Health_Insurance_Solicitation_REVISED.pdf

LES Health Insurance Services Solicitation Page 2 of 60

STC10014R0001

SECTION B

PART I; PRICE - HEALTH INSURANCE

B.1. HEALTH INSURANCE SERVICES

The Contractor shall provide the Health Insurance services to employees (U.S. Embassy, Abu

Dhabi and U.S. Consulate General, Dubai) of the Government of the United States of America in the United Arab Emirates 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.1.1.16. This insurance shall be provided in accordance with Section C and the Exhibits in Section J.

B.1.1. Official Residence Expense (ORE) Staff, American Embassy Employees Association

(AEEA) and MSG Detachment Employees and their eligible dependents are covered under a rider to the contract. The employing officer, not the U.S. Government (USG) is responsible for the employer’s share of the premium expenses for ORE, AEEA and MSG Detachment employees and their dependents. The Contractor shall separately bill the Chief of Mission, Deputy Chief of Mission and Consul General (for ORE Staff), the American Embassy

Employees Association (AEEA) and MSG Detachment for their employees’ premium expenses.

B.2. PRICES

B.2.1 VALUE ADDED TAX.

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.

B.2.2 This is a fixed price with economic price adjustment requirements type contract under which firm, fixed-price task orders will be issued. 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: (Annual maximum AED 400,000 per individual per year)

Bi-Weekly Rates Per Insured Members:

Category Estimated

Number of insured members

Rate Total

Single Employees

(Self only)

Family Members 619

SUBTOTAL

Total Price for Base Year (Subtotal x 26): _______

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B.2.4. FIRST OPTION YEAR OF THE CONTRACT:

Number of insured members

Rate Total

Single Employees

(Self only)

Total Price for First Option Year (Subtotal x 26): _______

B.2.5. SECOND OPTION YEAR OF THE CONTRACT:

number of

Insured

Members

Rate Total

Single Employees

(Self only)

Total Price for Second Option Year (Subtotal x 26): _______

B.2.6. THIRD OPTION YEAR OF THE CONTRACT:

Insured

Members

Rate Total

Single Employees

(Self only)

Total Price for Third Option Year (Subtotal x 26): _______

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B.2.7. FOURTH OPTION YEAR OF THE CONTRACT:

Insured

Members

Rate Total

Single Employees

(Self only)

Total Price for Fourth Option Year (Subtotal x 26): _______

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.

B.3.2.1 Bi-Weekly Retention Amounts per separate premium paid per single employee and per family members.

Period of

Performance

Single Employees (Self

Only)

Family Members

Base Period

Option Year 1

Option Year 2

Option Year 3

Option Year 4

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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.

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. Before any such adjustment is made, the contractor agrees to provide the Government a balance sheet showing two main components for the time period: (1) receipts (premiums received) minus the retention amount and (2) claims paid. The retention amount is not subject to adjustment. The

Government reserves the right to have an independent third party review the balance sheet 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. 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.

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SECTION C

DESCRIPTION/SPECIFICATION/WORK STATEMENT

PART I - HEALTH INSURANCE

C.1. HEALTH INSURANCE SERVICES

The Government of the United States of America requires Health Insurance coverage for its employees (as further described in C.1.1) in the United Arab Emirates. The Government has determined that the prevailing practice by employers in United Arab Emirates is to provide for their employees health insurance protection and that the cost of such insurance protection is usually borne by the employer. 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.

C.1.1 Employee and Dependent Health Services Benefits:

C.1.1.1.Health Services Benefits Plan/Medical Coverage

Insurance coverage applies when services are rendered at a network medical provider unless otherwise pre-approved or outside the network medical provider on reimbursement basis. The insurance company will cover/reimburse 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 UAE, the United

States, or in the country in which the treatment or prescription is received. Coverage of expenses will be made in local currency. The health insurance coverage details are as follows:

C.1.1.2. Deductible:

None.

C.1.1.2. Hospitalization:

100% coverage of room and board expenses for a ward room, semi-private room, or 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 land ambulance service.

C.1.1.3. 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 for medical services and expenses when not hospitalized such as laboratory tests and x-rays, prescription medicines, physical therapy, routine annual physical examinations, and inoculations.

Co-payment: Employee is responsible for 50 AED per doctor’s visit for out-patient for employee and dependents.

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C.1.1.4. Prescription Drugs and Medicines:

100% coverage of expenses when hospitalized, and 100% coverage of expenses when not hospitalized, of the cost of medicines and drugs for which a prescription is legally required. Prior approval is required for any medication that exceeds 500 AED.

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.1.1.5. HIV/AIDS Coverage (for active employees only):

100% coverage of expenses (up to a limited of U.S. $10,000) 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. This expanded coverage does not apply to dependents or to retired employees.

NOTE: WHEN THE INSURANCE COMPANY WILL NOT PROVIDFE HIV/AIDS COVERAGE, THE

U.S. EMBASSY WILL PROVIDE 100% REIMBURSEMENT TO A MAXIMUM OF USD 10,000 PER

PERSON FOR MEDICATIONS TO SUPPRESS OPPORTUNISTIC INFECTIONS, SUCH AS

TUBERCULOSIS AND TOXOPLASMOSIS FOR EMPLOYEES ONLY 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. THIS EXPANDED COVERAGE

DOES NOT APPLY TO DEPENDENTS OR TO RETIRED EMPLOYEES.

C.1.1.6. Obstetrical Care:

100% coverage of expenses when hospitalized and 100% coverage of expenses when not hospitalized, of obstetrical medical care including pre-natal care and post-natal care.

C.1.1.7. Family planning:

Not Covered.

C.1.1.8. Hearing Aid:

70% coverage of the cost of a hearing aid apparatus and related examination.

C.1.1.9. Optical Care:

50% coverage of expenses for eye examination and treatment and prescription eyeglass or contact lenses. Prescription eyeglass or contact lenses up to a maximum of 832.00 AED a year per patient.

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

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C.1.1.10. Dental Care:

100% coverage of expenses for dental services including dentists' fees, x-rays, examination and treatment, cleaning, fillings, extractions, false teeth, crowns, and bridges.

100% coverage for minor restorative, major restorative and orthodontia treatments up to a maximum of 7,190.00 AED per patient per year.

C.1.1.11. Psychiatric treatment:

100% coverage of expenses for psychiatric treatment.

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

C.1.1.13. Transportation for Out of Country Treatment:

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

C.1.1.14. Expenses Not Covered:

Expenses will not be covered for elective cosmetic surgery; spa cures; rejuvenation cures; massage; exercise therapy; long term rehabilitative therapy; eyeglass frames;

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

U.A.E. LE Staff workers compensation program workers' compensation type 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; a self- inflicted wound; or service in the armed forces of any country.

No coverage will be made for expenses incurred after an employee leaves the service of the U.S. Mission.

C.1.1.15. Maximum Annual Limit:

With the exception of expenses incurred under paragraph C.1.1.5. above, the

Insurance Company will reimburse covered expenses up to a limit of AED 400,000 per individual per contract year.

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The maximum limit for employees regularly scheduled to work on a part-time basis work for fewer than 30 hours per week will be prorated based on hours in the workweek.

C.1.1.16. Eligible Participants

C.1.1.16.1 Eligible Employees:

Eligible employees are Locally Employed (LE) Staff who are:

Working on a full time or part time basis under non-temporary Direct Hire (DH) appointments, Personal Services Agreements (PSAs), or Personal Services Contracts

(PSCs) and paid under the terms of the Local Compensation Plan (LCP).

C.1.1.16.2 Not Eligible Employees:

Not eligible employees are those LE Staff who are:

Working under temporary appointments; those working under a PSC or PSA that is time limited to less than one year; non-personal services contract personnel and their employees, supplied by an independent contractor licensed to do business in United

Arab Emirates who provides services to other local organizations as well as to the

U.S. Mission; employees of USAID institutional contractors; Peace Corps personal services contractors as indicated in MS 743; and Recreation Association employees.

C.1.1.16.3 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) 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 calendar year in which the child turns age 19, or in the case of a child who is a full-time student, until the end of the calendar year in which the child turns age 22. 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.1.1.16.4 Coverage After Retirement:

Retirees are not covered.

C.1.1.16.5 Participants Covered Under a Rider:

a. All current active employees and their eligible dependents of the Chief of

Mission, Deputy Chief of Mission and the Principal Officer assigned to their respective official Government residences and paid under an ORE account. All costs for ORE employees and their dependents are the responsibility of the employing officer, not the U.S. Government.

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b. All current active employees and their eligible dependents of the Employee

Association at Embassy/Consulate in Abu Dhabi/Dubai, United Arab Emirates.

All costs for American Embassy Employees Association (AEEA) employees and their dependents are the responsibility of the AEEA, not the U.S. Government.

c. All current active employees and their eligible dependents of the Marine Security

Guard (MSG) Detachment at Embassy/Consulate in Abu Dhabi/Dubai, United

Arab Emirates. All costs for MSG Detachment employees and their dependents are the responsibility of the MSG Detachment, not the U.S. Government.

C.1.1.17. Coverage Eligibility and Premium Expenses:

C.1.1.17.1. Term of Eligibility and Coverage Effective Date

All current active eligible employees and their dependents will be enrolled for health insurance under the contract upon award and thereafter during the performance period of the contract (list of active employees and their dependents is provided in Exhibit F). Each new eligible employee will be enrolled upon entering on duty with the United States Government

(USG). An employee is considered active ("on the rolls") whenever such employee is on approved leave, whether paid or unpaid. For active employees who are regularly scheduled to work 30 or more hours per week: the USG will pay 100% of the premium cost for employee and dependent coverage. For eligible employees who are regularly scheduled to work less than 30 hours per week: the USG will pay a prorated share of the premium cost for employee and dependent coverage, based on the number of hours the employee is regularly scheduled to work.

The USG will continue to pay premium costs (per UAE law) for employees in a non-pay status not to exceed thirty days after cancellation of their residency visa. A newborn eligible child will be deemed eligible for insurance coverage on the date of birth when the birth is reported within

14 days’ time.

C.1.1.17.2. 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 80 work hours) 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.

C.1.1.18. Brochure Requirement

C.1.1.18.1. The Contractor shall provide a document (brochure/pamphlet/other written document) in English that sets forth a complete listing of the health insurance benefits and terms and conditions to be provided under this contract. This brochure shall be provided in sufficient

LES Health Insurance Services Solicitation Page 11 of 60 quantities so that each covered employee receives a copy. The Contractor shall furnish all copies of the brochures to the Contracting Officer’s Representative (COR) who will ensure that appropriate distribution is made.

C.1.1.18.2. The Contractor shall provide the document described in C.1.1.18. to the COR not later than 20 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.1.1.18.3. The Contractor assumes full responsibility for ensuring that the document described in C.1.1.18. 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 U.S. 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.1.2. Service Location

Medical insurance claims processing and administration services shall be performed at the facilities of the Contractor or their Third-Party Administrator (TPA).

C.1.3. Service Hours

Health plan pre-approval services shall be provided on a 24-hour, seven (7) days a week basis.

C.1.4. Legal Capacity

Contractor shall maintain appropriate licensure as a health insurance service provider with the Health Authority Abu Dhabi (HAAD) and Dubai Health Authority (DHA).

C.1.5. Contract Performance

Contractor shall maintain the organization and its staffing for implementing and operating the Contract. This Contract is a high priority and that the Contractor shall commit to supply any necessary resources to assure full performance of the Contract. Staffing in medical pre-approval department and other health services and in fiscal and administrative services shall be sufficient to result in the effective conduct of the plan’s business.

C.1.6. Medical Decisions

Contractor shall ensure that medical insurance approval decisions, including those by subcontractors and rendering providers, are not unduly influenced by fiscal and administrative management.

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C.1.7. Network Capacity

Contractor shall maintain health care provider network adequate to serve the insured members under this contract. Contractor shall maintain and provide all insured members, a list of approved health care provider network. The Contractor shall accept the insured member’s choice to go for treatment/surgery to any hospital/medical facility designated by the Contractor under their network in order that the Contractor will pay for the expenses directly to the hospital/medical facility.

C.1.8. Claims Processing and Reimbursement

Insured members have formal right to make a choice about the medical services provider.

This includes the right to choose a doctor/hospital/medical provider of their choice who is outside the Contractor’s approved Network. In case an insured member chooses a medical service provider outside the Contractor’s approved Network, the Contractor will be responsible for the settlement of medical expenses on reimbursement basis up to the benefits plan limit under this contract. The Contractor shall be responsible for all planning, estimating, programming, project management, scheduling, dispatching, supervision, and inspection of claims reimbursement work. The Contractor shall treat the information provided by the Embassy concerning employees' personal data, medical information, as highly sensitive and not divulge any employee information to unauthorized persons. The Contractor shall establish procedures for handling medical insurance claims as follows:

C.1.8.1. Administrative Records

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.

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.

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

The Contractor shall send claim reimbursement check to the employee not later than two weeks after a claim is submitted.

C.1.8.2. Medical Insurance Claims Reimbursement

Settlement of medical insurance claims shall be completed as follows:

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 by the Contractor from the

COR each Tuesday.

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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).

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

Settlement of medical claims shall either be by issuance of checks in the name of the employee for each claim submitted or through wire transfer to employee’s personal bank account in the UAE. Each check shall be accompanied by a form providing details of the amount reimbursed with an explanation of deductions, if any.

Claims with missing or incorrect information will be referred back to claimant within two days of receipt with request for correct information.

Unallowable claims will be sent back to claimant within two weeks of receipt with documentation or reasons for benefit denial.

C.1.9. Report Requirements

C.1.9.1. The Contractor shall provide the following reports monthly. All reports must be received by the COR no later than the 10 th day of each month. These reports shall report on the previous month's activities.

Employee Claims Report: The report will list all claims paid by the Contractor to a claimant, including the name of the claimant, date claim is received by the Contractor, and the amount claimed. This report shall also include all outstanding claims and a brief description of why claim has not been paid.

C.1.9.2. Reports and Other Deliverables

All reports and other deliverables required under this contract shall be delivered to the

COR at the following address:

Human Resources Office

Embassy of the United States of America

P.O. Box 4009

Abu Dhabi, UAE

C.1.10. Security/Premises Access

On occasion, a Contractor employee may require entry into U.S. Government-owned facilities. If so, the Contractor should be prepared to provide the necessary identification to permit escorted access within that facility.

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PART II GROUP LIFE INSURANCE

Paragraph C.2 is Reserved

C.3.0 DEFINITIONS

FMO The Financial Management Officer or the paying office for all U.S. Government

Agencies except AID.

COR Contracting Officer's Representative

Contributory Insurance for which the employee contributes toward the premium.

Dependent Spouse and unmarried children up to age 19 residing with employee in the United

Arab Emirates. 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 employee. An eligible child will be covered until the end of contract year (insurance) or calendar year (direct reimbursement plan) in which he/she reaches age 19 or in the case of a child who is a full-time student, until the end of the calendar year in which the child turns age 22. There is no age limit for a child who is physically or mentally handicapped. 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, or personal services agreement, as further defined in Section C.1.1.16. for health insurance. This may also include ORE

Staff, AEEA and MSG Staff, if this category of individual is listed as participating under a rider in C.1.1.16.5 for health insurance.

Employer The United States Government or in the case of ORE, AEEA and, MSG the Chief of Mission/Deputy Chief of Mission/Consul General, American Employee

Association and US Marine Detachment (MSG) respectively.

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.

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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.

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.

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SECTION D

PACKAGING AND MARKING

(RESERVED)

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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).

No more than one allowable claim payment delayed beyond this two week limit in a four-week period. No payment delayed more than two weeks.

No more than one interim response delayed in a four-week period.

C.1.0 thru

C.9

All required services are performed and no more than one

(1) customer complaint is received per month.

Allowable insurance claims are paid within 2 weeks of receipts.

Claims with missing or incorrect information will be referred back to claimant within 2 days of receipt with request for correct http://www.statebuy.state.gov/

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No more than one interim response delayed in a two-week period.

information.

Unallowable claims will be sent back to claimant within 2 days of receipt with documentation or reasons for benefit denial.

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 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 complainant.

(h) Repeat customer complaints are not permitted for any services. If a repeat customer complaint is received for the same deficiency during the service period, the COR will contact the Contracting Officer for appropriate action under the Inspection clause.

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SECTION F

DELIVERIES OR PERFORMANCE

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

http://acqusition.gov/far/index.html or, http://farsite.hill.af.mil/search.htm 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, Google, etc.) to obtain the latest location of the most current FAR.

52.242-15 STOP WORK ORDER (AUG 1989)

52.242-17 GOVERNMENT DELAY OF WORK (APR 1984)

F.2 PERIOD OF PERFORMANCE. The performance period of this contract is one year beginning no later than 10 days after contract award with four one-year options to renew.

F.3 OPTIONS

(a) The Government may extend this contract in accordance with the option clause at

Section I, clause I.2, FAR Clauses Incorporated by Full Text (FAR 52.217-9, Option to Extend the Term of the Contract), which also specifies the total potential duration of the contract.

(b) The Government may exercise the option set forth at Section I, "FAR 52.217-8, Option to Extend Services".

F.4 REPORTS AND OTHER DELIVERABLES

All reports and other deliverables required under this contract shall be delivered to the following address:

_Human Resources Office ____________________

_Embassy of the United States of America________

_P.O. Box 4009, ____________________________

_Abu Dhabi, United Arab Emirates______________

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SECTION G

CONTRACT ADMINISTRATION DATA

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

(a) The Contracting Officer may designate in writing one Government employee, by name or position title, to take action for the Contracting Officer under this contract. This designee shall be identified as a Contracting Officer’s Representative (COR). Such designation shall specify the scope and limitations of the authority so delegated; provided, that the designee shall not change the terms or conditions of the contract, unless the COR is a warranted

Contracting Officer and this authority is delegated in the designation.

(b) The COR for this contract is the Human Resources Specialist.

G.2 COR DUTIES

G.2.1 The COR is responsible for inspection and acceptance of services. These duties include review of Contractor invoices, including the supporting documentation required by the contract. The COR may provide technical advice, substantive guidance, inspections, invoice approval, and other purposes as deemed necessary under the contract.

G.2.2 In addition, the COR shall maintain updated list of employees and dependents insured, which will supersede the initial list provided under this contract and as reported to the insurer without prejudice to the ineligibility clause.

G.2.3. The COR has the additional responsibility of maintaining the eligible listing of employees and dependents for insurance coverage.

G.2.4 The COR may not change the terms and conditions of the contract. While the

COR is authorized to provide the Contractor with updated listings of eligible employees and dependents, only the Contracting Officer may modify existing task orders or issue new task orders, reflecting these changes, since only the Contracting Officer can obligate funding and commit the Government.

G.3. Payment shall be made in AED (Dirhams).

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 Center_________________________

_Embassy of the United States of America_________________

_P.O. Box 4009______________________________________

_Abu Dhabi, United Arab Emirates_______________________

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G.4.2. Frequency of Payments The Contracting Officer will issue a task order as soon as possible after contract award to identify all employees to be covered by the insurance described in this contract and the coverage selected by each employee, including eligible dependents to be covered. The COR will make subsequent additions or deletions to this list in writing and provide the revised list to the Contractor. If any changes have been made to the coverage listing, the Contracting Officer anticipates issuance of a new task order on quarterly basis. This new task order will include all changes made since the previous task order was issued and will include any increase or decrease in necessary funding. The changes to the list of eligible individuals will supersede the initial list provided under prior task orders. Task orders will indicate the effective date of employment, for purposes of calculating the premium due.

All funds under this contract will be obligated by issuance of task orders, as described above. Each task order will fund a specific period of time and number of employees, and the task orders will be issued on quarterly basis. The Contractor may submit invoices on monthly basis but the payments will be made on semi-annual basis. Each year, 1 st payment will be made in the last week of January and 2 nd payment will be made in the last week of July. All the necessary adjustments (additions/deletions) will be made at the end of each contract year upon receipt of final invoice/Statement of Account. The final invoice/Statement of Account will be processed within two weeks’ time upon verification/scrutiny of all adjustments.

G.4.3. U.S. Government Employees. The Government shall make payments directly to the contractor for all Government employees, whether or not the employee is contributing to the premium amount.

G.4.4 ORE Staff. The Chief of Mission, Deputy Chief of Mission and/or Consul General will make payment directly to the contractor for the entire premium amount of the ORE staff, whether or not the ORE employee is contributing to the premium amount.

G.4.5. AEEA Staff. The American Employee Association will make payment directly to the contractor for the entire premium amount of the AEEA employee, whether or not the AEEA employee is contributing to the premium amount.

G.4.6. MSG Staff. US Marine Detachment will make payment directly to the contractor for the entire premium amount of the MSG employee, whether or not the MSG employee is contributing to the premium amount.

G.5 REFUNDS TO THE GOVERNMENT

If at any time during performance of the contract the Government finds that the contractor has been overpaid because the number of employees and/or dependents covered has decreased, the

Contracting Officer may either allow that overpayment to be credited to the Government’s account or require that the contractor refund the overpayment. If the Contracting Officer requests a refund, the contractor shall make that refund to the Government within ten calendar days of receipt of the request.

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G.6 VALUE ADDED TAX.

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.

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SECTION H

SPECIAL CONTRACT REQUIREMENTS

H.1 SECURITY. On occasion, a Contractor employee may require entry into U.S.

Government-owned or -operated facilities. If so, the Contractor should be prepared to provide the necessary identification to permit escorted access within that facility.

H.2 STANDARDS OF CONDUCT. The Contractor shall maintain satisfactory standards of employee competency, conduct, cleanliness, appearance, and integrity and shall be responsible for taking such disciplinary action with respect to employees as may be necessary. Each

Contractor employee is to adhere to standards that reflect credit on themselves, their employer, and the United States Government.

H.3 ORDERING PROCEDURES. The Government will issue a task order as soon as possible after contract award to identify all employees to be covered by the insurance described in this contract and the coverage selected by each employee, including dependents to be covered.

The COR will make subsequent additions or deletions to this list in writing and provide the revised list to the Contractor. All such revisions shall be consolidated, and a new or modified task order will be issued by the Contracting Officer. If any changes have been made to the coverage listing, the Government anticipates issuance of a new task order on a [] monthly and/or

[ ] semi-annually, [X] quarterly basis. This new task order will include all changes made since the previous task order was issued and will include any increase or decrease in necessary funding. The changes to the list of eligible individuals will supersede the initial list provided under prior task orders without prejudice to the ineligibility clause. Task orders will indicate the effective date of employment, for purposes of calculating the premium due.

H.3.1 The ORE staff, AEEA and MSG employees under separate riders are not included under the task orders issued by the Contracting Officer. Because their coverage is under a rider, their employer is responsible for directly interacting with the contractor to order any coverage for their employees. When contacted by the employer, the contractor shall advise the employer of the paperwork and payment that will be necessary to order coverage for the identified individuals.

Because more than one employer may have ORE staff, the contractor may be contacted by more than one employer (typically the Chief of Mission, Deputy Chief of Mission and the Consul

General).

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:

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(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 send employee claim reimbursement checks to employees not later than two weeks after a claim is 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. Each check 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 treatment/surgery to any hospital/medical facility designated by the Contractor under their network in order that the Contractor will pay for the expenses directly to the hospital/medical facility. Insured members have formal right to make a choice about the medical services provider. This includes the right to choose a doctor/hospital/medical provider of their choice who is outside the Contractor’s approved Network.

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(6) Claims with missing or incorrect information will be referred back to claimant within 2 days of receipt with request for correct information.

(7) Unallowable claims will be sent back to claimant within 2 days of receipt with documentation or reasons for benefit denial.

H.5. REPORT REQUIREMENTS:

The Contractor shall provide the following reports monthly. All reports must be received by the

COR no later than the 10 th day of each month. These reports shall report on the previous month's activities.

Employee Claims Report: The report will list all claims paid by the Contractor to a claimant, including the name of the claimant, date claim is received by the Contractor, and the amount claimed. This report shall also include all outstanding claims and a brief description of why claim has not been paid.

H.6. MISCELLANEOUS CONTRACTOR REQUIREMENTS

H.6.1. General. The Contractor shall take all such steps as are necessary, and obtain and pay for all permits, taxes and fees as are required by the United Arab Emirates government to establish and/or operate a commercial venture locally. A contract with the U.S. Government conveys no special privileges or immunities to the Contractor. The Contractor is an independent commercial concern and not a part of the U.S. mission. The Contractor's employees are not U.S.

Government employees. Registration of this contract with the United Arab Emirates government, if required by law, will be the sole responsibility of the Contractor, and any fees, taxes, or other duties shall be payable by the Contractor without recourse to the Government of the amounts thereof.

H.6.2. Licenses and Local Laws. The Contractor shall possess all permits, licenses, and any other appointments required for the prosecution of work under this contract, all at no additional cost to the Government. The Contractor shall perform this contract in accordance with local laws.

H.7 Erroneous Payments. If the Government becomes eligible for a refund of payment because of erroneous overpayment or other cause, the Contractor shall refund the amounts or use them to offset future payments owed by the Government, whichever the Government prefers.

The Contractor shall refund any refunds not complete or discovered after the completion date of this contract.

H.8 Requiring Activity. The requiring activity under this contract is the U.S.

Embassy/Consulate.

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SECTION I

CONTRACT CLAUSES

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

http://www.acquisition.gov/far/ or http://farsite.hill.af.mil/vffara.htm available at the locations indicated above, use the Department 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” (for example Google, Yahoo, Excite) to obtain the latest location of the most current

FAR.

52.202-1 DEFINITIONS (NOV 2013)

52.203-3 GRATUITIES (APR 1984)

52.203-5 COVENANT AGAINST CONTINGENT FEES (APR 1984)

52.203-6 RESTRICTIONS ON SUBCONTRACTOR SALES TO THE

GOVERNMENT (SEP 2006)

52.203-7 ANTI-KICKBACK PROCEDURES (OCT 2010)

52.203-8 CANCELLATION,…