Attachment 2: Statement of Work

Attachment 2 – Statement of Work
Statement of Work under Contract No_19BH2022D0001

C.1.

HEALTH INSURANCE SERVICES

The Government of the United States of America requires Health Insurance coverage for its employees as described herein.
All LE Staff covered under post’s medical benefit plan will pay a 10% share of the premium based on the number of individuals covered.
C.1.1 Employee and Dependent Health Service Benefits
C.1.1.1
Hospitalization (Treatment in the Hospital for Inpatient Care): Minimum Coverage - 100%
Services and supplies provided during hospitalization including services provided by a licensed healthcare provider, bed and board (semi-private accommodations), operating room, recovery room, intensive care, imaging and diagnostic testing, and general hospital nursing care, physical therapy, as well as drugs and medicines administered while inpatient. When private accommodations are provided, coverage will be limited to the cost of a semi-private room unless otherwise covered in an off the shelf plan. See Mental Health and Substance Abuse care (C.1.1.13) for details concerning inpatient psychiatric care.
See Mental Health and Substance Abuse Care (below) for details concerning inpatient psychiatric care.
See Outpatient Services (below) for details concerning professional services. C.1.1.2
Emergency Services (Trips to Emergency Room): Minimum
Coverage - 100%
Services provided for conditions that could lead to serious disability or death if not immediately treated, such as accidents or sudden illness. C1.1.3
Ambulance: Minimum Coverage - 80%
Professional ground transport to move a patient from the place where s/he is injured or becomes ill to the nearest hospital able to provide treatment or to move a patient from one medical facility to another.
C.1.1.4
Outpatient Services: Minimum Coverage - 80%
Services provided by a licensed healthcare provider on an ambulatory or outpatient basis (without being admitted to a hospital), including surgeon’s fees and other medical

services provided at a hospital, clinic, doctor’s office, medical facility, etc. Examples include, but are not limited to:
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Annual physical examinations
Specialist consultations and treatment, including second surgical opinion Minor surgical interventions
Chemotherapy and radiation treatments
Immunizations recommended by local authorities and/or the World Health Organization
Diagnostic tests and diagnostic imaging

See Rehabilitative and Habilitative Services and Devices (below) for details concerning