Proposed Contract with Group Hospitalization and Medical Services, Inc. d/b/a CareFirst BlueCross BlueShield; CareFirst BlueChoice, Inc. and CareFirst Advantage PPO, Inc. to Contract No. CW130184

M
URIEL BOWSER
MAYOR
October 27, 2025
Honorable Phil Mendelson
Chairman
Council of the District of Columbia
John A. Wilson Building
1350 Pennsylvania Avenue, NW, Suite 504
Washington, DC 20004
Dear Chairman Mendelson:
Pursuant to section 451 of the District of Columbia Home Rule Act (D.C. Official Code § 1-
204.51) and section 202 of the Procurement Practices Reform Act of 2010 (D.C. Official Code §
2-352.02), enclosed for consideration and approval by the Council of the District of Columbia is a
proposed resolution, “Group Hospitalization and Medical Services, Inc. d/b/a CareFirst BlueCross
BlueShield, CareFirst BlueChoice, Inc., and CareFirst Advantage PPO, Inc. Health Benefits
Contract Emergency Approval Resolution of 2025,” and the accompanying emergency declaration
resolution, in the estimated amount of $769,361,993.67 for the five year base terms of
the
contracts.
Under the proposed multiyear contract Group Hospitalization and Medical Services, Inc. d/b/a
CareFirst BlueCross BlueShield, CareFirst BlueChoice, Inc., and CareFirst Advantage PPO, Inc.
will provide and administer fully insured health benefits to District employees, their dependents,
and retirees, in accordance with the rules of the D.C. Employees Health Benefits Program.
My administration is available to discuss any questions you may have regarding the proposed
contract. In order to facilitate a response to any questions you may have, please have your staff
contact Marc Scott, Chief Operating Officer, Office of Contracting and Procurement, at (202) 724-
8759.
I urge the Council to take prompt and favorable action on the enclosed legislation.
Sincerely,
M
uriel Bowser

1

GOVERNMENT OF THE DISTRICT OF COLUMBIA
Office of Contracting and Procurement

Pursuant to section 202(c) of the Procurement Practices Reform Act of 2010, as amended, D.C.
Official Code § 2-352.02(c), the following contract summary is provided:

COUNCIL CONTRACT SUMMARY
(Multiyear)

(A) Contract Number: CW130184

Proposed Contractor: Group Hospitalization and Medical Services, Inc. d/b/a
CareFirst BlueCross BlueShield; CareFirst BlueChoice,
Inc.; and CareFirst Advantage PPO, Inc. (CareFirst)

Proposed Contractor’s Principals: Ja’Ron Bridges, Angela Celestin, Dorothea Henderson,
Susan Idzi, Ricardo Johnson, James Leleszi, Randolph
Sergent, Brian Wheeler

Contract Amount (Base Period): Estimated $769,361,993.67

Unit and Method of Compensation: Premium rates per enrollee

Term of Contract: Date of award through December 31, 2030

Type of Contract: Indefinite Delivery/Indefinite quantity

Source Selection Method: Request for Proposal

(B) For a contract containing option periods, the contract amount for the base period and for
each option period. If the contract amount for one or more of the option periods differs from
the amount for the base period, provide an explanation of the reason for the difference:

Base Period Amount: Estimated $769,361,993.67

Option Period 1 Amount: TBD
Explanation of difference from base period (if applicable): Per the terms of the contract,
CareFirst will submit adjusted fixed unit prices annually. The prices are reviewed and approved by
the agency prior to each contract year.

2

Option Period 2 Amount: TBD
Explanation of difference from base period (if applicable): Per the terms of the contract,
CareFirst will submit adjusted fixed unit prices annually. The prices are reviewed and approved by
the agency prior to each contract year.

(C) The goods or services to be provided, the methods of delivering goods or services, and any
significant program changes reflected in the proposed contract:

CareFirst will provide and administer fully insured health benefits to District employees, their
dependents, and retirees, in accordance with the rules of the D.C. Employees Health Benefits
Program administered by the Department of Human Resources (DCHR). CareFirst will provide the
following plan types: Preferred Provider Organization, Health Maintenance Organization,
Consumer-Driven Health Plan, and Medicare Advantage.

(D) The selection process, including the number of offerors, the evaluation criteria, and the
evaluation results, including price, technical or quality, and past performance components:

Solicitation, Doc765357, was issued on May 8, 2025, and closed on June 30, 2025. The District
received five proposals. The evaluation criteria were: (1) plan design, (2) technical approach, (3)
network capability, (4) past performance, and (5) price. After evaluation, the contracting officer
determined that it is in the District’s best interest to issue awards to the four most highly rated
proposals.

(E) A description of any bid protest related to the award of the contract, including whether the
protest was resolved through litigation, withdrawal of the protest by the protestor, or
voluntary corrective action by the District. Include the identity of the protestor, the grounds
alleged in the protest, and any deficiencies identified by the District as a result of the protest:

None.

(F) A description of any other contracts the proposed contractor is currently seeking or holds
with the District:

CW76695 – Employee Health Benefits

(G) The background and qualifications of the proposed contractor, including its organization,
financial stability, personnel, and performance on past or current government or private
sector contracts with requirements similar to those of the proposed contract:

CareFirst has provided the same services to the District for over five years. DCHR has consistently
rated their performance as satisfactory or above. They have demonstrated through their technical
approach and past performance record that they have the organization, financial stability, personnel,
and performance history required to successfully meet the requirements of the proposed contract.

(H) A summary of the subcontracting plan required under section 2346 of the Small, Local, and
Disadvantaged Business Enterprise Development and Assistance Act of 2005, as amended,
3

D.C. Official Code § 2-218.01 et seq. (“Act”), including a certification that the subcontracting
plan meets the minimum requirements of the Act and the dollar volume of the portion of the
contract to be subcontracted, expressed both in total dollars and as a percentage of the total
contract amount:

The Department of Small and Local Business Development approved an adjustment of the
subcontracting requirement to 0.50% since the District’s healthcare benefits contributions are
shared between the District and employees and the majority of costs are straight pass-through
payments directly covering employee health care. The adjustment results in a spending requirement
of $3,846,809.97. CareFirst will submit a compliant subcontracting plan prior to the
commencement of the benefit year.

(I) Performance standards and the expected outcome of the proposed contract:

CareFirst will adhere to specific performance requirements relating to implementation, enrollment
assistance, claims administration, financial accuracy, customer service response, and reporting.
They will be required to administer claims completely and accurately. They will also regularly
report on their performance against established performance guarantee measures.

(J) The amount and date of any expenditure of funds by the District pursuant to the contract
prior to its submission to the Council for approval:

None.

(K) A certification that the proposed contract is within the appropriated budget authority for the
agency for the fiscal year and is consistent with the financial plan and budget adopted in
accordance with D.C. Official Code §§ 47-392.01 and 47-392.02:

The Office of the Chief Financial Officer has certified that the proposed contract is within the
appropriated budget authority for the fiscal year and is consistent with the financial plan and budget
adopted in accordance with D.C. Official Code §§ 47-392.01 and 47-392.02.

(L) A certification that the contract is legally sufficient, including whether the proposed
contractor has any pending legal claims against the District:

The Office of the Attorney General has certified that the contract is legally sufficient and that
CareFirst does not have any legal claims pending against the District.

(M) A certification that the Citywide Clean Hands database indicates that the proposed contractor
is current with its District taxes. If the Citywide Clean Hands Database indicates that the
proposed contractor is not current with its District taxes, either: (1) a certification that the
contractor has worked out and is current with a payment schedule approved by the District;
or (2) a certification that the contractor will be current with its District taxes after the District
recovers any outstanding debt as provided under D.C. Official Code § 2-353.01(b):
4

The Citywide Clean Hands database indicates that CareFirst is current with their District taxes.

(N) A certification from the proposed contractor that it is current with its federal taxes, or has
worked out and is current with a payment schedule approved by the federal government:

CareFirst has certified that they are current with their federal taxes.

(O) A certification that the proposed contractor has been determined not to violate section 334a of
the Board of Ethics and Government Accountability Establishment and Comprehensive
Ethics Reform Amendment Act of 2011, D.C. Official Code § 1-1163.34a; and (2) A
certification from the proposed contractor that it currently is not and will not be in violation
of section 334a of the Board of Ethics and Government Accountability Establishment and
Comprehensive Ethics Reform Amendment Act of 2011, D.C. Official Code § 1-1163.34a:

CareFirst has been determined not to violate section 334a of the Board of Ethics and Government
Accountability Establishment and Comprehensive Ethics Reform Act of 2011, and they have
certified that they are not and will not be in violation of section 334a of the Board of Ethics and
Government Accountability Establishment and Comprehensive Ethics Reform Act of 2011.

(P) The status of the proposed contractor as a certified local, small, or disadvantaged business
enterprise as defined in the Small, Local, and Disadvantaged Business Enterprise
Development and Assistance Act of 2005, as amended; D.C. Official Code § 2-218.01 et seq.:

CareFirst is not a certified local, small, or disadvantaged business enterprise.

(Q) Other aspects of the proposed contract that the Chief Procurement Officer considers
significant:

None.

(R) A statement indicating whether the proposed contractor is currently debarred from providing
services or goods to the District or federal government, the dates of the debarment, and the
reasons for debarment:

CareFirst is not currently debarred from providing services or goods to the District or federal
government.

(S) Any determination and findings issues relating to the contract’s formation, including any
determination and findings made under D.C. Official Code § 2-352.05 (privatization
contracts):

Determination and Findings for Contractor Responsibility
Determination and Findings for Price Reasonableness
Determination and Findings for a Multiyear Contract with a Contract Period Exceeding Five Years
Determination and Findings for Use of Competitive Sealed Proposals
5

(T) Where the contract, and any amendments or modifications, if executed, will be made
available online:

www.ocp.dc.gov

(U) Where the original solicitation, and any amendments or modifications, will be made available
online:

www.ocp.dc.gov
1101 4th Street, SW
Washington, DC 20024
Date of Notice: October 9, 2025 L0015056407Notice Number:
FEIN: **-***8219
Case ID: 18732638

Government of the District of Columbia
Office of the Chief Financial Officer
Office of Tax and Revenue
CAREFIRST BLUECHOICE INC
10455 MILL RUN CIR
OWINGS MILLS MD 21117-4208

Branch Chief, Collection and Enforcement Administration
Authorized By Melinda Jenkins
To validate this certificate, please visit MyTax.DC.gov. On the MyTax DC homepage, click the
“Validate a Certificate of Clean Hands” hyperlink under the Clean Hands section.
CERTIFICATE OF CLEAN HANDS
As reported in the Clean Hands system, the above referenced individual/entity has no outstanding
liability with the District of Columbia Office of Tax and Revenue or the Department of Employment
Services. As of the date above, the individual/entity has complied with DC Code § 47-2862, therefore
this Certificate of Clean Hands is issued.
TITLE 47. TAXATION, LICENSING, PERMITS, ASSESSMENTS, AND FEES
CHAPTER 28 GENERAL LICENSE
SUBCHAPTER II. CLEAN HANDS BEFORE RECEIVING A LICENSE OR PERMIT
D.C. CODE § 47-2862 (2006)
§ 47-2862 PROHIBITION AGAINST ISSUANCE OF LICENSE OR PERMIT
1101 4th Street SW, Suite W270, Washington, DC 20024/Phone: (202) 724-5045/MyTax.DC.gov

GOVERNMENT OF THE DISTRICT OF COLUMBIA
OFFICE OF THE CHIEF FINANCIAL OFFICER
Glen Lee
Chief Financial Officer
John A. Wilson Building * 1350 Pennsylvania Avenue, N.W. * Suite 203 * Washington, D.C. 20004
Phone: (202) 727-2476 * Fax: (202) 727-1643 * www.cfo.dc.gov
MEMORANDUM
TO: Julius Wiggins
Supervisory Contract Specialist / Contracting Officer
Office of Contracting and Procurement
FROM: Glen Lee
Chief Financial Officer
DATE:
SUBJECT: Certification of Funds for Health Insurance Contracts
The Department of Human Resources (DCHR) and th e Office of Contracting and Procurement (OCP)
estimate that the cost for the new insurance contracts for the D.C. Employees Health Benefits Program for
the period from the date of award through December 31, 2030, (the Contract Period) will be the total amount
of $3,747,472,078.21. The awards will be multiyear contracts, and the Contract Period will include five
benefit plan years (calendar years 2026 through 2030). Premiums are based on the coverage selected by
employees, with 75 percent of the cost paid by the District and 25 percent of the cost paid by employees.
The District’s share of premiums for the five-year period is estimated at $2,810,604,058.66 (75%
contribution), and the employee share is estimated at $936,868,019.55 (25% contribution). The table below
shows the five-year overall cost by vendor and contract number.
Vendor Contract
Number Contract Period Total
Aetna CW130182 Date of Award to 12/31/2030 $1,576,229,125.75
CareFirst CW130184 $769,361,993.67
Kaiser CW130186 $806,032,713.45
UnitedHealthcare CW130188 $595,848,245.34
TOTAL $3,747,472,078.21
This memorandum certifies that the District of Columbia plans to certify funds on an annual basis
throughout the Contract Period and will appropriate the respective proposed budget for future years of the
Contract Period in each corresponding fiscal year budget. This funding is sufficient to support all the
beneficiaries expected to enroll during the Contract Period.
Upon approval of the District’s Budget and Financia l Plan, funds will be sufficient to pay the costs
associated with these contracts.
pervisory Contract Spepppppp cialist
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October 22, 2025
Certification of Available Funding: Health Insurance
Page 2

For benefit plan year 2026 (contract year one), the District’s share of premiums (75% of the coverage) for
the new health plan contracts is estimated at $479,085,603. Based on estimates using current enrollment
data and premium levels, this statement certifies that $359,314,202 is available to fund the health insurance
contracts: CW130182, CW130184, CW130186, and CW130188, respectively, with Aetna, CareFirst,
Kaiser, and UnitedHealthcare, for the District of Columbia Employees Health Benefits (DCEHB) program
from January 1, 2026, through September 30, 2026. For the remaining period of contract year one, October
1, 2026, through December 31, 2026, the District will seek budget authority through the FY 2027
appropriation in the amount of $119,771,401. Premiu ms are based on the coverage selected by the
employee, with 75 percent of the cost paid by the District and 25 percent of the cost paid by the employee.
The total cost for contract year one for the four healthcare contracts is estimated at $638,780,804. This
amount assumes an enrollment of 29,891 employees. The District’s cost of health insurance premiums is
included in Account 701400C, Fringe Benefits, , which is part of each agency’s budget for active
employees. The employees’ cost will be deducted from their paychecks.

Vendor Aetna, CareFirst, Kaiser, and UnitedHealthcare
Contract Number CW130182, CW130184, CW130186, and CW130188
Contract Option/
Modification New Contracts
Contract Year One
Certified Amount
FY 2026 - From 1/1/2026 to 9/30/2026
FY 2027 - From 10/1/2026 to 12/31/2026 $638,780,804

If there are any questions regarding this matter, pl ease feel free to contact Samuel Terry, Director,
Financial Planning, Analysis, and Management Services, Office of Budget and Planning, at 202-724-
7477.
GOVERNMENT OF THE DISTRICT OF COLUMBIA
OFFICE OF THE CHIEF FINANCIAL OFFICER
Glen Lee
Chief Financial Officer
John A. Wilson Building * 1350 Pennsylvania Avenue, N.W. * Suite 203 * Washington, D.C. 20004
Phone: (202) 727-2476 * Fax: (202) 727-1643 * www.cfo.dc.gov
CERTIFICATION OF THE AVAILABILITY OF FUNDING
FOR THE HEALTH INSURANCE CONTRACTS
FOR POST-SEPTEMBER 30, 1987 DISTRICT EMPLOYEES
FOR THE PERIOD JANUARY 1, 2026 THROUGH SEPTEMBER 30, 2026
And
FOR THE PERIOD OCTOBER 1, 2026 THROUGH DECEMBER 31, 2026
The District’s share of premiums (75% of the coverage) for contract year one of the new health plan
contracts is estimated at $479,085,603. Based on estimates using current enrollment data and
premium levels, this statement is to certify that $359,314,202 is available to fund the health insurance
contracts: CW130182, CW130184, CW130186, and CW130188, respectively, with Aetna, CareFirst,
Kaiser, and UnitedHealthcare, for the District of Columbia Employees Health Benefits (DCEHB)
program from January 1, 2026, through September 30, 2026. For the remaining period of contract
year one, October 1, 2026, through December 31, 2026, the District will seek budget authority
through the FY 2027 appropriation in the amount of $119,771,401. Premiums are based on the
coverage selected by the employee, with 75 percent of the cost paid by the District and 25 percent of
the cost paid by the employee. The total amount for contract year one for the four health insurance
companies is estimated at $638,780,804. This amount assumes an enrollment of 29,891 employees.
The District’s cost of health insurance premiums is included in Account 701400C, Fringe Benefits,
which is part of each agency’s budget for active employees. The employees’ cost will be deducted
from their paychecks.
Please certify the availability of funding by signing below:
G l e n L e e D a t e
Chief Financial Officer
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Lee

October 22, 2025
400 6th Street NW, Suite 9100, Washington, DC 20001 (202) 727-3400

GOVERNMENT OF THE DISTRICT OF COLUMBIA
Office of the Attorney General

ATTORNEY GENERAL
BRIAN L. SCHWALB

Commercial Division

MEMORANDUM

TO: Tomás Talamante
Director
Office of Policy and Legislative Affairs

FROM: Robert Schildkraut
Section Chief
Government Contracts Section

DATE: October 22, 2025

SUBJECT: Approval of Contract for Employee Health Benefits Program
Contractor: Group Hospitalization and Medical Services, Inc. d/b/a
CareFirst BlueCross BlueShield, CareFirst BlueChoice, Inc., and CareFirst
Advantage PPO, Inc.
Contract No.: CW130184
Estimated Total Amount: $769,361,993.67

This is to Certify that this Office has reviewed the above- referenced Contract and that we have
found it to be legally sufficient contingent upon receiving a compliant fiscal certification. If you
have any questions in this regard, please do not hesitate to call me at (202) 724-4018.

______________________________
Robert Schildkraut

AWARD/CONTRACT
1. Reserved for later use Page of Pages
1 70
2. Contract Number 3. Effective Date 4. Requisition/Purchase Request/Project No.
CW130184 See Box 20C
5. Issued By: Code MT 6. Administered by (If other than line 5)
The Government of the District of Columbia
Office of Contracting and Procurement
441 4 th Street, NW, Suite 330 South
Washington, DC 20001
The Government of the District of Columbia
D.C. Department of Human Resources
1015 Half Street, SE, 9 th Floor
Washington, DC 20003
7. Name and Address of Contractor (No. street, city, county, state and Zip Code)
Group Hospitalization and Medical Services, Inc. d/b/a
CareFirst BlueCross BlueShield
CareFirst BlueChoice, Inc.
840 First St. NE
Washington, DC 20065
CareF
irst Advantage PPO, Inc.
1501 South Clinton St.
Baltimore, MD 21224
8. Delivery
FOB Destination Other
9. Discount for prompt payment:
10. Submit invoices to the Address shown in Section 6
(2 copies unless otherwise specified)
Duns No. 05-518-5862 TIN 53-0078070
11. Ship to/Mark For Code 12. Payment will be made by Code
See Section G .
13. Remit Address:
Same as Block 7.
14. Accounting and Appropriation Data
ENCUMBRANCE CODE:
15A. Item 15B. Supplies/Services 15C. Qty. 15D. Unit 15E. Unit Price 15F. Amount
See Price Schedules in B.3.
Total Estimated Price  $769,361,993.67
16. Table of Contents
(X) Section Description Page (X) Section Description Page
PART I – THE SCHEDULE PART II – CONTRACT CLAUSES
X A Award/Contract Form 1 X I Contract Clauses 55
X B Price Schedule 2 PART III – LIST OF DOCUMENTS, EXHIBITS AND OTHER
ATTACHMENTS
X C Services-Specifications/Work Statement 6 X J List of Attachments 70
X D Packing and Marking 31 PART IV – REPRESENTATIONS AND INSTRUCTIONS
X E Inspection and Acceptance 32 Representations, Certifications and Other
Statements of Offerors X F Period of Performance & Deliverables 33
X G Contract Administration Data 38 Instructions, conditions & notices to Offerors
X H Special Contract Requirements 44 Evaluation factors for award
Contracting Officer will complete Item 17 or 18 as applicable:
17. CONTRACTOR’S NEGOTIATED AGREEMENT
(Contractor is required to sign this document and return (1) copy to issuing office.)
Contractor agrees to furnish and deliver all items, perform all the services set forth or
otherwise identified above and on any continuation sheets, for the consideration stated
herein. The rights and obligations of the parties to this Agreement shall be subject to and
governed by the following documents: (a) this award/contract, (b) the solicitation, as
amended, and (c) such provisions, representations, certifications, and specifications, as are attached or incorporated by reference herein. (Attachments are listed herein.)
18. AWARD (Contractor is not required to sign this document.) Your offer on
Solicitation Number including the additions or changes made by which additions or
changes are set forth in full above, is hereby accepted as to the items listed in B.3 and
on any continuation sheets. This award consummates the contract which consists of
the following documents: (a) this award/contract, and (b) your offer. No further
contractual document is necessary.
19A. Name and Title of Signer (Type or print) 20A. Name of Contracting Officer
Julius Wiggins
19B. Group Hospitalization and Medical Services, Inc.,
CareFirst BlueChoice, Inc., and CareFirst Advantage PPO,
Inc.
(Signature of person authorized to sign)
19C. Date Signed 20B. District of Columbia
(Signature of Contracting Officer)
20C. Date Signed
DC OCP 201 (7 -99)
Ricardo Johnson, Executive Vice President, Chief Growth Officer
October 21, 2025

D.C. Employees Health Benefits Program
CW130184: CareFirst
Page 2 of 70
SECTION B: CONTRACT TYPE, SUPPLIES OR SERVICES, AND PRICE/COST
B.1 The District of Columbia Office of Contracting and Procurement (OCP), on behalf of the
Department of Human Resources (DCHR and/or the District), is awarding Group Hospitalization
and Medical Services, Inc., doing business as CareFirst BlueCross BlueShield, located at 840 First
St., NE, Washington, DC 20065; CareFirst BlueChoice, Inc., located at 840 First St., NE,
Washington, DC 20065; and CareFirst Advantage PPO, Inc., located at 1501 South Clinton St.,
Baltimore, MD 21224, a contract to administer the hea lth benefit plans listed below for District
employees who were first hired on or after October 1, 1987, retirees, temporary continuation of
coverage (TCC) participants, and eligible dependents . A licensed health care insurance carrier is
defined as an entity that has been granted a certificate of authority (COA) to provide health benefits
from the District of Columbia Department of Insurance, Securities , and Banking (DISB).
The Contractor shall provide a network of healthcare participating providers for enrollees in the
Contractor’s plan for which premium payment s have been made.
The District is awarding the following plan types:
B.1.1 Preferred Provider Organizati on (PPO) Plan (Plan One )
B.1.2 Health Maintenance Organization (HMO) P lan (Plan Two )
B.1.3 Consumer -Driven Health Plan (CDHP) (Plan Three)
B.1.4 Medicare Advantage/C ost (MA) Plan (Plan Four)
B.2 CONTRACT TYPE
B.2.1 Indefinite Delivery/Indefinite Quantity Contract
The District is awarding an indefinite -delivery/indefinite-quantity (IDIQ) type contract based
on fixed-unit prices /biweekly premium rates per enrollee for each coverage type, with annual
prospective price redetermination, i n accordance with 27 DCMR Chapter 24. The estimated
amount for the base period is $769,361,993.67. Although an estimated contract amount is used,
this is not intended to be a requirements contract. This is an IDIQ contract pursuant to the
minimum and estimated maximum requirements in Section B.3.
The contract will be effective for the period stated in Section F.1, with the effective date of the
plans expected to be January 1, 2026 , or the first full pay period in January. The Contractor
shall furnish to the District the services specified in Section C for all enrollees in their plan(s).
(a) The Contractor shall furnish to the District, when and if ordered, the supplies or services
specified in the Price Schedule, Section B.3, and in accordance with the Ordering Clause,
Section G.10, up to and including the maximum quantity of 45,000 enrollees per month for
each coverage type. The District will order at least a minimum quantity of one enrollee per
month for each coverage type.
(b) There is no limit on the number of orders that may be issued. The District may issue orders
requiring delivery to multiple destinations or performance at multiple locations .
(c) Any order issued during the effective period of this contract and not completed within that
period shall be completed by the Contractor within the time specified in the order. The
Contract shall govern the Contractor's and the District's rights and obligations with respect
D.C. Employees Health Benefits Program
CW130184: CareFirst
Page 3 of 70
to that order to the same extent as if the order were completed during the Contract's
effective period.
B.3 PRICE SCHEDULES
Each premium rate constitutes full premium payment for all individuals with coverage under the enrollee’s
benefit plan and coverage type selection for the pay period, for the base period contract year one . This
coverage type selection may include the employee or retiree, eligible dependents, and eligible survivors.
Each premium rate includes the District’s contribution and the enrollee’s contribution to the premium.
The rates for TCC participants shall be 102% of the rates in the schedules, except that rates for participants
on extended disability shall be 150% of the rates in the schedules.
B.3.1 Transition
Base Period Contract Year One
(A)
Contract Line-Item
Number (CLIN)
(B)
Description
(C)
Quantity
(D)
Unit Price
(E)
Total Price
0001
(C.5.2)
Transition and
Implementation 1 $1NSP NSP
B.3.2 Plan One: Preferred Provider Organization
Base Period Contract Year One
(A)
CLIN
(B)
Coverage Type
(C)
Minimum
Enrollment
Quantity
(D)
Maximum
Enrollment
Quantity
(E)
Estimated
Enrollment
Quantity
(F)
Biweekly
Premium
Rate per
Enrollee
(G)
Total Estimated
Price
(E x F x 26)
0002
(C.5) Self Only 1 45,000 2,458 $502.75 $32,129,747.00
0003
(C.5) Self plus One 1 45,000 835 $960.26 $20,847,244.60
0004
(C.5) Self and Family 1 45,000 905 $1,473.06 $34,661,101.80
TOTAL $87,638,093.40
B.3.3 Plan Two: Health Maintenance Organization
Base Period Contract Year One
(A) (B) (C) (D) (E) (F) (G)

1 Not Separately Priced : The unit price is included in the premium rates for the awarded plan(s).
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CLIN Coverage Type Minimum
Enrollment
Quantity
Maximum
Enrollment
Quantity
Estimated
Enrollment
Quantity
Biweekly
Premium
Rate per
Enrollee
Total Estimated
Price
(E x F x 26)
0005
(C.5) Self Only 1 45,000 1,214 $430.53 $13,589,248.92
0006
(C.5) Self plus One 1 45,000 390 $848.14 $8,600,139.60
0007
(C.5) Self and Family 1 45,000 597 $1,244.22 $19,312,782.84
TOTAL $41,502,171.36
B.3.4 Plan Three: Consumer-Driven Health Plan
Base Period Contract Year One
(A)
CLIN
(B)
Coverage Type
(C)
Minimum
Enrollment
Quantity
(D)
Maximum
Enrollment
Quantity
(E)
Estimated
Enrollment
Quantity
(F)
Biweekly
Premium
Rate per
Enrollee
(G)
Total Estimated
Price
(E x F x 26)
0008
(C.5) Self Only 1 45,000 140 $216.62 $788,496.80
0009
(C.5) Self plus One 1 45,000 37 $413.75 $398,027.50
0010
(C.5) Self and Family 1 45,000 43 $634.69 $709,583.42
TOTAL $1,896,107.72
B.3.5 Plan Four: Medicare Advantage
Base Period Contract Year One
(A)
CLIN
(B)
Coverage Type
(C)
Minimum
Enrollment
Quantity
(D)
Maximum
Enrollment
Quantity

(E)
Estimated
Enrollment
Quantity
(F)
Monthly
Premium
Rate per
Enrollee
(G)
Total Estimated
Price
(E x F x 12)
0011
(C.5) Self Only 1 1000 10 $438.90 $52,668.00
0012
(C.5) Self plus One 1 1000 5 $877.80 $52,668.00
TOTAL $105,336.00
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B.3.6 Contracting Funding Maximum
The contract funding maximums for the base period, contract years two through five, for option period
one, contract years one through five, and for option period two, contract years one through five, will be
determined in accordance with Section C.6, Premium Rate Redetermination.
B.4 SUBCONTRACTING
B.4.1 An offeror responding to this solicitation, that is required to subcontract, shall not be required to
submit a subcontracting plan with its proposal. See Section H.9.2.
B.4.2 For contracts in excess of $250,000, at least 0.50% of the dollar volume of the contract shall be
subcontracted in accordance with section H.9 .
A Subcontracting Plan form is available at http://ocp.dc.gov , under Quick Links click on
“Required Solicitation Documents”.
B.5 NONPROFIT FAIR COMPENSATION ACT OF 2020, D.C. Code § 2 -222.01 et seq.
B.5.1 Nonprofit organizations, as defined in the Act, shall include in their rates the indirect costs incurred
in provision of goods or performance of services under this contract pursuant to the nonprofit
organization's unexpired Negotiated Indirect Cost Rate Agreement (NICRA). If a nonprofit
organization does not have an unexpired NICRA, the nonprofit organization may elect to instead
include in its rates its indirect costs:
(1) As calculated using a de minimis rate of 10% of all direct costs under this contract;
(2) By negotiating a new percentage indirect cost rate with the awarding agency;
(3) As calculated with the same percentage indirect cost rate as the nonprofit organization
negotiated with any District agency within the past 2 years; however, a nonprofit organization
may request to renegotiate indirect costs rates in accordance with B. 5.2; or
(4) As calculated with a percentage rate and base amount, determined by a certified public
accountant, as defined in the Act, using the nonprofit organization's audited financial
statements from the immediately preceding fiscal year, pursuant to the OMB Un iform
Guidance, and certified in writing by the certified public accountant.
B.5.2 If this contract is funded by a federal agency, indirect costs shall be consistent with the
requirements for pass -through entities in 2 C.F.R. § 200.331, or any successor regulations.
B.5.3 The Contractor shall pay its subcontractors, which are nonprofit organizations the same indirect
cost rates as the nonprofit organization subcontractors would have received as a prime contractor.

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SECTION C: SPECIFICATIONS/WORK STATEMENT
C.1 SCOPE
DCHR is entering into a contract with a health care insurance carrier , certified to do business within the
District, to provide health insurance benefit plans for employees of the District of Columbia Government
who were first hired on or after October 1, 1987, their eligible dependents, TCC participants, and retirees.
Prescription drug coverage administration shall be included in the health plans .
It is anticipated that enrollees will be able to choose from a menu of health benefit plans , which may
include PPO, HMO, CDHP with an accompanying health savings account (HSA ), and Medicare plans.
C.2 APPLICABLE DOCUMENTS
The following documents are applicable to this procurement and are hereby incorporated by this reference:
Item
No. Title Date
1
District of Columbia 2026 EHB Benchmark Plan Information
https://www.cms.gov/marketplace/resources/data/essential-health -
benefits#ehb
October 7,
2024
C.3 DEFINITIONS
These terms when used in this contract have the following meanings:
1. Benefits Personnel: Employees of the DCHR Benefits and Retirement Administration (BRA) or
other District employees as designated by the contract administrator.
2. Carrier: A v oluntary association, corporation, partnership, or other nongovernmental
organization that is lawfully engaged in providing, paying for, or reimbursing the cost of health
services under group insurance policies or contracts, medical or hospital service agr eements,
membership or subscription contracts, or similar group arrangements, in consideration of
premiums or other periodic charges payable to the organization.
3. Catastrophic Condition: any medical condition where total cost of treatment, regardless of
payment source, is expected to exceed $100,000.
4. Contractor : Licensed Health Care Insurance Carrier that has contracted, or will contract, with the
District to provide health care insurance and related benefits to District employees under the
District of Columbia Employees Health Benefits (DCEHB) Program . The carrier must have and
maintain a certificate of authority from DC DISB.
5. Copayment or copay: An amount that a participant pays for a specific covered service(s).
6. Coordination of Benefits (COB): An arrangement in health insurance to discourage multiple
payments for the same claim under two or more policies. When two or more group health insurance
plans cover the insured and dependents, one plan becomes the primary plan and the other plan(s)
the secondary plan(s). For example, a plan covering a person as an employee is primary. When a
dependent child is covered under two group plans, the plan of the parent with the earliest birthday
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will pay first unless otherwise authorized in writing by both parents and properly notarized in the
state where the children reside or unless a court order otherwise appoints a parent to provide health
coverage to a dependent child. For children of divorced or separated parents, the plan of the parent
with custody shall pay first . If the parent with custody of the child has remarried, that parent's
coverage pays first unless otherwise authorized in writing by both parents and properly notarized
in the state where the children reside or if a court order otherwise appoints a parent to provide
health coverage to a dependent child.
7. Consumer-Driven Health Plan (CDHP): Health insurance plans with a high deductible that
allow participants to use personal Health Savings Accounts (HSAs) or similar medical payment
products to pay routine health care expenses directly.
8. Coverage Type: Types of coverage are as follows :
a. Self Only: eligible enrollee ;
b. Self plus One Dependent: eligible enrollee and one eligible dependent; and
c. Self and Family: eligible enrollee and two or more eligible dependents.
Any of the above categories can also have eligible TCC participants. Premiums for TCC
participants shall be 102% of the applicable premium for a non-TCC enrollee.
9. District of Columbia Employees Health Benefits Program (DCEHB Program or DCEHBP):
The District’s employer -sponsored employee health benefit s program, which includes fully
insured health benefit plans offered to eligible District employees who were first employed on or
after October 1, 1987, retirees, TCC participants, and eligible dependents.
10. Deductible: The amount of covered expenses incurred each calendar year by participants before
specific benefits are paid.
11. De-identified: Reports, claims lists, or other data that are devoid of any personal ly identifiable
information (PII) or protected health information (PHI) and that are compliant with the Health
Insurance Portability and Accountability Act ( HIPAA).
12. Dependent Children: Dependent children may include, without being limited to, adopted
children, stepchildren, foster children, natural children, or any other children in the legal custody
of an enrollee, the enrollee’s spouse, or the enrollee’s domestic partner.
13. Eligible Dependent: Eligible dependents include, without being limited to, a n employee’s or
retiree’s spouse, an employee’s or retiree’s a domestic partner, dependent child ren up to the age
of 26, or an e ligible disabled dependent .
14. Eligible Disabled Dependent: An unmarried dependent child who is incapable of self -support
due to physical or mental disability that existed before reaching age 26 while covered under one
or both parents’ group medical benefit plan(s) and the incapacity can be expected to continue for
more than one year.
15. Eligible Employee: A District of Columbia government employee who wa s hired on or after
October 1, 1987, and who is eligible for the DCEHB program.
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16. Eligible Survivor: An eligible survivor may be a surviving spouse, surviving domestic partner, or
surviving unmarried child of a deceased individual who was a District employee.
17. Employer Contribution: Funds paid by the District of Columbia government towards each of its
sponsored health benefit plan options. The District currently pays 75% of the total premium for
each sponsored health benefit plan option, and the employee pays at least 25% of the total premium
for each option. In no event shall the District’s contribution exceed 75% of the total subscription
charge of any plan or option in which the employee is enrolled.
18. Enrollee: Enrollees may include employee s, retiree s, survivor s, TCC participants , or other
participants enrolled in the health plan, but do not include covered dependents.
19. Health Benefit Plan or Health Plan: a group insurance policy or contract, medical or hospital
service agreement, membership or subscription contract, or similar group arrangement provided
by a carrier for the purpose of providing, paying for, or reimbursing expenses for health services
under D.C. Code § 1-621.05.
20. Health Maintenance Organization (HMO): A health care system that assumes or shares both
the financial risks and the delivery risks associated with providing comprehensive medical services
to a voluntarily enrolled population in a particular geographic area. Except for emergency
situations and for certain special exemptions granted by the HMO, only visits to providers within
the HMO network are covered by the plan.
21. Licensed Health Care Insurance Carrier: An entity that has been granted a certificate of
authority (COA) to provide health benefits from D.C. DISB.
22. Medicare Advantage (MA): A health plan that couples private provider coverage with the federal
health insurance program for people 65 years of age or older and certain younger people with
disabilities (Medicare) that provides participants with additional coverages. Enrollees with
Medicare Parts A and B are eligible, except those who have End -Stage Renal Disease (unless
certain exceptions apply).
23. No Loss/No Gain: The circumstance under which an employer may transfer the group plan from
one carrier or benefit plan to another. Despite the change, persons enrolled under the previous plan
will lose benefit coverage if they must change carriers or benefit plans because a new carrier is
awarded the contract. The intention of this concept is that, aside from the actual changes in plan
provisions, employees will not gain or lose any earned rights due to circumstances which would
not have occurred without the change in carriers.
24. Overage Dependent: A dependent that has reached the age of 26.
25. Participant: All enrollees and their dependents, including eligible disabled dependents, enrolled
in any plan provided by carrier.
26. Participating Provider: A doctor, hospital, or other covered health care provider , who is in the
carrier’s provider network, who may be an independent contractor, and who has an agreement with
the Contractor to provide health care services to persons insured for healthcare benefits. The
participating provider, referenced above, shall not be considered a subcontractor of the Contractor
under this contract.
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27. Plan Year: The period, beginning on the first day of the first full pay period in the calendar year
and ending on the last day of the last pay period that starts in the same calendar year, during which
the health plan is in effect and enrollees are entitled to benefi ts and coverage under the plan.
28. Preferred Provider Organization (PPO): A health plan with an established provider network
that provides maximum benefit coverage when a participant uses its own contracted physicians,
hospitals, and other providers. Participants may use providers outside of the set provider network,
usually at reduced coverage.
29. Premium: Agreed upon fees paid for coverage of medical benefits for a defined benefit period.
30. Retiree: An employee first employed by the District on or after October 1, 1987, who has
subsequently retired or separated pursuant to the following :
a. Teachers Retirement System (D.C. Code, 2001 ed., §§ 38-2001 to 38-2023.16).
b. Police and Fire Retirement System (D.C. Code, 2001 ed., §§ 5-701 to 5-724).
c. Judges Retirement System (D.C. Code, 2001 ed., §§ 11-1561 to 11-1572).
d. Teachers Insurance and Annuity Association; or
e. An employee first employed by the District on or after October 1, 1987, who has
subsequently separated from District employment pursuant to the District Retirement
Benefit Program (D.C. Code §§ 1-626.03 to 1-626.14) after any of the following:
i. reaching 57 years of age and having completed 25 years of creditable District
service in a correctional officer position;
ii. reaching 62 years of age and having completed ten years of District government
service in a position other than correctional officer ; or
iii. becoming entitled to disability benefits under the Social Security Act.
31. Subcontractor: An entity such as a supplier, distribut or, vendor, or firm that performs a portion
of the Contractor’s contract or another subcontract or’s contract with the Contractor. A
participating provider shall not be considered a Subcontractor under this contract.
32. Temporary Continuation of Coverage (TCC): TCC is the District’s option for continuing health
insurance health benefits for separated employees and their dependents . It operates similar to
Consolidated Omnibus Budget Reconciliation Act (COBRA) coverage in the private sector.
Individuals are eligible for TCC if they meet at least one of the qualifying events below:
a. Employees who separate from District service, voluntarily or involuntarily, and, on the
day before separation from service were enrolled in a DCEHB plan, and would not
otherwise be eligible for continued coverage, not including the 31-calendar day
temporary extension of coverage.
b. Children who have been covered under an employee's, spouse’s former spouse's ,
domestic partner’s, former domestic partner’s, or retiree's enrollment because they had
met the requirement of dependent children of the employee, spouse, former spouse,
domestic partner, former domestic partner, or retiree, but stop meeting the requirements
for being considered dependent children of the employee, former spouse, or retiree, and
not otherwise eligible for continued coverage . This group includes children who:
i. lose their coverage because they reach age 26;
ii. lose their status as stepchildren or foster children;
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iii. no longer meet the coverage requirements as recognized natural children; or
iv. have a physical or mental disability, are age 26 or older, and have recovered
from their disability or become able to support themselves.
c. Former spouses or domestic partners who meet the requirement of having been enrolled
as a family member of an employee or retiree under a health benefit plan at some time
during the preceding 18 months before the marriage or partnership ended, but who are
not eligible to enroll for health benefits in accordance with spouse equity provisions
because they have either (I) remarried before reaching age 55 or (ii) are not entitled to
a portion of the employee's or retiree's annuity benefit or a survivor benefit based on
the employee's or retiree's service.
33. Trauma-Informed Care (TIC): Trauma-informed care is an approach that explicitly
acknowledges the role trauma plays in peoples’ lives. TIC means that every part of an organization
or department understands the impact of trauma on the individuals they serve and promotes
cultural, and organizations change in responding to the people served and their families.
34. Washington, DC, Metropolitan Area: The Washington-Baltimore-Arlington combined metropolitan
statistical area, as defined by the Office of Management and Budget (OMB).
C.4 BACKGROUND
The Government of the District of Columbia administer s an employee health benefits program for
employees first hired on or after October 1, 1987. The District of Columbia Employees Health Benefits
Program is governed in accordance with all applicable D istrict and federal laws and regulations. The
District’s health care benefits are provided on a fully insured, prospectively rated basis.
As of January 2025 , there are approximately 36,400 employees and retirees eligible to receive health
benefits through the DCEHB program. Approximately 29,025 employees are enrolled in the DCEHB
program, of which 16,968 are enrolled in an HMO plan, 10,419 are enrolled in a PPO plan, and 1,066 are
enrolled in a CDHP plan. This information is only an estimate, current as of January 2025 . The actual
number of enrollees during the contract period of performance may be more or less.
There is also a TCC program that provides health benefits to approximately 1 00 former employees and
former family members on terms similar to The Consolidated Omnibus Budget Reconciliation Act of l985
(COBRA) continuation of health bene fits provisions.
C.5 REQUIREMENTS
C.5.1 General Requirements
C.5.1.1 The Contractor shall , prior to award, be a licensed health care insurance carrier that has
been granted a COA by DISB to provide the offered health insurance product (s).
C.5.1.2 The Contractor and all Subcontractors , while providing services under the DCEHB
Program, shall comply with all applicable federal and District of Columbia laws,
regulations, executive orders , and ordinances, as they may be amended from time to time
during the term of the Contract . In such cases where District or federal law limits or
conditions contract performance, the Contractor shall inform the District of such
limitations or conditions before they are halted or implemented.
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C.5.1.3 The Contractor shall administer the awarded PPO, HMO, or CDHP health insurance plan
each plan year . The plan(s) shall cover medical and pharmacy care, providing benefits and
coverage that are consistent with or exceed the coverage required by DISB’s Essential
Health Benefits (EHB) Benchmark Plan for the plan year and that are within the parameters
specified in the applicable plan design in Attachment J.11, Plan Designs. For each plan,
all copays, deductibles, and coinsurance shall contribute toward the out -of-pocket
maximum, and there shall be a single out -of-pocket limit covering both medical and
pharmacy care. The Contractor may provide additional benefits and coverage not listed in
Attachment J.11 . The Contractor’s restrictions, conditions, and medical management
practices may be tailored to their book of business and the plan offered . However, at no
time shall benefits and coverage be less favorable to District employees than specified in
the EHB Benchmark Plan or i n Attachment J.11.
C.5.1.4 Medicare Advantage plans shall provide hospital, medical, and prescription drug coverag e
as well as additional healthcare benefits, in accordance with federal and District
regulations.
C.5.1.5 For CDHP plans, the Contractor shall manage and administer a health savings account
(HSA) program which shall be available to all enrollees in the plan. Enrollment in the HSA
will be at the discretion of the enrollee.
C.5.2 Transition and Implementation
C.5.2.1 During the initial start-up period, the Contractor shall submit a preliminary transition plan,
to include all transition activities including, but not limited to, securing claims history from
the current carrier(s), scheduling meetings with the Contract Administrator (CA) regarding
the transition, coordinating claims for services in process as of the effective date of the
benefit plan(s), educating enrollees regarding plan design and benefits, issuing
identification cards, developing both hard copy and elec tronic communication materials,
and enrolling eligible employees , retirees, survivors, TCC participants, and dependents in
the plan(s).
C.5.2.2 The Contractor shall provide a final transition plan to the CA electronically within ten days
after contract award. The Contractor shall confer with the District's payroll office to
establish an electronic eligibility system to maintain eligibility data. The Contractor shall
outline, in its final transition plan, the method to be used to ensure eligibility data is
accurately uploaded and prepared for u se by the anticipated plan effective date of January
1, 2026 .
C.5.2.3 During the transition period, the Contractor shall prepare drafts of all digital and hardcopy
communication materials ( for example, e-blasts, flyers, and posters created for use during
Open Enrollment) and administration manuals that explain the Contractor’s internal
processes for making changes to e nrollee records.
C.5.2.4 The Contractor shall provide the necessary interface between the District’s electronic
eligibility and payment systems (PeopleSoft HRIS System v9.2). In addition, the
Contractor must be compliant with the technical requirements in Attachment J.13, System
Integration Requirements. The eligibility and payment systems shall be ready for testing
30 days after the contract is awarded , and sample enrollment and billing files shall be
exchanged with the District by October 4, 2025, or as soon as possible thereafter. The f irst
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plan year is anticipated to start on or around January 1, 2026. The contractor shall ensure
that its systems are compatible with and interface with the current version of the PeopleSoft
HRIS and any changes implemented.
C.5.2.5 The Contractor shall provide no-loss/no -gain coverage to enrollees and their covered
dependents.
C.5.2.6 Within 15 days of contract award, the Contractor shall attend a kick -off meeting with the
District to discuss transition and implementation of the awarded benefit plans.
C.5.3 Enrollment Assistance
C.5.3.1 The Contractor shall design and print identification (ID) cards for plan participants in a
format acceptable to the District . Cards shall include enrollee and dependent names,
information about the plan, and telephone numbers for utilization of services.
C.5.3.2 The Contractor shall submit the design for the ID cards to the CA with the final transition
plan for approval prior to issuance. If medical treatment is required prior to the issuance of
the ID card, the employee’s Government employee identification or District/state -issued
identification shall serve as identification for plan eligibility purposes.
C.5.3.3 The Contractor shall mail identification cards to all plan enrollees within 14 calendar days
following receipt of enrollment notification from the District, for routine enrollments as
well as open enrollment elections, and make digital cards available thr ough its member
portal, member accounts, and apps within 3 days of enrollment notification. If requested
by the CA, the Contractor shall submit a report of ID cards issued within a given timeframe.
The report shall show the enrollee name, employee ID number (or other identifier), the date
of enrollment notification, and the date the card was issued.
C.5.3.4 The Contractor shall provide booklets , information about the plan, and other
communication materials on an ongoing basis for both employees and District benefits
personnel. The Contractor shall provide other plan-related information to plan participants
at the District's request, including but not limited to, electronic and printed communications
outreach, brochures, and documents.
C.5.3.5 The Contractor shall design and provide enrollee documents which describe the plan
benefits, co payments, and available services ( that is, certificates of coverage, s ummary
plan descriptions , and evidence of coverage) and summaries of benefits and c overage in
such quantities as requested by the District. The Contractor shall submit enrollee
documents to the CA a minimum of 30 calendar days prior to enrollment period. Upon
approval from the CA, the Contractor shall mail these documents directly to the D.C.
Department of Human Resources, Benefits and Retirement Administration, located at 1015
Half St SE, 9th Floor, Washington, DC 20003, or to a human resources advisor at a District
agency, as specified by the CA . The Contractor shall also mail enrollee documents to
enrollees a minimum of 15 calendar days pri or to a plan year .
C.5.3.6 The Contractor’s enrollee documents and advertising material, including promotional
material, marketing material, or supplemental literature, shall be truthful and not
misleading, deceptive, or unfair. If the Contractor’s documents or materials appear to be
misleading, deceptive, or unfair, the District will notify the Contractor and allow the
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Contractor an opportunity to respond. If the Contractor’s documents or materials are then
determined by the District to be misleading, deceptive, or unfair, the District may take
appropriate corrective actions. The Contractor shall comply with corrective action
determined by the District. Appropriate corrective actions may include, without being
limited to, the following:
a. reducing premium rates , except when prohibited by applicable law
b. deducting from premium payments , except when prohibited by applicable law
c. ceasing and desisting from distribution, publication, or broadcast of the material
d. issuing corrections at the Contractor’s expense and in the same manner and media
as the original material was made
e. providing, at the Contractor's expense, the correction in writing by certified mail to
all enrollees of the plan(s) that were subject(s) of the original material
f. offering, at the Contractor’s expense, information sessions to enrollees, either
virtually or in person, as directed by the District, to explain the plan, the plan
benefits and coverage, and the corrections and to answer their questions
g. suspending new enrollments in the Contractor’s plan(s)
h. providing enrollees an opportunity to transfer to another plan
i. terminating the contract
C.5.3.7 The Contractor shall assist DCHR during annual open enrollment (OE) season, including
providing personnel and materials necessary to enroll District employees during o pen
enrollment. The Contractor shall assist, work , and coordinate with DCHR during open
enrollment to make information available to employees regarding health coverage elections
and to have all eligible employees enrolled by January 1 each contract year.
C.5.3.8 The Contractor shall participate in annual open enrollment activities, as required by the
District under the general direction of the CA. The Contractor shall attend all in -person
health fairs and assigned virtual webinars. Open enrollment is typically held each year from
the Monday of the second full week in November through the Monday of the second full
week in December .
C.5.3.9 The Contractor shall provide a minimum of four orientation sessions annually with District
benefits personnel to discuss administrative procedures, program goals, and policies to be
adhered to under this contract. The Contractor shall instruct District benefits personnel on
how to discuss the health care plans and administrative procedures with enrollees. The
Contractor shall assist the District in ongoing employee education about health issues as
required.
C.5.3.10 The Contractor shall, as determined by the District, whenever needed throughout the term
of the contract, make up to 52 written, oral, and video presentations or orientation fairs
describing the administration of the plan or health coverage election options.
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C.5.3.1 1 The Contractor shall provide the CA and District benefits personnel with an online
administration access tool for enrollment, termination, verification, and correction of
participant information. This tool shall accommodate up to 50 users.
C.5.3.1 2 The Contractor shall notify the CA electronically of any tempor ary newborn enrollments
on a monthly report electronically submitted to the CA .
C.5.4 Plan and Claims Administration
C.5.4.1 The Contractor shall submit its Administrative Manual to the CA within 30 days after the
contract is awarded. The Administrative Manual shall, at minimum, outline its procedures
for administering health plans. In addition, the Contractor’s procedures shall explain how
duplicate bills, ineligible claimants, fraudulent claims, and coordination expenses are
processed and resolved.
C.5.4.2 The Contractor shall provide all the services associated with administering the health plan
claims, including the COB with other District insurers and government programs such as
Medicare, which are incurred during the contract period. This shall include claims that are
incurred but not paid as of the end of the plan year or end of the contract term.
C.5.4.3 The Contractor shall at a minimum replicate the current procedures of the District in
administering the plan as set forth in District law and the District Personnel Manual (DPM:
https://edpm.dc.gov/ ).
C.5.4.4 The Contractor shall provide 24-hour direct access for participants to the customer service
center and claims office with local and toll-free phone numbers available for all participant
inquiries.
C.5.4.5 The Contractor shall establish minimum customer service center office hours from 8:00
a.m. to 6:00 p.m. Eastern Time , Monday through Friday, during which time participants
may speak with a representative at the customer service center and claims office. The
Contractor’s telephone responses shall be provided by customer service staff who are
knowledgeable in all aspects of the District's plan and personnel operations.
a. The Contractor’s customer service call center shall adhere to the standards identified
in Attachment J. 12, Performance Guarantees . The Contractor shall retain de -
identified telephone logs and, upon request of the CA, submit them electronically to
the CA for inspection and verification of performance guarantee measures.
b. The customer service staff shall attempt to resolve all inquiries on the first call. If a
resolution cannot be provided immediately in the initial call, the customer service
center shall, on the same day as the initial call, provide the plan participant with either
a resolution or with an estimate of when a resolution will be provided.
c. The Contractor shall record and archive all calls and shall, upon request of an
employee, provide a transcript of calls to the employee within two business days
through the means specified by the employee (email, etc.). If an employee files a
grievance or appeal, the Contractor shall advise the employee of their right to obtain a
transcript of calls. The Contractor shall also provide notification of this right in the
Frequently Asked Questions section on their microsite. At the request of the employee,
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the Contractor shall redact health information from the transcript. In addition, upon
authorization by the employee, the Contractor shall provide a copy of the transcript to
District benefits staff.
d. The Contractor’s customer service center shall include representatives fluent in English
and Spanish. The Contractor shall provide access to interpretation and translation
services for other languages, as designated by the District. The Contractor shall provide
telecommunications relay services for individuals with hearing and speech disabilities.
C.5.4.6 The Contractor shall provide separate local and toll-free administrative telephone lines for
direct communication with District benefits personnel and administrative staff. The
Contractor shall provide these telephone lines, at a minimum, from 8:00 a.m. to 6:00 p.m.
Eastern Time, Monday through Friday.
C.5.4.7 Except as prohibited by applicable law or regulations, the Contractor shall make all its files,
records, and documentation related to the District health benefits programs available to
District auditors or independent third-party auditors designated by the District during
regular business hours upon ten business days’ advance written notice by the CA .
C.5.4.8 The Contractor shall maintain current, complete, and confidential records for each enrollee
in accordance with the requirements of HIPAA and this contract. (See Sections H.11 and
H.12.)
C.5.4.9 The Contractor shall ensure that all sensitive information and data is sent, transmitted, or
uploaded to the CA or other appropriate recipient via a secure file transfer protocol (FTP ).
The Contractor shall also establish and maintain a secure FTP to allow the CA or other
benefits personnel to send, transmit, or upload any sensitive information or data to the
Contractor within a secure FTP.
C.5.4.10 The Contractor shall administer 31 calendar days of extended benefits following the
termination of an enrollment or benefits under an enrollment funded by the District and the
employee. The 31-day extended benefit applies to active enrollments. The 31-day extended
coverage period shall commence at the end of the pay period in which active employees
separate or dependents’ coverage eligibility ends. The 31-day extension of coverage should
be calculated from the termination date transmitted via elect ronic file or the online
administration system. The 31 -day extended period of coverage shall be funded by the
Contractor.
C.5.4.1 1 The Contractor shall process all claims and shall provide other services, including but not
limited to the following : design, review, and print claim forms; issue claim forms;
determine the validity of all claims; pay valid claims; manage claim disputes and the
appeals/grievance review process; and provide information dissemination services ( for
example, traditional mail, telecommunications, etc.) to the District to provide participants
with surveys and other information. The Contractor shall adhere to the standards for claims
administration specified in Attachment J. 12, Performance Guarantees .
C.5.4.1 2 The Contractor shall provide Explanation of Benefit (EOB) Statements to enrollees with
each claim payment or denial, which includes an explanation of the appeals process within
7-10 days of each claim payment or denial.
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C.5.4.1 3 When a dependent is approaching the maximum age limit established by the District or in
the event of other anticipated changes to coverage for enrollees or their dependents, the
Contractor shall notify the primary enrollee no less than 30 days and no more than 90 days
prior to such a change taking effect . Notification may be made through one or more of the
following means: mail, phone call, application (app), automated phone call, or any other
effective communication .
C.5.4.1 4 The Contractor shall respond to all written inquiries and requests for forms f rom enrollees
within two business days of receipt of the inquiry or request. The Contractor shall respond
with the appropriate correspondence, review, or follow -ups.
C.5.4.1 5 When an enrollee submits a claims dispute or other request for the Contractor to reconsider
a decision, the Contractor shall acknowledge receipt and provide a timeline of the appeal
process within two business days of receipt of the dispute or request , except for urgent
appeal requests . An internal appeal shall be conducted as soon as possible after receipt by
the Contractor of all necessary documentation in accordance with the medical exigencies
of the case. The Contractor shall conclude the appea l and send written notification of their
determination to the enrollee within the following timeframes after receipt of the appeal
request from the enrollee :
a. Urgent: 24 hours (i f the internal appeal is from a decision regarding urgent or
emergency medical conditions )
b. Prospective: 30 calendar days
c. Retrospective: 60 calendar days
C.5.4.1 6 The Contractor shall seek third -party reimbursement for covered medical services also
covered by primary group health benefit plans and from third parties, other than the
insured, held responsible for the cost of covered medical expenses (subrogation) .
C.5.4.1 7 The Contractor shall provide advice and investigative assistance to the District on disputed
claims and report to the CA on outcomes .
C.5.4.18 The Contractor shall administer benefits, without any pre-existing condition limitations, to
existing employees, retirees, survivors, dependents, and TCCs, as well as to new
employees, retirees, survivors, dependents, and TCCs that enroll within the guidelines
prescribed by the documents listed in section C.2.
C.5.4.19 The Contractor shall price all network provider claims in accordance with the network’s
contractual provisions with such providers of care.
C.5.4.2 0 The Contractor shall keep diagnosis and surgical procedure information using industry
standard coding systems and information on patient age, sex, length of stay, and
complication conditions for use in analysis of hospital utilization based on analytic
techniques which use the diagnosis -related group (DRG) approach. This information shall
be summarized and reported to the CA within the annual report, except where restricted by
District or federal regulations .
C.5.4.2 1 The Contractor shall make a second surgical opinion (SSO) available to participants who
wish to receive a second or third opinion for diagnosis and treatment of an illness. The
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Contractor shall cover the cost of the second or third opinion with an employee cost share
no greater than the cost share specified for a specialist visit.
C.5.4.2 2 The Contractor shall provide participants access to an available mail order pharmacy.
C.5.4.2 3 The Contractor shall provide a pharmacy dedicated to dispensing specialty medications.
C.5.4.2 4 The Contractor shall provide and maintain a formulary, a list of prescription drugs that the
health plan has approved and that may receive preferential treatment via lower copays. The
Contractor shall provide notification to the CA and enrollees at least 60 days prior to the
effective date of any change to the formulary, including any deletion or placement to a
higher copay tier. No change shall take effect during an enrollment period that has the
effect of increasing any prescription drug copaymen t, unless the participant has the option
of a generic equivalent for equal or lower copay. The Contractor shall include the formulary
or a link to it in all plan summary documents.
C.5.4.25 The Contractor shall cover, as part of the pharmacy benefits, the following drugs:
a. compounded medications containing at least one federal legend drug
b. insulin, with or without a prescription, subject to District or state dispensing laws
c. needles and syringes, with or without a prescription, subject to District or state
dispensing laws
d. allergy sera
e. Rogaine, except for male patterned baldness
f. Retin-A (i) for patients up to the age of 30 and (ii) for patients over the age of 30, for
treatment of a cne vulgaris, keratosis follicularis, ichthyosis lamellaris, and verruca
plana
g. contraceptives in compliance with the women’s preventive services guidelines under
the regulations of the Affordable Care Act and the requirements of D.C. Law 22- 75,
Defending Access to Women's Health Care Services Amendment Act of 2018, which
allows women to get a year’s supply of birth control
h. prescription drugs made from blood and blood byproducts for treatment of hemophilia
and other blood diseases
C.5.4.2 6 The Contractor shall have adequate coverage of FDA -approved anti-obesity medications
on the formulary to meet patient needs and shall make available their exception process to
members. The Contractor shall cover at least one anti -obesity drug from the GLP-1 class
for weight loss and cover at least two additional oral anti -obesity drug options. As new
anti-obesity drugs are approved by the FDA, the Contractor shall evaluate and update their
coverage of anti -obesity drugs.
C.5.4.2 7 The Contractor shall accept electronic payment files in EDI 820, federal format , on a
biweekly basis. All payments files are to be reconciled with eligibility files within five
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business days of receipt of payment files, or notification must be made to the CA as to the
reason for the delay .
C.5.4.28 The Contractor shall accept electronic enrollment and eligibility files in EDI 834, federal
format , on a weekly basis. The Contractor shall upload the files into their member database
by the business day after receipt , or shall notify the CA about the reason for delay.
C.5.4.29 The Contractor shall implement midyear changes required by law, regulation, executive
order, and ordinance, or other rule or requirement passed or set forth by the f ederal
government or District government on the effective date or the date requested by the CA ,
whichever date is earlier . The CA will give the Contractor no less than 120 days to
implement such changes. The Contractor shall provide notices to participants no less than
60 days in advance of the effective date.
C.5.4.30 If the Contractor changes its plan coverage or its network of providers during a plan year,
the Contractor shall provide credit for partially and fully satisfied calendar year deductibles
and out -of-pocket maximums satisfied by out -of-network and in-netwo rk charges, as
applicable under the previous plan design provisions. If a participant requests to continue
to receive services from a medical provider no longer covered as a result of these chang es,
the Contractor shall continue coverage for no less than 90 days. A participant may continue
treatment with a provider no longer covered if the participant is experiencing any of the
following conditions:
1. Pregnancy, including the second and third trimesters of pregnancy.
2. A condition in the midst of ongoing treatment with a defined number of services or
period of treatment.
3. For employees and dependents who are hospitalized or who suffer from a serious
chronic or catastrophic condition (that is, any medical condition where total cost of
treatment, regardless of payment source, is expected to exceed $100,000), a 12 0-
calendar day transition period will apply. During this time such participants will be
identified by the Contractor and will have the option to provide to the CA, within
90 days, justification for remaining with their current provider or will be
automatically transitioned to an in-network provider if no justification is received
within the 90-day timeframe. During this period, benefits for such persons will be
paid at in-network levels although they are receiving treatment from non-network
providers or facilities, prov ided that the provider or facility is either in the existing
network or in the Contractor’s network.
The provisions of this paragraph shall not apply if the participant had the option to stay in-
network and keep their medical provider under which they were enrolled immediately prior
to the engagement of the Contractor.
C.5.5 Care Management
C.5.5.1 The Contractor shall provide care management services to help ensure that high quality
medical care is being provided in a cost -efficient manner. The Contractor’s systems and
techniques shall enable them to effectively manage and control the use of healthcare
services. The Contractor shall perform a review of medical necessity, incentives to use
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certain providers, and case management. The Contractor shall develop and maintain a
system of health payment and delivery of service arrangement wherein the plan shall
control or coordinate the use of health services by its participants in order to contain health
expenditures and improve quality. The Contractor may provide some or all care
management services through a patient -centered medical home.
C.5.5.2 The Contractor shall monitor hospital admissions and discharges as well as identify
potential catastrophic cases. The Contractor shall then work with the patient, patient's
family, health care community , and local resources to see that quality care is provided in
the most cost-efficient setting, which may include centers of excellence. This may include
arranging for services not normally within the scope of the plan in lieu of covered services
as defined by the District.
C.5.5.3 The Contractor shall establish an employee advice line , in accordance with C.5.4.4 and
C.5.4.5, where District employees may call for advice and guidance on benefits available
under the District's plan and alternate treatment settings where covered services can be
rendered.
C.5.5.4 The Contractor shall provide a drug utilization review program to help ensure that
prescribed medications are appropriate, medically necessary, and are not likely to result in
adverse medical outcomes.
C.5.5.5 The Contractor shall provide a case manager to assist patients with high costs and complex
conditions in finding appropriate care for their condition.
C.5.5.6 The Contractor shall provide a nurse telephone line to participants to assist with clinical
guidance and serve as a health information service that is staffed with a team of experienced
registered nurses who can provide information, support , and education for health-related
questions or concerns and advise participants on the appropriate level of care. The nurse
telephone line shall be available 24 hours a day, 7 days a week, without charge to
participants.
C.5.5.7 The Contractor shall provide patients with telehealth access to chronic care nurses to assist
in managing their chronic conditions and closing any gaps in care.
C.5.5.8 The Contractor shall coordinate care and benefits with the DCHR’s employee assistance
program (EAP) contractor so that participants receive care without interruption .
C.5.6 Provider Qualification s and Access
C.5.6.1 The Contractor shall maintain a provider network that provides comprehensive health care
services for plan participants in the Washington, DC, metropolitan area, in accordance with
applicable regulations. For participants outside the Washington, DC, metropolitan area, the
provider network shall maintain, at a minimum, two network primary care physicians (that
is, general practice, family practice, internist, ob-gyn, and pediatric) within eight miles of
each participant’s residence, the needed specialist wit hin 35 miles, a hospital within 15
miles, or the non-participating providers shall be covered at in -network benefit levels.
C.5.6.2 The Contractor shall maintain a network of retail pharmacies that provide drug access for
plan participants in the Washington, DC, metropolitan area . The Contractor shall also
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provide pharmacy access for participants outside the Washington, DC, metropolitan area
through nationwide retail pharmacies and major chains that are in-network or through out-
of-network pharmacies. The Contractor shall treat all pharmacy claims outside the
Washington, DC, metropolitan area as covered in network.
C.5.6.3 The Contractor shall expand, as the Contractor deems necessary or at the CA’s request, its
network with practices accepting new patients to meet the District’s requirements or add
providers in network locations where coverage gaps exist. The Contractor shall expand its
network within 120 days of receipt of the written request from the CA and provide written
notification to the CA and plan participants regarding the addition of providers. If the
Contractor cannot expand their network within this timeframe, the Contractor shall submit
a written explanation to the CA within 15 days and shall propose alternative solutions to
accommodate the District’s needs.
C.5.6.4 For all plans, the Contractor shall cover emergency out -of-network services for
participants. PPO and CDHP plans shall cover at a reduced rate non -emergency out-of-
network services as well.
C.5.6.5 The Contractor shall provide, prior to the initial plan year and throughout the term of the
contract, on -line access to up -to-date network provider listings and locations to assist
participants with provider selection.
C.5.6.6 The Contractor shall maintain a stable provider network. The total number of network
providers and the numbers of network providers for the following specialties and services,
specified in 26A DCMR § 4702.5 and § 4702.6, shall remain consistent throughout the
contract period: (a) neurology, (b) cardiology, (c) hematology/oncology, (d) dermatolog y,
(e) rheumatology, (f) orthopedics, (g) nephrology, (h) plastic surgery, (i) primary care, (j)
pediatrics, (k) OB/GYN, (l) behavioral health and substance abuse, and (m) habilitative
services. By January 31 each year, the Contractor shall submit a report to the CA specifying
the ratios of network providers to covered persons, (a) in total and (b) for each specialty or
service, as of January 1 of the prior year and as of December 31 of the prior year. Upon
request of the CA, the Contractor shall submit a list of its network providers assigned to
each specialty or service.
C.5.6.7 To ensure the accuracy of its online provider directory, t he Contractor shall conduct an
audit of at least 15% of its directory by September 30 each year , verifying the status and
contact information for providers. The Contractor shall update inaccurate information in
the online directory by October 30 each year . The Contractor shall report to the CA by
November 30 each year the results of the audit and corrective steps. Upon request of the
CA, the Contractor shall provide supporting documentation.
C.5.6.8 The Contractor shall notify the CA electronically at least 90 days in advance, or as soon as
practical, of any significant changes to the provider network (for example, more than 25
participants have used a particular provider or provider group within the last year) or to the
reimbursement levels paid to providers. Such notice shall include the estimated impact on
the District and its participants. Transition continuity of care provisions apply. The
Contractor shall notify the enrollee of the change in writing no less than 30 days prior to
the effective date of the change and shall offer alternative participating providers.
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C.5.6.9 The Contractor shall manage costs through the Contractor’s network discounts, utilization
controls, and plan management. The Contractor shall reflect any cost savings in the
premiums charged to the District and coinsurance paid by plan participants. In addition,
the Contractor shall maintain information showing individual and aggregate discounts off
the usual and customary charges and provide it to the District as requested.
C.5.6.10 The Contractor shall recredential network providers and facilities at least once every three
years. Upon request of the CA, the Contractor shall submit a list of network providers and
facilities and the date of completion of their last credentialing.
C.5.7 Wellness and Disease Management Program
C.5.7.1 The Contractor shall implement a w ellness program, which will provide effective
preventive programs and information to promote employee wellness. The Contractor shall
provide an online and sustainable wellness program and disease management program that
promotes healthy choices by increasing awareness of chronic health conditions, nutrition,
increasing physical activity and resiliency, and maintaining emotional, financial, mental,
and physical wellness. The program’s goal shall be to improve the health outcomes, reduce
stress, reduce secondary traum a, and foster a healthy District workforce .
C.5.7.2 The Contractor shall offer a fully developed and sustainable wellness platform that is
comprehensive, technologically advanced, interactive, and highly personalized for each
enrollee. The platform shall allow enrollees to access and view their personal electronic
medical records, including results from biometric screenings, health risk assessments, and
immunization records , as well as incentive rewards offered online and in-person that run
through the calendar year.
C.5.7.3 Wellness Campaign. The Contractor shall design and conduct various wellness campaig ns
and challenges throughout the contract term to stimulate a health -conscious work
environment and lifestyle. The Contractor shall design and execute a strategic engagement
plan that encourages all eligible employees to participate in wellness activities. At
minimum, this component shall include:
a. Health and wellness initiatives
b. Social networking
c. Educational content on health and wellness (e.g., flyers, video, text messaging, and
materials)
d. Fitness tracking
e. Focused disease management (e.g., substance abuse , diabetes, obesity,
hypertension)
f. Rewards through incentives and raffles based on completed activities , screening s,
and assessments.
C.5.7.4 Population Health Management . The Contractor shall identify individuals in need of
health and wellness services, disease management, and treatment through the use of claims
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data, biometric screenings, health risk assessments, and data from the District’s medical ,
vision, and pharmacy benefit reports to coordinate health care interventions. The programs
should empower individuals to work with health coaches and health care providers to
prevent or manage their diseases and prevent complications. The Contractor may interact
with employees throughout the District in a variety of work locations. The Contractor shall
offer multiple touchpoints including virtual or face-to -face meetings , coaching, and
educational classes. At a minimum, the Contractor shall provide the following services:
a. Health risk assessment
b. Biometric health screening
c. Health coaching , live virtual or in -person
d. Health management/intervention
e. Participation tracking for incentive purposes
f. Immunizations (e.g., flu shot)
g. Chronic Condition Management
h. Mental Health and Substance Abuse Management
i. Mobile health ( e.g., mammogram mobile van)
C.5.7.5 Onsite Services and Support. The Contractor shall provide a communication campaig n,
employee meetings , and health fairs that provide an explanation of plan benefits to
employees. The Contractor shall provide , at the CA’s request, flu vaccinations,
professional medical, technical , and nutritional personnel to provide biometric screenings,
visual testing, body-fat testing, healthy cooking , and other educational services that are
reasonably intended to promote the health of the plan participants . The Contracto r shall
conduct a minimum of 25 health fairs annually.
C.5.7.5.1 The Contractor shall submit to the CA a communication plan to increase participation
among enrollees in an annual health assessment no later than March 1 of each
performance year . The Contractor shall utilize a variety of communication methods,
including email, mailer, text messaging, calls , and videos . To the extent that it’s
permitted by law and regulations, t he Contractor shall ensure that the health risk
assessments and biometric screenings can be made available to the Contractor’s health
coaches and utilization review clinicians.
C.5.7.5.2 The Contractor shall assist in wellness challenges upon the CA’s request and
collaborate with other DC employee health benefit plan contractors . The Contractor
shall provide wellness challenges that help enrollees maintain a balanced diet, lose
weight, quit smoking, manage stress, lower blood pressure or cholesterol, drink water,
and/or improve physical strength and stamina.
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C.5.8 Mental Health, Trauma Informed Care Program , and Employee Support Services
C.5.8.1 Mental Health and Trauma Informed Care Program
C.5.8.1.1 While the District has an independent EAP contractor who leads the facilitation,
execution, and implementation of the Mental Health and TIC Program and Employee
Support Services , the Contractor shall collaborate and work with the District and the
EAP contractor to supplement the mental health and trauma-informed care (TIC)
program. The Contractor’s work and efforts shall be focused on assisting the EAP
contractor with expanding opportunities for employees to receive trauma-informed
interventions by enhancing efforts for directors, managers, and agencies to become
competent in TIC practices.
C.5.8.1.2 The Contractor shall collaborate and work in conjunction with the EAP contractor to
provide the following: (1) services to support a mental health and TIC program, (2)
services to reduce disparities in behavioral and mental health support access, and (3)
services to improve the Districts’ ability to manage crisis situations.
C.5.8.2 Employee Support Services
C.5.8.2.1 The Contractor shall collaborate and work with the District and the EAP contractor to
provide work-based mental health and TIC support services which offer free and
confidential assessments, counseling, referrals, and follow -up services to employees
who have experienced personal or work-related trauma. The Contractor shall
collaborate to support a multifaceted range of issues affecting mental and emotional
well-being, such as alcohol and other substance abuse, stress, grief, family problems,
community or workplace violence, and psychological disorders. The Contractor shall
work with participants in a variety of work locations as needed in the District metro
area.
C.5.8.2.2 The Contractor shall maintain records for seven years for each employee who contacts
the Contractor for services in conjunction with the EAP contractor.
C.5.8.2.3 The Contractor shall monitor the utilization of all mental health professional services
and make recommendations to improve utilization in conjunction with the EAP
contractor.
C.5.9 Quality Control
C.5.9.1 The Contractor shall submit a comprehensive quality control m anagement plan that
includes, at a minimum, grievance procedures, provider credentialing and termination
policies, an incentive plan for service providers, monitoring procedures for care
management, and a dispute resolution strategy. The Contractor shall submit the quality
control management plan to the CA within 60 days of contract award.
The Contractor shall include in its quality control management plan review of the
following:
a. Adherence to treatment guidelines and protocols
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b. Ongoing maintenance and evaluation of the quality and appropriateness of care
c. Utilization management
d. Process for reviewing and approving credentials of patient care professionals
e. Clinical aspects of risk management
f. Infection control
g. Facility quality (i.e., location, cleanliness, parking)
h. Grievance procedures
i. Provider credentialing and termination policies
j. Incentive plan for service providers
k. Monitoring procedures for care management
l. Dispute resolution strategy
C.5.9.2 The Contractor shall conduct an annual member satisfaction survey within 60 days of the
end of each plan year to assess enrollee satisfaction with the plan. The survey shall be sent
to all plan enrollees and shall ask about the quality of care, the Contractor’s responsiveness
to requests and communications, and the accessibility of the Contractor’s network
providers, as well as other topics to be determined by the Contractor and the CA. The
Contractor shall submit a draft of the survey for review and approval to the CA at least 60
days before the survey is sent to enrollees. The Contractor shall return the completed
surveys to the CA electronically within 30 days of the survey distribution. The Contractor’s
performance for the Membership Satisfaction Survey performance guarantee in
Attachment J.12, Performance Guarantees , will be assessed based on the results of this
survey. However, the liquidated damages payment shall not apply if the Contractor
receives responses from less than 25% of enrollees.
C.5.9.3 The Contractor shall adhere to the p erformance guarantee standards listed in Attachment
J.12, Performance Guarantees . The Contractor shall report its performance for each
guarantee an annual basis, within 90 days of the end of the plan year, on a report approved
by the CA. The Contractor’s audit and survey methodologies shall conform to industry
standards and shall be a pproved in advance by the CA. The Contractor shall issue, as
liquidated damages, payments, in accordance with the CA’s instructions, within 30 days of
report submission. If the Contractor does not issue the payment within 30 days, the District
may deduct the amount from biweekly premium payments. All performance guarantee
reports and payments shall be subject to audit by the CA, Distri ct auditors, or auditors
contracted by the District, and if requested by the CA, the Contractor shall transmit de-
identified supporting documentation to the CA or the auditor, in accordance with the CA’s
instructions and, when required, HIPAA protocols.
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C.5.10 Reporting
C.5.10.1 The Contractor shall reconcile its eligibility records with District eligibility files on a
weekly basis and shall notify the CA of any discrepancies within five days (see C.5.4.28).
The Contractor shall further reconcile remitted payments, payment files, and eligibility
files on a biweekly basis and shall report the results, including any discrepancies, no less
than monthly, to the CA by the 30 th of the month following the reported period or, if the
30th falls on a weekend or holiday, the next business day (see C.5.4.27 and C.5.4.28). The
Contractor’s reconciliation shall require certification of enrollees by name, social security
number or Medicare beneficiary identifier (MBI), and enrollment code. The reconciliation
shall identify missing payments, duplicate payments, overpayments, underpayments, and
any other discrepancies. The Contractor shall submit reconciliations electronically in a
format specified by the CA. Monthly reconciliation reporting shall be subject to the
performance standard specified in Attachment J.12, Performance Guarantees .
C.5.10.2 The Contractor shall provide a customer service inquiry statistics report that includes
monthly and year -to-date data on the number of calls by major category, inquiries resolved
in one call, wait times, abandonment rates, call duration, and other statistics as specified
by the District. The report shall be submitted to the CA on a quarterly basis by the last day
of the month following each quarter.
C.5.10.3 The Contractor shall provide an income and expenditures report by plan showing amounts
deposited by the District (including the date such electronic payments were received) and
claims paid for services incurred by plan members, enrollment, and separately identified
catastrophic claims in an electron ic format. The claim level for the catastrophic claim
report will be determined by the CA. The report shall be submitted to the CA on a quarterly
basis by the 30 th of the month following each quarter.
C.5.10.4 The Contractor shall cooperate with and act in good faith in working with the consulting
actuary and shall be prepared to respond to the actuary’s requests promptly. In that regard,
or for other purposes, the District may, on an ad hoc basis, request that the Contractor
prepare customized reports or provide the District with individual claims data on a timely
basis at no additional cost to the District. The Contractor’s reports shall be submitted
electronically to the CA in a mutually agreed upon timeline.
C.5.10.5 The Contractor shall provide a c laims processing statistics report containing monthly and
year-to-date claims processing statistics including the number of claims received, pended,
denied, or paid; claims received and pended inventories (number on hand at each week’s
end); and turnaround and aging statistics to be specified by the District. The Contractor
shall submit the report electronically in a format approved by the CA. The report shall be
submitted to the CA on a quarterly basis by the 30 th of the month following each quarter.
C.5.10.6 The Contractor shall provide a n electronic claims payment accuracy statistics r eport
containing monthly and year -to-date claims payment accuracy statistics from the
Contractor’s internal auditing process, including the number and amount of overpayments,
underpayments, miscoded claims, and other statistics as specified by the CA. The report
shall be submitted to the CA on a quarterly basis by the 30 th of the month following each
quarter.
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C.5.10.7 The Contractor shall perform an annual account reconciliation of monthly claims,
administration, and other expenditures and submit a detailed reconciliation report
electronically to the CA by March 31 after the close of the plan year.
C.5.10.8 The Contractor shall provide a de-identified list of all claimants who have incurred greater
than $50,000 in the current plan year and the prior plan year and include dependent status,
age/gender band, and major diagnostic category. The report shall be submitted to the CA
on a quarterly basis by the 30 th of the month following each quarter.
C.5.10.9 The Contractor shall submit a hospital utilization report showing the number of employees
using each hospital by plan, the lengths of stay, and the net amounts paid, including COB
and other third-party liability recoveries. The report shall be submitted to the CA on a
quarterly basis by the 30 th of the month following each quarter.
C.5.10.10 The Contractor shall submit a report of incurred claims, by plan, by month and year, and
by therapeutic class, showing number of claims, number of prescriptions, number of days’
supply, and net amount paid. The report shall be submitted to the CA on a quarterly basis
by the 30 th of the month following each quarter.
C.5.10.11 The Contractor shall furnish on-line access to reports to the District and its consultant(s) if
requested by the CA.
C.5.10.12 The Contractor shall benchmark data on plan costs and utilization with suggestions for plan
improvement and cost efficiency.
C.5.10.13 The Contractor shall provide a report on participant engagement in the wellness programs
and shall report annually on the estimate d claims savings of the wellness programs. The
report shall be submitted to the CA on a quarterly basis by the 30th of the month following
each quarter.
C.5.10.14 The Contractor shall provide an electronic report of those covered dependents of retirees
who will lose coverage due to reaching age 26 and any adult disabled dependents of retirees
who will lose coverage. The report shall be submitted to the CA by the 30 th day of each
month and shall contain at minimum those dependents who will lose coverage in the month
after report submission.
C.5.10.15 The Contractor shall provide an electronic report which will identify any active dependents
that will lose coverage due to reaching age 26 and any adult disabled dependents that will
lose coverage within the following month. The report shall be submitted to the CA by the
30th day of each month and shall contain at minimum those dependents who will lose
coverage in the month after report submission.
C.5.10.16 The Contractor shall provide to the CA electronic quarterly reports of in-network claims
and utilization and out -of-network claims and utilization by plan for the following groups:
a. Enrolled active D.C. employees and their dependents by coverage type (self only,
self plus one dependent , and self and family)
b. Temporary continuation of c overage enrollments
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c. Enrolled retired D.C. employees and their dependents by coverage type (self only,
self plus one dependent , and self and family)
The report shall be submitted to the CA on a quarterly basis by the 30 th of the month
following each quarter.
C.5.10.17 The Contractor shall provide to the CA quarterly electronic reports for each plan on the
following:
a. Retail network claims pre- and post-discounts , dispensing fees, and amount paid by
generic, formulary and non-formulary classifications;
b. Mail order claims pre - and post -discounts, dispensing fees, and amount paid by
generic, formulary and non-formulary classifications;
c. Brand utilization when generics are available;
d. Out-of-network claims pre- and post-discounts , dispensing fees, and amount paid
by generic, formulary and non-formulary classifications;
e. Manufacturers’ rebates
f. Other compensation or incentive payments received
g. Enrolled active D.C. employees;
h. Participating active overage eligible disabled dependents
i. Temporary continuation of c overage enrollments; and
j. Enrolled retired D.C. employees, split by pre - and post -Medicare
C.5.10.18 The Contractor shall keep in its individual claim records, at a minimum, the following
information:
a. Date of service
b. ID number
c. National drug code (11-digit NDC)
d. Drug type indicator (single source, multi -source, generic)
e. Maintenance drug indicator
f. Formulary drug indicator
g. National Council for Prescription Drug Programs (NCPDP) provider identification
number (formerly known as NABP Number)
b. Days’ supply
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c. Quantity
d. Net ingredient cost
e. Dispensing fee
f. Member copayment
g. Amount applied to d eductible
h. Plan payment
i. Average wholesale price
j. Date pharmacy paid
C.5.10.19 The Contractor shall report to the CA any law, regulation, executive order, ordinance, or
other rule or requirement enacted, that could result in a mid-year change to the health
coverage offered to participants. Contractor shall provide such notice within 30 days after
the passage of the law, regulation, executive order or ordinance, or other rule or
requirement.
C.5.10.20 The Contractor shall submit a letter to the CA by August 31 each plan year notifying the
District whether their Medicare Part D coverage is creditable. The letter shall also include
the results of the ir creditability test.
C.5.11 Continuity of Operations and Services
C.5.11.1 The Contractor shall perform its contractual obligations in a manner that demonstrates that
it recognizes (a) that the operations and services provided under this contract are vital to
the District and must be continued without interruption and (ii) that upon contract
expiration or termination, a successor, either the District or another contractor, at the
District’s option, may continue to provide these services.
C.5.11.2 The Contractor shall provide electronic copies of all eligibility and claims information
records and files related to the DCEHB plans it has administered, including but not limited
to supporting electronic files with individual benefit accumulation data relevant to the
provisions of the District’s health benefit plans. At the option of the District, the Contractor
shall adjudicate and pay all unpaid claims incurred prior to contract expiration or
termination.
C.5.11.3 The Contractor shall furnish phase -in/phase-out transition of operations and services,
including training, as notified by the CA and at the CA’s discretion, for up to 90 days after
contract expiration.
C.5.11.4 The Contractor shall exercise its best efforts and cooperation to effect an orderly and
efficient transition to a successor.
C.5.11.5 The Contractor shall negotiate in good faith a plan with a successor to determine the nature
and extent of phase -in/phase-out services required. The plan shall specify a training
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program and a date for transferring responsibilities for each division of work described in
the plan and shall be subject to the Contracting Officer’s approval.
C.5.11.6 The Contractor shall provide sufficient experienced personnel during the phase -in/phase-
out period to ensure that the services called for by this contract are maintained at the
required level of proficiency.
C.5.11.7 The Contractor shall allow as many personnel as practicable to remain on the job to help
the successor maintain the continuity and consistency of the services required by this
contract. For essential personnel whose sole responsibility is to provide servic es to the
District under this Contract and who are not engaged in services under other contracts held
by the Contractor, the Contractor shall disclose necessary personnel records and allow the
successor to conduct on-site interviews with such employees. If selected employees are
agreeable to the change, the Contractor shall release them at a mutually agreeable date and
negotiate transfer of their earned fringe benefits to the successor.
C.5.11.8 The Contractor shall not charge the District continuity of services cost if it is an incumbent
awarded a new contract. If the Contractor is not awarded a new contract, only in accordance
with a modification issued by the CO shall the Contractor be reimbursed for all reasonable
phase-in, phase -out costs (i.e., costs incurred within the agreed period after contract
expiration that result from phase -in, phase-out operations) and a fee (profit) not to exceed
a pro rata portion of the fee (profit) under this contract.
C.6 PREMIUM RATE REDETERMINATION
C.6.1 Redetermination Process
C.6.1.1 Subsequent contract years during the base period and during each year of the option periods
shall be subject to annual prospective price redetermination.
C.6.1.2 For contract years two through five of the base period, for contract years one throug h five
of option period one, and for contract years one through five of option period two, the
Contractor shall propose adjusted prices for any awarded plan no later than June 1 prior to
the first day of the contract year subject to price redetermination or when requested by the
CA. The Contractor’s proposed adjustment shall be sent in writing to the Contracting
Officer.
C.6.1.3 Upon receiving the Contractor’s proposed adjusted prices for any contract year subsequent
to the first contract year of the base period, the District will conduct an actuarial analysis
of the proposed adjusted prices. Based on the findings of the actuaria l analysis, the
Contractor’s proposed adjusted prices may be subject to negotiation between the District
and the Contractor. After review and approval of the adjusted prices, the Contracting
Officer will issue a modification to the contract incorporating the adjusted prices into the
contract for the specified contract year.
C.6.1.4 Any adjusted prices determined in the annual prospective price redetermination process
will be effective as of the first day of the plan year to which the adjusted premium rates
apply. In the event that the Contractor has requested a price redetermination and the District
and the Contractor have not reached an agreement by October 1 before the first day of the
plan year to which the adjusted premiums rates would apply, the District will conclude
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negotiations with the Contractor and will unilaterally adjust the premium rates in
accordance with the Department of Labor Bureau of Labor Statistic’s consumer price index
for urban consumers (CPI-U) for the medical care services expenditure category using the
statistics for the latest 12 months for which statistics are available.
C.6.1.5 In the event that the District, pursuant to the Changes Clause of the Standard Contract
Provisions, adds, deletes, or changes any services to be covered by the Contractor in any
contract year in the base period or option periods, the District will review the effect of the
change with the Contractor and may equitably adjust the premium biweekly rates following
completion of an actuarial review and approval from the District.
C.6.2 Premium Rate Guarantees
C.6.2.1 The District requests rate guarantees for each contract year. The Contractor shall guarantee
the renewal formula(s) to be used in the annual price redetermination. The Contractor shall
submit annual renewal rates to the District no later than June 1 prior to the first day of the
contract year subject to price redetermination or when requested by the CA.
C.6.2.2 In providing rate guarantees, the Contractor shall provide the basis of the guarantee,
including the assumptions used for which the guarantee is made or will be made as well as
the formula that applies to each annual rate guarantee. For example, rate guar antees may
be based (1) on the basis of “Rate Caps” (the maximum amount rates could increase in a
year based on enrollment or claims); or (2) on the basis of a renewal formula based on
claims experience, trends, and anticipated administrative costs; or (3) on some combination
of the above.
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SECTION D: PACKAGING AND MARKING
D.1 The packaging and marking requirements for this contract shall be governed by clause number (2),
Shipping Instructions -Consignment, of the Government of the District of Columbia's Standard
Contract Provisions for use with Supplies and Services Contracts, dated July 2010. (Attachment
J.1)

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SECTION E: INSPECTION AND ACCEPTANCE
E.1 The inspection and acceptance requirements for this contract shall be governed by clause number
six (6), Inspection of Service s, of the Government of the District of Columbia's Standard Contract
Provisions for use with Supplies and Services Contracts, dated July 2010. (Attachment J.1)

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SECTION F: PERIOD OF PERFORMANCE AND DELIVERABLES
F.1 TERM OF CONTRACT
The term of the contract shall start on the date of award and include up to three months of transition
services. Employee health benefits coverage shall start on January 1, 2026 , and end on December 31,
2030. The total duration of the base period shall not exceed 63 months.
F.2 OPTION TO EXTEND THE TERM OF THE CONTRACT
F.2.1 The District may extend the term of this contract for a period of two five-year option periods, or
successive fractions thereof, by written notice to the Contractor before the expiration of the
contract; provided that the District will give the Contractor preliminary written notice of its intent
to extend at least thirty (30) days before the contra ct expires. The preliminary notice does not
commit the District to an extension. The exercise of this option is subject to the availability of
funds at the time of the exercise of this option. The Contractor may waive the thirty (30) day
preliminary notice requirement by providing a written waiver to the Contracting Officer prior to
expiration of the contract.
F.2.2 If the District exercises this option, the extended contract shall be considered to include this option
provision.
F.2.3 The total duration of this contract, including the exercise of any options under this clause, shall
not exceed 183 months .
F.3 DELIVERABLES
The Contractor shall perform the activities required to successfully complete the District’s requirements
and submit each deliverable to the CA identified in section G.9 in accordance with the following:
Item
No.
Contract
Requirement Deliverable Quantity Format/Method
of Delivery Due Date
1 C.5.2.1 Preliminary transition
plan 1 Digital (email) At award
2 C.5.2.2 Final transition plan 1 Digital (email) 10 days after
award
3 C.5.2.6 Kick-off meeting 1 Virtual/in person 15 days after
award
4 C.5.3.2 ID card design 1 Digital (email) 10 days after
award
5 C.5.3.3 ID cards As needed Mail and online
14 days after
receipt of
enrollment
6 C.5.3.4 Plan information As needed Paper and digital As needed
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7 C.5.3.5
Certificates of Coverage,
Summary Plan
Descriptions, Evidence of
Coverage, Summaries of
Benefits and Coverage
1 annually Digital (email)
30 days before
open
enrollment
8 C.5.3.5 Enrollee documents As needed Paper (mail) 15 days before
plan year
9 C.5.3.8 Open enrollment fairs As needed Virtual/in person
Annually,
November and
December
10 C.5.3.9 Orientation sessions 4 annually Virtual/in person As needed
11 C.5.3.10 Presentations 52
annually Virtual/in person As needed
12 C.5.3.11 Online administration and
reporting tools As needed Online Ongoing
13 C.5.3.12 Temporary newborn
enrollment report
12
annually Digital (email) By the 15th
each month
14 C.5.4.1 Administrative manual 1 Digital (email) 30 days after
award
15 C.5.4.5.a
Customer service center
de-identified telephone
logs
1 annually Digital (email) As needed
16 C.5.4.5.c Customer service center
call transcripts As needed Digital or hard
copy As needed
17 C.5.4.7 Files for auditors As needed As needed As needed
18 C.5.4.12 Explanation of Benefits
statements As needed Digital or hard
copy
7-10 days after
a claim
19 C.5.4.13 Dependent eligibility
change notification As needed As needed As needed
20 C.5.4.14 Responses to written
inquiries As needed As needed 2 days after
request
21 C.5.4.15 Claims Dispute
Acknowledgment As needed As needed 2 days after
receipt
22 C.5.4.15
Claims Dispute
Response/Resolution
Urgent
As needed As needed

24 hours
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Prospective
Retrospective
30 days
60 days
23 C.5.4.20
Summarized diagnosis
and surgical procedure
information
1 annually Digital (email) Annually
24 C.5.4.24 Formulary changes As needed As needed 60 days prior
to change
25 C.5.4.27 Notification of delayed
payment reconciliation As needed Digital (email)
5 business days
after receipt of
payment files
26 C.5.4.28 Notification of delayed
eligibility processing As needed Digital (email)
1 business day
after receipt of
eligibility files
27 C.5.4.29 Notification of midyear
changes As needed Digital or hard
copy
60 days prior
to change
28 C.5.6.3 Notification of network
expansion As needed Digital (email) 120 days after
request
29 C.5.6.6 Provider network report 1 annually Digital (email) January 31
each year
30 C.5.6.7 Directory audit report 1 annually Digital (email) November 30
each year
31 C.5.6.8 Notification of significant
changes to the network As needed Digital (email) 90 days prior
to change
32 C.5.6.10 Recredentialing
verification As needed Digital (email) As needed
33 C.5.7.5 Wellness program health
fairs
25
annually Virtual/in person As needed
34 C.5.7.5.1 Wellness program
communication plan 1 annually Digital (email) March 1 each
year
35 C.5.9.1 Quality control
management plan 1 Digital (email) 60 days after
award
36 C.5.9.2 Annual member
satisfaction survey draft 1 annually Digital (email)
60 days before
distribution to
enrollees
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37 C.5.9.2 Annual member
satisfaction survey results As needed Digital (email)
30 days after
distribution to
enrollees
38 C.5.9.3 Performance guarantee
report 1 Digital (email)
90 days after
end of plan
year
39 C.5.9.3
Performance guarantee
liquidated damages
payment
As needed Mail
30 days after
performance
guarantee
report
submission
40 C.5.9.3
Performance guarantee
report supporting
documentation
As needed Digital (email) As needed
41 C.5.10.1 Payment reconciliation
report As needed Digital (email)
By the 30 th of
the following
month
42 C.5.10.2 Customer service inquiry
report 4 each year Digital (email)
The 30th of the
month
following each
quarter
43 C.5.10.3 Income and expenditures
report 4 each year Digital (email)
The 30th of the
month
following each
quarter
44 C.5.10.4 Customized actuarial
reports As needed Digital (email) As agreed
45 C.5.10.5 Claims processing report 4 each year Digital (email)
The 30th of the
month
following each
quarter
46 C.5.10.6 Claims payment accuracy
report 4 each year Digital (email)
The 30th of the
month
following each
quarter
47 C.5.10.7 Annual reconciliation
report 1 annually Digital (email) by March 31
each year
48 C.5.10.8 Large claims report 4 each year Digital (email)
The 30th of the
month
following each
quarter
49 C.5.10.9 Hospital utilization report 4 each year Digital (email)
The 30th of the
month
following each
quarter
50 C.5.10.10 Incurred claims report 4 each year Digital (email) The 30th of the
month
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following each
quarter
51 C.5.10.12 Benchmark data As needed Digital (email) As needed
52 C.5.10.13 Wellness program
engagement report 4 each year Digital (email)
The 30th of the
month
following each
quarter
53 C.5.10.14 Retired enrolled
dependents report
12 each
year Digital (email) The 30th of
each month
54 C.5.10.15 Active overage
dependents report
12 each
year Digital (email) The 30th of
each month
55 C.5.10.16 Utilization reports 4 each year Digital (email)
The 30th of the
month
following each
quarter
56 C.5.10.17 General plan reports 4 each year Digital (email)
The 30th of the
month
following each
quarter
57 C.5.10.19 Notification of regulatory
changes As needed Digital (email) As needed
58 C.5.10.20 Medicare creditable
coverage letter 1 annually Digital (email) August 31 each
year
59 C.6.1.2 Proposed price adjustment 1 annually Digital (email)
By June 1 prior
to each
contract year
60 G.4.3 Request for eligibility
verification As needed Digital (email) 72 hours after
service request
61 G.4.4 Reimbursement of
overpayment As needed Mail
Within 30 days
overpayment
notification

F.3.1 The Contractor shall submit to the district, as a deliverable, the report described in section H.5.5
that is required by the 51% District Residents New Hires Requirements and First Source
Employment Agreement. If the Contractor does not submit the report as part of the deliverables,
final payment t o the Contractor shall not be paid pursuant to section G.3.2.
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SECTION G: CONTRACT ADMINISTRATION
G.1 INVOICE PAYMENT
G.1.1 The District will make payments to the Contractor in accordance with Section G.4, at the prices
stipulated in this contract, for supplies delivered and accepted or services performed and
accepted, less any discounts, allowances , or adjustments provided for in this contract.
G.2 INVOICE SUBMITTAL
G.2.1 The District’s eligibility and premium remittance shall be on a self -accounting basis. The
Contractor shall accept the electronic payments made by the District at the end of each pay
period as payment in full, except as provided for in Section G.4 below.
G.3 FIRST SOURCE AGREEMENT REQUEST FOR FINAL PAYMENT
G.3.1 For contracts subject to the 51% District Residents New Hires Requirements and First Source
Employment Agreement requirements, final request for payment must be accompanied by the
report or a waiver of compliance discussed in section H.5.5.
G.3.2 The District shall not make final payment to the Contractor until the agency CFO has received
the CO’s final determination or approval of waiver of the Contractor’s compliance with 51%
District Residents New Hires Requirements and First Source Employment A greement
requirements.
G.4 PAYMENT
G.4.1 The District shall provide the Contractor with electronic eligibility from the payroll system for the
agencies covered under the authority of the Mayor and other participating District of Columbia
agencies. The Contractor shall not invoice the District but shall accept the District's electro nic
eligibility system and electronic remittance as payment in full. The banks levy a per transaction
charge for utilization of the electronic eligibility information and payment. The Contractor shall
be responsible for payment of such charges and should build this cost into the administrative
component of their premium rate.
G.4.2 Some i ndependent agencies are permitted by law to participate in the D.C. Employees Health
Benefits Program. Agencies that are independent and have their own payroll system will transmit
their eligibility and premium payments separately , on behalf of their own agencies . As of May
2025, independent agencies remitting payment separately are the D.C. Housing Authority (905
employees) and the D.C. Retirement Board ( retired police, firefighters, and teachers ). The
Contractor shall establish a method of eligibility and update method of payment and frequency of
payment with each of the aforementioned independent agenc ies.
G.4.3 The Contractor shall provide a network of healthcare participating providers to employees shown
on the biweekly pay listings. If there was no health premium payment made for an employee, the
Contractor shall only provide service for such employee upon appr oval by the CA. If the CA is
not available, then the Contractor shall provide coverage for a period not to exceed 72 hours as
long as the employee presents either their plan ID card or enrollment form. Upon verification by
the CA that the employee is cover ed, the Contractor will be paid any back premium. If the
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employee is not covered and if the Contractor will not be billing the employee directly, the
Contractor will only be paid any back premium if it did seek verification within the 72-hour period.
G.4.4 The District will receive credits for overpayment as determined by the CA for an unlimited
retroactive period. The Contractor shall submit a payment check within 30 days of the notification
of overpayment.
G.4.5 The Contractor shall not use premium payments by a covered employee to offset any obligation
or satisfy any debt which the Contractor or a Subcontractor deems owed to them by the
Government of the District of Columbia. Any such disputes in amounts owed (service fees,
contract administration fees, etc.), once resolved, shall only be satisfied by payments received from
the employer, the Governm ent of the District of Columbia.
G.4.6 All payments under this Contract shall be actuarially sound.
G.5 ASSIGNMENT OF CONTRACT PAYMENTS
G.5.1 In accordance with 27 DCMR 3250, the Contractor may assign to a bank, trust company, or
other financing institution funds due or to become due as a result of the performance of this
contract.
G.5.2 Any assignment shall cover all unpaid amounts payable under this contract, and shall not be
made to more than one party.
G.5.3 Notwithstanding an assignment of contract payments, the Contractor, not the assignee, is
required to prepare invoices. Where such an assignment has been made, the original copy of
the invoice must refer to the assignment and must show that payment of the invoice is to be
made directly to the assignee as follows:
“Pursuant to the instrument of assignment dated ___________, make payment of this invoice
to (name and address of assignee) .”
G.6 THE QUICK PAYMENT ACT
G.6.1 Interest Penalties to Contractors
G.6.1.1 The District will pay interest penalties on amounts due to the Contractor under the Quick
Payment Act, D.C. Official Code § 2 -221.01 et seq., as amended, for the period beginning
on the day after the required payment date and ending on the date on which payment of the
amount is made. Interest shall be calculated at the rate of at least 1% per month. No interest
penalty shall be paid if payment for the completed delivery of the item of property or
service is made on or before the required payment date. The required payment date shall
be:
G.6.1.1.1 The date on which payment is due under the terms of the contract;
G.6.1.1.2 Not later than 7 calendar days, excluding legal holidays, after the date of delivery of
meat or meat food products;
G.6.1.1.3 Not later than 10 calendar days, excluding legal holidays, after the date of delivery of
a perishable agricultural commodity; or
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G.6.1.1.4 30 calendar days, excluding legal holidays, after receipt of a proper invoice for the
amount of the payment due.
G.6.1.2 No interest penalty shall be due to the Contractor if payment for the completed delivery of
goods or services is made on or after:
G.6.1.2.1 3rd day after the required payment date for meat or a meat food product;
G.6.1.2.2 5th day after the required payment date for an agricultural commodity; or
G.6.1.2.3 15th day after any other required payment date.
G.6.1.3 Any amount of an interest penalty which remains unpaid at the end of any 30-day period
shall be added to the principal amount of the debt and thereafter interest penalties shall
accrue on the added amount.
G.6.2 Payments to Subcontractors
G.6.2.1 The Contractor shall take one of the following actions within seven (7) days of receipt of
any amount paid to the Contractor by the District for work performed by any subcontractor
under the contract:
G.6.2.1.1 Pay the subcontractor(s) for the proportionate share of the total payment received from
the District that is attributable to the subcontractor(s) for work performed under the
contract; or
G.6.2.1.2 Notify the CO and the subcontractor(s), in writing, of the Contractor’s intention to
withhold all or part of the subcontractor’s payment and state the reason for the
nonpayment.
G.6.2.2 The Contractor shall pay subcontractors or suppliers interest penalties on amounts due to
the subcontractor or supplier beginning on the day after the payment is due and ending on
the date on which the payment is made. Interest shall be calculated at the r ate of at least
1% per month. No interest penalty shall be paid on the following if payment for the
completed delivery of the item of property or service is made on or before the:
G.6.2.2.1 3rd day after the required payment date for meat or a meat product;
G.6.2.2.2 5th day after the required payment date for an agricultural commodity; or
G.6.2.2.3 15th day after any other required payment date.
G.6.2.3 Any amount of an interest penalty which remains unpaid by the Contractor at the end of
any 30-day period shall be added to the principal amount of the debt to the subcontractor
and thereafter interest penalties shall accrue on the added amount.
G.6.2.4 A dispute between the Contractor and subcontractor relating to the amounts or entitlement
of a subcontractor to a payment or a late payment interest penalty under the Quick Payment
Act does not constitute a dispute to which the District is a party. The Dis trict may not be
interpleaded in any judicial or administrative proceeding involving such a dispute .
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G.6.3 Subcontract requirements
G.6.3.1 The Contractor shall include in each subcontract under this contract a provision requiring
the subcontractor to include in its contract with any lower-tier subcontractor or supplier the
payment and interest clauses required under paragraphs (1) and (2) of D.C. Official Code
§ 2-221.02(d).
G.6.3.2 The Contractor shall include in each subcontract under this contract a provision that
obligates the Contractor, at the election of the subcontractor, to participate in negotiation
or mediation as an alternative to administrative or judicial resolution of a dispute between
them.
G.7 CONTRACTING OFFICER (CO)
Contracts will be entered into and signed on behalf of the District only by contracting officers. The contact
information for the Contracting Officer is:
Julius Wiggins
Office of Contracting and Procurement
1015 Half St SE, 8 th Floor
Washington, DC 20003
(202) 741-8781
Julius.Wiggins@dc.gov
G.8 AUTHORIZED CHANGES BY THE CONTRACTING OFFICER
G.8.1 The CO is the only person authorized to approve changes in any of the requirements of this
contract.
G.8.2 The Contractor shall not comply with any order, directive or request that changes or modifies
the requirements of this contract, unless issued in writing and signed by the CO.
G.8.3 In the event the Contractor effects any change at the instruction or request of any person other
than the CO, the change will be considered to have been made without authority and no
adjustment will be made in the contract price to cover any cost increase incurred as a result
thereof.
G.9 CONTRACT ADMINSTRATOR (CA)
G.9.1 The CA is responsible for general administration of the contract and advising the CO as to the
Contractor’s compliance or noncompliance with the contract. The CA has the responsibility of
ensuring the work conforms to the requirements of the contract and such other responsibilities
and authorities as may be specified in the contract. These include:
G.9.1.1 Keeping the CO fully informed of any technical or contractual difficulties encountered
during the performance period and advising the CO of any potential problem areas under
the contract;
G.9.1.2 Coordinating site entry for Contractor personnel, if applicable;
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G.9.1.3 Reviewing invoices for completed work and recommending approval by the CO if the
Contractor’s costs are consistent with the negotiated amounts and progress is satisfactory
and commensurate with the rate of expenditure;
G.9.1.4 Reviewing and approving invoices for deliverables to ensure receipt of goods and services.
This includes the timely processing of invoices and vouchers in accordance with the
District’s payment provisions; and
G.9.1.5 Maintaining a file that includes all contract correspondence, modifications, records of
inspections (site, data, equipment) and invoice or vouchers.
G.9.2 The address and telephone number of the CAs are :
Wendy Rooker (Primary)
Supervisory HR Specialist
Benefits & Retirement Administration
Department of Human Resources
1015 Half St SE, 9 th Floor
Washington, DC 20003
(202) 442-7627 (main)
Wendy.Rooker@dc.gov
or
Paul Shaw (Secondary)
Associate Director for Benefits & Retirement
Benefits & Retirement Administration
Department of Human Resources
1015 Half St SE, 9 th Floor
Washington, DC 20003
(202) 442-7627 (main)
Paul.Shaw@dc.gov
G.9.3 The CA shall NOT have the authority to:
1. Award, agree to, or sign any contract, delivery order or task order. Only the CO shall
make contractual agreements, commitments or modifications;
2. Grant deviations from or waive any of the terms and conditions of the contract;
3. Increase the dollar limit of the contract or authorize work beyond the dollar limit of the
contract,
4. Authorize the expenditure of funds by the Contractor;
5. Change the period of performance; or
6. Authorize the use of District property, except as specified under the contract.
G.9.4 The Contractor will be fully responsible for any changes not authorized in advance, in writing ,
by the CO; may be denied compensation or other relief for any additional work performed that
is not so authorized; and may also be required, at no additional cost to the District, to take all
corrective action necessitated by reason of the unauthorized changes.
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G.10 ORDERING CLAUSE
G.10.1 Any supplies and services to be furnished under this contract must be ordered by issuance of
delivery orders or task orders by the CO. Such orders may be issued during the term of this
contract.
G.10.2 All delivery orders or task orders are subject to the terms and conditions of this contract. In the
event of a conflict between a delivery order or task order and this contract, the contract shall
control.
G.10.3 If mailed, a delivery order or task order is considered "issued" when the District deposits the
order in the mail. Orders may be issued by facsimile or by electronic commerce methods.

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SECTION H: SPECIAL CONTRACT REQUIREMENTS
H.1 HIRING OF DISTRICT RESIDENTS AS APPRENTICES AND TRAINEES
H.1.1 For all new employment resulting from this contract or subcontracts hereto, as defined in
Mayor’s Order 83-265 and implementing instructions, the Contractor shall use its best efforts
to comply with the following basic goal and objectives for utilization of bona fide residents of
the District of Columbia in each project’s labor force:
H.1.1.1 At least fifty -one (51) percent of apprentices and trainees employed shall be residents of the
District of Columbia registered in programs approved by the District of Columbia
Apprenticeship Council.
H.1.2 The Contractor shall negotiate an Employment Agreement with the Department of
Employment Services (DOES) for jobs created as a result of this contract. The DOES shall be
the Contractor’s first source of referral for qualified apprentices and trainees in t he
implementation of employment goals contained in this clause.
H.2 DEPARTMENT OF LABOR WAGE DETERMINATIONS
The Contractor shall be bound by the Wage Determination No. 2015-4281, Revision No. 34 , dated July
8, 2025, issued by the U.S. Department of Labor in accordance with the Service Contract Act, 41 U.S.C.
§ 351 et seq., and incorporated herein as Section J.2. The Contractor shall be bound by the wage rates for
the term of the contract subject to revision as stated herein and in accordance with clause 24 of the SCP.
If an option is exercised, the Contractor shall be bound by the applicable wage rates at the tim e of the
exercise of the option. If the option is exercised and the CO obtains a revised wage determination, the
revised wage determination is applicable for the option periods and the Contractor may be entitled to an
equitable adjustment.
H.3 PREGNANT WORKERS FAIRNESS
H.3.1 The Contractor shall comply with the Protecting Pregnant Workers Fairness Act of 2016, D.C.
Official Code § 32-1231.01 et seq. (PPWF Act).
H.3.2 The Contractor shall not:
(a) Refuse to make reasonable accommodations to the known limitations related to
pregnancy, childbirth, related medical conditions, or breastfeeding for an employee,
unless the Contractor can demonstrate that the accommodation would impose an undue
hardship;
(b) Take an adverse action against an employee who requests or uses a reasonable
accommodation in regard to the employee's conditions or privileges of employment,
including failing to reinstate the employee when the need for reasonable
accommodations ceases to the employee's original job or to an equivalent position with
equivalent:
(1) Pay;
(2) Accumulated seniority and retirement;
(3) Benefits; and
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(4) Other applicable service credits;
(c) Deny employment opportunities to an employee, or a job applicant, if the denial is
based on the need of the employer to make reasonable accommodations to the known
limitations related to pregnancy, childbirth, related medical conditions, or
breastfeeding;
(d) Require an employee affected by pregnancy, childbirth, related medical conditions, or
breastfeeding to accept an accommodation that the employee chooses not to accept if
the employee does not have a known limitation related to pregnancy, childbirth, related
medical conditions, or breastfeeding or the accommodation is not necessary for the
employee to perform her duties;
(e) Require an employee to take leave if a reasonable accommodation can be provided; or
(f) Take adverse action against an employee who has been absent from work as a result of
a pregnancy -related condition, including a pre -birth complication.
H.3.3 The Contractor shall post and maintain in a conspicuous place a notice of rights in both English
and Spanish and provide written notice of an employee's right to a needed reasonable
accommodation related to pregnancy, childbirth, related medical condition s, or breastfeeding
pursuant to the PPWF Act to:
(a) New employees at the commencement of employment;
(b) Existing employees; and
(c) An employee who notifies the employer of her pregnancy, or other condition covered
by the PPWF Act, within ten days of the notification.
H.3.4 The Contractor shall provide an accurate written translation of the notice of rights to any non-
English or non-Spanish speaking employee.
H.3.5 Violations of the PPWF Act shall be subject to civil penalties as described in the Act.
H.4 UNEMPLOYED ANTI-DISCRIMINATION
H.4.1 The Contractor shall comply with the Unemployed Anti -Discrimination Act of 2012, D.C.
Official Code § 32-1361 et seq.
H.4.2 The Contractor shall not:
(a) Fail or refuse to consider for employment, or fail or refuse to hire, an individual as an
employee because of the individual's status as unemployed; or
(b) Publish, in print, on the Internet, or in any other medium, an advertisement or
announcement for any vacancy in a job for employment that includes:
(1) Any provision stating or indicating that an individual's status as unemployed
disqualifies the individual for the job; or
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(2) Any provision stating or indicating that an employment agency will not consider or
hire an individual for employment based on that individual's status as unemployed.
H.4.3 Violations of the Unemployed Anti -Discrimination Act shall be subject to civil penalties as
described in the Act.
H.5 51% DISTRICT RESIDENTS NEW HIRES REQUIREMENTS AND FIRST SOURCE
EMPLOYMENT AGREEMENT
Delete Article 35, 51% District Residents New Hires Requirements and First Source Employment
Agreement, of the Standard Contract Provisions dated July 2010 for use with District of Columbia
Government Supplies and Services Contracts and substitute the following Section H.5 51% DISTRICT
RESIDENTS NEW HIRES REQUIREMENTS AND FIRST SOURCE EMPLOYMENT
AGREEMENT in its place:
H.5 51% DISTRICT RESIDENTS NEW HIRES REQUIREMENTS AND FIRST SOURCE
EMPLOYMENT AGREEMENT
H.5.1 For contracts for services in the amount of $300,000 or more, the Contractor shall comply with
the First Source Employment Agreement Act of 1984, as amended, D.C. Official Code § 2-
219.01 et seq. (First Source Act).
H.5.2 The Contractor shall enter into and maintain during the term of the contract, a First Source
Employment Agreement (Employment Agreement) with the District of Columbia Department
of Employment Service’s (DOES), in which the Contractor shall agree that:
(a) The first source for finding employees to fill all jobs created in order to perform the
contract shall be the First Source Register; and
(b) The first source for finding employees to fill any vacancy occurring in all jobs covered
by the Employment Agreement shall be the First Source Register.
H.5.3 The Contractor shall not begin performance of the contract until its Employment Agreement
has been accepted by DOES. Once approved, the Employment Agreement shall not be
amended except with the approval of DOES.
H.5.4 The Contractor agrees that at least 51% of the new employees hired to perform the contract
shall be District residents.
H.5.5 The Contractor’s hiring and reporting requirements under the First Source Act and any rules
promulgated thereunder shall continue for the term of the contract.
H.5.6 The CO may impose penalties, including monetary fines of 5% of the total amount of the direct
and indirect labor costs of the contract, for a willful breach of the Employment Agreement,
failure to submit the required hiring compliance reports, or deliberat e submission of falsified
data.
H.5.7 If the Contractor does not receive a good faith waiver, the CO may also impose an additional
penalty equal to 1/8 of 1% of the total amount of the direct and indirect labor costs of the
contract for each percentage by which the Contractor fails to meet its hiring requirements.
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H.5.8 Any contractor which violates, more than once within a 10-year timeframe, the hiring or
reporting requirements of the First Source Act shall be referred for debarment for not more
than five (5) years.
H.5.9 The contractor may appeal any decision of the CO pursuant to this clause to the D.C. Contract
Appeals Board as provided in clause 14 of the SCP, Disputes .
H.5.10 The provisions of the First Source Act do not apply to nonprofit organizations which employ
50 employees or less.
H.6 RESERVED
H.7 RESERVED
H.8 RESERVED
H.9 SUBCONTRACTING REQUIREMENTS
H.9.1 Mandatory Subcontracting Requirements
H.9.1.1 For all contracts in excess of $250,000, at least 0.50 % of the dollar volume of the contract
shall be subcontracted to qualified small business enterprises (SBEs) .
H.9.1.2 If there are insufficient SBEs to completely fulfill the requirement of paragraph H.9.1.1,
then the subcontracting may be satisfied by subcontracting 0.50% of the dollar volume to
any qualified certified business enterprises (CBEs); provided, however, that all reasonable
efforts shall be made to ensure that SBEs are significant participants in the overall
subcontracting work.
H.9.1.3 A prime contractor that is certified by DSLBD as a small, local or disadvantaged business
enterprise shall not be required to comply with the provisions of sections H.9.1.1 and
H.9.1.2.
H.9.1.4 Except as provided in H.9.1.5 and H.9.1.7, a prime contractor that is a CBE and has been
granted a proposal preference pursuant to D.C. Official Code § 2-218.43, or is selected
through a set -aside program, shall perform at least 35% of the contracting eff ort with its
own organization and resources and, if it subcontracts, 35% of the subcontracting effort
shall be with CBEs. A CBE prime contractor that performs less than 35% of the contracting
effort shall be subject to enforcement actions under D.C. Official Code § 2 -218.63.
H.9.1.5 If the prime contractor is a certified joint venture and has been granted a bid preference
pursuant to D.C. Official Code § 2-218.43, or is selected through a set -aside program, the
CBE member of the certified joint venture shall perform at least 50% of th e contracting
effort with its own organization and resources and, if it subcontracts, 35% of the
subcontracting effort shall be with CBEs. If the CBE member of the certified joint venture
prime contractor performs less than 50% of the contracting effort, the certified joint venture
shall be subject to enforcement actions under D.C. Official Code § 2-218.63.
H.9.1.6 Each CBE utilized to meet these subcontracting requirements shall perform at least 35%
of its contracting effort with its own organization and resources.
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H.9.1.7 A prime contractor that is a CBE and has been granted a proposal preference pursuant to
D.C. Official Code § 2 -218.43, or is selected through a set-aside program, shall perform at
least 50% of the on-site work with its own organization and resources if the c ontract is $1
million or less.
H.9.2 Subcontracting Plan
If the prime contractor is required by law to subcontract under this contract, it must subcontract
at least 0.50% of the dollar volume of this contract in accordance with the provisions of section
H.9.1 of this clause.
A contractor required to subcontract under this contract shall submit its subcontracting plan for
this contract prior to commencement of performance of the 2026 plan year.
The plan will be based on: (1) The benefits plan type(s) awarded to the Contractor, (2) DCHR’s good faith
estimated enrollment for the benefits plan type awarded to the Contractor, (3) the final negotiated premium
rate for each CLIN associated with the benefits plan type(s) awarded to the Contractor, and (4) the
contract’s estimated not -to-exceed am ount for the base period.
No contractor shall be allowed to amend the subcontracting plan without the consent of the CO and the
Director of DSLBD.
Any reduction in the dollar volume of the subcontracted portion resulting from an amendment of the plan
after award shall inure to the benefit of the District.
Each subcontracting plan shall include the following:
(1) The name and address of each subcontractor;
(2) A current certification number of the small or certified business enterprise;
(3) The scope of work to be performed by each subcontractor; and
(4) The price that the prime contractor will pay each subcontractor
H.9.3 Copies of Subcontracts
Within twenty-one (21) days of the date of award, the Contractor shall provide fully executed copies of
all subcontracts identified in the subcontracting plan to the CO, CA, District of Columbia Auditor and the
Director of DSLBD.
H.9.4 Subcontracting Plan Compliance Reporting
H.9.4.1 If the Contractor has a subcontracting plan required by law for this contract, the Contractor
shall submit a quarterly report to the CO, CA, District of Columbia Auditor and the
Director of DSLBD. The quarterly report shall include the following information for each
subcontract identified in the subcontracting plan:
(A) The price that the prime contractor will pay each subcontractor under the
subcontract;
(B) A description of the goods procured or the services subcontracted for;
(C) The amount paid by the prime contractor under the subcontract; and
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(D) A copy of the fully executed subcontract, if it was not provided with an earlier
quarterly report.
H.9.4.2 If the fully executed subcontract is not provided with the quarterly report, the prime
contractor will not receive credit toward its subcontracting requirements for that
subcontract.
H.9.5 Annual Meetings
Upon at least 30 days ’ written notice provided by DSLBD, the Contractor shall meet annually with the
CO, CA, District of Columbia Auditor , and the Director of DSLBD to provide an update on its
subcontracting plan.
H.9.6 Notices
The Contractor shall provide written notice to the DSLBD and the District of Columbia Auditor upon
commencement of the contract and when the contract is completed.
H.9.7 Enforcement and Penalties for Breach of Subcontracting Plan
H.9.7.1 A contractor shall be deemed to have breached a subcontracting plan required by law, if
the contractor (a) fails to submit subcontracting plan monitoring or compliance reports or
other required subcontracting information in a reasonably timely manner; (ii) submits a
monitoring or compliance report or other required subcontracting information containing
a materially false statement; or (iii) fails to meet its subcontracting requirements.
H.9.7.2 A contractor that is found to have breached its subcontracting plan for utilization of CBEs
in the performance of a contract shall be subject to the imposition of penalties, including
monetary fines in accordance with D.C. Official Code § 2 -218.63.
H.9.7.3 If the CO determines the Contractor’s failure to be a material breach of the contract, the
CO shall have cause to terminate the contract under the default provisions in clause 8 of
the SCP, Default.
H.10 FAIR CRIMINAL RECORD SCREENING
H.10.1 The Contractor shall comply with the provisions of the Fair Criminal Record Screening
Amendment Act of 2014 , effective December 17, 2014 (D.C. Law 20-152) (the “Act” as used
in this section). This section applies to any employment, including employment on a temporary
or contractual basis, where the physical location of the employment is in whole or substantial
part within the District of Columbia.
H.10.2 Prior to making a conditional offer of employment, the Contractor shall not require an applicant
for employment , or a person who has requested consideration for employment by the
Contractor, to reveal or disclose an arrest or criminal accusation that is not then pending or did
not result in a criminal conviction .
H.10.3 After making a conditional offer of employment , the Contractor may require an applicant to
disclose or reveal a criminal conviction .
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H.10.4 The Contractor may only withdraw a conditional offer of employment, or take adverse action
against an applicant , for a legitimate business reason as described in the Act.
H.10.5 This section and the provisions of the Act shall not apply:
(a) Where a federal or District law or regulation requires the consideration of an applicant’s
criminal history for the purposes of employment;
(b) To a posit ion designated by the employer as part of a federal or District government
program or obligation that is designed to encourage the employment of those with
criminal histories ;
(c) To any facility or employer that provides programs, services, or direct care to, children,
youth, or vulnerable adults ; or
(d) To employers that employ less than 11 employees.
H.10.6 A person claiming to be aggrieved by a violation of the Act may file an administrative
complaint with the District of Columbia Office of Human Rights, and the Commission on
Human Rights may impose monetary penalties against the Contractor.
H.11 HIPAA COMPLIANCE
Contractor is a Covered Entity and the District of Columbia is a Hybrid Covered Entity as defined by the
Health Insurance Portability and Accountability Act of 1996 (HIPAA), as amended, and associated
regulations promulgated at 45 CFR Parts 160, 162, and 164, as amended. Contractor agrees to protect all
District data in compliance with HIPAA.
H.12 DATA PROTECTION
Contractor shall keep confidential, restrict, safeguard, maintain, and dispose of all Personally Identifiable
Information (PII) about individuals related to services provided under this Contract, as well as resulting
Protected Health Information (PHI) in your custody, in accordance with all relevant federal and District
privacy, security, and confidentiality statutes, rules, regulations, and guidance and agrees not to use or
disclose such PII or PHI other than as permitted by this Agreement or as Required by Law. Contractor
agrees to use appropriate technical, physical, and administrative safeguards to protect PII and PHI and to
prevent access, use, or disclosure, other than as provided in this Agreement, and further agrees to the
following:
1. Contractor shall name a Privacy and/or Security Officer who is accountable for overseeing the
protection of PII and PHI and implementing policies and procedures for the physical,
administrative, and technical safeguards, including training and sanctions, to enforce protection of
PII and PHI as indicated in this Agreement and applicable law within Contractor’s business.
2. The Contractor may use and disclose PII and PHI for the proper management and administration
of its business, provided that the disclosures are Required By Law or that the disclosures are
permitted by law and the Contractor obtains reasonable assurances from the person or entity to
whom the information is disclosed that it will remain confidential, private, and secure, used for the
purpose for which it was disclosed, and that the person or entity must notify the Contractor of any
instances where it has know ledge that the confidentiality, privacy or security of the information
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has been impacted.
3. Contractor agrees that its employees and other workforce members, agents, and Subcontractors
who fail to protect PII and PHI under this Agreement or other applicable federal or District privacy
law will be subject to discipline in accordance with Contractor’s policies and applicable collective
bargaining agreements.
4. Contractor may use District data for artificial intelligence (AI) technology and AI -related
technology for only the proper management and administration of its business to effect the best
health outcomes for the District and its employees, and such usage s hall be subject to the data
retention provisions in paragraphs 6 and 7 below. “District data” includes, without limitation, PII,
PHI, and all other information about individuals covered under District government health plans
or related to services provided under this Contract, as well as AI information derived or generated
from these sources. Contractor shall not access, use, store, process, transfer, or share any PII or
resulting PHI received or created under this Contract for any AI-related purposes, incl uding, but
not limited to, machine learning, testing, algorithmic and other training, development, natural
language processing, computer vision, predictive analysis, automation, or any AI-driven analysis,
without providing advance written notice to the Dis trict. The District reserves the right to deny
any use of District data (including, without limitation, PII and PHI) which, in the District’s sole
and absolute discretion, may compromise the best interests of the District government or its
employees. The District will not unreasonably deny AI or AI-related usage of District data but will
be guided by relevant laws, policies, and best practices when making its determination. Contractor
shall implement strict data security measures to prevent unauthorized access, copying, or usag e
for AI-related purposes. Contractor shall not anonymize, pseudonymize, aggregate, or otherwise
manipulate District data (including, without limitation, PII and PHI) received or created throug h
this Contract for the purpose of circumventing the restrictions set forth in this Data Protection
Agreement (H.12).
5. Contractor shall report to the District government, including the District-wide Privacy and Security
Official, within the Office of the Attorney General, any unauthorized use, disclosure, or condition
constituting a threat to PII or PHI involving District data within ten (10) calendar days from the
time Contractor becomes aware of the use, disclosure, or threat conditions. However, if the
Contractor is an agent of the District (i.e., performing delegated essential governmental functions),
the Contractor mus t immediately report the incident or condition, including non-permitted use or
disclosure, successful or anomalous Security Incident or Breach of Unsecured PII or PHI involving
District data. Reports shall be made both in writing and by telephone to confirm prompt receipt.
Notification to the District shall be made as permitted by applicable law and may, as required by
law, be de-identified or otherwise redacted to protect the privacy of the impacted individual(s).
The Parties acknowledge and agree that this Section constitutes notice by Contractor to the District
of the ongoing occurrence of events that may constitute Security Incidents but that are routine
(such as typical pings and port scans) and are considered unsuccessful, as distinguished from
anomalous threats and attacks, do not constitute a material threat to the security of PII or PHI, and
no additional notice to the District is required. Upon the determination of an actual data Breach,
and in consultation with the District’s Privacy and Security Official, the Contractor will reasonably
cooperate and will provide notifications to individuals, other notice required by law and potentially
to the media, including on behalf of the District of appropriate.
6. After termination or conclusion of this Contract, for any reason, and only if it would not violate
the personal privacy of the subjects of the PII and PHI, the Contractor shall, within six years
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following the termination date, return PII and AI information derived from District data in a
mutually agreed upon format or shall confidentially destroy any PII or AI information derived
from District data that is received or created under this Contract, as well as confidentially destroy
resulting PHI that is not required to be retained under HIPAA and AI information derived from
District data. The Contractor shall extend the protections of this Data Protection Agreement (H.12)
to all PII, PHI, and AI info rmation derived from District data that are retained by the Contractor
after termination. This provision shall apply to PII, PHI, and AI information derived from District
data that are in the possession of ALL Subcontractors, agents, or other workforce mem bers of
Contractor.
7. If, after six years following the termination date of this Contract, the Contractor determines that it
is not feasible to return or destroy the PII or AI information derived from District data or to destroy
PHI that is not required to be retained under HIP AA, the Contractor shall provide written
notification to the District of the conditions that make the return or confidential destruction
infeasible. Upon determination by the District, in consultation with the Districtwide Privacy and
Security Official, th at the return or confidential destruction of the PII or AI information derived
from District data or the destruction of PHI is infeasible, the Contractor shall extend the protections
of this Data Protection Agreement (H.12) to the PII, PHI, and AI information derived from District
data. The Contractor shall limit further uses and disclosures for as long as the Contractor maintains
such PII, PHI, or AI information derived from District data. Additionally, the Contractor shall:
(i) Continue to use appropriate technical, physical, and administrative safeguards and comply
with applicable law, rules, regulations, and guidance for as long as Contractor retains the
PII, PHI, or AI information derived from District data;
(ii) Not use or disclose the PII of the District, or resulting PHI, or AI information derived from
District data that is retained by Contractor other than for the purposes for which such PII,
PHI, or AI information derived from District data was retained; and
(iii) Return or destroy the PII of the District, as well as destroy resulting PHI, and AI
information derived from District data when it is no longer needed by Contractor for its
proper management and administration or to carry out its legal responsibilities.
8. The Contractor shall ensure that any agent, including a Subcontractor, and recipient of information,
other than when required by law, agrees to the same or substantially similar restrictions and
conditions with respect to PII and PHI received or created through this Contract.
H.13 AUDITS AND RECORDS
H.13.1 As used in this clause, “records” includes books, documents, accounting procedures and
practices, and other data, regardless of type and regardless of whether such items are in written
form, in the form of computer data, or in any other form.
H.13.2 Examination of Costs. If this is a cost-reimbursement, incentive, time -and-materials, labor-
hour, or price redeterminable contract, or any combination of these, the Contractor shall
maintain and the CO, or an authorized representative of the CO, shall have the right to examine
and audit all records and other evidence sufficient to reflect properly all costs claimed to have
been incurred or anticipated to be incurred directly or indirectly in performance of this contract.
This right of examination sha ll include inspection at all reasonable times of the Contractor’s
plants, or parts of them, engaged in performing the contract.
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H.13.3 Cost or pricing data. If the Contractor has been required to submit cost or pricing data in
connection with any pricing action relating to this contract, the CO, or an authorized
representative of the CO, in order to evaluate the accuracy, completeness, and currency of the
cost or pricing data, shall have the right to examine and audit all of the Contractor’s records,
including computations and projections, related to:
a. The proposal for the contract, subcontract, or modification;
b. The discussions conducted on the proposal(s), including those related to negotiating;
c. Pricing of the contract, subcontract, or modification; or
d. Performance of the contract, subcontract , or modification.
H.13.4 Comptroller General
H.13.4.1 The Comptroller General of the United States, or an authorized representative, shall have
access to and the right to examine any of the Contractor’s directly pertinent records
involving transactions related to this contract or a subcontract hereunder.
H.13.4.2 This paragraph may not be construed to require the Contractor or subcontractor to create
or maintain any record that the Contractor or subcontractor does not maintain in the
ordinary course of business or pursuant to a provision of law .
H.13.5 Reports. If the Contractor is required to furnish cost, funding, or performance reports, the CO
or an authorized representative of the CO shall have the right to examine and audit the
supporting records and materials, for the purpose of evaluating:
a. The effectiveness of the Contractor’s policies and procedures to produce data
compatible with the objectives of these reports; and
b. the data reported.
H.13.6 Availability. The Contractor shall make available at its office at all reasonable times the
records, materials, and other evidence described in clauses H. 13.1 through H. 13.5, for
examination, audit, or reproduction, until three (3) years after final payment under this contract
or for any shorter period specified in the solicitation, or for any longer period required by
statute or by other clauses of this contract. In addition:
a. If this contract is completely or partially terminated, the Contractor shall make
available the records relating to the work terminated until thee (3) years after any
resulting final termination settlement; and
b. The Contractor shall make available records relating to appeals under the Disputes
clause or to litigation or the settlement of claims arising under or relating to this contract
until such appeals, litigation, or claims are finally resolved.
H.13.7 The Contractor shall insert a clause containing all the terms of this clause, including this section
H.13.7, in all subcontracts under this contract that exceed the small purchase threshold of
$100,000, and:
a. That are cost -reimbursement, incentive, time -and-materials, labor -hour, or price -
redeterminable type or any combination of these;
b. For which cost or pricing data are required; or
c. That requires the subcontractor to furnish reports as discussed in H.13.5 of this clause.
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H.14 ADVISORY AND ASSISTANCE SERVICES
This contract is a “nonpersonal services contract”. The Contractor and the Contractor’s employees: (1)
shall perform the services specified herein as independent contractors, not as employees of the
government; (2) shall be responsible for their own manage ment and administration of the work required
and bear sole responsibility for complying with any and all technical, schedule, financial requirements or
constraints attendant to the performance of this contract; (3) shall be free from supervision or control by
any government employee with respect to the manner or method of performance of the service specified;
but (4) shall, pursuant to the government’s right and obligation to inspect, accept or reject work, comply
with such general direction of the CO, or t he duly authorized representative of the CO as is necessary to
ensure accomplishment of the contract objectives.

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SECTION I: CONTRACT CLAUSES
I.1 APPLICABILITY OF STANDARD CONTRACT PROVISIONS
The Standard Contract Provisions for use with District of Columbia Government Supplies and Services
Contracts dated July 2010 (“SCP”) are incorporated as part of the contract. T o obtain a copy of the SCP
go to http://ocp.dc.gov, under Quick Links click on “Required Solicitation Documents”.
I.2 CONTRACTS THAT CROSS FISCAL YEARS
Continuation of this contract beyond the current fiscal year is contingent upon future fiscal appropriations.
I.3 CONFIDENTIALITY OF INFORMATION
The Contractor shall keep all information relating to any employee or customer of the District in absolute
confidence and shall not use the information in connection with any other matters; nor shall it disclose
any such information to any other person, firm or corporation, in accordance with the District and federal
laws governing the confidentiality of records.
I.4 TIME
Time, if stated in a number of days, will include Saturdays, Sundays, and holidays, unless otherwise stated
herein.
I.5 RIGHTS IN DATA
Delete Article 42, Rights in Data, of the Standard Contract Provisions dated July 2010 for use with District
of Columbia Government Supplies and Services Contracts and substitute the following Article 42, Rights
in Data, in its place:
A. Definitions
1. “Products” - A deliverable under any contract that may include commodities, services
and/or technology furnished by or through Contractor, including existing and custom
Products, such as, but not limited to: a) recorded information, regardless of form or the
media on which it may be recorded; b) document research; c) experimental,
developmental, or engineering work; d) licensed software; e) components of the
hardware environment; f) printed materials (including but not limited to training
manuals, system and user documentation, reports, drawings); g) third party software;
h) modifications, customizations, custom programs, program listings, programming
tools, data, modules, components; and i) any intellectual property embodied therein,
whether in tangible or intangible form, including but not limited to utilities, interfaces,
templates, subroutines, algorithms, formulas, source code, and object code.
2. “Existing Products ” - Tangible Products and intangible licensed Products that exist
prior to the commencement of work under the contract. Existing Products must be
identified on the Product prior to commencement of work or else will be presumed to
be Custom Products.
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3. “Custom Products ” - Products, preliminary, final or otherwise, which are created or
developed by Contractor, its subcontractors, partners, employees, resellers or agents
for the District under the contract.
4. “District” – The District of Columbia and its agencies.
B. Title to Project Deliverables
The Contractor acknowledges that it is commissioned by the District to perform services detailed
in the contract. The District shall have ownership and rights for the duration set forth in the contract
to use, copy, modify, distribute, or adapt Products as follows:
1. Existing Products: Title to all Existing Licensed Product(s), whether or not embedded
in, delivered or operating in conjunction with hardware or Custom Products, shall
remain with Contractor or third party proprietary owner, who retains all rights, title and
interest (including patent, trademark or copyrights). Effective upon payment, the
District shall be granted an irrevocable, non-exclusive, worldwide, paid-up license to
use, execute, reproduce, display, perform, adapt (unless Contractor advises the District
as part of C ontractor’s bid that adaptation will violate existing agreements or statutes
and Contractor demonstrates such to the District’s satisfaction), and distribute Existing
Product to District users up to the license capacity stated in the contract with all license
rights necessary to fully effect the general business purpose of the project or work plan
or contract. Licenses shall be granted in the name of the District. The District agrees to
reproduce the copyright notice and any other legend of ownership on any copies
authorized under this paragraph.
2. Custom Products: Effective upon Product creation, Contractor hereby conveys, assig ns,
and transfers to the District the sole and exclusive rights, title and interest in Custom
Product(s), whether preliminary, final or otherwise, including all patent, trademark and
copyrights. Contractor hereby agrees to take all necessary and appropriate steps to
ensure that the Custom Products are protected against unauthorized copying ,
reproduction and marketing by or through Contractor.
C. Transfers or Assignments of Existing or Custom Products by the District
The District may transfer or assign Existing or Custom Products and the licenses thereunder to
another District agency. Nothing herein shall preclude the Contractor from otherwise using the
related or underlying general knowledge, skills, ideas, concepts, techniques and experience
developed under a project or work plan in the course of Contractor’s business.
D. Subcontractor Rights
Whenever any data, including computer software, are to be obtained from a subcontractor under
the contract, the Contractor shall use this clause, Rights in Data , in the subcontract, without
alteration, and no other clause shall be used to enlarge or diminish the District’s or the Contractor’s
rights in that subcontractor data or computer software which is required for the District.
E. Source Code Escrow
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1. For all computer software furnished to the District with the rights specified in section
B.2 of this clause, the Contractor shall furnish to the District, a copy of the source code
with such rights of the scope as specified in section B.2 of this clause. For all computer
software furnished to the District with the restricted rights specified in section B.1 of
this clause , the District, if the Contractor either directly or through a successor or
affiliate shall cease to provide the maintenance or warranty services provided the
District under the contract or any paid-up maintenance agreement, or if the Contractor
should be declared insolvent by a court of competent jurisdiction, shall have the rig ht
to obtain, for its own and sole use only, a single copy of the current version of the
source code supplied under the contract, and a single copy of the documentation
associated therewith, upon payment to the person in control of the source code the
reasonable cost of making each copy.
2. If the Contractor or Product manufacturer/developer of software furnished to the
District with the rights specified in section B. 1 of this clause offers the source code or
source code escrow to any other commercial customers, the Contractor shall either: (1)
provide the District with the source code for the Product; (2) place the source code in
a third party escrow arrangement with a designated escrow agent who shall be named
and identified to the District, and who shall be directed to release the deposited source
code in accordance with a standard escrow arrangement acceptable to the District; or
(3) will certify to the District that the Product manufacturer/ developer has named the
District as a named beneficiary of an established escrow arrangement with its
designated escrow agent who shall be named and identified to the District, and who
shall be directed to release the deposited source code in accordance with the terms of
escrow.
3. The Contractor shall update the source code, as well as any corrections or
enhancements to the source code, for each new release of the Product in the same
manner as provided above, and certify such updating of escrow to the District in
writing.
F. Indemnification and Limitation of Liability
The Contractor shall indemnify and save and hold harmless the District, its officers, agents and
employees acting within the scope of their official duties against any liability, including costs and
expenses, (i) for violation of proprietary rights, copyri ghts, or rights of privacy, arising out of the
publication, translation, reproduction, delivery, performance, use or disposition of any data
furnished under this contract, or (ii) based upon any data furnished under this contract, or based
upon libelous or other unlawful matter contained in such data.
I.6 OTHER CONTRACTORS
The Contractor shall not commit or permit any act that will interfere with the performance of work by
another District contractor or by any District employee.
I.7 SUBCONTRACTS
The Contractor hereunder shall not subcontract any of the Contractor’s work or services to any
subcontractor without the prior written consent of the CO. Any work or service so subcontracted shall be
performed pursuant to a subcontract agreement, which the District will have the right to review and
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approve prior to its execution by the Contractor. Any such subcontract shall specify that the Contractor
and the subcontractor shall be subject to every provision of this contract. Notwithstanding any such
subcontract approved by the District, the Contractor shall remain liable to the District for all Con tractor's
work and services required hereunder.
I.8 INSURANCE
A. GENERAL REQUIREMENTS. The Contractor at its sole expense shall procure and
maintain, during the entire period of performance under this contract, the types of insurance
specified below. The Contractor shall submit a Certificate of Insurance to the Contrac ting
Officer (CO) giving evidence of the required coverage prior to commencing performance under
this contract. In no event shall any work be performed until the required Certificates of
Insurance signed by an authorized representative of the insurer(s) have been provided to, and
accepted by, the CO.

If the Contractor and/or its subcontractors maintain broader coverage and/or higher limits than
the minimums shown below, the District requires and shall be entitled to the broader coverage
and/or the higher limits maintained by the Contractor and subcontr actors.
B. INSURANCE REQUIREMENTS
1. Commercial General Liability Insurance (“CGL”) - The Contractor shall provide evidence
satisfactory to the CO with respect to the services performed that it carries a CGL policy, written
on an occurrence (not claims-made) basis, on Insurance Services Office, Inc. (“ISO”) form CG 00
01 04 13 (or another occurrence -based form with coverage at least as broad and approved by the
CO in writing), covering liability for all on going and completed operations of the Contractor and
under all subcontracts, covering cla ims for bodily injury, including without limitation sickness,
disease or death and mental anguish of any persons, broad form property damage, including loss
of use resulting therefrom, personal and advertising injury, and including coverage for liability
arising out of an Insured Contract (including the tort liability of another assumed in a contract) and
acts of terrorism (whether caused by a foreign or domestic source). Such coverage shall have limits
of liability of not less than $1,000,000 for each occurrence, $2,000,000 general aggregate,
$2,000,000 products and completed operations aggregate, and $1,000,000 personal and advertising
injury aggregate limit.
The Commercial General Liability shall be further endorsed to:
a) To the fullest extent permitted by law, provide additional insured coverage using
ISO form CG 2010 0413 and CG2037 04 13 (or its equivalent) to The Government of the
District of Columbia
b) Coverage available to the additional insureds shall apply on a primary and non -
contributing basis as respects any other insurance, deductibles, or self -insurance available
to the additional insureds
c) A waiver of subrogation in favor of The Government of the District of Columbia
d) Defense costs shall be in addition to and not erode the limits of liability
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2. Automobile Liability Insurance - The Contractor shall provide evidence satisfactory to the
CO of commercial (business) automobile liability insurance written on ISO form CA 00 01 10 13
(or another form with coverage at least as broad and approved by the CO in writing) including
coverage for all owned, hired, borrowed and non-owned vehicles and equipment used by the
Contractor in connection with work under this agreement, with a minimum combined single limit
of $1,000,000. Such policy or policies of automobile liability insurance shall be written on an
"occurrence" (as opposed to a "claims made") basis.
The Commercial Auto Liability policy shall be further endorsed to:
a) To the fullest extent permitted by law, provide additional insured coverage to The
Government of the District of Columbia
b) Coverage available to the additional insureds shall apply on a primary and non -
contributing basis as respects any other insurance, deductibles, or self -insurance available
to the additional insureds
c) A waiver of subrogation in favor of The Government of the District of Columbia
d) Defense costs shall be in addition to and not erode the limits of liability
e) If applicable, include Form CA 99 48 03 06 Pollution Liability - Broadened
Coverage for Covered Autos - Business Auto, Motor Carrier, and Truckers (or its
equivalent)
f) Moving and Storage Companies shall be required to provide evidence of BMC91
or BMC91X filing
For Contractors providing transportation:
Contractors providing transportation must additionally comply with the following:
a) Operators holding a restricted WMATC Certificate of Authority must have a single
limit of $1.5 million in combined (bodily injury and physical damage) coverage, or
b) Operators holding an unrestricted WMATC Certificate of Authority must have a
single limit of $5M in combined (bodily injury and physical damage) coverage.
In addition, both types of WMATC certificate holders must have in place the following
Licensing Requirements as applicable:
a) Commercial Driver’s License (CDL) with the following endorsements:
i) P (Passenger): All drivers MUST have a P endorsement enabling them to transport
passengers (16 or more).
ii) S (School Bus): All drivers operating school buses (flashing lights, swing arm w/stop
sign) must also have an S endorsement. Please note that driver credentials for any
vehicles that are converted school buses must have S.
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b) Valid (unexpired) US Department of Transportation Medical Examiner
Certification (“Medical Card”).
For Contractors using District Government -Owned Vehicles :
Agencies that provide Contractors with District Government -owned or leased motor vehicles are
responsible for ensuring that such vehicles are used only for the performance under this
Contract. Contractor and its subcontractors are prohibited from using such vehicles for home -to-
work transportation unless specifically provided for under the terms of the contract and approved
in writing by the Contracting Officer, or otherwise provided by law. Contractor shall obtain
automobile liability insurance with a minimum combined single limit of $1,000,000 to cover
bodily injury and property damage to protect the Contractor and the District Government against
third-party claims arising from the use of District Government-owned vehicles. The Commercial
Auto Liability Policy shall be endorsed to include:
a) To the fullest extent permitted by law, provide additional insured coverage to The
Government of the District of Columbia;
b) Coverage available to the additional insureds shall apply on a primary and non -
contributing basis as respects any other insurance, deductibles, or self -insurance available
to the additional insureds; and
c) A waiver of subrogation in favor of The Government of the District of Columbia.
In the event of loss, destruction, or damage to any government -owned vehicles used in the
performance of contact, Contractor shall be liable for full cost of repair or replacement of lost,
destroyed, or damaged vehicle.
3. Workers’ Compensation Insurance - The Contractor shall provide evidence satisfactory to
the CO of Workers’ Compensation insurance in accordance with the statutory mandates of the
District of Columbia or the jurisdiction in which the contract is performed.
Employer’s Liability Insurance - The Contractor shall provide evidence satisfactory to the CO of
employer’s liability insurance as follows: $500,000 per accident for injury; $500,000 per employee
for disease; and $500,000 for policy disease limit.
The Workers Compensation and Employers Liability shall be further endorsed to:
a) Include a Waiver of Subrogation in favor of The Government of the District of
Columbia.
b) Where applicable, include United States Longshore and Harbor Workers
Compensation Act (USL&H)
c) Where applicable, include Jones Act Coverage for seamen or crew members on an
“if any” basis.
4. Network Security/Privacy (Cyber) Liability Insurance covering acts, errors, omissions, and
violation of any consumer protection laws arising out of Contractor’s operations or services with
a limit of $5,000,000 per claim and in the aggregate. Such coverage shall include but not be limited
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to, third party and first party coverage for loss or disclosure of any data, including personally
identifiable information and payment card information, network security failure, violation of any
consumer protection laws, unauthorized access and/or use or other intrusions, infringement of any
intellectual property rights (except patent), negligence or breach of duty to use reasonable care,
breach of any duty of confidentiality, invasion of privacy, or violations of any other legal
protections for personal i nformation, defamation, libel, slander, commercial disparagement,
negligent transmission of computer virus, or use of computer networks in connection with denial
of service attacks. Such coverage shall include regulatory defense and fines/penalties in any
jurisdiction anywhere in the world. Such coverage shall include contractual privacy coverag e for
data breach response and crisis management costs that would be incurred by Contractor on behalf
of The Government of the District of Columbia in the event of a data breach including legal and
forensic expenses, notification costs, credit monitoring costs, and costs to operate a call center.
Contractor shall maintain coverage in force during the term of this Agreement and for an extended
reporting period of not l ess than two (2) years after.
5. Professional Liability Insurance (Errors & Omissions) - The Contractor shall provide
Professional Liability Insurance (Errors and Omissions) to cover liability resulting from any error
or omission in the performance of professional services under this Contract. The policy shall
provide limits of $1,000,000 per claim or per occurrence for each wrongful act and $2,000,000
annual aggregate. The Contractor warrants that any applicable retroactive date precedes the date
the Contractor first performed any profess ional services for the Government of the District of
Columbia and that continuous coverage will be maintained or an extended reporting period will
be exercised for a period of at least ten years after the completion of the professional services.
Limits may not be shared with other lines of coverage.
6. Commercial Umbrella or Excess Liability - The Contractor shall provide evidence
satisfactory to the CO of commercial umbrella with minimum limits of $10,000,000 per occurrence
and $10,000,000 in the annual aggregate. Coverage must excess of required commercial general
liability, commercial auto liability, and employers’ liability. The insurance required under this
paragraph shall be written in a form that annually reinstates all required limits. Coverage shall be
primary to any insurance, self -insurance or reinsurance maintained by The Government of the
District of Columbia and the “other insurance” provision must be amended in accordance with this
requirement and principles of vertical exhaustion.
C. SUBCONTRACTOR INSURANCE REQUIREMENTS
Any and all subcontractors engaged by Contractor for work under this agreement shall be required
to have the same insured required of Contractor. Should the Contractor wish to propose different
insurance requirements for the subcontractor than the ones outlined in the Contract, then, prior to
commencement of work by the subcontractor, the Contractor shall submit in writing the name and
brief description of work to be performed by the subcontractor to the CO. The CO will promptly
provide in writing to the Contractor with a decision regarding the insurance requirements
applicable to the subcontractor. When requested by the CO, the Contractor must provide proof of
the subcontractor's required insurance prior to commencement of work by the subcontractor.
D. PRIMARY AND NONCONTRIBUTORY INSURANCE
The insurance required herein shall be primary to and will not seek contribution from any other
insurance, reinsurance or self -insurance including any deductible or retention, maintained by the
Government of the District of Columbia.
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E. DURATION. The Contractor shall carry all required insurance until all contract work is
accepted by The Government of the District of Columbia and shall carry listed coverages for ten
years for construction projects following final acceptance of the work pe rformed under this
contract and two years for non-construction related contracts.
F. LIABILITY. These are the required minimum insurance requirements established by The
Government of the District of Columbia. However, it is understood that The Government of the
District of Columbia does not in any way represent that the insurance or the li mits of insurance
specified herein are sufficient or adequate to protect your interests or liabilities and will not in any
way limit the contractor’s liability under this contract.
G. CONTRACTOR’S PROPERTY. Contractor and subcontractors are solely responsible for
any loss or damage to their personal property, including but not limited to tools and equipment,
scaffolding, and temporary structures, rented machinery, or owned and leased equipment. A
waiver of subrogation shall apply in favor of The Government of the District of Columbia.
H. MEASURE OF PAYMENT. The Government of the District of Columbia shall not make
any separate measure or payment for the cost of insurance and bonds. The Contractor shall include
all the costs of insurance and bonds in the contract price.
I. NOTIFICATION. The Contractor shall ensure that all policies provide that the CO shall
be given thirty (30) days prior written notice in the event of cancellation, non-renewal, or material
changes to the extent such cancellation or material changes results in Contractor no long
complying with the above requirements. The Contractor shall provide the CO with ten (10) days’
prior written notice in the event of non-payment of premium. The Contractor will also provide the
CO with an updated Certificate of Insurance should its insurance coverages renew during the
contract. The Government of the District of Columbia may reasonably change the above insurance
coverage requirements during the Term by giving Contractor at least 30 days’ notice of the chang e.
Contractor must comply, at your expense, and deliver to the CO evidence of compliance before
the change becomes effective.
J. CERTIFICATES OF INSURANCE. The Contractor must send to CO, at least 10 days after
execution of this Agreement, certificates of insurance evidencing the required insurance coverag e
and endorsements required herein. Contractor must also provide us with evidence of renewal
before the expiration date of each insurance policy. Contractor is responsible for providing us with
30 days advanced written notice if the certificate of insurance by the insurer has been canceled,
reduced in coverage, or otherwise altered. Certificates of insurance must reference the
corresponding contract number. Evidence of insurance shall be submitted to:
The Government of the District of Columbia and mailed to the attention of:
Julius Wiggins
Office of Contracting and Procurement
1015 Half Street, SE
8th Floor
Washington, DC 20003
(202) 741-8781
julius.wiggins@dc.gov
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The CO may request, and the Contractor shall promptly deliver updated certificates of insurance,
endorsements indicating the required coverages, and/or certified copies of the insurance policies.
If the insurance initially obtained by the Contractor expires prior to completion of the contract,
renewal certificates of insurance and additional insured and other endorsements shall be furnished
to the CO prior to the date of expiration of all such initial insurance. For all coverage required to
be maintained after completion, an additional certificate of insurance evidencing such coverag e
shall be submitted to the CO on an annual basis as the coverage is renewed (or replaced).
K. DISCLOSURE OF INFORMATION. The Contractor agrees that The Government of the
District of Columbia may disclose the name and contact information of its insurers to any third
party which presents a claim against The Government of the District of Columbia for any damag es
or claims resulting from or arising out of work performed by the Contractor, its agents, employees,
servants or subcontractors in the performance of this contract.
L. CARRIER RATINGS. All Contractor’s and its subcontractors’ insurance required in
connection with this contract shall be written by insurance companies with an A.M. Best Insurance
Guide rating of at least A- VII or better (or the equivalent by any other rating agency) and licensed
in the District of Columbia.
M. WARRANTIES. When applicable, the Contractor should be named as an additional
insured on the applicable manufacturer’s/distributer’s Commercial General Liability policy using
Insurance Services Office, Inc. (“ISO”) form CG 20 15 04 13 (or another occurrence -based form
with coverage at least as broad). CO should collect, review for accuracy, and maintain all
warranties for goods and services.
I.9 EQUAL EMPLOYMENT OPPORTUNITY
In accordance with the District of Columbia Administrative Issuance System, Mayor’s Order 85-85 dated
June 10, 1985, the forms for completion of the Equal Employment Opportunity Information Report are
incorporated herein as Section J.3. An award cannot be made to any offeror who has not satisfied the equal
employment requirements.
I.10 ORDER OF PRECEDENCE
A conflict in language shall be resolved by giving precedence to the document in the highest order of
priority that contains language addressing the issue in question. The following documents are incorporated
into the contract by reference and made a part of the contract in the following order of precedence:
(1) An applicable Court Order, if any
(2) Contract document
(3) Standard Contract Provisions
(4) Contract attachments other than the Standard Contract Provisions
(5) RFP, as amended
(6) BAFOs (in order of most recent to earliest)
(7) Proposal
(8) Contractor’s Policies, Group Nos. 67168 (PPO, HMO, CDHP) and CMS Contract H7379,
PBP 801 (MA), and any and all associated amendments and modifications
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I.11 DISPUTES
Delete Article 14, Disputes, of the Standard Contract Provisions dated July 2010 for use with District of
Columbia Government Supplies and Services Contracts and substitute the following Article 14, Disputes,
in its place:
14. Disputes:
All disputes arising under or relating to the contract shall be resolved as provided herein.
(a) Claims by the Contractor against the District : Claim, as used in paragraph (a) of this
clause, means a written assertion by the Contractor seeking, as a matter of right, the
payment of money in a sum certain, the adjustment or interpretation of contract terms, or
other relief arising under or relating to the contract. A claim arising under a contract, unlike
a claim relating to that contract, is a claim that can be resolved under a contract clause that
provides for the relief sought by the claimant.
(1) All claims by a Contractor against the District arising under or relating to a contract
shall be in writing and shall be submitted to the CO for a decision. The Contractor’s
claim shall contain at least the following:
(i) A description of the claim and the amount in dispute;
(ii) Data or other information in support of the claim;
(iii) A brief description of the Contractor’s efforts to resolve the dispute prior to
filing the claim; and
(iv) The Contractor’s request for relief or other action by the CO.
(2) The CO may meet with the Contractor in a further attempt to resolve the claim by
agreement.
(3) The CO shall issue a decision on any claim within 120 calendar days after receipt
of the claim. Whenever possible, the CO shall take into account factors such as the
size and complexity of the claim and the adequacy of the information in support of
the claim provided by the Contractor.
(4) The CO’s written decision shall do the following:
(i) Provide a description of the claim or dispute;
(ii) Refer to the pertinent contract terms;
(iii) State the factual areas of agreement and disagreement;
(iv) State the reasons for the decision, including any specific findings of fact,
although specific findings of fact are not required and, if made, shall not be
binding in any subsequent proceeding;
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(v) If all or any part of the claim is determined to be valid, determine the amount
of monetary settlement, the contract adjustment to be made, or other relief
to be granted;
(vi) Indicate that the written document is the CO’s final decision; and
(vii) Inform the Contractor of the right to seek further redress by appealing the
decision to the Contract Appeals Board.
(5) Failure by the CO to issue a decision on a contract claim within 120 days of receipt
of the claim will be deemed to be a denial of the claim, and will authorize the
commencement of an appeal to the Contract Appeals Board as provided by D.C.
Official Code § 2-360.04.
(6) If a contractor is unable to support any part of its claim and it is determined that the
inability is attributable to a material misrepresentation of fact or fraud on the part
of the Contractor, the Contractor shall be liable to the District for an amount equal
to the unsupported part of the claim in addition to all costs to the District attributable
to the cost of reviewing that part of the Contractor’s claim. Liability under this
paragraph (a)(6) shall be determined within six (6) years of the commission of the
misrepresentation of fact or fraud.
(7) Pending final decision of an appeal, action, or final settlement, the Contractor shall
proceed diligently with performance of the contract in accordance with the decision
of the CO.
(b) Claims by the District against the Contractor: Claim as used in paragraph (b) of this
clause, means a written demand or written assertion by the District seeking, as a matter of
right, the payment of money in a sum certain, the adjustment of contract terms, or other
relief arising under or relating to the contract. A claim arising under a contract, unlike a
claim relating to that contract, is a claim that can be resolved under a contract clause that
provides for the relief sought by the claimant.
(1) The CO shall decide all claims by the District against a contractor arising under or
relating to a contract.
(2) The CO shall send written notice of the claim to the contractor. The CO’s written
decision shall do the following:
(i) Provide a description of the claim or dispute;
(ii) Refer to the pertinent contract terms;
(iii) State the factual areas of agreement and disagreement;
(iv) State the reasons for the decision, including any specific findings of fact,
although specific findings of fact are not required and, if made, shall not be
binding in any subsequent proceeding;
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(v) If all or any part of the claim is determined to be valid, determine the amount
of monetary settlement, the contract adjustment to be made, or other relief
to be granted;
(vi) Indicate that the written document is the CO’s final decision; and
(vii) Inform the Contractor of the right to seek further redress by appealing the
decision to the Contract Appeals Board.
(3) The CO shall support the decision by reasons and shall inform the Contractor of its
rights as provided herein.
(4) Before or after issuing the decision, the CO may meet with the Contractor to attempt
to resolve the claim by agreement.
(5) The authority contained in this paragraph (b) shall not apply to a claim or dispute
for penalties or forfeitures prescribed by statute or regulation which another District
agency is specifically authorized to administer, settle, or determine.
(6) This paragraph shall not authorize the CO to settle, compromise, pay, or otherwise
adjust any claim involving fraud.
(c) Decisions of the CO shall be final and not subject to review unless the Contractor timely
commences an administrative appeal for review of the decision, by filing a complaint with
the Contract Appeals Board, as authorized by D.C. Official Code § 2-360.04.
(d) Pending final decision of an appeal, action, or final settlement, the Contractor shall proceed
diligently with performance of the contract in accordance with the decision of the CO.
I.12 CHANGES
Delete clause 15, Changes, of the Standard Contract Provisions dated July 2010 for use with District of
Columbia Government Supplies and Services Contracts and substitute the following clause 15, Chang es
in its place:
15. Changes:
(a) The CO may, at any time, by written order, and without notice to the surety, if any, make
changes in the contract within the general scope hereof. If such change causes an increase
or decrease in the cost of performance of the contract, or in the time required for
performance, an equitable adjustment shall be made. Any claim for adjustment for a chang e
within the general scope must be asserted within ten (10) days from the date the chang e is
ordered; provided, however, that the CO, if he or she determines t hat the facts justify such
action, may receive, consider, and adjust any such claim asserted at any time prior to the
date of final settlement of the contract. If the parties fail to agree upon the adjustment to be
made, the dispute shall be determined as provided in clause 14 Disputes.
(b) The District shall not require the Contractor, and the Contractor shall not require a
subcontractor, to undertake any work that is beyond the original scope of the contract or
subcontract, including work under a District-issued change order, when the additional work
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increases the contract price beyond the not -to-exceed price or negotiated maximum price
of the contract, unless the CO :
(1) Agrees with the Contractor, and if applicable the subcontractor, on a price for the
additional work;
(2) Obtains a certification of funding to pay for the additional work;
(3) Makes a written, binding commitment with the Contractor to pay for the additional
work within thirty (30) days after the Contractor submits a proper invoice; and
(4) Provides the Contractor with written notice of the funding certification.
(c) The Contractor shall include in its subcontracts a clause that requires the Contractor to:
(1) Within five (5) business days of its receipt of notice of the approved additional
funding, provide the subcontractor with notice of the amount to be paid to the
subcontractor for the additional work to be performed by the subcontractor ;
(2) Pay the subcontractor any undisputed amount to which the subcontractor is entitled
for the additional work within ten (10) days of receipt of payment from the District;
and
(3) Notify the subcontractor and CO in writing of the reason(s) the Contractor
withholds any payment from a subcontractor for the additional work.
(d) Neither the District, Contractor, nor any subcontractor may declare another party to be in
default, or assess, claim, or pursue damages for delays until the parties agree on a price for
the additional work.
I.13 NON-DISCRIMINATION CLAUSE
Delete clause 19, Non-Discrimination Clause, of the Standard Contract Provisions dated July 2010 for use
with District of Columbia Government Supplies and Services Contracts and substitute the following clause
19, Non-Discrimination Clause, in its place:
19. Non-Discrimination Clause:
(a) The Contractor shall not discriminate in any manner against any employee or applicant for
employment that would constitute a violation of the District of Columbia Human Rights
Act, effective December 13, 1977, as amended (D.C. Law 2 -38; D.C. Official Code § 2-
1401.01 et seq.) (“Act”, as used in this clause). The Contractor shall include a similar clause
in all subcontracts, except subcontracts for standard commercial supplies or raw materials.
In addition, the Contractor agrees, and any subcontractor shall agree, to post in conspicuous
places, available to employees and applicants for employment, a notice setting forth the
provisions of this non-discrimination clause as provided in section 251 of the Act.
(b) Pursuant to Mayor’s Order 85-85, (6/10/85), Mayor’s Order 2002-175 (10/23/02), Mayor’s
Order 2011-155 (9/9/11) and the rules of the Office of Human Rights, Chapter 11 of Title
4 of the D.C. Municipal Regulations, the following clauses apply to the contract :
(1) The Contractor shall not discriminate against any employee or applicant for
employment because of actual or perceived: race, color, religion, national origin,
sex, age, marital status, personal appearance, sexual orientation, gender identity or
expression, family responsibilities, genetic information, disability, matriculation,
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political affiliation, or credit information. Sexual harassment is a form of sex
discrimination which is prohibited by the Act. In addition, harassment based on any
of the above protected categories is prohibited by the Act.
(2) The Contractor agrees to take affirmative action to ensure that applicants are
employed, and that employees are treated during employment, without regard to
their actual or perceived: race, color, religion, national origin, sex, age, marital
status, personal appearance, sexual orientation, gender identity or expression,
family responsibilities, genetic information, disability, matriculation, political
affiliation, or credit information. The affirmative action shall include, but not be
limited to the following:
a. employment, upgrading or transfer;
b. recruitment, or recruitment advertising;
c. demotion, layoff , or termination;
d. rates of pay, or other forms of compensation; and
e. selection for training and apprenticeship.
(3) The Contractor agrees to post in conspicuous places, available to employees and
applicants for employment, notices to be provided by the contracting agency,
setting forth the provisions in paragraphs 19(b)(1) and (b)(2) concerning non -
discrimination and af firmative action.
(4) The Contractor shall, in all solicitations or advertisements for employees placed by
or on behalf of the Contractor, state that all qualified applicants will receive
consideration for employment pursuant to the non-discrimination requirements set
forth in paragraph 19(b)(2).
(5) The Contractor agrees to send to each labor union or representative of workers with
which it has a collective bargaining agreement or other contract or understanding ,
a notice to be provided by the contracting agency, advising the said labor union or
workers’ representative of that contractor’s commitments under this
nondiscrimination clause and the Act, and shall post copies of the notice in
conspicuous places available to employees and applicants for employment.
(6) The Contractor agrees to permit access to its books, records, and accounts
pertaining to its employment practices, by the Chief Procurement Officer or
designee, or the Director of the Office of Human Rights or designee, for purposes
of investigation to asc ertain compliance with the Act, and to require under terms of
any subcontractor agreement each subcontractor to permit access of such
subcontractors’ books, records, and accounts for such purposes.
(7) The Contractor agrees to comply with the provisions of the Act and with all
guidelines for equal employment opportunity applicable in the District adopted by
the Director of the Office of Human Rights, or any authorized official.
(8) The Contractor shall include in every subcontract the equal opportunity clauses,
i.e., paragraphs 19(b)(1) through (b)(9) of this clause, so that such provisions shall
be binding upon each subcontractor.
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(9) The Contractor shall take such action with respect to any subcontract as the CO
may direct as a means of enforcing these provisions, including sanctions for
noncompliance; provided, however, that in the event the Contractor becomes
involved in, or is threa tened with, litigation with a subcontractor or vendor as a
result of such direction by the contracting agency, the Contractor may request the
District to enter into such litigation to protect the interest of the District.
I.14 COST AND PRICING DATA
Delete Article 25, Cost and Pricing Data, of the Standard Contract Provisions dated July 2010 for use with
District of Columbia Government Supplies and Services Contracts.
I.15 STATE AND MUNICIPAL AGENCY RIDER CLAUSE
A. If authorized by the Contractor, the contract may be extended to any public corporation or public
agency of any state, county, city, town, or municipality within the United States or its territories
(“Participating Agency”) to purchase at contract prices i n accordance with contract terms.
B. Any Participating Agency utilizing this contract will place its own order(s) with the Contractor.
There shall be no obligation on the part of any Participating Agency to utilize the contract.
C. It is the Contractor’s responsibility to notify any Participating Agency of the availability of the
contract.
D. Each Participating Agency has the option of executing a separate contract with the Contractor.
Contracts entered into with a state or municipal agency may contain general terms and conditions
unique to that jurisdiction including, by way of illustration and not limitation, clauses covering
minority participation, non-discrimination, indemnification, naming the jurisdiction as an
additional insured under any required Comprehensive General Liability policies, and venue. If,
when preparing such a contract, the general terms and conditions of a Participating Agency are
unacceptable to the Contractor, the Contractor may withdraw its extension of the award to that
Participating Agency.
E. The District shall not be held liable for any costs or damages incurred by a Participating Agency
as a result of any award extended to that Participating Agency by the Contractor.

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SECTION J: ATTACHMENTS
The following list of attachments is incorporated into the contract by reference.
Attachment
Number Document
J.1
Government of the District of Columbia Standard Contract Provisions for Use
with the Suppl ies and Services Contracts (July 2010)
available at www.ocp.dc.gov. Under Quick Links , click on “Required Solicitation
Documents”
J.2 U.S. Department of Labor Wage Determination 2015-4281, Revision No. 34 ,
dated July 8, 2025: https://sam.gov/wage -determination/2015-4281/34
J.3
Equal Employment Opportunity Information Report and Mayor’s Order 85 -85
available at www.ocp.dc.gov. Under Quick Links , click on “Required Solicitation
Documents”
J.4
Department of Employment Services First Source Employment Agreement
available at www.ocp.dc.gov. Under Quick Links, click on “Required Solicitation
Documents”
J.5
Way to Work Amendment Act of 2006 - Living Wage Notice
available at www.ocp.dc.gov. Under Quick Links, click on “Required Solicitation
Documents”
J.6
Way to Work Amendment Act of 2006 - Living Wage Fact Sheet
available at www.ocp.dc.gov. Under Quick Links, click on “Required Solicitation
Documents”
J.7
Tax Certification Affidavit
available at www.ocp.dc.gov. Under Quick Links, click on “Required Solicitation
Documents”
J.8
Subcontracting Plan (if required by law)
available at www.ocp.dc.gov. Under Quick Links, click on “Required Solicitation
Documents”
J.9
First Source Initial Employment Plan (if contract is $300,000 or more) available
at www.ocp.dc.gov. Under Quick Links, click on “Required Solicitation
Documents”
J.10
Bidder/Offeror Certifications
available at www.ocp.dc.gov. Under Quick Links, click on “Required Solicitation
Documents”
J.11 Plan Designs (PPO, HMO, CDHP) (as applicable)
J.12 Performance Guarantees
J.13 System Integration Specifications

In-Network Out-of-Network
Employee Pays Employee Pays
Individual $0 to $750 $0 to $1500
Family $0 to $1500 $0 to $3000
Are there services covered before the
employee meets the deductible?
Preventive care
All services with copays
Office visits
Out-of-network services that are covered
at no charge (emergency medical
transportation)
Are there other deductibles for
specific services? No No
Individual $0 to $2500
(combined medical and pharmacy) Medical: $0 to $5000
Family $0 to $5000
(combined medical and pharmacy) Medical: $0 to $10,000
What is not included in the out-of-
pocket limit?
Will you pay less if you use a network
provider?
Does the employee need a referral to
see a specialist?
Primary care visit to treat an
injury or illness $0 to $15 copay 0% to 25% coinsurance
Specialist visit $0 to $30 copay 0% to 25% coinsurance
Retail health clinic $0 to $15 copay 0% to 25% coinsurance
Preventive care, screening,
immunization No charge 0% to 25% coinsurance
Diagnostic test (x-ray, blood
work) 0% to 15% coinsurance 0% to 25% coinsurance
Imaging (CT/PET scans, MRIs) 0% to 15% coinsurance 0% to 25% coinsurance
Select Preventive Medications No charge
Generic drugs $0 to $20 copay 1-30 day supply
$0 to $40 copay for 31-90 day supply
Preferred brand drugs $0 to $40 copay 1-30 day supply
$0 to $80 copay for 31-90 day supply
Non-preferred brand drugs $0 to $60 copay 1-30 day supply
$0 to $120 copay for 31-90 day supply
Preferred specialty drugs $0 to $65 copay for 1-30 day supply
$0 to $130 copay for 31-90 day supply
Non-preferred specialty drugs $0 to $75 copay for 1-30 day supply
$0 to $150 for 31-90 day supply
To be determined by offeror
Attachment J.11
Plan Designs
PPO Plan Design
Overall Deductible
Refer to C.5.1.3 for plan design requirements.
Out-of-Pocket Limit
Combined Medical and Pharmacy
Limitations, Exceptions & Other Important Information
All deductibles, copays, and coinsurance must contribute toward the out-of-pocket
maximum.
If the employee visits a healthcare
provider's office or clinic
Per C.6.2, all pharmacies outside the
Washington, DC, metropolitan area shall
be treated as in-network.
If the employee has a test
If the employee needs drugs to treat an
illness or condition
Yes
In-Network Out-of-Network
Employee Pays Employee Pays
PPO Plan Design
Refer to C.5.1.3 for plan design requirements.
Limitations, Exceptions & Other Important Information
Facility fee (e.g., ambulatory
surgery center) 0% to 15% coinsurance 0% to 25% coinsurance
Physician/surgeon fees 0% to 15% coinsurance 0% to 25% coinsurance
Emergency room care $0 to $200 copay $0 to $200 copay
Emergency medical
transportation No charge No charge
Urgent care $0 to $35 copay 0% to 25% coinsurance
Facility fee (e.g., hospital room) 0% to 15% coinsurance 0% to 25% coinsurance
Physician/surgeon fees 0% to 15% coinsurance 0% to 25% coinsurance
Outpatient services $0 to $15 copay 0% to 25% coinsurance
Inpatient services 0% to 15% coinsurance 0% to 25% coinsurance
Office visits No charge; not subject to deductible 0% to 25% coinsurance
Childbirth/delivery professional
services 0% to 15% coinsurance 0% to 25% coinsurance
Childbirth/delivery facility
services 0% to 15% coinsurance 0% to 25% coinsurance
Home health care 0% to 15% coinsurance 0% to 25% coinsurance Offeror's limitations and conditions shall be consistent with the District's Essential
Health Benefits Benchmark Plan.
Rehabilitation services 0% to 15% coinsurance 0% to 25% coinsurance Offeror's limitations and conditions shall be consistent with the District's Essential
Health Benefits Benchmark Plan.
Habilitation services 0% to 15% coinsurance 0% to 25% coinsurance
Services are provided under and limits are combined with rehabilitation services
above. Includes coverage of applied behavior analysis (ABA). A pre-authorization
requirement is permitted.
Skilled nursing care 0% to 15% coinsurance 0% to 25% coinsurance Offeror's limitations and conditions shall be consistent with the District's Essential
Health Benefits Benchmark Plan.
Durable medical equipment 0% to 15% coinsurance 0% to 25% coinsurance Offeror's limitations and conditions shall be consistent with the District's Essential
Health Benefits Benchmark Plan.
Hospice services 0% to 15% coinsurance 0% to 25% coinsurance Offeror's limitations and conditions shall be consistent with the District's Essential
Health Benefits Benchmark Plan.
Children's eye exam Coverage is optional and may be determined
by offeror.
Coverage is optional and may be
determined by offeror.
Children's glasses Coverage is optional and may be determined
by offeror.
Coverage is optional and may be
determined by offeror.
Children's dental check-up No coverage No coverage
Cosmetic Surgery Cosmetic surgery shall be excluded other than as covered for medically necessary
services.
If the employee's child needs dental or
eye care
If the employee needs help recovering
or has other special health needs

If the employee has outpatient surgery
If the employee needs immediate
medical attention
If the employee has a hospital stay
If the employee needs mental health,
behavioral health, or substance abuse
services
If the employee is pregnant
In-Network Out-of-Network
Employee Pays Employee Pays
PPO Plan Design
Refer to C.5.1.3 for plan design requirements.
Limitations, Exceptions & Other Important Information
Dental Care
Dental care shall be excluded other than as covered for medically necessary services.
Accidental dental and TMJ relating to a medical condition or diagnosis shall be
covered.
Long Term Care Long-term care shall be excluded.
Glasses
Hearing Aids
Non-emergency care outside of
the U.S.
Private Duty Nursing
Routine Eye Care (Adult)
Routine Foot Care Routine foot care may be excluded except as covered for diabetes.
Weight Loss Programs
Acupuncture
Coverage required.
Offeror shall determine copay or
coinsurance arrangements.
Coverage is optional and may be
determined by offeror. Offeror may determine limitations and conditions.
Bariatric Surgery Same coverage as other surgeries Coverage is optional and may be
determined by offeror.
Chiropractic Care 0% to 15% coinsurance 0% to 25% coinsurance
Infertility treatment Coverage required.
Offeror shall determine copay.
Coverage required.
Offeror shall determine coinsurance.
Coverage must comply with District law. Otherwise, the Offeror may determine
limitations.
Other Covered Services
(Limitations may apply.)
These services shall be excluded.
These services may be excluded. If covered, the offeror may determine coverage terms
and limitations.
Excluded Services
Optional Services
In-Network Out-of-Network
Employee Pays Employee Pays
Individual $0
Family $0
Are there services covered before the
employee meets the deductible? N/A
Are there other deductibles for specific
services? No
Individual $0 to $4000
(combined medical and pharmacy)
Family $0 to $10,000
(combined medical and pharmacy)
What is not included in the out-of-
pocket limit?
All copays, deductibles, and coinsurance must
contribute toward the out-of-pocket maximum.
Will you pay less if you use a network
provider? Yes
Does the employee need a referral to
see a specialist? To be determined by the offeror
Primary care visit to treat an
injury or illness $0 to $15 copay
Specialist visit $0 to $25 copay
Retail health clinic $0 to $10 copay
Preventive care, screening,
immunization No charge
Diagnostic test (x-ray, blood
work) No charge
Imaging (CT/PET scans, MRIs) No charge
Select Preventive Medications No charge
Generic drugs $0 to $20 copay 1-30 day supply
$0 to $40 copay for 31-90 day supply
Preferred brand drugs $0 to $40 copay 1-30 day supply
$0 to $80 copay for 31-90 day supply
Non-preferred brand drugs $0 to $60 copay 1-30 day supply
$0 to $120 copay for 31-90 day supply
Preferred specialty drugs $0 to $65 copay for 1-30 day supply
$0 to $130 copay for 31-90 day supply
Non-preferred specialty drugs $0 to $75 copay for 1-30 day supply
$0 to $150 for 31-90 day supply
Attachment J.11
Plan Designs
If the employee needs drugs to treat an
illness or condition
Per C.6.2, all pharmacies outside the
Washington, DC, metropolitan area shall
be treated as in-network.
If the employee visits a healthcare
provider's office or clinic
If the employee has a test
HMO Plan Design
Overall Deductible
Out-of-Pocket Limit
Combined Medical and Pharmacy
Refer to C.5.1.3 for plan design requirements.
Limitations, Exceptions & Other Important Information
In-Network Out-of-Network
HMO Plan Design
Refer to C.5.1.3 for plan design requirements.

Facility fee (e.g., ambulatory
surgery center) $0 to $50 copay
Physician/surgeon fees No charge
Emergency room care $0 to $200 copay per visit $0 to $200 copay per visit
Emergency medical
transportation No charge No charge
Urgent care $0 to $25 copay per visit
Facility fee (e.g., hospital room) $0 to $100 copay per admission
Physician/surgeon fees No charge
Outpatient services $0 to $10 copay per office visit
No charge for facility
Inpatient services $0 to $100 copay per admission
Office visits No charge For non-routine obstetrical care or complications of pregancy, specialist copay may
be applied.
Childbirth/delivery professional
services No charge
Childbirth/delivery facility
services $0 to $100 copay per admission
Home health care No charge Offeror's limitations and conditions shall be consistent with the District's Essential
Health Benefits Benchmark Plan.
Rehabilitation services $0 to $10 copay per visit Offeror's limitations and conditions shall be consistent with the District's Essential
Health Benefits Benchmark Plan.
Habilitation services $0 to $10 copay per visit
Services are provided under and limits are combined with rehabilitation services
above. Includes coverage of applied behavior analysis (ABA). A pre-authorization
requirement is permitted.
Skilled nursing care $0 to $100 copay Offeror's limitations and conditions shall be consistent with the District's Essential
Health Benefits Benchmark Plan.
Durable medical equipment 0% to 50% coinsurance Offeror's limitations and conditions shall be consistent with the District's Essential
Health Benefits Benchmark Plan.
Hospice services No charge Offeror's limitations and conditions shall be consistent with the District's Essential
Health Benefits Benchmark Plan.
Children's eye exam Coverage is optional and may be determined by
offeror.
Children's glasses Coverage is optional and may be determined by
offeror.
Children's dental check-up No coverage
Cosmetic Surgery Cosmetic surgery shall be excluded other than as covered for medically necessary
services.
Dental Care
Dental care shall be excluded other than as covered for medically necessary services.
Accidental dental and TMJ relating to a medical condition or diagnosis shall be
covered.
If the employee has outpatient surgery
Excluded Services These services shall be excluded.
If the employee needs immediate
medical attention
If the employee needs mental health,
behavioral health, or substance abuse
services
If the employee is pregnant
If the employee needs help recovering
or has other special health needs
If the employee's child needs dental or
eye care
If the employee has a hospital stay
In-Network Out-of-Network
HMO Plan Design
Refer to C.5.1.3 for plan design requirements.
Long Term Care Long-term care shall be excluded.
Glasses
Hearing Aids
Non-emergency care outside of
the U.S.
Private Duty Nursing
Routine Eye Care (Adult)
Routine Foot Care Routine foot care may be excluded except as covered for diabetes.
Weight Loss Programs
Acupuncture
Coverage required.
Offeror shall determine copay or coinsurance
arrangements.
Coverage is optional and may be
determined by offeror. Offeror may determine limitations and conditions.
Bariatric Surgery Same as other surgeries
Chiropractic Care $0 to $20 copay per visit
Infertility treatment Coverage required.
Offeror shall determine copay.
Coverage must comply with District law. Otherwise, the Offeror may determine
limitations.
Optional Services These services may be excluded. If covered, the offeror may determine coverage terms and
limitations.

Other Covered Services
(Limitations may apply.)
In-Network Out-of-Network
Employee Pays Employee Pays
Individual $0 to $2000 $0 to $4000
Family $0 to $4000 $0 to $8000
Are there services covered before the
employee meets the deductible? Preventive care No
Are there other deductibles for specific
services? No No
Individual $0 to $4000
(combined medical and pharmacy) Medical: $0 to $8000
Family $0 to $8000
(combined medical and pharmacy) Medical: $0 to $16,000
What is not included in the out-of-pocket
limit?
Will you pay less if you use a network
provider?
Does the employee need a referral to see
a specialist?
Primary care visit to treat an
injury or illness 0% to 15% coinsurance 0% to 40% coinsurance
Specialist visit 0% to 15% coinsurance 0% to 40% coinsurance
Retail health clinic 0% to 15% coinsurance 0% to 40% coinsurance
Preventive care, screening,
immunization No charge 0% to 40% coinsurance
Diagnostic test (x-ray, blood
work) 0% to 15% coinsurance 0% to 40% coinsurance
Imaging (CT/PET scans, MRIs) 0% to 15% coinsurance 0% to 40% coinsurance
Select Preventive Medications No charge;
not subject to deductible
Generic drugs $0 to $20 copay 1-30 day supply
$0 to $40 copay for 31-90 day supply
Preferred brand drugs $0 to $40 copay 1-30 day supply
$0 to $80 copay for 31-90 day supply
Non-preferred brand drugs $0 to $60 copay 1-30 day supply
$0 to $120 copay for 31-90 day supply
Preferred specialty drugs $0 to $65 copay for 1-30 day supply
$0 to $130 copay for 31-90 day supply
Non-preferred specialty drugs $0 to $75 copay for 1-30 day supply
$0 to $150 for 31-90 day supply
Attachment J.11
Plan Designs
CDHP Plan Design
Overall Deductible
Refer to C.5.1.3 for plan design requirements.
Limitations, Exceptions & Other Important Information
If the employee visits a healthcare
provider's office or clinic
If the employee has a test
If the employee needs drugs to treat an
illness or condition
Per C.6.2, all pharmacies outside the
Washington, DC, metropolitan area shall
be treated as in-network. Except for select preventive medications, all drugs will be subject to the
deductible.
Out-of-Pocket Limit
Combined Medical and Pharmacy
All deductibles, copays, and coinsurance must contribute toward the out-of-pocket
maximum.
To be determined by the offeror
Yes
In-Network Out-of-Network
Employee Pays Employee Pays
CDHP Plan Design
Refer to C.5.1.3 for plan design requirements.
Limitations, Exceptions & Other Important Information
Facility fee (e.g., ambulatory
surgery center) 0% to 15% coinsurance 0% to 40% coinsurance
Physician/surgeon fees 0% to 15% coinsurance 0% to 40% coinsurance
Emergency room care 0% to 15% coinsurance Covered as in-network
Emergency medical
transportation 0% to 15% coinsurance 0% to 40% coinsurance
Urgent care 0% to 15% coinsurance 0% to 40% coinsurance
Facility fee (e.g., hospital room) 0% to 15% coinsurance 0% to 40% coinsurance
Physician/surgeon fees 0% to 15% coinsurance 0% to 40% coinsurance
Outpatient services 0% to 15% coinsurance 0% to 40% coinsurance
Inpatient services 0% to 15% coinsurance 0% to 40% coinsurance
Office visits 0% to 15% coinsurance 0% to 40% coinsurance
Childbirth/delivery professional
services 0% to 15% coinsurance 0% to 40% coinsurance
Childbirth/delivery facility
services 0% to 15% coinsurance 0% to 40% coinsurance
Home health care 0% to 15% coinsurance 0% to 40% coinsurance Offeror's limitations and conditions shall be consistent with the District's
Essential Health Benefits Benchmark Plan.
Rehabilitation services 0% to 15% coinsurance 0% to 40% coinsurance Offeror's limitations and conditions shall be consistent with the District's
Essential Health Benefits Benchmark Plan.
Habilitation services 0% to 15% coinsurance 0% to 40% coinsurance
Services are provided under and limits are combined with rehabilitation services
above. Includes coverage of applied behavior analysis (ABA). A pre-authorization
requirement is permitted.
Skilled nursing care 0% to 15% coinsurance 0% to 40% coinsurance Offeror's limitations and conditions shall be consistent with the District's
Essential Health Benefits Benchmark Plan.
Durable medical equipment 0% to 15% coinsurance 0% to 40% coinsurance Offeror's limitations and conditions shall be consistent with the District's
Essential Health Benefits Benchmark Plan.
Hospice services 0% to 15% coinsurance 0% to 40% coinsurance Offeror's limitations and conditions shall be consistent with the District's
Essential Health Benefits Benchmark Plan.
Children's eye exam Coverage is optional and may be
determined by offeror.
Coverage is optional and may be
determined by offeror.
Children's glasses Coverage is optional and may be
determined by offeror.
Coverage is optional and may be
determined by offeror.
Children's dental check-up No coverage No coverage
Cosmetic Surgery Cosmetic surgery shall be excluded other than as covered for medically
necessary services.
If the employee has a hospital stay
If the employee has outpatient surgery
If the employee needs immediate
medical attention
If the employee needs mental health,
behavioral health, or substance abuse
services
If the employee is pregnant
If the employee needs help recovering or
has other special health needs
If the employee's child needs dental or
eye care

In-Network Out-of-Network
Employee Pays Employee Pays
CDHP Plan Design
Refer to C.5.1.3 for plan design requirements.
Limitations, Exceptions & Other Important Information
Dental Care
Dental care shall be excluded other than as covered for medically necessary
services. Accidental dental and TMJ relating to a medical condition or diagnosis
shall be covered.
Long Term Care Long-term care shall be excluded.
Glasses
Hearing Aids
Non-emergency care outside of
the U.S.
Private Duty Nursing
Routine Eye Care (Adult)
Routine Foot Care Routine foot care may be excluded except as covered for diabetes.
Weight Loss Programs
Acupuncture
Coverage required.
Offeror shall determine copay or
coinsurance arrangements.
Coverage is optional and may be
determined by offeror. Offeror may determine limitations and conditions.
Bariatric Surgery 0% to 15% coinsurance Coverage is optional and may be
determined by offeror.
Chiropractic Care 0% to 15% coinsurance 0% to 40% coinsurance
Infertility treatment Coverage required.
Offeror shall determine coinsurance.
Coverage required.
Offeror shall determine coinsurance.
Coverage must comply with District law. Otherwise, the Offeror may determine
limitations.
Other Covered Services
(Limitations may apply.)
Excluded Services These services shall be excluded.
Optional Services These services may be excluded. If covered, the offeror may determine coverage
terms and limitations.
Category Description of Standard/Guarantee Reporting Measurement Threshold for Liquidated Damages
Liquidated Damages
(Percentage of Premium
Payments)
C.5.3 Enrollment Assistance
C.5.3.3 ID Cards
The Contractor shall make 99% of digital ID cards available within 3
days. Days are calculated as the number of days elapsed between
the date of receipt of enrollment notification and the date the
temporary card is available in the member portal.
The percentage of ID cards made available in the member portal
after 3 days, as calculated by dividing the number of ID cards made
available after 3 days by the total number of new enrollments. The
Contractor may measure and report this performance guarantee
based on the performance of their book of business or other
responsible business unit within the organization.
If less than 99%
0.02% for each percentage point
below 99%,
not to exceed a total of 0.10%
C.5.3.5 Enrollee Documents
The Contractor shall submit enrollee documents to the CA no less
than 30 days before open enrollment period.
The number of days elapsed between the day the documents are
provided and the first day of open enrollment. If less than 30 days
0.001% for each day less than 30
days, not to exceed a total of
0.020%
C.5.3.8 Open Enrollment Support
The Contractor shall have at least one knowledgeable staff member
present at 100% of open enrollment fairs, both in person and virtual,
unless the CA has approved the Contractor's absence in advance.
The percentage of open enrollment fairs attended, as calculated
by dividing the number of fairs the Contractor attends by the total
number of fairs the Contractor has been asked to attend by the
District.
If less than 100%
0.001% for each fair not
attended, not to exceed a total of
0.020%
C.5.4 Plan and Claims Administration
C.5.4.5 Customer Service Call Center
First Call Resolution
The Contractor shall resolve 85% of first calls on the first call. The percentage of DCEHB calls resolved during the first phone call,
as calculated by dividing the number of DCEHB first calls that
result in a resolution of the issue by the total number of DCEHB
first calls for an issue. It may be calculated automatically with a
computerized telephone call distribution system.
If less than 85% of first calls are resolved
0.02% for each percentage point
below 85%,
not to exceed a total of 0.10%
Call Answer Timeliness
The Contractor shall answer 85% of calls within 30 seconds. The percentage of DCEHB calls answered timely by a live voice
during operating hours, as calculated by dividing the number of
DCEHB calls answered within 30 seconds by the total number of
DCEHB calls received. It may be calculated automatically with a
computerized telephone call distribution system and shall
measure the time from the first ring to an answer by a live voice.
If less than 85% of calls are answered in 30
seconds or less
0.02% for each percentage point
below 85%,
not to exceed a total of 0.10%
Call Abandonment Rate
The Contractor or their phone system shall not abandon more than
3% of calls.
The percentage of DCEHB calls not connected, as calculated by
dividing the number of DCEHB calls attempted but not connected
to a live voice during operating hours by the total number of
DCEHB calls attempted. It may be calculated automatically with a
computerized telephone call distribution system.
If more than 3% of calls are abandoned
0.02% for each percentage point
above 3%,
not to exceed a total of 0.10%
C.5.4.11 Claims Administration
Claims Processing Timeliness
The Contractor shall process 95% of DCEHB claims within 30
calendar days from receipt of the claim.
The percentage of DCEHB claims adjudicated (paid, denied, or
request for further information sent out) within 30 calendar days,
as calculated by dividing the number of DCEHB claims adjudicated
within 30 calendar days by the total number of DCEHB claims
received.
If less than 95%
0.02% for each percentage point
below 95%, not to exceed a total
of 0.10%
Claims Processing Accuracy
The Contractor shall process 97% of DCEHB claims accurately. The percentage of DCEHB claims processed accurately, as
calculated by dividing the number of DCEHB claims processed
accurately by the total number of DCEHB claims processed.
If less than 97%
0.02% for each percentage point
below 97%, not to exceed a total
of 0.10%
Attachment J.12
Performance Guarantees
The Contractor may measure and report the three Customer Service Call Center performance guarantees based on the performance of their book of business or other responsible business unit within the organization.
The Contractor may measure and report the six Claims Administration performance guarantees based on the performance of the responsible business unit within the organization.
Claims Financial Accuracy
(Claims Dollar Accuracy)
The Contractor shall process 99% of claims-paid dollars accurately. The percentage of DCEHB claims-paid dollars processed
accurately, as calculated by dividing the amount of DCEHB claims
payments that are processed accurately by the total amount of
DCEHB claims payments.
If less than 99%
0.02% for each percentage point
below 99%, not to exceed a total
of 0.10%
Payment Incidence Accuracy
The Contractor shall process 97% of claims paid accurately. The percentage of DCEHB claims paid processed accurately, as
calculated by dividing the number of DCEHB claims payments that
are processed accurately by the total number of DCEHB claims
payments.
If less than 97%
0.02% for each percentage point
below 97%, not to exceed a total
of 0.10%
C.5.4.14 Responsiveness to Written Inquiries
The Contractor shall respond to 90% of written inquiries within 2
business days.
The percentage of DCEHB written inquiries responded to within 2
business days, as calculated by dividing the number of DCEHB
inquiries responded to within 2 business days by the total number
of DCEHB inquiries received.
If less than 90%
0.02% for each percentage point
below 90%, not to exceed a total
of 0.10%
C.5.4.15 Claims Disputes Response and
Resolution
Urgent. The Contractor shall send written notification of their final
determination for 99% of urgent reviews/appeals within 24 hours.
Prospective. The Contractor shall send written notification of their
final determination for 99% of prospective reviews/appeals within 30
calendar days.
Retrospective. The Contractor shall send written notification of their
final determination for 99% of retrospective reviews/appeals within
60 calendar days.
Urgent. The percentage of DCEHB claims disputes resolved within
24 hours, as calculated by dividing the number of urgent DCEHB
claims disputes resolved within 24 hours by the total number of
urgent DCEHB claims disputes received.
Prospective. The percentage of DCEHB claims disputes resolved
within 30 days, as calculated by dividing the number of prospective
DCEHB claims disputes resolved within 30 days by the total
number of prospective DCEHB claims disputes received.
Retrospective. The percentage of DCEHB claims disputes resolved
within 60 days, as calculated by dividing the number of
retrospective DCEHB claims disputes resolved within 60 days by
the total number of retrospective DCEHB claims disputes received.
If any category—urgent, prospective, or
retrospective—is less than 99%
0.02% for each percentage point
below 99%, not to exceed a total
of 0.10%
C.5.9 Quality Control
C.5.9.2 Member Satisfaction Survey
85% of respondents to the Contractor's annual DCEHB survey must
rate the Contractor's overall service as satisfactory or higher.
The percentage of satisfactory ratings, as calculated by dividing
the number of overall satisfactory ratings by the total number of
survey responses received.
If less than 85%, provided that the Contractor
receives responses from at least 25% of the
plan enrollees
0.02% for each percentage point
below 85%, not to exceed a total
of 0.10%
C.5.10 Reporting
C.5.10.1 Reconciliation
The Contractor shall submit monthly reconciliation reports by the
30th of the month following the reporting period. If the 30th falls on a
weekend or holiday, the Contractor may submit the report the next
business day.
The number of days elapsed between the 30th day of each month
and the day the monthly reconcilitation report is submitted. If after the 30th of the month 0.005% for each day late, not to
exceed a total of 0.100%