HealthInsuranceRFP_03_29_ 2011final

March 29, 2011

Dear Prospective Offeror:

SUBJECT: Solicitation Number SUP300-11-R-0004

The Embassy of the United States of America in Kyiv, Ukraine invites you to submit a proposal for customized health insurance for its local employees.

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 of the attached Request for Proposals (RFP).

Your proposal must be submitted in a sealed envelope marked "Proposal Enclosed" to Ina Erickson, Contracting Office at US Embassy Kyiv, 4 Glybochytska St., Artem Business Center on or before 17.00 pm on April 29, 2011. No proposal will be accepted after this time.

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 Olena Stavnycha, Contracting Specialist in writing to e-mail address StavnychaO@state.gov letter or by telephone +380-44-490-4113 during regular business hours.

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, Ina Erickson

Contracting Officer

SECTION A

UNDER DPAS (15 CFR 350)

2 | 56

2. CONTRACT (Proc. Inst. Ident.) NO.

3. SOLICITATION NO.

SUP300-11-R-0004

4. TYPE OF SOLICITATION

[ ] SEALED BID (IFB)

[x] NEGOTIATED (RFP)

5. DATE ISSUED

March 29, 2011

6. REQUISITION/PURCHASE NO.

7. ISSUED BY CODE

8. ADDRESS OFFER TO (If other than item 7)

American Embassy in Kyiv, Ukraine Phone: 380-44-490-4000 Fax: 380-44-490-4085 4 Glybochytska St, Kyiv 04050, Ukraine American Embassy, Contracting Office

NOTE: In sealed bid solicitation "offer" and "offeror” mean "bid" and "bidder".

SOLICITATION

9. Sealed offers in original and 0 copies for furnishing the supplies or services in the Schedule will be received at the place specificed, in the depository located in until April 29, 2011 local time 17:00 .

(hour)

(date)

CAUTION - LATE Submissions, Modifications, and Withdrawals: See Section L. Provision No. 52.215-1. All offers are subject to all tems and conditions contained in this solicitation.

10. FOR INFORMATION

CALL:

A. NAME

Olena Stavnycha

B. TELEPHONE (NO COLLECT CALLS)

AREA CODE NUMBER EXT

380-44-490-4113

C. E-MAIL ADDRESS

StavnychaO@state.gov

11. TABLE OF CONTENTS

PART III - LIST OF DOCUMENTS, EXHIBITS, AND OTHER ATTACH.

PART IV - REPRESENTATIONS AND INSTRUCTIONS

OTHER STATEMENTS OF OFFERORS

OFFER (Must be fully completed by offeror)

NOTE: ITEM 12 does not apply if the solicitation includes the provisions at 52.214-16, Minimum Bid Acceptance Period.

12. In compliance with the above, the undersigned agrees, if this offer is accepted within calendar days (120 calendar days unless a different period is inseted by the offer) from the date for receipt of offers specified above, to furnish any or all items upon which prices are offered at the price set opposite each item, delivered at the designated point(s), within the time specified in the schedule.

13. DISCOUNT FOR PROMPT PAYMENT

SEE 14

(See section I, Clause No 52.232-8)

10 CALENDAR DAYS

20 CALENDAR DAYS

30 CALENDAR DAYS

CALENDAR DAYS

(The offeror acknowledges receipt of amendments to the solicitation and related documents ) numbered and dated:

15A.

NAME

CODE

FACILITY

16. NAME AND TITLE OF PERSON AUTHORIZED

AND

ADDRESS

OF

OFFEROR

TO SIGN OFFER (Type or print)

15B. TELEPHONE NO. (Include area code)

15C. CHECK IF REMITTANCE ADDRESS [ ]

IS DIFFERENT FROM ABOVE - ENTER

SUCH ADDRESS

AWARD (To be completed by Government)

19. ACCEPTED AS TO ITEM NUMBERED

22. AUTHORITY FOR USING OTHER THAN FULL AND OPEN COMPETITION:

[ ] 10 U.S.C. 2304(c)( ) [ ] 41 U.S.C. 253(c)( )

23. SUBMIT INVOICES TO ADDRESS SHOWN IN

(4 copies unless otherwise specified)

ITEM

24. ADMINISTRATION BY (If other than Item 7) CODE

25. PAYMENT WILL BE MADE BY CODE

26. NAME OF CONTRACTING OFFICER (Type or print)

27. UNITED STATES OF AMERICA

(Signature of Contracting Officer)

28. AWARD DATE

IMPORTANT - Award will be made on this form, or on the Standard Form 26, or by other authorized official written notice.

NSN 7540-01-152-8064

STANDARD FORM 33 (REV 9-97)

PREVIOUS EDITION NOT USABLE

Prescribed by GSA

SECTION B

PRICE

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 Ukraine 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. 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 Peace Corps Staff 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 Peace Corps Ukraine at the rates specified below. See Section G for billing procedures.

B.2.

PRICES

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 (calculated in US dollars) for the health insurance services as specified in Section C are as follows:

B.2.1.

BASE YEAR OF CONTRACT:

Bi-Weekly Rates per Employee:

Category

Estimated Number of Employees

Rate per

Employee, USD

Total for all categories, Single employees (Self only)

Employee with two dependents

Employee with three dependents

Employee with four or more dependants (up to seven dependents)

SUBTOTAL: USD

TOTAL PRICE FOR BASE YEAR: (Subtotal x 26): USD_______

B.2.2.

FIRST OPTION YEAR OF THE CONTRACT:

Category

Estimated Number of Employees

Rate per

Total for all categories, Single employees (Self only)

Employee with two dependents

Employee with three dependents

Employee with four or more dependants (up to seven dependents)

SUBTOTAL: USD

TOTAL PRICE FOR OPTION YEAR ONE: (Subtotal x 26): USD_______

B.2.3.

SECOND OPTION YEAR OF THE CONTRACT:

Category

Estimated Number of Employees

Rate per

Total for all categories, Single employees (Self only)

Employee with two dependents

Employee with three dependents

Employee with four or more dependants (up to seven dependents)

SUBTOTAL: USD

TOTAL PRICE FOR OPTION YEAR TWO: (Subtotal x 26): USD_______ B.2.4.

THIRD OPTION YEAR OF THE CONTRACT:

Category

Estimated Number of Employees

Rate per

Total for all categories, Single employees (Self only)

Employee with two dependents

Employee with three dependents

Employee with four or more dependants (up to seven dependents)

SUBTOTAL: USD

TOTAL PRICE FOR OPTION YEAR THREE: (Subtotal x 26): USD_______ B.2.5.

FOURTH OPTION YEAR OF THE CONTRACT:

Category

Estimated Number of Employees

Rate per

Total for all categories, Single employees (Self only)

Employee with two dependents

Employee with three dependents

Employee with four or more dependants (up to seven dependents)

SUBTOTAL: USD

TOTAL PRICE FOR OPTION YEAR FOUR: (Subtotal x 26): USD_______ 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 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 Retention Amounts per separate premium paid per single employee and per family plan.

(Self Only), USD

Employee with three dependents, USD

Employee with four dependents (up to seven), USD

Total per year, USD

Base Period

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. 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.

SECTION C

DESCRIPTION/SPECIFICATION/WORK STATEMENT

C.1.

HEALTH INSURANCE SERVICES

The Government of the United States of America requires 24-hour 7 days/week Health Insurance coverage for its employees as further described in C.1.2 in Ukraine. The Government has determined that the prevailing practice by employers in Ukraine is to provide for their employees health insurance protection and that the cost of such insurance protection is usually borne by both the employee and the employer. For the employee’s coverage the employer’s contribution is 95% and the employee’s contribution is 5%. For the dependents’ coverage the employer’s contribution is 60% and the employee’s contribution is 40%. The employer pays the dental services and HIV/AIDs treatment at 100%. 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/CMD.

C.1.1 Employee and Dependent Health Services Benefits

The health benefits under this contract are as follows. The annual maximum for every participant of the Plan is USD 13,000.00 for medical services plus USD 400.00 for routine dental care. Thus, the aggregate annual maximum for every participant under this contract is USD 13,400.00. 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.

Employee and Dependants

C. 1.1.1.

Hospitalization

· Organization of planned hospitalization at the discretion of respective physician

· Organization of emergency hospitalization in case of acute disease or accident

· Transportation to the hospital/transportation between hospitals

· Free choice of the medical facility (in cases of emergency this choice is made by the physician of the ambulance)

· Semi-private room and board

· Providing all necessary tests and examinations according to the treating physician’s prescriptions

· Providing medications

· Private nursing shall be provided when medically necessary at supervising physician discretion

· Physiotherapy at treating physician’s prescription

· Up to two alternative consultations upon patient’s request

· When the hospitalization cannot be provided by the private clinic the contractor organizes it in the specialized clinic (e.g. Oncology Center, Proctology Center, SRI of Orthopedic & Trauma, SRI of Urology & Nephrology etc.)

· When the hospitalization in private clinics is not possible (e.g. in cases of emergency when the state ambulance takes the patient to any available state clinic) the contractor does everything possible to move the patient to the private clinic as soon as the patient’s condition allows it.

Clinics for hospitalization (see para. C.1.1.18.).

C.1.1.2.

Surgery

· Organization of planned surgery at the discretion of respective physician

· Organization of emergency surgery

· Transportation to the hospital/between hospitals

· Free choice of the medical facility (in cases of emergency this choice is made by the physician of the ambulance)

· Semi-private room and board

· Providing all necessary tests and examinations according to the treating physician’s prescriptions

· Providing medications

· Private nursing shall be provided when medically necessary at supervising physician discretion

· Post surgery treatment and physiotherapy at treating physician’s prescription

· Up to two alternative consultations upon patient’s request

· When the surgery cannot be provided by the private clinic the contractor organizes it in the specialized clinic (e.g. Oncology Center, Proctology Center, SRI of Orthopedic & Trauma, SRI of Urology & Nephrology etc.)

· When the surgery in private clinics is not possible (e.g. in cases of emergency when the state ambulance takes the patient to any available state clinic) the contractor does everything possible to move the patient to the private clinic as soon as the patient’s condition allows it.

Clinics for surgery (see para. C.1.1.18.).

C.1.1.3.

Doctor Visits (see C.1.1.6. Hospital Outpatient Services)

C.1.1.4.

Prescription Drugs

· Prescription of all necessary drugs and supplies

· Organizing of drugs/supplies delivery (home/office) and/or pick up at the consulting medical facility or conveniently located drug store

· Patient has the right to choose the brand of a prescribed drug(s)

C.1.1.5.

Maternity

· Pre natal care

· Delivery of any complexity

· Post natal care

· Semi-private room and board

· Free choice of medical facility and physician

· Neonatal care – Intensive care for premature infant

· Monitoring of the post-natal period by the respectively assigned medical specialist

· All maternity homes all over the territory of Ukraine shall be available upon request.

· Brief courses of anti-retroviral drugs during childbirth to prevent the transmission of HIV to the participant’s child. Duration of treatment is to be determined by the participant’s personal physician, following WHO and CDC guidelines.

C.1.1.6.

Hospital Outpatient Services

· Physician’s (specialist’s) consultations at the clinic

· Physician’s (specialist’s) visits to the patient’s home when necessary

· Free choice of the medical facility and physician

· Duty Doctor services on weekends

· Tests at home upon treating physician’s discretion

· Medical certifications issuance (bolnichny).

· Physiotherapy at treating physician’s discretion

· Up to two alternative consultations upon the patient’s request

C.1.1.7.

Optical Service

· Doctor’s consultations, treatment and medications.

Not covered under this contract: eyeglasses, contact lenses, durable medical equipment and prosthesis, except as a result of trauma.

C.1.1.8.

Dental Services

· Doctor’s consultations

· Treatment and medications (except exclusions indicated under Exclusions from the coverage)

· Two routine examinations per year

· Two cleanings per year

Exclusions from Dental Coverage:

· Cosmetic services (the tooth form change, tooth decorations, veneers), excluding cases when it is necessary for correction of trauma sequences;

· Bleaching (teeth whitening with special equipment and solutions);

· Orthodontics (teeth straightening) and bracket system;

· Prosthesis as bridges, implant, UDA – universal dental attachments (excluding simple prosthesis that are necessary for correction of trauma sequences).

Clinics that are listed below are acceptable and are currently being used under existing Health Insurance Contract and offerors should consider working with these particular clinics or ones of the same standards (existing or newly opened during the course of the contract).

The Dental clinics list includes but not limited to:

Avanto

Avanto Plus

Eurodent

Prizma

Estedentax

Fenestra

Kyiv city Dental Policlinic

American Beauty Int.

Bormental

Stomatologia na Klovskoy

C.1.1.9.

Physical Therapy

· Physical Therapy is provided at treating physician’s discretion.

C.1.1.10.

Psychiatric Treatment

· Doctor’s visit and specialized medical care (if it is not the specialized psychiatric state facility).

NOTE: The treatment in the specialized psychiatric state medical establishments is not covered under this contract.

C.1.1.11.

Ambulance Service

Providing Ambulance Services in accordance with the general emergency services rules.

Ambulance services providers (see para. C.1.1.18.).

C.1.1.12.

Hearing Aids

Hearing aids (apparatus), durable medical equipment and prosthesis, if not as a result of trauma or disease, are not covered under this contract (see exclusions).

C.1.1.13.

Expenses Incurred Out-of-Country

Expenses incurred out-of-country must be covered by a separate medical insurance and are not covered under this contract.

C.1.1.14.

Other Benefits

C.1.1.14.1 Gynecology/Urology treatment

· One routine check-up per year (without indications)

· Doctor’s consultations

· Providing all necessary tests and examinations at treating doctor’s discretion

· STDs diagnostics (consultations and tests)

· Providing medications

Clinics (see para. C.1.1.18.).

C.1.1.14.2 Pediatric care Patronage (children under one year)

· Assignment of individual pediatrician

Pediatrician’s visits according to the plan:

(in complicated cases) Specialists according to pediatrician’s recommendations: Orthopedist, Ophthalmologist, Surgeon.

1 home visit of Neuropathologist, Orthopedist.

Ultrasound of the hip joint, Surgeon (umbilical ring), EMT doctor (nasal synopses).

Complete blood count (when 6 month). Specialists’ consultations if indicated.

1 visit to Ophthalmologist, Neuropathologist, EMT, Dentist, Surgeon, Orthopedist.

Complete blood count, Urinalysis.

Specialists’ consultations if indicated.

· Pediatrician’s/specialists’ home visits in case of illness

· Tests and checkups at home at doctor’s discretion

· Immunization program for children, including vaccination

· Organization of specialists’ consultations/tests/checkups at medical facilities

· Physiotherapy at doctor’s discretion

· Up to two alternative consultations upon the parent’s request

Children from 1 to 18 years

· Assignment of individual pediatrician

· Pediatricians/specialists visits at home in cases of illness

· Organization of pediatricians/specialists consultations/tests/checkups at medical facilities

· Immunization program for children, including vaccination

· Physiotherapy at pediatrician’s prescription

· Up to two alternative consultations upon the parent’s request

Clinics (see para. C.1.1.18.).

C.1.1.14. 3 Hospitalization for children (age 0-18)

· Organization of planned hospitalization

· Organization of emergency hospitalization

· Free choice of the medical facility (in cases of emergency this choice is made by the physician of the ambulance)

· Semi-private room and board

· Providing all necessary tests and examinations according to the treating doctor’s prescriptions

· Providing medications

· Up to two alternative consultations upon parents’ request

· Room and board for one accompanying person (parent, relative or nanny) until age 6

Clinics (see para. C.1.1.18.).

C.1.1.14.4 HIV/AIDs treatment

· Physician’s consultations and treatment

· Providing medications

C.1.1.14.5 Medical and Ambulance facilities Clinics that are listed below are acceptable and are currently being used under existing Health Insurance Contract and offerors should consider working with these particular clinics or ones of the same standards (existing or newly opened during the course of the contract).

The Medical clinics list includes but not limited to:

Oberih

Medikom

Boris

Dobrobut

Dobry Doctor

Isida

Valeria

Garant

Ohmatdyt Alpha-Vita

Cardio Clinic ”Sertse i Sudyny” (Zhylyanska St.)

TASS, and all other clinics on the territory of Ukraine of the same level of services.

When the treatment cannot be provided by the private clinic it should be organized in specialized clinic (e.g. Oncology Center, Proctology Center, SRI of Orthopedic & Trauma, SRI of Urology & Nephrology etc.)

C.1.1.15.

Maximum Limits

The maximum health benefit under this contract is determined not to exceed USD 13,400.00 divided as 13,000.00 USD for medical services and 400.00 USD for dental services per eligible participant.

C.1.2 Health Benefits Conditions and Limitations.

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

1) Pre-insurance Congenital diseases:

· Infant Cerebral Palsy

· Turner’s Syndrome, Gonadal Dysgenesis

· Trisomy

· Klinefelter’s Syndrome

· Hermaphroditism

· Testicular Feminisation Syndrom

· Congenital Heart Abnormalities

· Gastro-Intestinal Anomaly

· Kidney Transport Anomaly

· Congenital Carbohydrates Metabolism Disorder

· Phenylketonuria

· Congenital Connective Tissue Disease

· Ostheochondrodystrophy

2) Cosmetology treatment (except cases when it is necessary as a result of trauma or disease).

3) Sexually Transmitted Diseases:

· Chlamydial infection

· Gonococcal infections

· Syphilis

· Genital Herpes Simplex infection

· Chancroid

· Granuloma Inguinale (Donovanosis)

· Limphogranuloma Venerum

· T. Vaginalis infection

· Ureoplasma urealiticum

· Trichomoniasis

· Human Papillomavirus infection

· Hepatitis C

4) Alcohol, drug and tobacco abuse treatment.

5) Infertility.

6) Monitoring of medical treatment of mental/nervous disorders at the specialized governmental medical facilities.

7) Treatment of medical consequences of suicide attempt.

8) Plastic, cosmetic or reconstructive treatment and surgery, if not a result of trauma or disease.

9) Birth control drugs or prescription including the insertion and removal of intrauterine spiral (IUS) devices, abortion, vacuum extraction of fetus, if not prescribed by the physician.

10) Eyeglasses, contact lenses, durable medical equipment and prosthesis, except as a result of trauma.

11) Hearing aids (apparatus), durable medical equipment and prosthesis, if not as a result of trauma or disease.

12) Medical certification of general health condition for sports facilities, international health insurance, obtaining driver’s license and for entering educational institutions, as well as laboratory tests related to such certifications.

13) Fees of persons who are not licensed physicians or nurses; or services or supplies, which have not been prescribed or approved by a physician.

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

C.1.3 Eligible Participants

C.1.3.1 Eligible Employees - The employees eligible for the health insurance services include the following:

C.1.3.1.1 All current active employees of the United States Government, employed within the geographic boundaries of Ukraine 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), Personal Services Agreements-Plus (PSAs-Plus) and Personal Services Contracts (PSCs);

C.1.3.1.3.

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

C.1.3.1.4 Third country nationals (TCNs) employed under direct hire appointments, PSAs, PSAs-Plus 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 Ukraine by:

Department of State

U.S. Agency for International Development

Department of Defense

Department of Commerce

Department of Agriculture

Department of Energy

Department of Health and Human Services

Department of Justice and other Departments assigned to post during the course of the contract.

Non-personal services contract personnel and any other individual not falling within one f the categories of employees described in this clause are excluded from this contract.

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 Peace Corps Ukraine paid under Peace Corps account (see separate rider, Exhibit B). All costs for Pease Corps Ukraine employees are the responsibility of their employer- Peace Corps Ukraine, 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; Peace Corps Personal Services Contractors as required by MS 743; employees working on a temporary basis; employees with an intermittent, seasonal, or WAE (when actually employed) schedule; and any other individual not falling within one of the categories of employees described in this clause.

C.1.5.

Other Eligible Participants

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

LE staff employees’ dependents, defined as the employee’s legal spouse and each unmarried, economically dependent child who resides with the employee and children of divorced spouses when the employee has financial responsibility for the child. An eligible child will be covered under this contract until the age of 18, or 22, if a full-time student. A maximum of one spouse and six children will be covered per employee at one time. If both spouses are employed by the U.S. Mission, a maximum of six children will be covered per family. There is no limit for an eligible child who is physically or mentally handicapped.

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.

Newly eligible employees must complete the form within 60 days after the successful completion of the probation period (3 months).

To enroll additional eligible dependents (upon marriage, birth, adoption) or to delete dependents, the employee must, within 60 days of the event, complete the Enrollment Form.

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

C.1.6.2.

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 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 Ukrainian/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.

C.1.7.2.

The contractor shall provide the document described in C.1.7.1 to the COR not later than 15 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.

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 (Human Resources Officer at post).

Contributory Insurance for which the employee contributes toward the premium.

Dependent The employee’s legal spouse and each unmarried, economically dependent child who resides with the employee and children of divorced spouses when the employee has financial responsibility for the child. An eligible child will be covered under this contract until the age of 18, or 22, if a full-time student. A maximum of one spouse and six children will be covered per employee at one time. If both spouses are employed by the U.S. Mission, a maximum of six children will be covered per family. There is no limit for an eligible child who is physically or mentally handicapped.

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.1.3 for health insurance and C.2.3 for life insurance. This may also include ORE Staff and Peace Corp PSCs, if this category of individuals is listed as participating under a rider in C.1.3.3 for health insurance.

Employer The United States Government or in the case of ORE the Chief of Mission/Deputy Chief of Mission and in case of Peace Corps Staff – Peace Corps Ukraine.

GSO

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

Hospital An institution established and operated for the care and treatment of sick and injured persons.

It provides 24-hour nursing care and has diagnostic, laboratory, treatment, and surgical facilities. Any institution which does not meet this definition is not considered a hospital.

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

Maximum Benefit

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

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.

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://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.

Services.

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

C.1.0 thru C.3.0

All required services are performed and no more than Two (2) customer complaints are received per month

Repeated Complains for the same deficiency are not permitted by this Contract

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 two (2) customer complaints 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 complaint.

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

SECTION F

DELIVERIES OR PERFORMANCE

F.1.

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:

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.

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 in 30 days following contract award with four one-year options to renew.

F.3

OPTIONS

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.

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:

Attn: Contracting Office, US Embassy in Ukraine

4 Hlybochytska St, Kyiv, 04050, Ukraine

Artem Business Center

SECTION G

CONTRACT ADMINISTRATION DATA

G.1.

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

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.

The COR for this contract is the Human Resources Officer.

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 or through the broker if the contractor is a broker, 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 US Dollars.

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):

Attn. COR, HR Office, US Embassy Kyiv, Ukraine

4 Glybochytska St, Artem Business Center

G.4.2.

Frequency of Payments. All funds under this contract will be obligated by issuance of task orders, as described in H.3. Each task order will fund a specific period of time and number of employees, and the task orders will be issued at the frequency described in H.3. All payments under this contract will be made at the conclusion of the period covered. Invoices may be submitted be-weekly with payments being made be-weekly by the Government.

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. US Embassy Financial center will be making payments on behalf of The Chief of Mission and/or Deputy Chief of Mission 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. Peace Corps Staff. US Embassy Financial center will be making payments on behalf of Peace Corps Ukraine directly to the contractor for the entire premium amount of the Peace Corps Ukraine staff, whether or not the Peace Corps 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.

G.6 Reserved.

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, [ ] quarterly, [X] be-weekly 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 and Peace Corps Staff 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 and Deputy Chief of Mission).

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:

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.

Medical Insurance Claims. Settlement of medical insurance 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 from the COR each Tuesday.

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 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 surgery to hospitals designated by the Contractor in order that the Contractor will pay the expenses directly to the hospitals.

Reserved

H.5.

REPORT REQUIREMENTS. The Contractor shall provide the following reports monthly. All reports must be received by the COR no later than the 10th 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…