Solicitation_-_Health_Insurance_Uniform_Contract_for_US_Embassy_Sanaa_Locally_Engaged_Staff.pdf

SOLICITATION, OFFER AND AWARD

1. THIS CONTRACT IS A RATED ORDER

UNDER DPAS (15 CFR 350)

RATING PAGE OF PAGES

2. CONTRACT (Proc. Inst. Ident.) NO. 3. SOLICITATION NO.

SYE70015R0007

4. TYPE OF SOLICITATION

_ SEALED BID (IFB)

x NEGOTIATED (RFP)

5. DATE ISSUED

04/16/2015

6. REQUISITION/PURCHASE NO.

PR4221096

7. ISSUED BY CODE YE700 8. ADDRESS OFFER TO (If other than item 7)

U.S. CONSULATE GENERAL - JEDDAH

ATTN- YEMEN AFFAIRS UNIT - GSO

P.O. BOX #149

JEDDAH 21411 SAUDI ARABIA

Phone:+966-12-667-0080 Fax: +966-12-669-3082

U.S.CONSULATE GENERAL- JEDDAH

ATTN: YEMEN AFFAIRS UNIT, GSO

PALESTINE STREET, HAMRA DISTRICT

JEDDAH, SAUDI ARABIA

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

SOLICITATION

9. Sealed offers in original and 2 copies for furnishing the supplies or services in the Schedule will be received at the place specificed, in the depository located in

YAU - GSO Office until 05/18/2015 (date) local time 15:00 (hour).

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

Gregory V. Tolle

B. TELEPHONE (NO COLLECT CALLS)

+966-12-667-0080

C. E-MAIL ADDRESS

TOLLEGV@state.gov

11. TABLE OF CONTENTS

(x) SEC. DESCRIPTION PAGE(S) (x) SEC. DESCRIPTION PAGE(S)

PART I - THE SCHEDULE PART II - CONTRACT CLAUSES

x A SOLICITATION/CONTRACT FORM 1 x I CONTRACT CLAUSES 30 x B SUPPLIES OR SERVICE AND PRICES/COSTS 4 PART III - LIST OF DOCUMENTS, EXHIBITS, AND OTHER ATTACH.

x C DESCRIPTION/SPECS/WORK STATEMENT 10 x J LIST OF ATTACHMENTS 42 x D PACKAGING AND MARKETING 17 PART IV - REPRESENTATIONS AND INSTRUCTIONS x E INSPECTION AND ACCEPTANCE 19 x K REPRESENTATIONS, CERTIFICATIONS, AND 50 x F DELIVERIES OR PERFORMANCE 21 OTHER STATEMENTS OF OFFERORS x G CONTRACT ADMINISTRATION 23 x L INSTRS., COND., AND NOTICES TO OFFERORS 60 x H SPECIAL CONTRACT REQUIREMENTS 25 x M EVALUATION FACTORS FOR AWARD 67

OFFER (Must be ful ly 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 furn ish 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

14. ACKNOWLEDGMENT OF AMENDMENTS AMENDMENT NO. DATE AMENDMENT NO. DATE

(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

17. SIGNATURE 18. OFFER DATE

AWARD (To be completed by Government)

19. ACCEPTED AS TO ITEM NUMBERED 20. AMOUNT 21. ACCOUNTING AND APPROPRIATION

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

11. SCHEDULE

(Include applicable Federal, State and local taxes)

ITEM NO.

(a)

SUPPLIES/SERVICES

(b)

QUANTITY

(c)

UNIT

(d)

UNIT PRICE

(e)

AMOUNT

(f)

1 The contractor shal l provide health insurance to the Local ly Employed Staff of the U.S. Embassy -Sanaa.

Funding Information:

Total:

TABLE OF CONTENTS

SECTION A SOLICITATION/CONTRACT FORM

SECTION B PRICE - HEALTH INSURANCE

SECTION C DESCRIPTION/SPECIFICATION/WORK STATEMENT

SECTION D PACKAGING AND MARKING

SECTION E INSPECTION AND ACCEPTANCE

SECTION F DELIVERIES OR PERFORMANCE

SECTION G CONTRACT ADMINISTRATION DATA

SECTION H SPECIAL CONTRACT REQUIREMENTS

SECTION I CONTRACT CLAUSES

SECTION J LIST OF EXHIBITS/ATTACHMENTS

SECTION K REPRESENTATIONS, CERTIFICATIONS, AND OTHER STATEMENTS OF OFFERORS50

SECTION L INSTRUCTIONS, CONDITIONS AND NOTICES TO OFFERORS

SECTION M EVALUATION FACTORS FOR AWARD

SECTION B

PRICE - HEALTH INSURANCE

B.1. HEALTH INSURANCE SERVICES

This contract is not intended to purchase a standard policy; it is intended to purchase a policy that conforms exactly to the solicitation requirements outlined in this document.

The Contractor shall provide the Health Insurance services to employees of the Government of the United States of America in Yemen 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 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), 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 VAT as a separate charge on the

Invoice and as a separate line item in Section B.

B.2.2 CONTRACT TYPE

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

Category

Estimated Number of Employees Rate per Employee Bi-Weekly Total

a. Single Employees ( Self Only) 289

b. Family Plan 522

Bi-Weekly Rates per Employee

B.2.3. Base Year of Contract

c. Subtotal (a + b)

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

Category

Estimated Number of Employees Rate per Employee Bi-Weekly Total

a. Single Employees ( Self Only) 297

b. Family Plan 537

Bi-Weekly Rates per Employee

B.2.4. Option Year 1 of Contract

c. Subtotal (a + b)

d. Total Price for Option Year 1 (c x 26)

Category

Estimated Number of Employees Rate per Employee Bi-Weekly Total

a. Single Employees ( Self Only) 314

b. Family Plan 570

Bi-Weekly Rates per Employee

B.2.6. Option Year 3 of Contract

c. Subtotal (a + b)

d. Total Price for Option Year 3 (c x 26)

Category

Estimated Number of Employees Rate per Employee Bi-Weekly Total

a. Single Employees ( Self Only) 305

b. Family Plan 553

Bi-Weekly Rates per Employee

B.2.5. Option Year 2 of Contract

d. Total Price for Option Year 2 (c x 26)

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

Base Year Total

Option Year 1 Total

Option Year 2 Total

Option Year 3 Total

Option Year 4 Total

Grand Total of Base plus All Option Years

Category

Estimated Number of Employees Rate per Employee Bi-Weekly Total

a. Single Employees ( Self Only) 323

b. Family Plan 587

Bi-Weekly Rates per Employee

B.2.7. Option Year 4 of Contract

d. Total Price for Option Year 4 (c x 26)

B.3 ADMINISTRATIVE RETENTION AMOUNTS

B.3.1 If the Contractor requests a price adjustment under B.4 below, the Contractor must present cost experience data that includes the retention amount. For purposes of any economic price adjustment, this retention amount is a fixed amount that is a part of the premium amounts in B.2. This retention amount will not be adjusted for any reason.

The retention amount is part of the premium and may include, but not be limited to, such costs as overhead and general and administrative costs. It will also include any profit. Essentially, it includes all costs except the actual portion of the premium intended to fund claims paid to the health care provider/claimant. B.3.2 sets forth the retention amounts per premium paid for each category of premium and for each period of performance.

NOTE TO OFFEROR: Fill in the fixed bi-weekly retention amounts for each period of performance and for each category of premium. This fixed amount must be expressed in the currency in which the premium amount is proposed. The fixed retention amount shall

NOT be expressed in terms of a percentage of the premium.

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

Period of Performance Single Employees (Self Only) Family Plan

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, 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.

B.5 DEFENSE BASE ACT INSURANCE

The prices in the contract shall not include Defense Base Act (DBA) Insurance. The

Government will reimburse the Contractor directly for DBA Insurance that is required and obtained in accordance with Section I, DOSAR 652.228-71, "Worker's Compensation Insurance

(Defense Base Act) – Services" and FAR 52.228-3, "Worker's Compensation Insurance (Defense

Base Act)".

When the contract is awarded, the Contractor shall contact the Contracting Officer and request the name of the insurance broker under contract to the Department of State. After paying the DBA insurance premium, the Contractor shall submit the certification of coverage from the carrier and a voucher for payment to the Contracting Officer. A paid invoice must support the voucher. The Contractor shall submit the certification to the Contracting Officer before the

Notice to Proceed (see Section F).

The cost of DBA insurance is paid on an annual basis. The period of performance of this contract may be extended beyond one year. If so, the Contractor shall contact the Contracting

Officer, request the new rates, and be reimbursed by the Government for the actual, documented

DBA insurance costs.

B.5.1. DEFENSE BASE ACT (DBA) INSURANCE

The Government will reimburse the Contractor for DBA insurance. The total estimated cost of this insurance is: $__________. [NOTE TO OFFEROR: Fill in the estimated cost of the insurance]

SECTION C

DESCRIPTION/SPECIFICATION/WORK STATEMENT

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 Yemen The Government has determined that the prevailing practice by employers in Yemen 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 90% employer/10% employee basis. 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 insurance company will reimburse covered medical expenses incurred, subject to the stated limits. Payment will be made for reasonable and customary expenses of covered benefits. The medical treatment must be prescribed or provided by a physician or nurse licensed in Yemen, the

United States, or in the country in which the treatment or prescription is received. Coverage of expenses will be made in US Dollars.

The Contractor shall insure that health care under this contract does not exclude

HIV/AIDS care.

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.

C.1.1.1. Hospitalization: 100% coverage of room and board for a ward room or semi-private room. 80% coverage of room and board for a private room, not to exceed 100% of the cost of a semi-private room. 100% coverage of hospital medical expenses including laboratory tests and x-rays, nursing care, operating room costs, intensive care, prescription medicines, and physical therapy. 90% coverage of ambulance service.

C.1.1.2 Professional Services and Treatment: 90% 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. 90% coverage for medical services and expenses when not hospitalized such as laboratory tests and x-rays, prescription medicines, physical therapy, routine annual physical examination, and inoculations.

C.1.1.3. Prescription Drugs and Medicines: 100% coverage when hospitalized, and 90% coverage 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 HIV/AIDS Coverage (For Active Employees Only): 100% coverage of expenses for medications to suppress opportunistic infections, such as tuberculosis and toxoplasmosis for employees who have HIV/AIDS; as well as brief courses of anti-retroviral drugs during childbirth to prevent the transmission of HIV to the employee's child. This expanded coverage generally excludes medications for the long-term suppression of AIDS through the combination of anti-retroviral drugs at those posts with inadequate local healthcare infrastructures. This expanded coverage does not apply to dependents or to retired employees..

The maximum limit for expenses reimbursed under section C.1.1.4 is USD$10,000 patient per contract year.

C.1.1.5 Obstetrical Care: 90% coverage when hospitalized, and 90% coverage when not hospitalized, of obstetrical medical care including prenatal and postnatal care.

C.1.1.6 RESERVED

C.1.1.7 Hearing Aids: 45% coverage of the cost of a hearing aid apparatus and related examination up to a maximum of USD$75. Limited to one apparatus per ear per patient in a three-year period.

C.1.1.8 Optical Care: 80% coverage for eye examination and treatment.

Prescription lenses will be reimbursed at 50% every two years up to a maximum of USD $60. No reimbursement for eyeglass frames, nonprescription lenses, or tinting.

C.1.1.9 Dental Care: 50% of expenses for dental services including dentists’ fees, x-rays, examination and treatment, cleaning, fillings, and extractions up to a maximum according to the official tariff on date of procedure per year for employee and dependent.

Not covered are: false teeth, crowns, bridges, and orthodontia treatment.

C.1.1.10 Physical Therapy: 50% coverage of expenses for physical therapy.

Treatment up to maximum limit for reasonable and customary costs for treatment.

C.1.1.11 Psychiatric Treatment: 50% coverage of expenses for psychiatric treatment up to maximum limit for reasonable and customary costs for treatment.

C.1.1.12 Medical Expenses Incurred Out of Country:

Medical expenses incurred out of country will be covered for employees and dependents when (a) a life threatening condition occurs when the individual is out of the country and treatment is medically necessary before the individual returns home or (b) the individual’s attending physician certifies in advance that such treatment is medically necessary and unavailable locally. Reimbursement will be made at the same percentage rate and subject to the same annual maximum limit as for expenses incurred in Yemen.

C.1.1.13 Transportation for Out of Country Treatment

Transportation for out of country treatment is a covered expense for employees only.

The employee’s attending physician must certify in advance that the treatment is medically necessary and unavailable locally.

80% of the patient’s transportation expenses by the least expensive, appropriate means of transportation to the nearest city with adequate medical facilities will be reimbursed, including repatriation in the case of death.

80% 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.1.1.14 Catastrophic Coverage:

For catastrophic conditions, the annual aggregate maximum shall be 80% 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.

C.1.1.15 Maximum Annual Coverage:

With the exception of expenses incurred under paragraph C.1.1.4 above, the insurance company will reimburse covered expenses up to a limit of USD $9,000 per person per contract year.

The maximum limit for employees regularly scheduled to work on a part-time basis work for fewer than 30 hours per week will be prorated based on hours in the workweek. For example, the maximum limit for an employee regularly scheduled to work 20 hours per week is USD $9,000 x 20/40, or USD $4,500.

C.1.2 Health Benefits Conditions and Limitations

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

massage; exercise therapy; long term rehabilitative therapy; eyeglass frames; non-medical hospital charges such as telephones or television; home help, family help, or similar household assistance; fees of persons who are not licensed physicians or nurses; or services or supplies which have not been prescribed or approved by a physician or nurse.

No coverage will be made for expenses that will be reimbursed or paid directly under a host country medical program or workers' compensation program; the U.S. workers’ compensation program; or any Yemeni government workers' compensation type program.

No coverage will be made for expenses related to an illness or injury that is a result of an unlawful action on the part of the patient; the practice of a dangerous sport; excessive or illegal use of alcohol or drugs; a self-inflicted wound; or service in the armed forces of any country.

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

Mission, except in the case of retired employees who elect to continue coverage.

C.1.3 Eligible Participants

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

C.1.3.1.1 All current active employees of the United States Government, employed within the geographic boundaries of Yemen paid under the Local

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

C.1.3.1.1.1 Locally Employed Staff (LES) employed under direct hire appointments, Personal Services Agreements (PSAs) and Personal Services

Contracts (PSCs);

C.1.3.1.1.2. 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 Yemen by:

Department of State

Department of Justice

Department of Homeland Security

Department of Defense

Department of Agriculture

U.S. Agency for International Development

Peace Corps

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.1.4 Individuals Not Eligible for Coverage

Not eligible are those working under temporary appointments; those working under a PSC or

PSA that is time limited to less than one year; nonpersonal services contract personnel and their employees, supplied by an independent contractor licensed to do business in Yemen who provides services to other local organizations as well as to the U.S. Mission; employees of

USAID institutional contractors; Peace Corps personal services contractors as indicated in MS

743; Recreation Association employees;; 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.

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

C.1.5 Other Eligible Participants (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 18, or in the case of a child who is a full-time student, until the end of the calendar year in which the child turns age 22. There is no age limit for an eligible child who is physically or mentally handicapped so as to be unable to live independently. There is no limit on the number of children covered per employee.

Note: As previously stated in C.1.4, parents, grandparents, siblings, and other relatives are not eligible dependents.

C.1.6 Coverage after Retirement:

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

C.1.7 Premium Expenses

For active employees who are regularly scheduled to work 30 or more hours per week: the USG will pay 90% of the premium cost and the employee will pay 10% of the premium cost for employee and dependent coverage.

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, based on the number of hours the employee is regularly scheduled to work.

For retired employees: the retired employee will pay 100% of the premium cost for employee and dependent coverage.

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

C.1.8 Deductible: None

C.1.9. Eligibility

C.1.9.1. Term of Eligibility and Effective Date

Each current active eligible employee is enrolled for health benefits under this contract upon award and thereafter during the performance period of this contract. Each new eligible employee will be enrolled upon entering on duty with the United States Government. An employee is considered active ("on the rolls") whenever such employee is on approved leave, whether paid or unpaid.

During a period of Leave Without Pay (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.1.9.2. 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. Alternatively, the employee may elect to have coverage cease if that employee prefers not to pay the premium.

C.1.10. BROCHURE REQUIREMENT

C.1.10.1. 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.

C.1.10.2. The Contractor shall provide the document described in C.1.7.1 to the

COR not later than 30 days after date of contract award. The Contractor shall provide additional brochures for new employees within ten (10) days of the COR’s request.

C.1.10.3. 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.

C.2 Paragraph C.2 is Reserved.

C.3 Definitions

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

Government Agencies.

Child 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 18, or in the case of a child who is a full-time student, until the end of the calendar year in which the child turns age 22. There is no age limit for an eligible child who is physically or mentally handicapped so as to be unable to live independently.

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 Includes the employee's legal spouse (limit one), and each unmarried, economically dependent child who resides with the employee unless away at school. Parents, grandparents, siblings, and other relatives are not eligible dependents.

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. This may also include

ORE Staff and Peace Corp PSCs, if this category of individual is listed as participating under a rider in C.1.3.3.

Employer The United States Government or, in the case of ORE, the Chief of

Mission/Deputy Chief of Mission.

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 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 subject to change. If the Federal Acquisition Regulation (FAR) is not available at the locations indicated above, use the Department of State Acquisition website at http://www.statebuy.state.gov/ to see the links to the FAR. You may also use an internet “search engine” (for example, Google, Yahoo, Excite) to obtain the latest location of the most current

FAR.

The following Federal Acquisition Regulation clause(s) is/are incorporated by reference:

CLAUSE TITLE AND DATE

52.246-4 INSPECTION OF SERVICES - FIXED PRICE (AUG 1996)

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

This plan is designed to provide an effective surveillance method to promote effective Contractor performance. The QASP provides a method for the Contracting Officer's Representative (COR) to monitor Contractor performance, advise the Contractor of unsatisfactory performance, and notify the Contracting Officer of continued unsatisfactory performance. The Contractor, not the

Government, is responsible for management and quality control to meet the terms of the contract.

The role of the Government is to conduct quality assurance to ensure that contract standards are achieved.

Performance Objective

PWS

Paragraph Performance Threshold

Services

Performs all the insurance services set forth in the Performance Work Statement (PWS)

C.1.0 thru

C.3.0

All required services are performed and no more than one

(1) customer complaint is received per month

Concurrently, the COR will visit the Contractor’s office every quarter if in Yemen or once a year if abroad to discuss http://www.acquisition.gov/far/ http://farsite.hill.af.mil/vffara.htm http://www.statebuy.state.gov/

E.2.1 Surveillance.

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

E.2.2 Standard.

The performance standard is that the Government receives no more than one (1) customer complaint per month. The COR shall notify the Contracting Officer of the complaints so that the

Contracting Officer may take appropriate action to enforce the inspection clause (FAR 52.246-4, Inspection of Services – Fixed Price (AUG 1996) or the appropriate Inspection of Services clause), if any of the services exceed the standard.

E.2.3 Procedures

(a) If any Government personnel observe unacceptable services, either incomplete work or required services not being performed, they should immediately contact the COR.

(b) The COR will complete appropriate documentation to record the complaint.

(c) If the COR determines the complaint is invalid, the COR will advise the complainant. The COR will retain the annotated copy of the written complaint for his/her files.

(d) If the COR determines the complaint is valid, the COR will inform the Contractor and give the Contractor additional time to correct the defect, if additional time is available. The

COR shall determine how much time is reasonable.

(e) The COR shall, as a minimum, orally notify the Contractor of any valid complaints.

(f) If the Contractor disagrees with the complaint and challenges the validity of the complaint, the Contractor will notify the COR. The COR will review the matter to determine the validity of the complaint.

(g) The COR will consider complaints as resolved unless notified otherwise by the 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. 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

http://www.statebuy.state.gov/ to see the links to the FAR. You may also use an internet “search

The following Federal Acquisition Regulation clauses are incorporated by reference:

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 30 days after contract award. with four (4) one-year options to renew.

F.3 OPTIONS

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

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

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

http://www.acquisition.gov/far/

F.4 REPORTS AND OTHER DELIVERABLES

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

Human Resources Officer

U.S. Embassy

Sa’awan Street

Sana’a

Republic of Yemen

SECTION G

CONTRACT ADMINISTRATION DATA

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

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

Contracting Officer and this authority is delegated in the designation.

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

G.3.1 Payment shall be made in United States Dollars (USD)

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):

FMO Billing

U.S. Embassy

Sa’awan Street

Yemen

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.

Contractor may submit invoices monthly for payment to be made at the beginning of the month for which insurance coverage is provided in accordance with FAR 32.404.

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

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

G.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 VALUE ADDED TAX

VALUE ADDED TAX (VAT). The Contractor shall include VAT as a separate charge on the

Invoice and as a separate line item in Section B.

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

H.3.1. The ORE staff 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

H.4.1. GENERAL

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

(a) Administrative Records

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

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

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

(4) The Contractor shall send employee claim reimbursement using Electronic

Funds Transfer (EFT) to employees not later than two weeks after a claim is submitted.

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

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

COR each Tuesday.

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

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

(4) Settlement shall be by issuance of checks in the name of the employee for each claim submitted. Each check shall be accompanied by a form providing details of the amount reimbursed with an explanation of deductions, if any.

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

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.

(a) Employee Claims Report. The report will list all claims paid by the Contractor to a claimant, including the name of the claimant, date claim is received by the Contractor, and the amount claimed. This report shall also include all outstanding claims and a brief description of why claim has not been paid, including, if applicable, a list of what additional documents are needed for payment.

H.6. MISCELLANEOUS CONTRACTOR REQUIREMENTS

H.6.1. GENERAL

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

Registration of this contract with the Yemeni government, if required by law, will be the sole responsibility of the Contractor, and any fees, taxes, or other duties shall be payable by the

Contractor without recourse to the Government of the amounts thereof.

H.6.2. LICENSES AND LOCAL LAWS.

The Contractor shall possess all permits, licenses, and any other appointments required for the prosecution of work under this contract, all at no additional cost to the Government. The

Contractor shall perform this contract in accordance with local laws.

H.7 ERRONEOUS PAYMENTS.

If the Government becomes eligible for a refund of payment because of erroneous overpayment or other cause, the Contractor shall refund the amounts or use them to offset future payments owed by the Government, whichever the Government prefers. The Contractor shall refund any refunds not complete or discovered after the completion date of this contract.

H.8 REQUIRING ACTIVITY.

The requiring activity under this contract is the U.S. Embassy.

H.9 ON-SITE PROVISION OF SERVICE

The Embassy requires that the Contractor make personnel available on-site to assist the covered employees in preparing claims, as well as to receive and process the claims.

The Embassy estimates that approximately 150 claims will be processed per week.

H.9.1 PROVISION OF SERVICE DURING PERIODS OF SUSPENDED OPERATIONS OR

CLOSURE

During periods of suspended operations or closure, when access to the on-site facilities office is prohibited or not possible, the Contractor shall operate out of its own facility, not on Government property. Facilities located in the city to be served are preferred. The availability of a contractor representative within the city to be served is also preferred. The Contractor shall perform all the required services in a timely manner, through effective communications and delivery systems. If the Contractor's facility is so remote from the Embassy so that Government employees must incur long-distance charges to submit claims, the Contractor shall provide an adequate number of toll-free lines (or accept collect calls) for Government use during regular working hours. Off-site operation during periods of suspended operations or closure shall be provided without additional cost to the Government.

H.10 FURNISHING OF EQUIPMENT/PROPERTY

H.10.1. The Government will provide the property listed in Section J, Exhibit C. The

Contractor has the option to reject any or all Government furnished property or items. However, if the Government furnished property is rejected, Contractor shall provide all necessary property, equipment or items, adequate in quantity and suitable for the intended purpose, to perform all work and provide all services at no additional cost to the Government. The Contractor shall use all Government furnished property or items only in connection with performance under this contract. The Contractor is responsible for the proper care, maintenance and use of Government property in its possession or control from time of receipt until properly relieved of responsibility in accordance with the terms of the contract. Negligent use of Government furnished property that results in damage or destruction is cause for repair or replacement at the Contractor's expense.

H.10.1.1. The Contractor shall maintain written records of work performed, and report the need for major repair or replacement work for Government property in its control. The Contractor shall ensure that the Government property will be used only for those purposes authorized in the contract and that any required approvals for use will be obtained prior to use.

H.10.1.2. The Contractor shall physically inventory all Government property in its possession. Physical inventories consist of sighting, tagging or marking, describing, recording, reporting and reconciling the property with written records. The Contractor shall conduct these physical inventories annually, as directed by the COR, and at termination or completion of the contract. Unless approved in advance by the

Contracting Officer, personnel who maintain the property records or who have custody of the property shall not be the individuals who perform these inventories.

H.11 SPACE FOR PERFORMANCE OF REQUIRED SERVICES

H.11.1 ON-SITE SERVICES

For…