TRICARE Dental Program Request for Information

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).2. Please note that the collection of this requested information does not obligate the U.S. Government to incorporate any solicited comments 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 (FOIA). 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. The Defense Health Agency (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 Request for Information (RFI). This RFI is issued for the sole purpose of conducting market research in accordance with the Federal Acquisition Regulation (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 Department of Defense (DOD) Defense Health Agency (DHA) seeks information about methods DHA may use to improve its TRICARE Dental Program (TDP) that provides private sector dental care to active-duty family members, eligible National Guard and Reservists and their families. The intent of the RFI is to gather information from industry about commercial best practices, benchmarks, or other methods which DHA may use for upcoming contract requirements. The information will not be utilized for any purpose other than for market research in determining DHA's acquisition strategy and contract requirements, and to achieve its overall objectives under the Program. Specific requirements and additional detailed information about the Program are below.BACKGROUND: The TDP is a voluntary premium-based dental program that provides care in the continental United States (CONUS) and outside the continental United States (OCONUS) service areas. The TDP CONUS service area includes the 50 United States, the District of Columbia, Puerto Rico, Guam, and the U.S. Virgin Islands. The TDP OCONUS service area includes areas not in the CONUS service area and covered services provided aboard a ship or vessel outside the territorial waters of the CONUS service area. The next generation TDP contract will have new requirements to better meet the needs of beneficiaries:DHA expects to contract with between two and four dental insurers to provide a greater number of dental treatment providers to TDP beneficiariesDHA expects to contract with a third-party administrator to connect with the Defense Enrollment and Eligibility Reporting System (DEERS) and manage administration, to include: eligibility, enrollment, plan changes, premium payment process, submission of qualifying life events, and address changesDHA expects to establish three enrollment options for TDP: self, self plus one, and familyDHA expects to establish two different levels of dental plans, a standard option and a high optionDHA expects to establish an open season for enrollmentRFI RESPONSE FORMAT: DHA requests RFI responses in the form of a white paper in Microsoft Word (Times New Roman, 12-point font). Please submit responses in the following format:Section I. Company name, mailing address; and the name, phone number, fax number, and email of the designated point of contact.Section II. The name and contact information for the business or other organization whose views are represented in the paper if that contact information is different from that provided in Section I.Section III. Please provide responses to each of the questions listed below.QUESTIONS/REQUESTED INFORMATION: Respondents should review the background information above prior to answering the questions. Respondents are asked to draw their responses from objective, empirical, and actionable evidence and to cite this evidence within their responses. DHA is particularly interested in how the new requirements align with industry standards for employers with third party administrators and multiple dental carriers. DHA may use responses in designing the future direction of the TRICARE Dental Program.Provide a description of the company or team’s background, technical expertise, experience, staffing, and other capabilities that demonstrate its capability to provide the anticipated TDP requirements.Describe your capability and approach to manage all administrative functions including open season enrollment and qualifying life events (QLEs), three-tiers (self, self+1, and family), eligibility for multiple national dental carriers (2-4) with standard and high-option plans, and split premium payment streams (government and beneficiary).Describe your capability and approach to processing monthly reconciliations for retro eligibility.Would a Third Party Administrator (TPA) have the capability to send DHA monthly reconciled/certified bills or invoices for auditability?Are split premiums and retro eligibility unique government requirements or an industry standard? What are the major risk factors associated with split premiums and retro eligibility?If any of these requirements are unique to the government, how will these requirements impact beneficiary choice of dental carriers and cost of premiums?In commercial dental business, is it industry standard for employer tier premiums (e.g. self, self plus one, family, etc.) to vary depending on beneficiary location, or other factors or to be set for each of the tiers nation-wide?What are the pros and cons of DHA providing guidance on fixed standard and high-option tier premiums?What is the dental carrier industry standard for employer benefit plan contracts? (i.e., evergreen contracts with annual dental carrier plan renegotiations or multi-year contracts)Considering overseas beneficiaries:Do national dental carriers offer overseas dental plans?How much will costs and premium rates increase for inclusion of overseas dental plans?Will the TPA be able to administer all features of overseas plans?What percentage of enrollees change plans each open season (between standard and high) and what are the administrative costs of doing so?What percentage of enrollees change carriers each open season and what are the administrative costs of doing so?Value-based care is becoming more important in health care as health plans strive to create health value by improving health outcomes and the patient experience while controlling cost. Value-based reimbursement using alternative payment models prioritizes health value creation. What flexibility could DHA give dental carriers to incorporate alternative payment models into TDP7 provider networks?Considering solicitation characteristics such as contract type, options, etc., what specific solicitation characteristics would encourage your organization to submit a bid proposal in response to a solicitation for these services? Why?What solicitation characteristics would discourage or prevent your organization from submitting a bid proposal?THIS IS AN RFI ONLY: This RFI is issued solely for market research. It does not constitute a Request for Proposal. Interested firms shall not send proposals in response to this Notice nor shall they contact any other individuals about this Notice or the requirement. Any information provided to DHA is strictly voluntary and given with no expectation of compensation and is clearly provided at no cost to the Government. A solicitation will not be issued at this time, and this Notice shall not be construed as a commitment by the Government to issue a solicitation nor does it restrict the Government to a particular acquisition approach. The Government may issue a formal solicitation on Sam.gov website at a future date. If the Government issues a solicitation, the Government will conduct any source selection in accordance with the Federal Acquisition Regulation (FAR), as supplemented. Any future information on this acquisition (statement of work, specifications, solicitation, etc.) will be posted on Sam.gov. It is the responsibility of the prospective offeror to review this site regularly for updates and/or changes. DHA will not respond to questions about the policy issues raised in this RFI.