, seasonal, or WAE (when actually employed) schedule; and any other individual not falling within one of the categories of employees described in this clause.

C.1.5.

Other Eligible Participants

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

C.1.5.1 Covered dependents include the participating employee’s spouse and children. A limit of one spouse per employee is covered. An eligible child is defined as the employee’s natural child, adopted child, stepchild, or foster child. The child must be unmarried, economically dependent upon the employee, and reside with the employee unless away at school. An eligible child will be covered until the end of the contract year in which he/she reaches age 18, or age 25 if a full time student. There is no age limit for a child who is physically or mentally handicapped so as to be unable to live independently. There is no limit on the number of children covered per employee.

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

C.1.5.2. Employees who were covered under the medical insurance plan at the time of retirement may elect to continue coverage for themselves and their dependents after retirement.

C.1.5.3.

Eligibility

C.1.5.4.

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 that is one pay period or less, coverage under the insurance contract will continue. The USG will pay the total premium cost to the contractor. The employee’s share of the premium will be collected through payroll deduction in that or the subsequent pay period.

C.1.5.5. 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 or unpaid leave, the employee is responsible for the full cost of the insurance premiums for self and dependents. The Mission will pay the premiums directly to the contractor, and will collect the full cost from the employee on a quarterly basis. Alternatively, the employee may elect to have coverage cease if that employee prefers not to pay the premium.

C.1.6.

BROCHURE REQUIREMENT.

C.1.6.1.

The contractor shall provide a document (brochure/pamphlet/other written document) in English and 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.1.6.2.

The contractor shall provide the document described in C.1.6.1 to the COR not later than 45 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.1.6.3.

The contractor assumes full responsibility for ensuring that the document described in C.1.6.1 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 RESERVED

C.3.0

DEFINITIONS

FMO:

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

COR:

Contracting Officer's Representative (COR) (Human Resources Officer at post).

Contributory:

Insurance for which the employee contributes toward the premium.

Dependent:

Covered dependents include the participating employee’s spouse and children. A limit of one spouse per employee is covered. An eligible child is defined as the employee’s natural child, adopted child, stepchild, or foster child. The child must be unmarried, economically dependent upon the employee, and reside with the employee unless away at school. An eligible child will be covered until the end of the contract year in which he/she reaches age 18, or age 25 if a full time student. There is no age limit for a child who is physically or mentally handicapped so as to be unable to live independently. There is no limit on the number of children covered per employee.

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.

Emergency Situation that requires immediate medical care as a delay could cause life threatening or harm to the patient’s health.

Employee:

An individual employed by the U.S. Government, under a direct-hire appointment, personal services contract (PSC), or personal services agreement (PSA). This may also include an ORE Staff, if this category of individual is listed as participating under a rider in Section C.1.3.3.

ORE Employee: ORE stands for Official Residence Expenses. ORE employees work at Ambassador and Deputy Chief of Mission residences. These employees will be covered under a rider.

Employer:

The United States Government or in the case of ORE the Chief of Mission and or Deputy Chief of Mission, 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.

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

Premium: The amount that the Policy Holder has to pay the insurer.

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.

Registered Nurse: An individual who has a Diploma in Nursing and is legally qualified and authorized to provide nursing care.

Surgical procedure:

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