Health Insurance Contract/Solicitation

SOLICITATION, OFFER AND AWARD / 1. THIS CONTRACT IS A RATED ORDER
UNDER DPAS (15 CFR 350) / RATING / PAGE OF PAGES
1 | 84
2. CONTRACT (Proc. Inst. Ident.) NO. / 3. SOLICITATION NO.
SRS500-13-R-0001 / 4. TYPE OF SOLICITATION
[ ] SEALED BID (IFB)
[x] NEGOTIATED (RFP) / 5. DATE ISSUED
2 July, 2013 / 6. REQUISITION/PURCHASE NO.
7. ISSUED BY CODE / 8. ADDRESS OFFER TO (If other than item 7)
American Embassy Moscow,
8 Bolshoy Devyatinsky per., Moscow 121099 Russia
Phone: 7-495-728-5233 Fax: 7-495-728-5077
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 specified, in the depository located in until 17:00 local time on August 26, 2013
(hour) (date)
CAUTION - LATE Submissions, Modifications, and Withdrawals: See Section L. Provision No. 52.215-1. All offers are subject to all terms and conditions contained in this solicitation.
10. FOR INFORMATION
CALL: / A. NAME

VLADIMIR YEREMKIN

/ B. TELEPHONE (NO COLLECT CALLS)
AREA CODE NUMBER EXT
7-495 728-5216 6238 / C. E-MAIL ADDRESS

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 / 34
X / B / PART I PRICE / 2 / PART III - LIST OF DOCUMENTS, EXHIBITS, AND OTHER ATTACH.
X / C / DESCRIPTION/SPECS/WORK STATEMENT / 15 / X / J / LIST OF ATTACHMENTS / 47
D / PACKAGING AND MARKING / N/A / PART IV - REPRESENTATIONS AND INSTRUCTIONS
X / E / INSPECTION AND ACCEPTANCE / 26 / X / K / REPRESENTATIONS, CERTIFICATIONS, AND
X / F / DELIVERIES OR PERFORMANCE / 28 / OTHER STATEMENTS OF OFFERORS / 48
X / G / CONTRACT ADMINISTRATION / 29 / X / L / INSTRS., COND., AND NOTICES TO OFFERORS / 61
X / H / SPECIAL CONTRACT REQUIREMENTS / 32 / X / M / EVALUATION FACTORS FOR AWARD / 67
OFFER (Must be fully completed by offeror)
NOTE: ITEM 12 does not apply if the solicitation includes the provisions at 52.214-16, Minimum Bid Acceptance Period.
12. In compliance with the above, the undersigned agrees, if this offer is accepted within calendar days (120 calendar days unless a different period is inserted by the offer) from the date for receipt of offers specified above, to furnish any or all items upon which prices are offered at the price set opposite each item, delivered at the designated point(s), within the time specified in the schedule.
13. DISCOUNT FOR PROMPT PAYMENT SEE 14
(See section I, Clause No 52.232-8) / 10 CALENDAR DAYS % / 20 CALENDAR DAYS
% / 30 CALENDAR DAYS % / CALENDAR DAYS
%
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
G.4.1
24. ADMINISTRATION BY (If other than Item 7) CODE / 25. PAYMENT WILL BE MADE BY
Financial Management Office, U.S. Embassy
Human Resources Office, U.S. Embassy Moscow
26. NAME OF CONTRACTING OFFICER (Type or print)
ROBERT BURNETT / 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 7540-01-152-8064STANDARD FORM 33 (REV 9-97)

PREVIOUS EDITION NOT USABLEPrescribed by GSA

SECTION B

PART I PRICE - HEALTH INSURANCE

B.1HealthInsuranceServices

The Contractor shall provide the Health Insurance services to employees of the Government of the United States of America in the Russian Federation 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.1.2. This insurance shall be provided in accordance with Section C and the Exhibits in Section J.

B.1.1Official Residence Expense (ORE) Staff and American Embassy Community Association Employees (AECA) are included under this contract only as a rider; the Contractor shall bill the Chief of Mission and Deputy Chief of Mission (for ORE Staff) and the American Embassy Community Association (for AECA employees) separately, at the rates specified below. See Section G for billing procedures.

B.2Prices

The contract type shall be a fixed price with economic price adjustment requirement type contract under which will be issued firm, fixed-price task orders. The prices shall not include VAT. The fixed prices/premium rates for health insurance services, as specified in Section C and Exhibits in Section Jshall be offered in U.S. dollars and are as follows:

B.2.1.BASE YEAR OF CONTRACT COMMENCING FROM THE DATE OF AWARD AND CONTINUING FOR A PERIOD OF 12 MONTHS.

(a)Health Insurance Services for locally employed staff of the U.S. Embassy Moscow and their eligible dependents:

(b) Health Insurance Services for locally employed staff of the U.S. Consulate General in St. Petersburg and their eligible dependents:

(c) Health Insurance Services for locally employed staff of the U.S. Consulate General in Vladivostok and their eligible dependents:

(d) Health Insurance Services for locally employed staff of the U.S. Consulate General in Yekaterinburg and their eligible dependents:

Description / Estimated # of employees and eligible dependents / Annual fee per person (p/p) / Total Annual Fee for all employees and eligible dependents
01. Outpatient Services:
Adult Annual Premium / 83 / $ / $
Child (age 19-23) / 12 / $ / $
Child (age 1-18) / 23 / $ / $
Child (age below 1) / 1 / $ / $
02. Inpatient Services
(for adults and children): / 119 / $ / $
03. Pre-Employment Exam / 10 / $ / $
04. Childbirth Services / 5 / $ / $
SUBTOTAL: / $
(e) Health Insurance Services for locally employed staff of the U.S. Consulate General in Sochi and their eligible dependents:
Description / Estimated # of employees and eligible dependents / Annual fee per person (p/p) / Total Annual Fee for all employees and eligible dependents
01. Outpatient Services:
Adult Annual Premium / 10 / $ / $
Child (age 19-23) / 10 / $ / $
Child (age 1-18) / 10 / $ / $
Child (age below 1) / 10 / $ / $
02. Inpatient Services
(for adults and children): / 10 / $ / $
03. Pre-Employment Exam / 10 / $ / $
04. Childbirth Services / 10 / $ / $
SUBTOTAL: / $
TOTAL ESTIMATED PRICE FOR BASE YEAR
((Subtotals (a) + (b) + (c) + (d)+ (e)) / $

B.2.2. PRICES FOR HEALTH INSURANCE SERVICES FOR OPTION YEAR ONE COMMENCING FROM THE DAY AFTER EXPIRATION OF THE BASE YEAR AND CONTINUING FOR A PERIOD OF 12 MONTHS.

(a) Health Insurance Services for locally employed staff of the U.S. Embassy Moscow and their eligible dependents

(b) Health Insurance Services for locally employed staff of the U.S. Consulate General in St. Petersburg and their eligible dependents

(c)Health Insurance Services for locally employed staff of the U.S. Consulate General in Vladivostok and their eligible dependents

(d) Health Insurance Services for locally employed staff of the U.S. Consulate General in Yekaterinburg and their eligible dependents

B.2.3. PRICES FOR HEALTH INSURANCE SERVICES FOR OPTION YEAR TWO COMMENCING FROM THE DAY AFTER EXPIRATION OF OPTION YEAR ONE AND CONTINUING FOR A PERIOD OF 12 MONTHS.

(a) Health Insurance Services for locally employed staff of the U.S. Embassy Moscow and their eligible dependents:

(b) Health Insurance Services for locally employed staff of the U.S. Consulate General in St. Petersburg and their eligible dependents:

(c) Health Insurance Services for locally employed staff of the U.S. Consulate General in Vladivostok and their eligible dependents

(d) Health Insurance Services for locally employed staff of the U.S. Consulate General in Yekaterinburg and their eligible dependents:

B.2.4. PRICES FOR HEALTH INSURANCE SERVICES FOR OPTION YEAR THREE COMMENCING FROM THE DAY AFTER EXPIRATION OF OPTION YEAR TWO AND CONTINUING FOR A PERIOD OF 12 MONTHS.

(a) Health Insurance Services for locally employed staff of the U.S. Embassy Moscow and their eligible dependents:

(b) Health Insurance Services for locally employed staff of the U.S. Consulate General in St. Petersburg and their eligible dependents

(c) Health Insurance Services for locally employed staff of the U.S. Consulate General in Vladivostok and their eligible dependents:

(d) Health Insurance Services for locally employed staff of the U.S. Consulate General in Yekaterinburg and their eligible dependents:

B.2.5. PRICES FOR HEALTH INSURANCE SERVICES FOR OPTION YEAR FOUR COMMENCING FROM THE DAY AFTER EXPIRATION OF OPTION YEAR THREE AND CONTINUING FOR A PERIOD OF 12 MONTHS.

(a) Health Insurance Services for locally employed staff of the U.S. Embassy Moscow and their eligible dependents:

(b) Health Insurance Services for locally employed staff of the U.S. Consulate General in St. Petersburg and their eligible dependents:

(c) Health Insurance Services for locally employed staff of the U.S. Consulate General in Vladivostok and their eligible dependents:

(d) Health Insurance Services for locally employed staff of the U.S. Consulate General in Yekaterinburg and their eligible dependents:

B.3ADMINISTRATIVE RETENTION AMOUNTS

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

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

NOTE TO OFFEROR - Fill in the fixed retention amounts for each period of performance and for each category of premium. This fixed amount must be expressed in the currency in which the premium amount is proposed. The fixed retention amount shall NOT be expressed in terms of a percentage of the premium.

B.3.2. Retention Amounts per separate premium paid per single employee children.

Period of Performance / Adult Employees / Children age 1-18
Base Period
Option Year 1
Option Year 2
Option Year 3
Option Year 4

B.4.ECONOMIC PRICEADJUSTMENT-HEALTH INSURANCE PREMIUMS

B.4.1.Premium Adjustment based on Experience - For health insurance, prices may be adjusted upward or downward based on the experience rating of the Mission(s) covered by this contract. No adjustment will be allowed during the first twelve months. After such time, the contractor or the Government may request an adjustment in premiums on an annual basis. Before any such adjustment is made, the contractor agrees to provide the Government a balance sheet showing two main components for the time period: (1) receipts (premiums received) minus the retention amount and (2) claims paid. The retention amount is not subject to adjustment. The Government reserves the right to have an independent third party review the balance sheet and make recommendations regarding the appropriateness of the requested adjustment. Any adjustment shall be subject to mutual agreement of the parties and shall result in a written modification to the contract. Any failure to reach agreement under this clause shall be subject to the procedures in the Disputes clause.

B.4.2.Premium Adjustment Based on Laws - The rates may also be adjusted during the performance period of the contract as a result of laws enacted by the host Government, if such change in the laws has a direct impact on the cost to the contractor to perform this contract at the contracted rate. In that event, the Contracting Officer may enter into negotiations with the Contractor to modify the contract to adjust the premium rate. The contractor agrees to provide all documentation necessary to support any requested adjustment.