USCA18R0092_062818_v2.pdf

SOLICITATION/CONTRACT/ORDER

OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24 & 30

1. REQUISITION NUMBER

BD170011

5. SOLICITATION NUMBER

USCA18R0092

2. CONTRACT NO. 3. AWARD/EFFECTIVE DATE 4. ORDER NUMBER 6. SOLICITATION ISSUE

DATE

06/29/2018

7. FOR INFORMATION CALL: a. NAME Patricia A. Butler

b. TELEPHONE NUMBER (No collect calls) 202-502-2796

8. OFFER DUE DATE / LOCAL

TIME

08/01/2018 10:00:00

CODE PMD

Procurement Management Division Administrative Office of the United States Courts One Columbus Circle, N.E.

Suite 3-250 Washington, DC 20544-0001

9. ISSUED BY 10.

NOT USED

SEE

SCHEDULE

11. DELIVERY FOR FOB DESTINATION

UNLESS BLOCK IS MARKED

12. DISCOUNT TERMS 13.

NOT USED RFQ X RFP

14. METHOD OF SOLICITATION

BDCODE15. DELIVER TO

Benefits Division Administrative Office of the United States Courts One Columbus Circle, N.E.

Suite 5-430 Washington, DC 20544-0001

CODE16. ADMINISTERED BY (if other than Block 9)

FACILITY

CODE

CODE

Telephone No.

17a. CONTRACTOR/

OFFEROR

BDCODE18a. PAYMENT WILL BE MADE BY Benefits Division Administrative Office of the United States Courts One Columbus Circle, N.E.

Suite 5-430 Washington, DC 20544-0001

17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN

OFFER

18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK BELOW IS

CHECKED

19. ITEM NO. 20. SCHEDULE OF SUPPLIES/SERVICES

(Use Reverse and/or Attach Additional Sheets as Necessary)

21. QUANTITY 22. UNIT 23. UNIT PRICE 24. AMOUNT

See Lines

25. ACCOUNTING AND APPROPRIATION DATA 26. TOTAL AWARD AMOUNT (For Govt. Use Only)

27. Applicable terms and conditions are as stated in the continuation pages.

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN ____ COPIES TO

ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND DELIVER ALL ITEMS SET FORTH

OR OTHERWISE IDENTIFIED ABOVE AND ON ANY ADDITIONAL SHEETS SUBJECT TO THE

TERMS AND CONDITIONS SPECIFIED.

29. AWARD OF CONTRACT: REF. _____________________________ OFFER

DATED _________________ . YOUR OFFER ON SOLICITATION (BLOCK 5)

INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE SET FORTH HEREIN,

IS ACCEPTED AS TO ITEMS:

30a. SIGNATURE OF OFFEROR/CONTRACTOR 31a. UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER)

30b. NAME AND TITLE OF SIGNER (TYPE OR PRINT) 30c. DATE SIGNED 31b. NAME OF THE CONTRACTING OFFICER (TYPE OR PRINT) 31c. DATE SIGNED

AUTHORIZED FOR LOCAL REPRODUCTION

PREVIOUS EDITION IS NOT USABLE

USCA18R0092 - Page 1 of 64

19.

ITEM NO.

20.

SCHEDULE OF SUPPLIES/SERVICES

21.

QUANTITY

22.

UNIT

23.

UNIT PRICE

24.

AMOUNT

32a. QUANTITY IN COLUMN 21 HAS BEEN

RECEIVED INSPECTED ACCEPTED, AND CONFORMS TO THE CONTRACT, EXCEPT AS NOTED: _________________________________

32b. SIGNATURE OF AUTHORIZED GOVERNMENT

REPRESENTATIVE

32c. DATE 32d. PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT

REPRESENTATIVE

32e. MAILING ADDRESS OF AUTHORIZED GOVERNMENT REPRESENTATIVE 32f. TELEPHONE NUMBER OF AUTHORIZED GOVERNMENT

REPRESENTATIVE

32g. E-MAIL OF AUTHORIZED GOVERNMENT REPRESENTATIVE

PARTIAL FINAL

33. SHIP NUMBER 34. VOUCHER NUMBER 35. AMOUNT VERIFIED

CORRECT FOR

COMPLETE PARTIAL FINAL

36. PAYMENT 37. CHECK NUMBER

38. S/R ACCOUNT NUMBER 39. S/R VOUCHER NUMBER 40. PAID BY

41a. I CERTIFY THIS ACCOUNT IS CORRECT AND PROPER FOR PAYMENT 42a. RECEIVED BY (Print)

41b. SIGNATURE AND TITLE OF CERTIFYING OFFICER 41c. DATE

42b. RECEIVED AT (Location)

42c. DATE REC'D (YY/MM/DD) 42d. TOTAL CONTAINERS

USCA18R0092 - Page 2 of 64

Supplies or Services and Prices/Costs

CLIN NO. Supplies or Services Quantity Unit of Issue Unit Price Extended Amount

0001 Transition Items (Base Period)

Enter pricing on Attachment D.

0 Lot

Period of Performance:10/22/2018 - 10/21/2019

CLIN NO. Supplies or Services Quantity Unit of Issue Unit Price Extended Amount

0002 Annual Enrollment Planning, Communication

Development, Distribution & Enrollment for Plan

Year 2020 (Base Period)

Enter pricing on Attachment D.

0 Lot

Period of Performance:07/01/2019 - 06/30/2020

CLIN NO. Supplies or Services Quantity Unit of Issue Unit Price Extended Amount

0003 Reimbursable charges (to include travel, postage and other reimbursable charges) for Annual

Enrollment (Base Period)

Enter pricing on Attachment D.

0 Not-To-

Exceed

Period of Performance:07/01/2019 - 06/30/2020

CLIN NO. Supplies or Services Quantity Unit of Issue Unit Price Extended Amount

0004 Benefits Administration (Base Period)

Monthly Price per Eligible person. Based on

34,000 employees. Enter pricing on Attachment D.

0 Month

Period of Performance:07/01/2019 - 06/30/2020

USCA18R0092 - Page 3 of 64

0005 Thrift Savings Account Administration (Base

Period)

Monthly Price per Eligible person. Based on

34,000 employees. Enter pricing on Attachment D.

0 Month

Period of Performance:07/01/2019 - 06/30/2020

CLIN NO. Supplies or Services Quantity Unit of Issue Unit Price Extended Amount

0006 Flexible Spending Account Administration inclusive of run-out (Base Period)

Monthly Price per participant. Based on 11,000 participants.

Enter pricing on Attachment D.

0 Month

Period of Performance:07/01/2019 - 06/30/2020

CLIN NO. Supplies or Services Quantity Unit of Issue Unit Price Extended Amount

0007 Commuter Parking Reimbursement Account

Administration inclusive of run-out (Base Period)

Monthly Price per participant. Based on 3,000 participants. Enter pricing on Attachment D.

0 Month

Period of Performance:07/01/2019 - 06/30/2020

CLIN NO. Supplies or Services Quantity Unit of Issue Unit Price Extended Amount

0008 Commuter Mass Transit Reimbursement Account

Administration inclusive of run-out (Base Period)

Monthly Price per participant. Based on 1,000 participants. Enter pricing on Attachment D.

0 Month

USCA18R0092 - Page 4 of 64

0009 Reimbursable charges (to include travel, postage and other reimbursable charges) for Administration

(Base Period)

Enter pricing on Attachment D.

0 Not-To-

Exceed

Period of Performance:07/01/2019 - 06/30/2020

CLIN NO. Supplies or Services Quantity Unit of Issue Unit Price Extended Amount

0010 Affordable Care Act Administration (Base Period)

Monthly Price per Eligible person. Based on

34,000 employees. Enter pricing on Attachment D.

0 Month

Period of Performance:07/01/2019 - 06/30/2020

CLIN NO. Supplies or Services Quantity Unit of Issue Unit Price Extended Amount

0011 Education/Training Services (train the trainer, group sessions)

(Base Period)

Price per event - assumes 5 events/per year;

travel included as applicable. Enter a

Not-to-Exceed of $ 10,000 on Attachment D.

0 Not-To-

Exceed

Period of Performance:07/01/2019 - 06/30/2020

CLIN NO. Supplies or Services Quantity Unit of Issue Unit Price Extended Amount

0012 FSA non-discrimination testing (Base Period) 0 Lot

USCA18R0092 - Page 5 of 64

0013 Total Compensation Statement (Base Period) 0 Lot

Period of Performance:07/01/2019 - 06/30/2020

CLIN NO. Supplies or Services Quantity Unit of Issue Unit Price Extended Amount

1001 Annual Enrollment Planning, Communication

Development, Distribution & Enrollment for Plan

Year 2021 (Option Period 1)

Enter pricing on Attachment D.

0 Lot

Period of Performance:07/01/2020 - 06/30/2021

CLIN NO. Supplies or Services Quantity Unit of Issue Unit Price Extended Amount

1002 Reimbursable charges (to include travel, postage and other reimbursable charges) for Annual

Enrollment (Option Period 1)

Enter pricing on Attachment D.

0 Not-To-

Exceed

Period of Performance:07/01/2020 - 06/30/2021

CLIN NO. Supplies or Services Quantity Unit of Issue Unit Price Extended Amount

1003 Benefits Administration (Option Period 1)

Monthly Price per Eligible person. Based on

34,000 employees. Enter pricing on Attachment D.

0 Not-To-

Exceed

Period of Performance:07/01/2020 - 06/30/2021

CLIN NO. Supplies or Services Quantity Unit of Issue Unit Price Extended Amount

1004 Thrift Savings Account Administration (Option

Period 1)

0 Month

USCA18R0092 - Page 6 of 64

Monthly Price per Eligible person. Based on

34,000 employees. Enter pricing on Attachment D.

Period of Performance:07/01/2020 - 06/30/2021

CLIN NO. Supplies or Services Quantity Unit of Issue Unit Price Extended Amount

1005 Flexible Spending Account Administration inclusive of run-out (Option Period 1)

Monthly Price per participant. Based on 11,000 participants.

Enter pricing on Attachment D.

0 Month

Period of Performance:07/01/2020 - 06/30/2021

CLIN NO. Supplies or Services Quantity Unit of Issue Unit Price Extended Amount

1006 Commuter Parking Reimbursement Account

Administration inclusive of run-out (Option Period

1)

Monthly Price per participant. Based on 3,000 participants. Enter pricing on Attachment D.

0 Month

Period of Performance:07/01/2020 - 06/30/2021

CLIN NO. Supplies or Services Quantity Unit of Issue Unit Price Extended Amount

1007 Commuter Mass Transit Reimbursement Account

Administration inclusive of run-out (Option Period

1)

Monthly Price per participant. Based on 1,000 participants. Enter pricing on Attachment D.

0 Month

Period of Performance:07/01/2020 - 06/30/2021

USCA18R0092 - Page 7 of 64

1008 Reimbursable charges (to include travel, postage and other reimbursable charges) for Administration

(Option Period 1)

Enter pricing on Attachment D.

0 Not-To-

Exceed

Period of Performance:07/01/2020 - 06/30/2021

CLIN NO. Supplies or Services Quantity Unit of Issue Unit Price Extended Amount

1009 Affordable Care Act Administration (Option Period

1)

Monthly Price per Eligible person. Based on

34,000 employees. Enter pricing on Attachment D.

0 Not-To-

Exceed

Period of Performance:07/01/2020 - 06/30/2021

CLIN NO. Supplies or Services Quantity Unit of Issue Unit Price Extended Amount

1010 Education/Training Services (train the trainer, group sessions)

(Option Period 1)

Price per event - assumes 5 events/per year;

travel included as applicable. Enter a

Not-to-Exceed of $ 10,000 on Attachment D.

0 Not-To-

Exceed

Period of Performance:07/01/2020 - 06/30/2021

CLIN NO. Supplies or Services Quantity Unit of Issue Unit Price Extended Amount

1011 FSA non-discrimination testing (Option Period 1) 0 Not-To-

Exceed

Period of Performance:07/01/2020 - 06/30/2021

USCA18R0092 - Page 8 of 64

1012 Total Compensation Statement (Option Period 1) 0 Lot

Period of Performance:07/01/2020 - 06/30/2021

CLIN NO. Supplies or Services Quantity Unit of Issue Unit Price Extended Amount

2001 Annual Enrollment Planning, Communication

Development, Distribution & Enrollment for Plan

Year 2022 (Option Period 2)

Enter pricing on Attachment D.

0 Lot

Period of Performance:07/01/2021 - 06/30/2022

CLIN NO. Supplies or Services Quantity Unit of Issue Unit Price Extended Amount

2002 Reimbursable charges (to include travel, postage and other reimbursable charges) for Annual

Enrollment (Option Period 2)

Enter pricing on Attachment D.

0 Not-To-

Exceed

Period of Performance:07/01/2021 - 06/30/2022

CLIN NO. Supplies or Services Quantity Unit of Issue Unit Price Extended Amount

2003 Benefits Administration (Option Period 2)

Monthly Price per Eligible person. Based on

34,000 employees. Enter pricing on Attachment D.

0 Not-To-

Exceed

Period of Performance:07/01/2021 - 06/30/2022

CLIN NO. Supplies or Services Quantity Unit of Issue Unit Price Extended Amount

2004 Thrift Savings Account Administration (Option

Period 2)

USCA18R0092 - Page 9 of 64

34,000 employees. Enter pricing on Attachment D.

Period of Performance:07/01/2021 - 06/30/2022

CLIN NO. Supplies or Services Quantity Unit of Issue Unit Price Extended Amount

2005 Flexible Spending Account Administration inclusive of run-out (Option Period 2)

Monthly Price per participant. Based on 11,000 participants.

Enter pricing on Attachment D.

0 Month

Period of Performance:07/01/2021 - 06/30/2022

CLIN NO. Supplies or Services Quantity Unit of Issue Unit Price Extended Amount

2006 Commuter Parking Reimbursement Account

Administration inclusive of run-out (Option Period

2)

Monthly Price per participant. Based on 3,000 participants. Enter pricing on Attachment D.

0 Month

Period of Performance:07/01/2021 - 06/30/2022

CLIN NO. Supplies or Services Quantity Unit of Issue Unit Price Extended Amount

2007 Commuter Mass Transit Reimbursement Account

Administration inclusive of run-out (Option Period

2)

Monthly Price per participant. Based on 1,000 participants. Enter pricing on Attachment D.

0 Month

Period of Performance:07/01/2021 - 06/30/2022

USCA18R0092 - Page 10 of 64

2008 Reimbursable charges (to include travel, postage and other reimbursable charges) for Administration

(Option Period 2)

Enter pricing on Attachment D.

0 Not-To-

Exceed

Period of Performance:07/01/2021 - 06/30/2022

CLIN NO. Supplies or Services Quantity Unit of Issue Unit Price Extended Amount

2009 Affordable Care Act Administration (Option Period

2)

Monthly Price per Eligible person. Based on

34,000 employees. Enter pricing on Attachment D.

0 Not-To-

Exceed

Period of Performance:07/01/2021 - 06/30/2022

CLIN NO. Supplies or Services Quantity Unit of Issue Unit Price Extended Amount

2010 Education/Training Services (train the trainer, group sessions)

(Option Period 2)

Price per event - assumes 5 events/per year;

travel included as applicable. Enter a

Not-to-Exceed of $ 10,000 on Attachment D.

0 Not-To-

Exceed

Period of Performance:07/01/2021 - 06/30/2022

CLIN NO. Supplies or Services Quantity Unit of Issue Unit Price Extended Amount

2011 FSA non-discrimination testing (Option Period 2) 0 Not-To-

Exceed

Period of Performance:07/01/2021 - 06/30/2022

USCA18R0092 - Page 11 of 64

2012 Total Compensation Statement (Option Period 2) 0 Lot

Period of Performance:07/01/2021 - 06/30/2022

CLIN NO. Supplies or Services Quantity Unit of Issue Unit Price Extended Amount

3001 Annual Enrollment Planning, Communication

Development, Distribution & Enrollment for Plan

Year 2023 (Option Period 3)

Enter pricing on Attachment D.

0 Lot

Period of Performance:07/01/2022 - 06/30/2023

CLIN NO. Supplies or Services Quantity Unit of Issue Unit Price Extended Amount

3002 Reimbursable charges (to include travel, postage and other reimbursable charges) for Annual

Enrollment (Option Period 3)

Enter pricing on Attachment D.

0 Not-To-

Exceed

Period of Performance:07/01/2022 - 06/30/2023

CLIN NO. Supplies or Services Quantity Unit of Issue Unit Price Extended Amount

3003 Benefits Administration (Option Period 3)

Monthly Price per Eligible person. Based on

34,000 employees. Enter pricing on Attachment D.

0 Not-To-

Exceed

Period of Performance:07/01/2022 - 06/30/2023

CLIN NO. Supplies or Services Quantity Unit of Issue Unit Price Extended Amount

3004 Thrift Savings Account Administration (Option

Period 3)

USCA18R0092 - Page 12 of 64

34,000 employees. Enter pricing on Attachment D.

Period of Performance:07/01/2022 - 06/30/2023

CLIN NO. Supplies or Services Quantity Unit of Issue Unit Price Extended Amount

3005 Flexible Spending Account Administration inclusive of run-out (Option Period 3)

Monthly Price per participant. Based on 11,000 participants.

Enter pricing on Attachment D.

0 Month

Period of Performance:07/01/2022 - 06/30/2023

CLIN NO. Supplies or Services Quantity Unit of Issue Unit Price Extended Amount

3006 Commuter Parking Reimbursement Account

Administration inclusive of run-out (Option Period

3)

Monthly Price per participant. Based on 3,000 participants. Enter pricing on Attachment D.

0 Month

Period of Performance:07/01/2022 - 06/30/2023

CLIN NO. Supplies or Services Quantity Unit of Issue Unit Price Extended Amount

3007 Commuter Mass Transit Reimbursement Account

Administration inclusive of run-out (Option Period

3)

Monthly Price per participant. Based on 1,000 participants. Enter pricing on Attachment D.

0 Month

Period of Performance:07/01/2022 - 06/30/2023

USCA18R0092 - Page 13 of 64

3008 Reimbursable charges (to include travel, postage and other reimbursable charges) for Administration

(Option Period 3)

Enter pricing on Attachment D.

0 Not-To-

Exceed

Period of Performance:07/01/2022 - 06/30/2023

CLIN NO. Supplies or Services Quantity Unit of Issue Unit Price Extended Amount

3009 Affordable Care Act Administration (Option Period

3)

Monthly Price per Eligible person. Based on

34,000 employees. Enter pricing on Attachment D.

0 Month

Period of Performance:07/01/2022 - 06/30/2023

CLIN NO. Supplies or Services Quantity Unit of Issue Unit Price Extended Amount

3010 Education/Training Services (train the trainer, group sessions)

(Option Period 3)

Price per event - assumes 5 events/per year;

travel included as applicable. Enter a

Not-to-Exceed of $ 10,000 on Attachment D.

0 Not-To-

Exceed

Period of Performance:07/01/2022 - 06/30/2023

CLIN NO. Supplies or Services Quantity Unit of Issue Unit Price Extended Amount

3011 FSA non-discrimination testing (Option Period 3) 0 Lot

Period of Performance:07/01/2022 - 06/30/2023

USCA18R0092 - Page 14 of 64

3012 Total Compensation Statement (Option Period 3) 0 Lot

Period of Performance:07/01/2022 - 06/30/2023

CLIN NO. Supplies or Services Quantity Unit of Issue Unit Price Extended Amount

4001 Annual Enrollment Planning, Communication

Development, Distribution & Enrollment for Plan

Year 2024 (Option Period 4)

Enter pricing on Attachment D.

0 Lot

Period of Performance:07/01/2023 - 06/30/2024

CLIN NO. Supplies or Services Quantity Unit of Issue Unit Price Extended Amount

4002 Reimbursable charges (to include travel, postage and other reimbursable charges) for Annual

Enrollment (Option Period 4)

Enter pricing on Attachment D.

0 Not-To-

Exceed

Period of Performance:07/01/2023 - 06/30/2024

CLIN NO. Supplies or Services Quantity Unit of Issue Unit Price Extended Amount

4003 Benefits Administration (Option Period 4)

Monthly Price per Eligible person. Based on

34,000 employees. Enter pricing on Attachment D.

0 Month

Period of Performance:07/01/2023 - 06/30/2024

CLIN NO. Supplies or Services Quantity Unit of Issue Unit Price Extended Amount

4004 Thrift Savings Account Administration (Option

Period 4)

USCA18R0092 - Page 15 of 64

34,000 employees. Enter pricing on Attachment D.

Period of Performance:07/01/2023 - 06/30/2024

CLIN NO. Supplies or Services Quantity Unit of Issue Unit Price Extended Amount

4005 Flexible Spending Account Administration inclusive of run-out (Option Period 4)

Monthly Price per participant. Based on 11,000 participants.

Enter pricing on Attachment D.

0 Month

Period of Performance:07/01/2023 - 06/30/2024

CLIN NO. Supplies or Services Quantity Unit of Issue Unit Price Extended Amount

4006 Commuter Parking Reimbursement Account

Administration inclusive of run-out (Option Period

4)

Monthly Price per participant. Based on 3,000 participants. Enter pricing on Attachment D.

0 Month

Period of Performance:07/01/2023 - 06/30/2024

CLIN NO. Supplies or Services Quantity Unit of Issue Unit Price Extended Amount

4007 Commuter Mass Transit Reimbursement Account

Administration inclusive of run-out (Option Period

4)

Monthly Price per participant. Based on 1,000 participants. Enter pricing on Attachment D.

0 Month

Period of Performance:07/01/2023 - 06/30/2024

USCA18R0092 - Page 16 of 64

4008 Reimbursable charges (to include travel, postage and other reimbursable charges) for Administration

(Option Period 4)

Enter pricing on Attachment D.

0 Not-To-

Exceed

Period of Performance:07/01/2023 - 06/30/2024

CLIN NO. Supplies or Services Quantity Unit of Issue Unit Price Extended Amount

4009 Affordable Care Act Administration (Option Period

4)

Monthly Price per Eligible person. Based on

34,000 employees. Enter pricing on Attachment D.

0 Month

Period of Performance:07/01/2023 - 06/30/2024

CLIN NO. Supplies or Services Quantity Unit of Issue Unit Price Extended Amount

4010 Education/Training Services (train the trainer, group sessions)

(Option Period 4)

Price per event - assumes 5 events/per year;

travel included as applicable. Enter a

Not-to-Exceed of $ 10,000 on Attachment D.

0 Not-To-

Exceed

Period of Performance:07/01/2023 - 06/30/2024

CLIN NO. Supplies or Services Quantity Unit of Issue Unit Price Extended Amount

4011 FSA non-discrimination testing (Option Period 4) 0 Lot

Period of Performance:07/01/2023 - 06/30/2024

USCA18R0092 - Page 17 of 64

4012 Total Compensation Statement (Option Period 4) 0 Lot

Period of Performance:07/01/2023 - 06/30/2024

CLIN NO. Supplies or Services Quantity Unit of Issue Unit Price Extended Amount

5001 Benefits Administration (Option Period 5)

Monthly Price per Eligible person. Based on

34,000 employees. Enter pricing on Attachment D.

0 Month

Period of Performance:07/01/2024 - 12/31/2024

CLIN NO. Supplies or Services Quantity Unit of Issue Unit Price Extended Amount

5002 Thrift Savings Account Administration (Option

Period 5)

Monthly Price per Eligible person. Based on

34,000 employees. Enter pricing on Attachment D.

0 Month

Period of Performance:07/01/2024 - 06/30/2025

CLIN NO. Supplies or Services Quantity Unit of Issue Unit Price Extended Amount

5003 Flexible Spending Account Administration inclusive of run-out (Option Period 5)

Monthly Price per participant. Based on 11,000 participants.

Enter pricing on Attachment D.

0 Month

Period of Performance:07/01/2024 - 06/30/2025

CLIN NO. Supplies or Services Quantity Unit of Issue Unit Price Extended Amount

5004 Commuter Parking Reimbursement Account

Administration inclusive of run-out (Option Period

USCA18R0092 - Page 18 of 64

5)

Monthly Price per participant. Based on 3,000 participants. Enter pricing on Attachment D.

Period of Performance:07/01/2024 - 06/30/2025

CLIN NO. Supplies or Services Quantity Unit of Issue Unit Price Extended Amount

5005 Commuter Mass Transit Reimbursement Account

Administration inclusive of run-out (Option Period

5)

Monthly Price per participant. Based on 1,000 participants. Enter pricing on Attachment D.

0 Month

Period of Performance:07/01/2024 - 06/30/2025

CLIN NO. Supplies or Services Quantity Unit of Issue Unit Price Extended Amount

5006 Reimbursable charges (to include travel, postage and other reimbursable charges) for Administration

(Option Period 5)

Enter pricing on Attachment D.

0 Not-To-

Exceed

Period of Performance:07/01/2024 - 06/30/2025

CLIN NO. Supplies or Services Quantity Unit of Issue Unit Price Extended Amount

5007 Affordable Care Act Administration (Option Period

5)

Monthly Price per Eligible person. Based on

34,000 employees. Enter pricing on Attachment D.

0 Month

Period of Performance:07/01/2024 - 06/30/2025

USCA18R0092 - Page 19 of 64

5008 Education/Training Services (train the trainer, group sessions)

(Option Period 5)

Price per event - assumes 5 events/per year;

travel included as applicable. Enter a

Not-to-Exceed of $ 10,000 on Attachment D.

0 Not-To-

Exceed

Period of Performance:07/01/2024 - 06/30/2025

CLIN NO. Supplies or Services Quantity Unit of Issue Unit Price Extended Amount

5009 FSA non-discrimination testing (Option Period 5) 0 Lot

Period of Performance:07/01/2024 - 06/30/2025

CLIN NO. Supplies or Services Quantity Unit of Issue Unit Price Extended Amount

5010 Total Compensation Statement (Option Period 5) 0 Lot

Period of Performance:07/01/2024 - 06/30/2025

Descriptions/Specifications/Statement of Work

C-1 Third-Party Benefits Administrative Services for the Federal Judiciary Benefit Programs

STATEMENT OF WORK

THIRD-PARTY BENEFITS ADMINISTRATION SERVICES FOR THE FEDERAL JUDICIARY

BENEFIT PROGRAM

BENEFITS DIVISION, OFFICE OF HUMAN RESOURCES

Section C - Statement of Work

C.1 Background

The Federal Judiciary is the third branch of the United States Government and was established under Article III of the Constitution. The Federal Judiciary is composed of federal courts throughout the United States and its territories. This includes the Supreme Court, the Administrative Office of the United States Courts (AOUSC), USCA18R0092 - Page 20 of 64

13 U.S. Courts of Appeals, 94 U.S. District Courts, 90 Bankruptcy Courts and various other special courts. The federal probation system, pretrial service program, and federal defenders program are also nationwide elements of the Federal Judiciary.

The AOUSC is devoted to serving the courts in fulfilling the federal judicial system's critical mission, which is providing justice to the citizens of this country. The agency provides service to the federal courts in three es-sential areas: administrative support, program management, and policy development. It is charged with imple-menting the policies of the Judicial Conference of the United States and supporting the network of Confer-ence committees. It is also the focal point for Judiciary communication, information, program leadership, and administrative reform.

The Benefits Division of the AOUSC is responsible for development and oversight of judiciary benefits pro-grams and initiatives, evaluating the effectiveness of new benefit programs, and managing the policy, opera-tion and communications for the benefit programs offered to the judiciary workforce.

The Federal Judiciary Benefits Program covers approximately 2,000 judges and 32,000 judiciary employees in more than 800 locations throughout the United States and its territories. The Federal Judiciary Benefits Pro-gram offered to judges and judiciary employees is currently comprised of the following benefit programs:

• Flexible Benefit Program (which includes: Premium Payment Plan (PPP), Health Care Reimbursement Ac-count (HCRA), and Dependent Care Reimbursement Account (DCRA))

• Commuter Benefit Program (which includes: Mass Transit Reimbursement Account and Parking Reim-bursement Account)

• Federal Judiciary Long-Term Care Insurance Program (closed to new enrollees)

• Federal Long-Term Care Insurance Program (federal government-wide)

• Federal Employees’ Group Life Insurance Program (FEGLI)

• Federal Employee Health Benefits Program (FEHBP)

• Federal Employees Dental and Vision Insurance Program (FEDVIP)

• Federal Occupational Health (FOH) clinical services

• Employee Assistance Program (EAP)

• Work/Life Services

• Workers’ Compensation Program (OWCP)

• Federal Employee Retirement System (FERS)

• Civil Service Retirement System (CSRS)

• Thrift Savings Program (TSP)

• Transportation Subsidy Program

• Professional Liability Insurance Reimbursement Program

C.2 Scope of Work

The scope of this contract is for services for benefits included in the Federal Judiciary Benefits Program. Begin-ning with contract award, the contractor shall prepare documents related to the administration of the benefits program, establish the Judiciary Benefits Center website, set up an Interactive Voice Response (IVR) system, design computer system interfaces, perform all transition services, and develop standard operating procedures to support the Federal Judiciary Benefits Program. In addition, the contractor shall administer the compliance and filing requirements of the Affordable Care Act, as amended, and create and distribute a total compensation

USCA18R0092 - Page 21 of 64 statement to employees.

The contractor shall conduct the annual enrollment for the 2020 Plan Year, which will occur in the fall of 2019. Beginning with Plan Year 2020, the contractor shall provide administration of all the benefits listed be-low, and provide annual open enrollment and other enrollment services for these benefit programs for Plan Years 2020, 2021, 2021, 2023, and 2024.

In this case, a Plan Year is defined to include: 1) the planning for annual enrollment; 2) developing, printing, and distributing all communication materials before the annual enrollment period; 3) enrollment processing dur-ing the annual enrollment period; 4) the calendar year following the enrollment period; and 5) the reimburse-ment account claim run-out period ending June 30th the following calendar year.

Example:

July 2019 – Planning

Aug – Oct 2019 – Communication development and distribution

Nov – Dec 2019 – Annual enrollment period

Jan – Dec 2020 –Plan Year

Jan 2021 – June 2021 – Reimbursement account claim run-out period

• The contractor shall provide administrative services as appropriate for the benefit programs listed below:

• Flexible Benefit Program (comprised of Premium Payment Plan, which allows for pre-tax premiums for the federal health care program, a health care reimbursement account, a dependent care reimbursement account and a limited Flexible Spending Account)

• Commuter Benefit Program (comprised of Mass Transit and Parking Reimbursement Accounts)

• Federal Employee Health Benefits Program (FEHB)

• Federal Employees’ Group Life Insurance Program (FEGLI)

• Thrift Savings Plan (TSP)

• Health Savings Account (HSA)

• The contractor shall host the Judiciary Benefits Center website which enables judges and employees to manage their elections, view important program information, enroll and make changes to their benefits, view a personal comprehensive benefits statement, view a personalized total compensation statement, track claim status for the reimbursement accounts, and file claims online.

• The contractor shall prepare necessary documents, establish a secure online web-based enrollment and in-formational portal (the Judiciary Benefits Center), set up an Interactive Voice Response (IVR) system, de-velop and test all necessary system interfaces, develop standard operating procedures, provide all customer service, and prepare a variety of reports.

• The contractor shall administer the Flexible Benefit and Commuter Benefit Program following the IRS rules and regulations for IRC Sections 125 and 132(f) respectively.

• The contractor shall administer the FEHB, FEGLI, and TSP in accordance with U.S.C. Title 5 regulations for those benefits governed by Title 5.

• The contractor shall collect and transfer to the AO election options and appropriate enrollment data for the Flexible Benefit Program, the Commuter Benefit Program, the Federal Employee Health Benefits Program (FEHB), the Federal Employees’ Group Life Insurance Program (FEGLI), and the Thrift Savings Account (TSP). For the FEHB, the contractor will be expected to transmit election data to the health plan carriers using the Office of Personnel Management’s data transfer hub at OPM-Macon.

USCA18R0092 - Page 22 of 64

• The contractor shall develop interfaces with the other benefit providers [such as CNA for the Federal Judi-ciary’s Long-Term Care (LTC) Program, LTC Partners for the Federal Long-Term Care Insurance Program and the Federal Employees Dental and Vision Insurance Program FEDVIP, and other providers as needed] to obtain election information to populate an online employee benefits statement.

• The contractor shall provide links to information on the Judiciary Benefits Center and send AO-approved educational materials regarding other Federal Judiciary Benefit Programs (such as CNA for the Federal Ju-diciary’s Long-Term Care Program, and LTC Partners for the Federal Long-Term Care Insurance Program and the FEDVIP).

• The contractor shall provide all services necessary for transition of support/administration of the Federal Ju-diciary Benefits Program from the current contractor.

• The Judiciary’s current payroll system is PeopleSoft. The contractor shall receive PeopleSoft demographic and payroll data for judges and employees. The Judiciary’s payroll system shall send full flat files and changes-only files and shall expect to receive full flat files and changes-only files unless otherwise author-ized by the Judiciary. Except for the judges and the Director of the AO, all payroll cycles are on a biweekly basis. The payroll cycle for judges and the Director are monthly.

• Several Judiciary organizations participate in the Federal Judiciary Benefit Programs as affiliates. These in-clude the U. S. Supreme Court, the Administrative Office of the US Courts, the U. S. Sentencing Commis-sion, the Judicial Panel on Multi-District Litigation, and the Federal Judicial Center. The contractor shall provide data transfers that conform with the requirements set by these affiliate organizations. (Currently, these affiliates except the U. S. Supreme Court participate in the Judiciary payroll system described above. The U.S. Supreme Court provides biweekly and monthly payrolls on a separate payroll system ad-ministered by the Internal Business Center.)

• The contractor shall designate a bank account to which the judiciary would have funds wired by the Treas-ury Department as a result of salary-reduction elections made by participating employees. Under the cur-rent administrative environment, salary reductions will be wired as a single deposit. Participating employ-ees incurring covered expenses will seek reimbursement directly from the contractor, according to a bon-afide reimbursement program. The bank designated by the contractor must be able to reimburse claims to participating employees’ banking accounts via Electronic Funds Transfer (EFT). Funds for which particip-ating employee(s) make no reimbursable claim and which consequently become forfeited will be reported to the COR and program manager at the Administrative Office. The contractor will apply the aggregate amount of the forfeitures for all participating employees in a given year as directed by the COR and the pro-gram manager and permitted under Internal Revenue Code §125.

• The contractor shall manage all elements of the Affordable Care Act reporting requirements to include eli-gibility and affordability determination and regulatory compliance for the Annual Health Coverage Report (Forms 1094-C and 1095-C), exchange notices and penalty management.

• In addition, this contract may require the services listed in the Scope of Work and the Statement of Work for additional benefit programs that are currently part of the Federal Judiciary Benefit Program, but not lis-ted above or may become part of the Federal Judiciary Benefit Program in the future.

C.3. - Minimum Mandatory Requirements

C.3.1 - Requirement for Transition from Current Contractor

In addition to requirements stated in the scope of work and the statement of work, a new contractor shall provide all services required for transition of support for the Federal Judiciary’s Benefits Program from the cur-rent contractor. This transition period will last from the date of award of this contract, to the date of expiration of the current contract, which is June 30, 2020. These transition services include, but may not be limited to:

• conduct a planning meeting with Administrative Office staff within one week of contract award to discuss the implementation plan

• preparation and submission of a transition plan

USCA18R0092 - Page 23 of 64

• safe, secure, and complete transfer of all plan records from current contractor

• facilitation of continued services for all past Flexible Reimbursement and Commuter Reimbursement Ac-counts as described below

• close-out audit of financial data for pre-tax salary deductions and reimbursement claims paid for all prior plan years transitioning to the new contractor

• facilitation of continued services for all past Flexible Reimbursement and Commuter Reimbursement Ac-counts as described below

• creation of communications materials consistent in all respects (e.g., appearance, content, variety of media, quality) with existing communications materials unless approved by the Administrative Office

• completion of system and data transfer testing at least 2 months prior to Annual Enrollment period for 2020 Plan Year

• provision of all necessary coordination with current contractor to ensure that eligibles and participants re-ceive fully satisfactory services for Plan Year prior to contract award throughout the transition period

• provision for maintaining current user names and passwords assigned to participants for use of secure on-line enrollment and account inquiry

• provision of training for judiciary human resources personnel (court benefit coordinators) within 4 months prior to Annual Enrollment for 2020 Plan Year, to familiarize them with the contractor’s organization and personnel

• provision of webcast training for Judiciary employees to familiarize them with contractor staff and contacts

C.3.2 - Contractor-maintained Website (also known as the Judiciary Benefits Center)

• Provide secure contractor-maintained website for employees to enroll, review, cancel or change enrollment through the website. The website shall be designed using the Judiciary’s theme, logo and tagline and the most current industry best practices.

• Provide access to the website via single-sign on from Judiciary’s Enterprise Network and via a secure log-in through the internet.

• Provide single-sign on access to FSA/Commuter Administrator’s website for online account inquiry capab-ility which provides participant information on benefit election, disposition of individual claims, and ac-count status.

• Provide, and keep current, communication materials and interactive decision tools on the website to assist employees in making participation and election decisions

• Provide benefits enrollment summary and email notification to participants about confirmation of election/ changes. If elections are made via the JBC, show enrollment summary and allow option for print or email at the end of the election process.

• Maintain participant user names and passwords for use of secure online enrollment and account inquiry

• Provide sufficient interactive web capability 24 hours/seven days a week, year-round.

• Perform routine testing and maintenance of all web systems throughout the year.

• Provide a demo site, which mirrors the Judiciary Benefits Center, for AO staff and court human resources staff to use throughout the year as they counsel employees.

C.3.3 - Interactive Voice Response (IVR)

• Provide IVR account inquiry capability which provides participant information on benefit election and ac-count status.

• Provide capability for employees to enroll, review, cancel or change enrollment through the IVR

USCA18R0092 - Page 24 of 64

• Provide “one-stop shopping” capability by providing caller options on the IVR that transfers the caller to telephone lines maintained by providers of other Judiciary benefits (e.g. flexible spending accounts, BE- NEFEDS, insurance companies)

• Provide sufficient IVR lines capability 24 hours/seven days a week, year-round.

• Provide the ability to customize IVR scripts

• Perform routine testing and maintenance of all IVR systems throughout the year.

C.3.4 - Affordable Care Act (or future federal health care reform provisions) Support

• Manage all elements of ACA reporting requirements to include:

• ACA eligibility determination

• ACA affordability determination

• Regulatory compliance for Annual Health Coverage Report (1094-C and 1095-C), exchange notices, and penalty management. Includes all research, processing, preparing, filing and distributing as required by the ACA or future federal health care reform provisions.

C.3.5 – Personalized Total Compensation Statement

• On an annual basis, create a personalized total compensation statement for employees using data provided by the AOUSC.

• Design the layout of the total compensation statement using an approved format.

• Print and mail the statement via US Mail to each employee unless an electronic distribution method is avail-able and agreed to by the AOUSC.

C.3.6 - Member Services

• Staff the member services/benefits administration services function with a services team dedicated to serving the Judiciary account solely.

• Submit annual staffing plan by the 10th business day in September to the COR and program manager that covers Annual Enrollment, year-end claim processing, and ongoing staffing as affected by participation levels.

• Provide member services staffing adjustment, as required by participation levels.

• Staff the member services/benefits administration services function, at a minimum, from 9:00 a.m. to 9:00 p.m. Eastern Time, Monday through Friday excluding federal holidays.

• Benefit Service Representatives (BSRs) must be trained, during ongoing enrollment and throughout the year

• Provide interpreter service upon request

• Provide an annual report to the COR and program manager established standards for all member services.

At a minimum:

• 90% of all calls answered within 30 seconds

• 5% or less of total calls abandoned

• 3 business days for call resolution

• 90% of all emails answered within 3 business days

• Capability for BSRs to access employees' reimbursement accounts during a conversation with a Judiciary employee

• As determined by the COR and program manager, conduct member satisfaction surveys and provide results

USCA18R0092 - Page 25 of 64 to the COR and program manager, but no more frequently than biennial.

C.3.7 File Transfers

• Populate/edit contractor system with demographic data provided to the contractor from the Judiciary’s sys-tems. Change-only files will be sent daily, full files will be sent every Friday.

• Facilitate electronic transfer of data in the Judiciary’s secure environment, either real time or batch, as de-termined by the Administrative Office.

• Send full files which will interface to the Judiciary’s payroll system (currently PeopleSoft), with biweekly and monthly pay period election data and contribution amounts.

• Send full files which will interface to other vendors [OPM, Flex/Commuter Vendor, LTC Partners (LTC and Benefeds), and Affordable Care Act (ACA) Administrator] as needed.

• Test all system and data transfer interfaces as needed

• Create an annual file transfer schedule

• Reconcile all files sent and received each pay period and report any discrepancies to the COR and program manager

• Annually receive file with data to populate a total compensation statement for each employee of the Judi-ciary.

• File layouts are found in Attachment A.

C.3.8 Management of Enrollments/Changes/Terminations of Elections

• Develop and distribute enrollment materials, to include at a minimum, a letter explaining the programs, how to enroll, and how to obtain documents and forms:

• (i) no later than 15 calendar days, and no earlier than 21 calendar days, prior to the beginning of the An-nual Enrollment period

• (ii) for all newly-hired eligible employees or newly-eligible employees, no later than 2 working days fol-lowing notification to the contractor via the eligibility file of their appointment and eligibility to enroll in the Plan.

• Receive, verify and process elections via secure contractor-maintained internet website (also known as the Judiciary Benefits Center), paper and/or Interactive Voice Response (IVR)

• Accept elections for new hires, annual enrollment, and qualified life events online, via mail and fax lines dedicated to the Judiciary account

• Provide “scan-to-database” imaging functionality that is compliant with the Health Insurance Portability and Accountability Act of 1996 (HIPAA)

• If elections are made via the JBC, show enrollment summary and allow option for print or email at the end of the election process.

• If elections are made via a paper form or IVR, email a confirmation and enrollment summary if email provided by participant. If no email is on file, contact the participant within 24 hours to collect the email ad-dress and email the confirmation and enrollment summary. If participant is not willing to provide email, send by U.S. Mail, within 24 hours.

• Notify all judges and employees that made no election(s) during annual enrollment to review their current elections on the JBC. Notice should be made via email, if one is on file, otherwise U.S. Mail, during the first week of January following the annual enrollment period.

• Collect and maintain dependent data as part of the election process

• Receive notification of qualified status changes from employee/participants; notify him/her of benefit

USCA18R0092 - Page 26 of 64 rights; process new benefit elections.

• If an election is entered directly by the Administrative Office and sent to the contractor on the demograph-ics file, the contractor will process it in their system so it populates the participant’s enrollment summary.

C.3.9 Communications Development and Planning

• Develop and provide annually to the COR and program manager a comprehensive communications and project plan covering the Plan Year phases

• Conduct a planning meeting with Administrative Office staff during the second quarter of each year to dis-cuss the implementation plan for Annual Enrollment.

• Develop for posting to the JBC or downloading to print comprehensive communication/educational items, to include, but not limited to:

• Benefits brochures, effective date schedules, eligibility charts, fact sheets, registration and enrollment in-structions, privacy notices, ACA information

• Decision support tools, calculators and worksheets

• Links to forms, handbooks, other benefit vendors

• Develop all letters and notices that need to be sent to participants to include, but not limited to, new hire/ newly eligible notices, annual enrollment announcements

• Provide periodic review of the communication/educational materials, including the Judiciary Benefits Cen-ter, taking into account any legislative changes, end-user feedback, and industry best practices, and make all necessary updates.

• All materials shall use the Judiciary’s approved theme, logo and tagline.

• Deliver communications materials (including enrollment materials) to the COR and program manager for review in draft form within 4 months prior to Annual Enrollment for the Plan Year

• Deliver these communications materials to the COR and program manager in final form at least 1 month prior to Annual Enrollment for the Plan Year

• Develop annually and deliver a personalized total compensation statement for the active biweekly employ-ees

C.3.10 Education and Training on the Federal Judiciary Benefits Program

• The contractor shall provide train-the-trainer and/or group educational and/or training services of the Feder-al Judiciary Benefits Program for start-up, transition and on-going administration

• Services include traveling to the event; developing materials for the event; and presenting at the event.

• No more than five (5) events per year shall occur.

C.3.11 Standard Reports - all reports should be delivered in Excel or other agreed upon format by the COR and program manager unless otherwise stated:

• Report immediately upon identification all problems that impact, or potentially impact, the program

• Provide standard error/reconciliation reports – every pay period

• Provide Retroactive-Election Processing and Analysis reports – every quarter

• Provide enrollment summary reports - monthly

• Provide enrollment status tracking reports - quarterly, weekly during annual enrollment

• Provide business statistics reports – monthly

• Provide an annual analytics report to include enrollment data analysis, service delivery analysis, forfeiture

USCA18R0092 - Page 27 of 64 analysis, and retro elections – annually

• Provide Standard Reports specific to the Flexible Spending Accounts and Commuter Benefit Accounts

• Provide optional ad-hoc reports

C.3.12 Quality Control (QC)

• Provide annual QC to the COR and program manager and maintain a written quality control procedure for data entry, data management, financial and data reconciliation, communications, and claim accuracy, that will ensure timeliness, effectiveness, efficiency, and soundness in preforming the required services under this contract

• Conduct quality control as outlined in this procedure, including identifying, correcting, and following up on correction of deficiencies.

• Conduct system testing (enrollment, IVR, website, etc.)

• Conduct interface testing during transition process prior to going live and during any interface changes

• Provide a QC report annually to the COR and program manager and maintain a plan with provisions to pre-vent and recover from telecommunications disruptions

• Provide a Qc report annually to the COR and program manager and maintain a disaster recovery plan which provides a backup processing center and provides for no interruptions of services in excess of 24 hours and no more than 2 service interruptions per year.

• Backup employee information daily

• Maintain and update contractor systems at no additional cost to the Judiciary

• Ensure accuracy of outgoing communications.

C.3.13 Data Security and Information Assurance

• Protect all sensitive and personal data as outlined in Clause 7-35, Disclosure or Use of Information and

2-140, Judiciary IT Security Standards.

• Comply with the Standards for Privacy of Individually Identifiable Health Information as required by the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

• Maintain and provide to the COR and program manager on an annual basis an Application System Secur-ity Plan, in compliance with NIST 800-53 and Judiciary Information Security Framework, for security measures to protect computer systems and Judiciary’s employee information. The Plan must address:

• System confidentiality: providing assurance that the information in an IT system is protected from dis-closure to unauthorized persons, processes, or devices.

• System integrity: providing assurance that information in an IT system is protected from unauthorized, unanticipated, or unintentional modification or destruction. System integrity also addresses the quality of an IT system reflecting the logical correctness and reliability of the operating system; the logical completeness of the hardware and software implementing the protection mechanisms; and the consist-ency of the data structures and occurrence of the stored data.

• System availability: providing assurance that information, services, and IT system resources are access-ible to authorized users and/or system-related processes on a timely and reliable basis and are protected from denial of service. See Attachment B, for sample Application Security Plan.

• Ensure transfer of sensitive data is done via secure methods of transfer, such as Secure File Transfer Pro-tocol (SFTP), which allows for secure delivery and encryption of data, in compliance with FITS 140-2 and as agreed to by the COR and program manager.

• Provide on an annual basis to the COR the most recent Statement on Standard for Attestation Engage-

USCA18R0092 - Page 28 of 64 ments (SSAE) No. 18, Service Organization Controls (SOC) 1 report.

C.3.14 Benefit Specific Additional Administration Requirements C.3.14.1 Federal Employees Health Benefits Program (FEBH) Administration

In addition to all the above requirements, specific to the FEHB, the contractor shall:

• On the JBC, display the national FEHB plans and only the location-specific FEHB plans that are available to the participant

• On the JBC, display the participant's election and the employee share of the premium for each plan tier

• Pre-populate the premium payment plan indicator on the participant election screen with the data sent on the demographics file from the AO (eligible new hires are automatically enrolled in pre-tax)

• Display the premium payment plan indicator, the FEHB plan name…