Health_ _Life_Insurance_Solicitation_(RFP)_.pdf

RFP No. STD550-15-R-0001 nd

July, 2015

15 Queen’s Park West, Port of Spain

Dear Prospective Offeror:

SUBJECT: Solicitation Number STD550-15-R-0001

The Embassy of the United States of America invites you to submit a proposal for customized

Health and Life Insurance for the US Embassy of Port of Spain, Trinidad.

The Embassy intends to conduct a pre-proposal conference, and all prospective offerors who have received a solicitation package are invited to attend. See Section L (page 73) of the attached

Request for Proposals (RFP) for details.

Your proposal must be submitted in a sealed envelope marked "Proposal Enclosed" to the below on or before 3 p.m. on July 3 rd

, 2015. No proposal will be accepted after this time.

Mark Hernandez

Contracting Officer, 15 Queen’s Park West, Port of Spain, Trinidad, W.I.

In order for a proposal to be considered, you must also complete and submit the following:

1. SF-33

2. Section B, Pricing Schedule

3. Section B, Retention Amounts in B.3 and B.7

3. Section K, Representations and Certifications;

4. Additional information as required in Section L.

Direct any questions regarding this solicitation to bidjoukc@state.gov.

Clarifications will be advertised on FebBizOps (https://www.fbo.gov/).

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

The U.S. Government intends to award a contract to the responsible company submitting an acceptable offer at the lowest price. We intend to award a contract based on initial proposals, without holding discussions, although we may hold discussions with companies in the competitive range if there is a need to do so.

Sincerely, Mark Hernandez

Contracting Officer mailto:bidjoukc@state.gov https://www.fbo.gov/

Table of Contents

SECTION A - MODEL CONTRACT

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

PART II: PRICE - GROUP LIFE INSURANCE

B.5. GROUP LIFE INSURANCE SERVICES

B.6. GROUP LIFE INSURANCE RATES

B.7 ADMINISTRATIVE RETENTION AMOUNTS

B.8 ECONOMIC PRICE ADJUSTMENT (EPA)-LIFE INSURANCE PREMIUMS

SECTION C

DESCRIPTION/SPECIFICATION/WORK STATEMENT

PART I - HEALTH INSURANCE

C.1. HEALTH INSURANCE SERVICES

C.1.1 EMPLOYEE AND DEPENDENT HEALTH SERVICES BENEFITS

C.1.1.1: HOSPITALIZATION:

C.1.1.2.: SURGERY / DOCTOR VISITS:

C.1.1.3: PRESCRIPTION DRUGS AND MEDICINES:

C.1.1.4 MATERNITY:

C.1.1.5: HOSPITAL OUTPATIENT SERVICES

C.1.1.6: OPTICAL SERIVCES

C.1.1.7: DENTAL SERIVCES:

C.1.1.8: PHYSICAL THERAPHY:

C.1.1.9: PSYCHIATRIC TREATMENT:

C.1.1.10: AMBULANCE SERVICE:

C1.1.11: HEARING AIDS:

C.I.I.14: OTHER BENEFITS:

SECTION E

INSPECTION AND ACCEPTANCE

SECTION F

DELIVERIES OR PERFORMANCE

SECTION G

CONTRACT ADMINISTRATION DATA

SECTION H

SPECIAL CONTRACT REQUIREMENTS

H.4. CONTRACTOR RESPONSIBILITY IN CLAIMS AND REIMBURSEMENT TO

CLAIMANTS

H.6. MISCELLANEOUS CONTRACTOR REQUIREMENTS

SECTION I

CONTRACT CLAUSES

SECTION J

LIST OF EXHIBITS/ATTACHMENTS

EXHIBIT A- EMPLOYEE STATISTICS

EXHIBIT B – CLAIM EXPERIENCE

SECTION K

REPRESENTATIONS, CERTIFICATIONS,

AND OTHER STATEMENTS OF OFFERORS

SECTION L

INSTRUCTIONS, CONDITIONS AND NOTICES TO OFFERORS

L.1. SUBMISSION OF OFFERS

L.2. SUMMARY OF INSTRUCTIONS

L.5 52.252-1 SOLICITATION PROVISIONS INCORPORATED BY REFERENCE

(FEB 1998)

L.6 SOLICITATION PROVISIONS INCLUDED IN FULL TEXT

L.8. PRE-PROPOSAL CONFERENCE

L.9 FINANCIAL STATEMENT

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

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

M.7. PRICE EVALUATION

M.8. SEPARATE CHARGES

M.9 AWARD WITHOUT DISCUSSIONS

SECTION B

PART I: PRICE - HEALTH INSURANCE

ALTERNATE A – Coverage for ORE Staff and EAE Staff

B.1. HEALTH INSURANCE SERVICES

The Contractor shall provide the Health Insurance services to employees of the Government of the United States of America in Port of Spain 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. Official Residence Expense (ORE) Staff and Embassy Association Employees (EAE) 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 Embassy Association (for EAEs) at the rates specified below. See Section G for billing procedures.

B.2. PRICES

B.2.1 VALUE ADDED TAX.

VALUE ADDED TAX (VAT). The Contractor shall include 15% VAT as a separate charge on the Invoice and as a separate line item in Section B.

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 in Trinidad &

Tobago TT $ for the health insurance services as specified in Section C are as follows:

Category

Estimated Number of Employees Rate per Employee Bi-Weekly Total

a. Single Employees ( Self Only) 38

b. Family Plan 80

c. Retirees 15

d. Subtotal (a + b + c)

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

f. Plus VAT of 15%

g. Total Price for Base Year including VAT (e + f)

Bi-Weekly Rates per Employee

B.2.3. Base Year of Contract of Employees Rate per Employee Bi-Weekly Total

a. Single Employees ( Self Only) 38

b. Family Plan 80

c. Retirees 15

d. Subtotal (a + b + c)

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

f. Plus VAT of 15%

g. Total Price for Base Year including VAT (e + f)

Bi-Weekly Rates per Employee

B.2.6. Option Year 2 of Contract

Category

Estimated Number of Employees Rate per Employee Bi-Weekly Total

a. Single Employees ( Self Only) 38

b. Family Plan 80

c. Retirees 15

d. Subtotal (a + b + c)

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

f. Plus VAT of 15%

g. Total Price for Base Year including VAT (e + f)

B.2.4. Option Year 1 of Contract of Employees Rate per Employee Bi-Weekly Total

a. Single Employees ( Self Only) 38

b. Family Plan 80

c. Retirees 15

d. Subtotal (a + b + c)

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

f. Plus VAT of 15%

g. Total Price for Base Year including VAT (e + f)

Bi-Weekly Rates per Employee

B.2.7. Option Year 4 of Contract

Category

Estimated Number of Employees Rate per Employee Bi-Weekly Total

a. Single Employees ( Self Only) 38

b. Family Plan 80

c. Retirees 15

d. Subtotal (a + b + c)

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

f. Plus VAT of 15%

g. Total Price for Base Year including VAT (e + f)

B.2.6. Option Year 3 of Contract

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.

B.3.2.1 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

B.2.8. Grand Total of Base plus All Option Years

Base Year Total including VAT

Option Year 1 Total including VAT

Option Year 2 Total including VAT

Option Year 3 Total including VAT

Option Year 4 Total including VAT

Grand Total of Base plus All Option Years including VAT

Option Year 1

Option Year 2

Option Year 3

Option Year 4

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, ie 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

ALTERNATE A – ORE and EAE Staff Covered

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 Port of Spain, Trinidad. 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 Embassy Employee Association

Embassy Association Employees (EAE) and Peace Corp Personal Service Contracts (PSC) 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 Embassy Association (for EAEs) 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 Trinidad

& Tobago (TT) $ per one thousand of salary to provide life insurance, accidental death and dismemberment or work related death and partial and total disability coverage are as follows:

Type of Insurance

Premium

(per 1,000 of Salary)

Estimated Payroll

(Bi-Weekly in Thousands) Bi-Weekly Total

a. Basic Life 680.00$

b. Accidental Death & Dismemberment 680.00$

c. Partial & Total Disability Coverage 680.00$

d. Subtotal (a + b + c)

g. Total Price for Base Year including VAT (e + f)

Bi-Weekly Rates per Employee

B.6.1. Base Year of Contract

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

f. Plus VAT of 15%

(per 1,000 of Salary)

Estimated Payroll

(Bi-Weekly in Thousands) Bi-Weekly Total

a. Basic Life 745.00$

b. Accidental Death & Dismemberment 745.00$

c. Partial & Total Disability Coverage 745.00$

d. Subtotal (a + b + c)

g. Total Price for Base Year including VAT (e + f)

Bi-Weekly Rates per Employee

B.6.3. Option Year 2 of Contract

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

f. Plus VAT of 15%

Type of Insurance

Premium

(per 1,000 of Salary)

Estimated Payroll

(Bi-Weekly in Thousands) Bi-Weekly Total

a. Basic Life 740.00$

b. Accidental Death & Dismemberment 740.00$

c. Partial & Total Disability Coverage 740.00$

d. Subtotal (a + b + c)

f. Plus VAT of 15%

g. Total Price for Base Year including VAT (e + f)

Bi-Weekly Rates per Employee

B.6.2. Option Year 1 of Contract

(per 1,000 of Salary)

Estimated Payroll

(Bi-Weekly in Thousands) Bi-Weekly Total

a. Basic Life 900.90$

b. Accidental Death & Dismemberment 900.90$

c. Partial & Total Disability Coverage 900.90$

d. Subtotal (a + b + c)

f. Plus VAT of 15%

g. Total Price for Base Year including VAT (e + f)

Bi-Weekly Rates per Employee

B.6.5. Option Year 4 of Contract

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

Type of Insurance

Premium

(per 1,000 of Salary)

Estimated Payroll

(Bi-Weekly in Thousands) Bi-Weekly Total

a. Basic Life 819.00$

b. Accidental Death & Dismemberment 819.00$

c. Partial & Total Disability Coverage 819.00$

d. Subtotal (a + b + c)

f. Plus VAT of 15%

g. Total Price for Base Year including VAT (e + f)

Bi-Weekly Rates per Employee

B.6.4. Option Year 3 of Contract

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

Option Year 1

Option Year 2

B.6.6. Grand Total of Base plus All Option Years

Base Year Total including VAT

Option Year 1 Total including VAT

Option Year 2 Total including VAT

Option Year 3 Total including VAT

Option Year 4 Total including VAT

Grand Total of Base plus All Option Years

Option Year 3

Option Year 4

B.8 ECONOMIC PRICE ADJUSTMENT (EPA)-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, ie 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 clause.

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.

SECTION C

DESCRIPTION/SPECIFICATION/WORK STATEMENT

PART I - HEALTH INSURANCE

C.1. HEALTH INSURANCE SERVICES

The Government of the United States of America requires Health Insurance coverage for its employees as further described in C.1.2 in Port of Spain, Trinidad The Government has determined that the prevailing practice by employers in Trinidad 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 on a:

1. For active employees who are regularly scheduled to work 30 or more hours per week, the

USG will pay 70% of the premium cost for employee and dependent coverage and the employee will pay 30% of the premium.

2. For active 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 coverage, based on the number of hours the employee is regularly scheduled to work. The employee will pay

100% of the premium cost for dependent coverage.

3. For retired employees: the retired employee will pay 100% of the premium cost 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.

ALTERNATE A – Post-Unique Benefits

C.1.1 EMPLOYEE AND DEPENDENT HEALTH SERVICES BENEFITS

The health benefits under this contract are as follows. Reimbursement 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.

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 (refer to attached listing which outline the reasonable and customary amounts). The medical treatment must be prescribed or provided by a physician or nurse licensed in Trinidad and Tobago, the

United States, or in the country in which the treatment or prescription is received. Coverage of expenses will be made in Trinidad and Tobago Dollars (TT).

Deductible: None.

C.1.1.1: HOSPITALIZATION:

a) 100% coverage of room and board expenses for a ward room or semi-private room.

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

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

d) 90% coverage of ambulance service.

C.1.1.2.: SURGERY / DOCTOR VISITS:

Professional Services and Treatment:

a) 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.

b) 90% coverage of medical services and expenses when not hospitalized such as laboratory tests and x-rays, prescription medicines, physical therapy, routine annual physical examinations, and inoculations.

C.1.1.3: PRESCRIPTION DRUGS AND MEDICINES:

a) 100% coverage of expenses when hospitalized, of the cost of medicines and drugs for which a prescription is legally required.

b) 90% coverage of expenses when not hospitalized, 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 MATERNITY:

Obstetrical Care:

a) 100% coverage of expenses when hospitalized, of obstetrical medical care including prenatal and postnatal care.

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

Family Planning:

40% coverage of expenses of prescribed contraceptive devices and drugs, voluntary sterilization, and diagnosis and treatment of infertility, fertility drugs.

Not covered is reversal of voluntary sterilization, infertility treatment after voluntary sterilization, genetic counseling, and assisted reproductive technology.

C.1.1.5: HOSPITAL OUTPATIENT SERVICES

Refer to Sections C.1.1.2 and C.1.1.3 above.

C.1.1.6: OPTICAL SERIVCES

a) 100% coverage of expenses for eye examination and treatment and

b) 100% for prescription eyeglass (frames and lenses) or contact lenses.

Limited to one eyeglass or two lenses per patient every two years. No coverage of expenses for nonprescription lenses, or tinting.

C.1.1.7: DENTAL SERIVCES:

100% 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.1.1.8: PHYSICAL THERAPHY:

Refer to Section C.1.1.2. above

C.1.1.9: PSYCHIATRIC TREATMENT:

80% coverage of expenses for psychiatric treatment.

C.1.1.10: AMBULANCE SERVICE:

Refer to Section C.1.1.1. above.

C1.1.11: HEARING AIDS:

0% coverage of the cost of a hearing aid apparatus and related examination. Limited to one apparatus per ear per patient in a three-year period.

C.1.1.12: EXPENSES INCURRED OUT-OF-COUNTRY:

a) Medical Expenses Incurred Out of Country:

Medical expenses incurred out of country will be covered only for an employee when on official travel and when the treatment is medically necessary due to a life threatening condition before the employee returns to post. Coverage of medical expenses will be made at the same percentage rate and subject to the same annual maximum limit as for expenses incurred in country.

b)Transportation for Out of Country Medical Treatment:

Transportation for out of country treatment will be a covered expense for employees only. The employee's attending physician must certify in advance that the treatment is medically necessary and unavailable locally.

a) 90% of the patient's transportation expenses of insured patient by the least expensive, appropriate means of transportation to and from the nearest city with adequate medical facilities will be reimbursed – including repatriation of the body in case of death.

b) 90% of the transportation expenses of an attendant will be reimbursed if the patient's attending physician certifies that an attendant for the patient is necessary, e.g., a family member to make medical decisions in the case of a patient who is unconscious.

Transportation expenses are subject to the annual maximum limit.

C.I.I.14: OTHER BENEFITS:

a) HIV/AIDS coverage:

For employees only: 100% reimbursement for medications to suppress opportunistic infections, such as tuberculosis and toxoplasmosis for employees who have HIV/AIDS.

For employee and spouse: 100% reimbursement for 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.

b) SEPARATE MAXIMUM BENEFIT LIMIT:

There must be a maximum limit for this benefit for HIV/AIDS coverage for employees, a limit of U.S. Dollars (USD) $10,000.

C.I.I.15: MAXIMUM LIMITS:

Maximum Annual Coverage:

a)The insurance company will reimburse covered expenses described under paragraph

C.1.1.14 (Separate Maximum Benefit Limit for HIV/AIDS) of the plan up to a separate limit of 400,000TT per employee per contract year.

b)FOR CATASTROPHIC CONDITIONS:

The annual aggregate maximum shall be 458,333TT per covered individual for medical expenses. Catastrophic conditions shall be defined as major medical conditions occurring as a result of a single illness, accident, or closely related set of major illnesses (or conditions relating to a single accident) that exceed the standard maximum coverage limit

Paragraph Covered Benefit Employee Dependent

C.1.1.1.

Hospitalization: 100% coverage of room and board expenses for a ward room or semi-private room.

C.1.1.2.

Surgery - 100% coverage of surgeon's fees incurred while hospitalized, at a hospital on an out-patient basis, at a clinic or doctor's office, or at home.

C.1.1.3.

Doctor Visits: 100% coverage of doctors’ fees incurred while hospitalized, at a hospital on an out-patient basis, at a clinic or doctor's office, or at home.

C.1.1.4.

Prescription Drugs - 90% coverage when not hospitalized including those that suppress opportunistic infections, such as tuberculosis and toxoplasmosis.

C.1.1.5.

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

C.1.1.6. Hospital Outpatient Services

C.1.1.7.

Optical Services a) 100% coverage of expenses for eye examination and treatment

b) 100% for prescription eyeglass

C.1.1.8.

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

C.1.1.9.

Physical Therapy: 90% coverage of medical services and expenses when not hospitalized such as physical therapy.

C.1.1.10.

Psychiatric Treatment : 80% coverage of expenses for psychiatric treatment.

C.1.1.11. Ambulance Service: 90% coverage of ambulance service.

C.1.1.12. Hearing Aids: 0% Coverage of hearing aids

C.1.1.13.

Expenses Incurred Out-of-Country: Covered only for an employee when on official travel and when the treatment is medically necessary a) Employees only- 90% of the patient's transportation expenses.

b) 90% of the transportation expenses of an attendant.

C.1.1.14.

Other Benefirs: HIV/ AIDS coverage for medications to suppress opportunistic infections

C.1.1.15.

Maximum Limits: A) Limit of 400,000TT per employee per contract year. B) For catastrophic conditions the annual aggregate maximum shall be 458,333TT per covered individual for medical expenses.

[ALTERNATE A – Post-Unique Benefits]

C.1.2 Health Benefits Conditions and Limitations.

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

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 of 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 Post’s 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:

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. Participation will be mandatory.

C.1.3.1.1 All current active employees of the United States Government, employed within the geographic boundaries of Trinidad and Tobago 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 Trinidad and Tobago by:

Department of State, U.S. Agency for International Development, Department of Commerce

Department of Defense/ Military Liaison Office

Department of Justice

Department of Agriculture

Center for Disease Control

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 Employee Association at

Embassy/Consulate Port of Spain, Trinidad (see separate rider, Exhibit C). All costs for

American Embassy Employee Association EAEs are the responsibility of the Employee

Association, not the U.S. Government.

C.1.4 Individuals Not Eligible for Coverage

Individuals not eligible for coverage under this contract are non-personal services contract personnel; 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.

ALTERNATE A

C.1.5. Other Eligible Participants

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

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 26. 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.

Retired Employee:

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.1.6. 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. No waiting period for medical coverage.

During a period of Leave Without Pay (LWP) 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.1.6.2. 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 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. An initial amount of 150 copies in color are required.

C.1.7.2. The Contractor shall provide the document described in C.1.7.1 to the

COR not later than 21 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.2.0 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 Port of Spain Trinidad and Tobago. The

Government has determined that the prevailing practice by employers in Trinidad and Tobago 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 both the employee and the employer on a50/50 basis i.e. USG pays 50% of the premium costs and the employee will pay

50% of the premium costs. 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 Life Insurance: Natural Death

The amount of life insurance coverage for each employee is based upon:

25 times the amount of monthly basic salary (Trinidad and Tobago Dollars) paid to the participant’s named beneficiaries or estate upon the natural death of the participant. Salary:

monthly salary is one-twelfth of the employee’s annual basic salary, exclusive of premium pay, allowances, bonuses, or any other separate payments.

C.2.1.2 Amount of Accidental Death and Dismemberment Coverage or Work Related

Death

The employee's estate or employee will receive an amount equal to:

25 months’ basic salary (Trinidad and Tobago Dollars) upon accidental or work related death or dismemberment. Salary: monthly salary is one-twelfth of the employee’s annual basic salary, exclusive of premium pay, allowances, bonuses, or any other separate payments.

C.2.1.3 Partial and Total Disability Coverage

The employee's estate or employee will receive an amount equal to:

25 months’ basic salary (Trinidad and Tobago Dollars). Salary: monthly salary is one-twelfth of the employee’s annual basic salary, exclusive of premium pay, allowances, bonuses, or any other separate payments.

NOTE: : In the instance of disability/dismemberment being the first criteria for payment of the

25 months of basic salary benefit, an employee, named beneficiary, or estate will only receive another payment of 25 months of basic salary for death if the cause of death is unrelated to the disability/dismemberment.

C.2.2 Life Insurance Benefits Conditions and Limitations

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

a) 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.

b) No benefits shall be payable under this contract if the employee’s bodily injuries have 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, excluding a suicide or attempted suicide after 2 years' continuous coverage under this or the Government's previous life insurance contract,

2. Violating the law or in 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. Suicide will not be covered.

C.2.3. Eligible Participants

C.2.3.1 Eligible Employees. The employees eligible for the group life insurance coverage include the following:

C.2.3.1.1 All current active employees of the United States Government, employed within the geographic boundaries of Trinidad and Tobago, paid under the

Local Compensation Plan, and certified by the Contracting Officer. Covered employees include:

C.2.3.1.2. Foreign Service Nationals (FSNs) employed under direct hire appointments, Personal Services Agreements (PSAs) and Personal Services Contracts

(PSCs);

C.2.3.1.3. Locally hired U.S. citizens employed under direct hire appointments, PSAs, and PSCs.

C.2.3.2 Location of Employment

C.2.3.2 The individuals covered by C.2.3.1 must be employed within the geographic boundaries of Trinidad and Tobago by: Department of State, Drug Enforcement

Agency (DEA), Military Liaison Office (MLO), Animal and Plant Health Inspection Service

(APHIS).

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

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,

(2) Paid under the terms of the Local Compensation Plan.

(3) Current active employees of the United States Government, employed within the geographic boundaries of Trinidad and Tobago, and

(4) Certified by the Contracting Officer.

(5) Official Residence Expense (ORE) employees may be covered under a rider to the contract. The employing officer, not the USG, is responsible for the employer’s share of the premium costs for an ORE employee.

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 Employee Association at

Embassy/Consulate Port of Spain (see separate rider, Exhibit C). All costs for American

Embassy Employee Association EAEs are the responsibility of the Employee

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 60 prior to entering on duty with the U.S. Government will not be eligible for life insurance coverage.

C.2.4.2 Individuals not eligible for coverage under this contract are nonpersonal services contract personnel; 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.

Not eligible are:

a) 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;

b) Non personal services contract personnel and their employees, supplied by an independent contractor licensed to do business in Trinidad and Tobago who provides services to other local organizations as well as to the U.S. Mission;

employees of USAID institutional contractors;

c) New employees who have reached the age of 60 prior to entering on duty with the U.S. Government;

d) 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 clause.

e) Dependents and retirees are not covered.

C.2.5. Other Eligible Participants

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

Employee's dependents which 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 26. There is no age limit for an eligible child who is physically or mentally handicapped so as to be unable to live independently. There is no limit on the number of children covered per employee.

C.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 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 (LWP) 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.2.6.2. Period of Ineligibility

Employees are not entitled to life insurance 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

(LWP) 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) English 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 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.

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

Officer (HRO) at post.

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

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

Dependent The employee's legal spouse (limit one) and each unmarried, economically dependent child who primarily resides with the employee unless away at school.

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, AMerican

Embassy Employee Association EAE, and Peace Corp PSCs, 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 t he American

Embassy Employee Association EAE employees, the Chief of

Mission/Deputy Chief of Mission and the Employee 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

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

C.3.0 DEFINITIONS

SECTION D

PACKAGING AND MARKING

(RESERVED)

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://www.acquisition.gov/far/ or http://farsite.hill.af.mil/vffara.htm

These addresses are…