US Peace Corps

Office of Health Services (OHS)

Request for Information (RFI) Medical Claims Administration Services (MCAS)

This RFI is pursuant to federal acquisition regulation (FAR) part 10: Market Research.
This RFI is for acquisition planning purposes to inform the Peace Corps of the current
status of industry sources and best practices for medical claims administrative services.
This notice is not a commitment by the Government for any actual procurement and
does not constitute a solicitation or a promise of a solicitation in the future. Peace Corps
is not at this time seeking proposals or quotes, and will not accept unsolicited
proposals/quotes. Participation in this effort is voluntary; not responding to this RFI does
not preclude participation in any future solicitation, if one is issued. The Government will
not reimburse respondents for the information provided or for costs incurred in response
to this RFI. Respondents are responsible for properly marking and clearly identifying
any proprietary information or trade secrets contained within their response. Proprietary
information received in response to this sources sought will be safeguarded and
handled as marked and in accordance with applicable government regulations. The
Government will not be liable for protecting any proprietary information not properly
marked and clearly identified. Responses submitted to the Peace Corps will not be
returned. Any follow up communication regarding this RFI will be posted in Federal
Business Opportunities (www.fbo.gov). Please check the FBO.gov website for updates
we kindly ask you to not follow up for updates via email or phone.
1. BACKGROUND
As the preeminent international service organization of the United States, the Peace
Corps sends Americans abroad to tackle the most pressing needs of people around the
world. Peace Corps Volunteers work at the grassroots level toward sustainable change
that lives on long after their serviceat the same time becoming global citizens and
serving their country. When they return home, Volunteers bring their knowledge and
experiencesand a global outlookthat enriches the lives of those around them. The
Peace Corps mission is to promote world peace and friendship by fulfilling three goals:
- To help the people of interested countries in meeting their need for trained men
and women
- To help promote a better understanding of Americans on the part of the
peoples served
- To help promote a better understanding of other peoples on the part of
Americans.

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Office of Health Services (OHS)

Peace Corps is authorized to provide all necessary or appropriate health care to

Trainees and Volunteers, either in their country of service, in the United States, or in a
third country as needed.
More information about the Peace Corps can be found on www.peacecorps.gov
2. PURPOSE OF THIS REQUEST FOR INFORMATION (RFI)
This RFI is intended to inform the Peace Corps on the current status of industry sources
and best practices for medical claims administrative services.
The purpose of this notice is to obtain information regarding:
a. The availability and capability of qualified business sources; including their
DUNS, size classification relative to the North American Industry Classification
System (NAICS) code for the proposed acquisition. Whether there are other than
small business; small businesses; HUBZone small businesses; service-disabled
veteran-owned small businesses; 8(a) small businesses; veteran-owned small
businesses; woman-owned small businesses; or small disadvantaged
businesses.
b. Industries best practices for managing and administering self-insure medical
claims
c. Effective cost control methods including incentives
d. Available extensive international networks that can offer quality and cost control
e. General industry feedback.
Your responses to the information requested will assist the Government in acquisition
planning. The Peace Corps may utilize the responses to this RFI to conduct additional
market research.
3. INFORMATION REQUESTED
The Government is requesting that all interested vendors provide information regarding
their best practice experience and innovative practices to perform the types of services
outlined in Section 4 of this RFI.
Questions regarding this RFI are due January 18, 2016 at 12 noon ET please use
subject line RFI Medical Claims to ensure your questions are received. Final RFI
submissions are due January 29, 2016 at 9am ET to
cmejiasalamanca@peacecorps.gov please use subject line RFI Medical Claims to
ensure your submission is received. Submission shall be limited to up to 10 pages, 12
point font. Submissions shall contain:
a) Name, ownership, and address of firm;

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b) Size of business and socioeconomic status (i.e. other than small, small, small
disadvantaged business, woman owned, etc.);
c) Number of years in business;
d) Affiliate information;
e) Point of contact address and phone number;
f) List of existing Government Wide Acquisition Contracts (GWACS) for which you are
currently qualified;
g) What is your organizations experience in performing medical claims administrative
services? Describe the scope of services and the agency(ies) for which these services
were performed. Include names and telephone numbers of the agency representatives
with knowledge of the contract;
h) Does your company have a GSA schedule contract that includes medical claims
administrative services? What Special Identification Number (SIN) are the services
awarded under?;
i) Labor Categories Please provide pricing samples for possible labor categories for
services identified in the requirements section below.
j) Other pricing factors please provide any other pricing factors associated with
completing the requirements (cost per claim, administrative fees, IT)\
k) Peace Corps uses an electronic medical record system (EMR). Does your company
have the ability to process electronic claims forms provided through Peace Corps
EMR?
l) Do you currently have the ability to support self-insured organizations and if so,
please describe the services you provide and how you control costs while ensuring
quality of care.
m) What are the provider networks available to your company, both within the U.S. and
internationally, and how broad is their coverage? If a provider is needed in an area
where there are no network providers, how would your company determine
reimbursement rates for care?
n) How would your company determine reimbursement rates for out-of-network care;
specifically, what cost-controls and incentives would you use to allow for sufficient
coverage and high-quality care while complying with current allowable government
contracting options?
4. REQUIREMENTS
The US Peace Corps Office of Health Services (OHS) manages the healthcare of more
than 7,000 individuals in 70 countries. These individuals include: invitees, Peace Corps

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Office of Health Services (OHS)

trainees (PCTs), Peace Corps Volunteers (PCVs), and Returned Peace Corps
Volunteers (RPCVs).
The health benefits program at the Agency is a self-insurance program and is
considered primary coverage for all authorized care. The program is administered by
OHS. The current program includes three plans based on the status of the insured
individual at the agency (invitee, Volunteer, etc.). The number of applicants, volunteers,
and returned volunteers varies each year. However we have provided demographics
and information about prior years medical claims processing numbers by plan.
The demographics of Peace Corps Volunteers over the four year period 2011-2014 are
men 38%, women 62% and mean age 28. Demographic data and PCT/Vs on-board are
as of September 30 of that calendar year. Age breakdown by fiscal year:
Fiscal
Year
2011
2012
2013
2014

Age

20-29

30-39

40-49

50-59

60-69

Count
Count
Count
Count

7565
6798
5837
5586

782
547
694
648

156
142
131
126

199
217
173
158

348
332
318
253

Greater
than 70
45
37
56
47

The historical numbers for volunteers, applicants, and number of claims processed by
plan.
Fiscal Year Invitati PCT/V PCT/Vs
Plan 1
Plan 2
Plan 3
ons
s OnEnding
Medical No of Medical No Medical No
Accept board
Service
Claims
of Claims
of Claims
ed
11
*
9095
4106
9861
2994
7081
12
*
7209
4924
6200
4174
7678
13
3522
7209
4089
5339
3616
5993
14
3731
6818
4132
6509
4246
6757
*Peace Corps moved to a new process in 2013, the 2011 & 2012 data is not applicable.
The historical average cost per claim per plan by Fiscal Years 11-14
Fiscal
Year

11
12
13

Average
Plan 1
Medical
Claim
Amount
62.23
74.59
84.98

Average
Plan 2
Medical
Claim
Amount
620.31
894.41
957.62

Average
Plan 3
Medical
Claim
Amount
173.76
184.08
237.70
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Office of Health Services (OHS)

14

83.63

1024.49

204.77

Plan 1 Invitees for Peace Corps service require medical, dental, and vision
examinations in order to be evaluated for health status. Invitees are reimbursed by the
agency for these screening expenses up to a limited maximum amount for certain,
specific services. Reimbursement is provided based on proof of out of pocket expenses.
The maximum amount of reimbursement is based on an established fee schedule. The
invitee is responsible for submitting medical receipts to the medical claims
administrator.
The proposed maximum allowable reimbursement for invitees will be as follows:

Medical
Dental
Vision
Mental Health
Total

Invitee
$290
$135
$290
$280
$995

This requirement provides prompt payment of reimbursement to the invitee, upon proof
of out-of-pocket expenses, up to the maximum allowable amount.
Plan 2 - During Peace Corps service, trainees/PCVs receive routine and emergency
medical care, preventive health services, and health promotion education from their
Peace Corps Medical Officer while in-country. This care is not covered under the scope
of this RFI.
However, when volunteers are away from their posts in another country or on medical
leave, medical care may be required. Care under these circumstances is under the
scope of this RFI.
This care is provided by physicians, surgeons, counselors, psychologists, therapists,
dentists, other medical specialists and clinical providers. Primarily this care takes place
in any state within the United States (U.S.) but can take place in any country, or at a
Peace Corps-authorized regional medical center (typically in Bangkok, Thailand,
Pretoria, South Africa, or Rabat, Morocco, but can also be other regional centers). The
providers of this care are to be compensated for services provided to PCVs within the
scope of this requirement.
This requirement provides prompt payment to providers for medical services rendered
to Volunteers and Trainees. The requirement also allows for high-quality, acceptable
and medically appropriate services provided by the widest range of providers at the
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lowest cost to the agency. The agency requires the ability to send Volunteers to any
choice of provider, regardless of network affiliation.
All medical care provided under plan 2 shall be authorized in advance by the Peace
Corps. Claims are paid directly to the provider or directly to the Trainee or Volunteers
for out of pocket expenses.
Plan 3 Upon completion of Peace Corps service, Returned Peace Corps Volunteers
(RPCVs) may be authorized by the Agency for evaluation (but not treatment) of certain
health conditions related to Peace Corps service. The authorization for evaluation is
available for up to 6 months after Close of Service (COS). All treatment for conditions
proximally related to service must be provided through the Federal Employees
Compensation Act (FECA) program, administered by the Department of Labor (DoL).
The Peace Corps has been delegated a narrow authority by Department of Labor (DoL)
to provide payment authorization for limited treatment. The DoL delegated authority is
limited in dollar value (up to $1,500) and for specific, limited, clearly defined medical
conditions. The issuance of authorization by Peace Corps for DoL delegated authority
for treatment is rare and not a normal/regular occurrence under this requirement.
This requirement provides for prompt payment of authorized health care evaluations
and limited DoL authorized medical treatment for RPCVs. Services should be highquality, acceptable and medically appropriate services provided by the widest range of
providers at the lowest cost to the agency.
Plan 4 RPCVs are offered up to 3 months (1 month paid for by the agency and the
option of the RPCV purchasing an additional 2 months) group medical insurance after
close of service. This coverage should comply with the basic minimum requirements of
the Affordable Care Act.

4.1 GENERAL / Objectives

The scope of the program is to provide medical claims administrative services to the
Peace Corps Office of Health Services (OHS).
4.2 Goals
The goals of this requirement are to provide commercially available off the shelf
(COTS), accurate, timely, customer focused medical claims processing services to the
Peace Corps Office of Health Services (OHS).
4.3 LIST OF POTENTIAL TASKS
a. Task 1 Phase In
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(1) Vendor shall ensure there is appropriate coverage as the contract

starts up and transitions into full operation.
b. Task 2 Plan Medical Claims Administration
(1) Plan I reimburse medical claims promptly per the Peace Corps
established cost-share levels
(2) Plan 2 reimburse medical claims promptly per authorization of the
Peace Corps within a network, a wrap network, or after negotiation.
(3) Plan 3 reimburse medical claims promptly for RPCVs evaluation
claims per authorization of the Peace Corps within a network, a wrap
network, or after negotiation.
(4) Plan 4 provide group coverage automatically for 30 days with the
option of RPCV payment for 2 additional months of identical coverage.
c. Task 3 Customer Support
(1) IT Infrastructure
a. External Web Site for all individuals to access the general
public, applicants, invitees, trainees, volunteers, and RPCVs.
b. Web site for OHS administrative staff
c. Help desk phone line/email/call center for invitees/PCVs/RPCVs,
OHS staff, and providers with domestic and global capability
d. Ability to interface with Agency IT systems (Peace Corps
Electronic Health Record / invitee, Volunteer, RPCV status data).
e. Ability to access and enter on-line medical authorizations globally
such that OHS authorizations can be provided and tracked
electronically.
f. Ability to access an on-line claim status portal, to include the
ability to view/print the original invoice.
(2) Account Manager dedicated to the Agency requirement and represent
the vendor to the following: internal OHS, Agency representatives and
leadership.

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(3) Provide accurate information as needed to Volunteers who are

Medicare or Tricare beneficiaries with regards to maintaining coverage
and premium payments during and after Peace Corps service.
d. Task 4 Reports
(1) Quarterly Financial for all plans
(2) Bi-Annual Financial for all plans
(3) In person meeting with all of OHS at the Peace Corps HQ in
Washington, DC. (annually and as required)
(4) On demand, on line, real time data, and access to the following
accurate reports
a. Top 25 diagnosis codes (by quantity)
b. Top 25 medical claims (by cost)
c. Other assorted reports as required
e. Task 5 Financial responsibility
(1) Vendor shall provide evidence of a $2,000,000 line of credit throughout
the life of the award.
f. Task 6 Phase out
(1) Vendor shall ensure all operations are continuous and seamless as the contract
phases out.
___________________________ END ____________________________

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