Introduction: 1. This announcement constitutes a Request for Information (RFI). This announcement does not constitute a commitment, implied or otherwise that a solicitation will be issued. This is not a Request for Proposal (RFP) or an Invitation for Bids (IFB). In accordance with Federal Acquisition Regulation (FAR) 15.201, responses to this notice are not offers and cannot be accepted by the Government to form a binding contract. Contractors responding to this request are advised that participation does NOT ensure opportunities for future solicitations or contract awards. 2. Please note that the collection of this requested information does not obligate the Government to incorporate any responses or comments provided nor does it obligate the Government to procure the services. Responses to this RFI will not be returned. The Government is not liable to pay any costs associated with companies responding to this RFI. 3. All information received resulting from this RFI will be used by the Defense Health Agency (DHA) for acquisition planning and market research purposes only. However, your response may be releasable to the public under the Freedom of Information Act. If you wish the DHA to consider any portion of your response as “confidential commercial information,” you should clearly mark the portion as “confidential commercial information.” 4. DHA, at its discretion, may request respondents to this RFI to elaborate on information in their written response. Respondents to this RFI will not be notified of any results derived from a review of the information provided. 5. The DHA invites all interested parties to submit a written response to this RFI. This RFI is issued for the sole purpose of conducting market research in accordance with the FAR Part 10. 6. Please respond to as many or as few of the questions posed. The questions cover a broad range of topics that may not be applicable to all responders. Description: The DHA expects to contract with a Third-Party Administrator (TPA) in support of the seventh generation TRICARE Dental Program (TDP) contract(s)(TDP-7). Among other things, the TDP-7 acquisition will incorporate National Defense Authorization Act (NDAA) for Fiscal Year 2023, Sec. 701, Congressionally mandated improvements to the TDP, including offering beneficiaries the opportunity to: (1) enroll in plans offered by multiple (2-4) dental carriers; (2) enroll in self, self+1, and family dental plans; and (3) choose among standard and non-standard plans. The TPA contractor will manage the administrative features of TDP-7 including eligibility determinations, enrollments, standard or high option plans, plan changes, premium payment process, submission of qualifying life events, and address changes. The TPA contract will support TDP-7 which will deliver the DoD dental benefit to up to 3 million eligible family members of active-duty service members, members of the Selected Reserve and Individual Ready Reserve (IRR) and their eligible family members, as described in 10 U.S.C. Chapter 55 § 1076a. Of the 3 million eligible beneficiaries, approximately 1.8 million currently participate in TDP. TDP is a worldwide program, and many beneficiaries reside overseas and/or transfer to and from overseas locations. The TPA contractor will integrate eligibility, enrollment, and premium administrative services for the 2 to 4 dental carriers providing dental health services to beneficiaries. Having this centralized platform will eliminate the need for each TDP carrier to establish its own eligibility, enrollment, and premium administration services and to interface directly with the Defense Manpower Data Center (DMDC), multiple Service payroll offices for allotments, and with DHA to collect premiums. The TPA contractor will also provide beneficiaries the option of paying for these benefits through payroll allotments, direct billing (credit/debit card), or automatic bank withdrawals. The Government anticipates soliciting proposal for the TPA requirement in Fiscal Year 2026 and awarding the TPA contract in Fiscal Year 2027. The DHA is seeking information on how interested contractors could meet the new NDAA requirements and deliver the specific capabilities outlined below leveraging best industry practices. Required Contractor Capabilities: Management Ability to provide operational management of all human and capital resources for all TPA operations such as call centers, systems, system components and databases at contractor operational sites. Ability to manage, maintain and provide support services for configuration, access control, and basic troubleshooting and maintenance of all TPA systems. Ability to manage and oversee needed program/system changes quickly and efficiently, e.g., changes in TDP benefits or eligibility criteria. Ability to manage a diverse, geographically dispersed beneficiary population. Ability to provide management reports that monitor and measure key performance requirements and management indicators with the goal of continuous process improvement in all facets of the company’s operations. Customer Service Operate a Customer Service Call Center and Provide Customer Service: Ability to hire, train, and maintain a knowledgeable, courteous, and responsive call center staff resulting in highly satisfied beneficiaries. Ability to provide trained customer service representatives fluent in both English and Spanish and have the capability to provide other non-English/Spanish language support. Ability to provide surge capability. Ability to provide enrollment counseling services for beneficiaries to include management of Qualifying Life Events (QLE). Ability to communicate with beneficiaries through written correspondence or other approved methodologies. Ability to respond timely to emails and other correspondence from users, as well as service calls in response to communications from TPA, carriers, the Services, or DHA. Ability to collect and process beneficiary enrollment fees via debit/credit card payments, allotments, and automatic bank withdrawals where feasible on a monthly basis. Ability to provide human intervention as the primary mode of customer service. Ability to provide chat, artificial intelligence, and other acceptable forms of social media engagement. Ability to secure a government background check in order to operate within government systems. Monthly Reconciliation with Carriers and Government Ability to reconcile enrollments, premiums, allotments, payments, and refunds timely, completely, and accurately at the individual and family enrollment level with each TDP carrier and DHA. Implement Information Technology/Information Systems Solutions Ability to provide systems architecture flexible enough to support technical, business, and mandatory Federal requirements without inhibiting or limiting functionality or user experience. Ability to provide support for maintenance, upgrades, and changes of software and hardware for current systems to include change request(s), design and code changes, conduct testing of changes, prepare or update documentation affected by required change(s), and coordination of change implementation through established configuration management procedures. Ability to host many thousands of concurrent users, and to provide surge capabilities with little or no interruption to TPA system users. Ability to exchange information with DMDC/DEERS, and numerous Government and military pay centers. Ability to operate and manage a fully functional website that is secure, user-friendly, informative, provides dental plan information, and provides beneficiaries with account information and decision support tools including dental premiums, benefit comparisons for TDP plans, and enrollment/disenrollment functionality. Compliance with Federal and DoD Information Assurance/Security requirements The ability to obtain DoD’s Cybersecurity Maturity Model Certification in effect at the time of contract award (Currently, DFARS 252.204-7021 Cybersecurity Maturity Model Certification Requirements); and T-5 TRICARE Systems Manual (TSM), Chapter 1. Eligibility Ability to identify and process changes in beneficiary status: Ability to enroll beneficiaries based upon real-time, individual eligibility in DEERS (T-5 TSM Chapter 3). Ability to reconcile premiums versus retroactive eligibility changes. Ability to notify carriers of QLEs, and transfers. Ability to process family members with different plans/carriers. Process Enrollments and Disenrollments Ability to quickly and accurately enroll and disenroll beneficiaries. In some cases, multiple eligibility status changes may require multiple enrollment or disenrollment actions during an enrollment year. Ability to serve as the “intermediary” for beneficiary enrollment in the TDPs, providing and exchanging enrollment-related information to the TDPs, DEERS, and any other participating entities as appropriate. Ability to provide streamlined processes which improves the beneficiary experience. Manage beneficiary submission of QLEs and address changes. Marketing, Education and Outreach The ability to generate and produce all marketing materials to include: Written materials used to publicize, inform, educate, or otherwise influence eligible TDP beneficiaries. Publications, social media, beneficiary outreach, website management, TRICARE branding, and media relations as described in the T-5 TRICARE Operation Manual (TOM), Chapter 11, Section 6. Transition-in and Out Capability Ability to transition all systems, processes, and beneficiary information from or to a losing or gaining contractor with no impact on beneficiaries’ dental health outcomes, customer service, or customer satisfaction. Ability to timely and accurately receive or transfer all required beneficiary records and information from or to a losing or gaining contractor with no impact to TDP beneficiaries. Potential, Future Capability Under DHA’s Competitive Plans Demonstration (CPD) project, the Agency is contracting for stand-alone Eligibility, Enrollment and Encounter (EEE) services to support the managed care plans delivering the TRICARE benefit under the CPD through a line item on the US Family Health Plan’s Data Integrator contract. This requirement will sunset in 2028. Potential, future CPD managed care contracts may require a stand-alone EEE data requirement. The Encounter effort would include the ability to collect and process data, to include medical and pharmacy encounter data, Other Health Insurance (OHI), Primary Care Manager (PCM) data in support of the competitive Plans and the Government. An EEE contractor would need the ability to query DEERS for updated CATCAP/Deductible information as available and return an X12 271 Health Care Eligibility Benefit response transaction per T-5 TSM Chapter 3. Ability to provide a customer service and a customer service call center. Ability to collect and process beneficiary enrollments and enrollment fees. Ability to operate and manage a fully functional website that is secure, user-friendly, informative, provides CPD information, and provides beneficiaries with account information and decision support tools including CPD premiums, benefit comparisons for CPD, and enrollment/disenrollment functionality. The number of Competitive Plan beneficiaries would be approximately 10,000 to 50,000. Questions/Requested Information Describe your company or team’s ability to meet the required contractor capabilities listed above. Describe any commercial or industry best practices that would support the NDAA mandate or the required contractor capabilities listed above. Describe your company or team’s background, technical expertise, experience, staffing, ability to meet/comply with DoD System security requirements (T-5 TSM Chap 1 https://manuals.health.mil/pages/DisplayManualHtmlFile/2024-10-11/AsOf/TST5/C1S1_1.html) and other capabilities that demonstrate its capability to provide the anticipated TPA requirements. Describe your capability and approach to manage all administrative functions including enrollment, QLEs, three enrollment options (self, self+1, and family), eligibility for multiple dental carriers (2-4) with standard and high-option plans, and split premium payment streams (beneficiary and Government). Describe your capability and approach to combining premium payments, processing monthly invoices and reconciliations (especially with regards to retro eligibility), and providing DHA with an auditable bill/invoice. Describe your capability and approach to interoperability (i.e., communicating and interacting with other systems). Describe your recommended approach to a typical deployment and implementation of the TPA, including key activities, tasks, timelines, resources, and dependencies. Does your company have a federal supply schedule contract with the scope and labor categories able to meet the requirements of this effort? Considering solicitation characteristics such as contract type, options, etc., what specific solicitation characteristics would encourage your organization to submit a proposal in response to a solicitation for these services? Why? What solicitation characteristics would discourage or prevent your organization from submitting a proposal? What would be your company’s ability to ramp up and absorb an EEE capability for a CPD managed care support effort? Is such a requirement feasible? Please submit any questions, comments, or recommendations. Information Submission Instructions: The Government encourages responses from interested parties capable of providing the entire scope of the requirement, as well as interested parties who may have specific expertise in only limited areas of this RFI. Respondents are advised that the Government will not pay for any information or administrative costs incurred in responding to this RFI. All costs associated with responding to this RFI will be solely at the responding party’s expense. Proprietary information may be submitted; however, interested parties are responsible for adequately marking proprietary, restricted, or competition sensitive information contained in their response. Proper restrictions shall be marked as such on each page. Only the Government will review this the responses to this RFI. All interested parties, including both small and large businesses, are asked to respond to the RFI using the Industry Response Matrix located in the attachment section. Respondents may also submit any additional information (limited to two pages) using PDF or MS Word formats with subject labeled as “Third Party Administrator Response.” Only electronic submissions will be accepted. Electronic files larger than 10 MB should be broken down into multiple files with no one (1) file exceeding 10 MB. Each electronic submission shall include: RFI Procurement Instrument Identification Number and “Third Party Administrator Response” in the subject line. If the submission includes more than one (1) electronic file, the file number and total files being submitted (e.g., File 1 of 4, File 2 of 4, etc.) in the subject line. A brief summary of the email’s content, the vendor’s name, point of contact, vendor size and socioeconomic status (if any), and contact information including mailing address. All responses to the RFI must be submitted electronically (via e-mail) by November 4, 2024 to: Mr. David Smith, Contracting Officer, at
[email protected], and Ms. Chelsea Lavelle, Contract Specialist, at
[email protected].