SECTION C: DESCRIPTION/SPECIFICATIONS/ PERFORMANCE STATEMENT OF WORK

C.1 Peace Corps is an independent executive agency of the Federal Government established in 1961 by President John F. Kennedy to promote world peace and friendship through the service of American volunteers abroad. The volunteers’ service fulfills the three primary Peace Corps goals established in the founding legislation: 1) Improve the lives of people through grassroots assistance, 2) Foster a better understanding of Americans on the part of the people served, and 3) Foster a better understanding of other people on the part of Americans. The agency currently manages more than 7,700 volunteers in approximately 70 international posts. Peace Corps manages healthcare services for more than 15,000 individuals each year. These individuals are Applicants, Peace Corps Volunteers (PCVs), and Returned Peace Corps Volunteers (RPCVs). The health benefits program is comprised of both a self-insured and a fully insured component. Applicants for Peace Corps service receive medical, dental, and vision examinations used by VS/MS to evaluate health status. While overseas, PCVs receive routine medical care, preventive health services, and health promotion from health care professionals at Peace Corps posts. Upon completion of service, RPCVs are entitled to extend health insurance coverage for up to 18 months and may be eligible for FECA benefits under Department of Labor regulations if they meet required criteria. Peace Corps’ Volunteer health system is administered by its Office of Volunteer Support Medical Services (VS/MS), which is located at 1111 20th Street, NW, 5th Floor, Washington, D.C. 20526. Peace Corps Self-Insured Program Background Information: Peace Corps applicants submit their medical receipts for exams required for clearance into Peace Corps and receive a cost-sharing reimbursement fee. The maximums for reimbursement are based on an age and gender formula and are reimbursed to the beneficiary. When in the US on leave status, PCVs who require routine medical or dental care receive health care services from US providers whose costs are paid for by Peace Corps through a self-insured health benefits program. All healthcare services provided to beneficiaries must be pre-authorized by Peace Corps and are reimbursed to the beneficiary or paid to the provider in accordance with Peace Corps Health Benefits Program fee schedule. Returned Peace Corps Volunteers (RPCVs) who require post-service evaluation may receive services from local providers. Pre-authorized services are generally provided in the US, but may

be provided overseas. Payments made for evaluations provided to eligible claimants are reimbursed by Peace Corps. RPCVs who require post-service treatment for health conditions stemming from or exacerbated by overseas service are entitled to petition for relief under the Federal Employees Compensation Act (FECA). Conditions with onset during Peace Corps service, which are service-connected, as well as pre-existing conditions aggravated, accelerated or precipitated by service are covered under FECA. While outside the United States, all PCVs are considered "employed" 24 hours a day, 7 days per week for the purpose of access to FECA benefits. All service-related conditions, with or without associated disability, are eligible for FECA benefits through the US Department of Labor. FECA benefits are separate from and in addition to benefits provided by a fully insured program for those conditions not related to Peace Corps service. Peace Corps Fully Insured Program Peace Corps has a requirement for Post-Service Health Insurance coverage for Returned Peace Corps Volunteers (RPCVs) similar to that which is available under Federal Employees Health Benefits (FEHB) Temporary Continuation of Coverage (TCC) (5 U.S.C. §8905a). All RPCVs shall be enrolled at end of their Peace Corps service, regardless of length of service. Peace Corps will pay the first month’s premium of the primary plan for the RPCVs. Extension of this coverage beyond the first month will be at the RPCVs discretion, expense and at the premium amount stated in this contract. Approximately 4,200 Volunteers close service annually and enrollment levels may and will fluctuate based on and in response to overseas program expansions and completions. There is no minimum and no maximum number of people that the Government may require to be covered under this contract. C.2 SCOPE

The scope of this contract is to provide services to Peace Corps in the support and administration of all components of its Health Benefits Program. There are two components to the program, the ―self-insured‖ and the ―fully- insured: Peace Corps Self-insured Component for PCVs, RPCVs [and Their Dependents] 1. Provider Network Component – The contract shall: a. Provide access to a network of hospitals, qualified physicians, ancillary service providers, mental health professionals, dentists, and diagnostic and treatment facilities with the capacity to meet the healthcare needs of PCVs med-evaced to the Washington, D.C. metro area and to provide professional consultation for Peace Corps medical staff. Herein referred to as the Washington D.C. Service Network. b. Provide access to a national Preferred Provider Network (PPO) of hospitals, physicians, ancillary service providers, mental health professionals, dentists, and diagnostic and treatment facilities with the capacity to meet the healthcare needs of PCVs and RPCVs in the United States for medical evacuation to home-of-record, medical hold, home leave or administrative leave. This does include coverage for the PCV while in travel mode.

c. Provide access to a Preferred Provider Network (PPO) of hospitals, physicians, ancillary service providers, mental health professionals, dentists, and diagnostic and treatment facilities with the capacity to meet the healthcare needs of PCVs and RPCVs internationally, when requested. 2. Pharmaceutical Component – The contractor shall: Provide access to a managed prescription drug service for use by PCVs while they are in the US on medical hold or authorized leave. 3. Claims Component – The contractor shall a. Support the administrative and financial management of and provide claims processing and reimbursement and payment services for Peace Corps’ Health Benefits Program. b. Provide claims re-pricing and discount services for the national PPO. Peace Corps Fully Insured Component for RPCVs The contractor shall: 1. Provide pricing for each of the options on the ― Benefit Schedule‖ (Appendix 1 of PWS) 2. Provide two plan designs, primary plan provides coverage the first month after completion of service (Peace Corps pays one month premium), second plan available after first month and optional for extension coverage (RPCV pays). 3. Guarantee issuance to all eligible Volunteers, spouses and minor dependents, effective 12 midnight on the date the PCVs end their service consistent with the provisions of TCC (Temporary Continuation of Coverage) for spouses and dependents. 4. Provide emergency medical evacuation to the U.S. or to the closest adequate facility. 5. Premiums, deductibles and co-payments that meet or exceed the benefits requirements of an FEHB/TCC plan. 6. Provide a program that ensures that eligibility and portability are consistent with all provisions of the Health Insurance Portability and Accountability Act (HIPAA) at all times during the performance of this contract. 7. Provide detailed benefits structure of the plan and provision of a copy of the proposed insurance contract between beneficiary and insurer. 8. Not increase premiums or deductibles and not change coverage for the first year of performance of the contract. 9. Provide extension of coverage beyond 18 months, for as long a period as possible, for individuals who are, or become, unable to work because of a medical condition, is strongly desired. 10. Provide detailed procedures for provision of coordination of benefits with both Peace Corps post-service evaluation and FECA medical benefits. These procedures should identify primary responsibility for coverage in all circumstances. The circumstances which must be addressed include: PC service related conditions; pre-existing conditions

which are exacerbated, accelerated or precipitated by PC service; pre-existing conditions which are not exacerbated, accelerated or precipitated by PC service; illness or injury sustained in the United States during service while Volunteer is not on Peace Corps business (home leave, emergency leave, etc.); and illness or injury sustained after end of service. 11. If a provider network or other managed care arrangement is proposed, the Contractor shall provide: Name of the network; Availability and reach of the network; How the RPCV gets access to the provider network; and Relationship between Contractor and provider network or other managed care arrangement 12. Provide electronic and on-line access for premium payments, enrollments, extensions, benefit detail, certificates, provider network searches, claim submission, claims assistance, inquiries, issues and updates. 13 The Contractor shall provide the COTR a monthly report of all rejected claims. C.3 GENERAL REQUIREMENTS OF THE CONTRACTOR

Peace Corps is especially committed to doing no harm, to acting in good faith, and to preserving its reputation as an agent of goodwill in the eyes of beneficiaries of its Health Benefits Program and of the American public. The Contractor, therefore, shall provide access to high quality, responsive, timely healthcare and administrative services in a manner that preserves Peace Corps’ good working relationship with beneficiaries of its Health Benefits Program. The Contractor shall:— a) Provide satisfactory assurances that the Contractor and all affiliated contractors will maintain and protect the confidentiality of ―protected health information‖, health insurance medical records, documents, and claims received from the Peace Corps, as required by HIPAA. At all times, b) Comply with, and require that all affiliated contractors comply with, the Health Information Portability and Accountability Act (HIPAA) and the Privacy Act for the duration of the performance period of this Contract. c) Keep Peace Corps’ Contracting Officer Technical Representative (COTR) apprised of incidents, situations, and circumstances that affect the administration, management, financial viability or costs associated with its health insurance program on an ongoing basis, recommending action to resolve those issues that require immediate intervention. d) Attend meetings called by Peace Corps to investigate and/or resolve incidents, situations, and circumstances that affect the administration, management, or costs associated with its Health Benefits or Health Insurance Program. e) Administer Peace Corps’ Health Benefits Program components in accordance with the policies established by Peace Corps for each benefit PLAN. f) Manage the accounts of Peace Corps’ Health Benefits Program on a Federal Government

Fiscal Year schedule beginning October 1st and ending the following September 30th. g) Designate an account representative to serve as ongoing liaison to Peace Corps. This account representative, or a designee duly authorized to act in the account representative's absence, shall be available to handle inquiries made by Peace Corps’ personnel between the hours of 9:00 a.m. and 6:00 p.m. Eastern Time on established US Government workdays. h) Maintain a current minimum financial strength rating of A - (excellent) as assigned by A.M. Best and/or Standard and Poor’s current minimum of AA (very strong). Provide satisfactory assurances that the Contractor and all subcontractors, insurers, claims and program administrators report on a regular basis and maintain acceptable financial stability, required licensing and service ratings from rating organizations such as A. M. Best and/or Standard and Poor’s. i) No Contractor employees will be required to work on site. j) No claims processing staff are subject to Peace Corps personnel security clearances. k) The Contractor shall provide staff to adjudicate claims in 10 business days from the date the claim is received by the Contractor. l) The Contractor is not required to pay any interest payment on claims paid later than 10 business days. m) Preferred length of record retention is 7 years beyond the close of the fiscal year in which the claim was adjudicated. Paper copies of claims must be maintained for 3 years from the date of final adjudication including any appeals. C.3.1 PROVIDER NETWORK COMPONENT C.3.1.1Contract Requirements of the Washington D.C. Service Network The Contractor is not required to provide overseas healthcare, to arrange for the transportation or logistical support of, nor to manage the course of evaluation and treatment of any beneficiary of Peace Corps’ Health Benefits Program while the beneficiary is outside the United States. The Contractor shall provide access to a network of qualified physicians and ancillary service providers, mental health professionals, dentists, and diagnostic and treatment facilities (the ―Washington D.C. Service Network‖) with the capacity to meet the healthcare needs of medevaced PLAN II PCVs and their minor dependents whose medical, mental, and/or dental conditions have been evaluated and deemed beyond appropriate management in an overseas environment and who are med-evaced under Peace Corps’ authority to the Washington, D.C. metro area for evaluation and/or treatment. . The Contractor shall provide access to medical and dental service through 1) a single network that includes physicians and dentists or 2) separate medical and dental provider networks.

The Contractor shall integrate current network providers (Georgetown University Hospital, George Washington University Hospital, Sibley Hospital, Virginia Hospital Center, and DC Service network with a network broker to maximize re-pricing opportunities on all out of network claims submitted. C.3.1.2Service Requirements of the Washington D.C. Service Network The Contractor shall-a) Ensure that practitioners and facilities affiliated with the Washington D.C. Service Network allow 24-hour phone access for the purposes of emergency inquiry and 24-hour access to emergency evaluation and treatment facilities 365 days a year. b) Establish and maintain mechanisms to ensure that in-network referrals for evaluation and treatment are given priority attention by practitioners and facilities affiliated with the Washington D.C. Service Network. Priority attention is defined as services that occur or commence within two business days of an in-network referral. c) Facilitate timely communication and transmission of medical reports and records from practitioners and facilities affiliated with the Washington D.C. Service Network to Peace Corps’ medical staff. Timely communication and transmission is defined as 1) a complete response to a telephone inquiry or written report issued and mailed or faxed by the service provider within 24 hours of an evaluation or treatment and 2) a written report issued and mailed or faxed by the service provider within five business days of the end of a course of evaluation and/or treatment. d) Provide general practice and specialist physicians, mental health professionals, and dentists who are qualified based on the required license, board-certification and credentials for their respective areas of practice. They must also be in good professional standing to meet the health needs of med-evaced PLAN II PCVs and practice within a ten (10) mile radius of Peace Corps’ Washington D.C. headquarters building at 1111 20th Street, NW. e) Provide institutional care to meet the health needs of med-evaced PLAN II PCVs at treatment facilities that are accredited and/or Medicaid/Medicare certified and state licensed as appropriate and are located within a ten (10) mile radius of Peace Corps’ Washington D.C. headquarters building at 1111 20th Street, NW. f) Establish and maintain a mechanism to ensure that practitioners and facilities affiliated with the Washington D.C. Service Network provide 24-hour telephone access to specialists for the purpose of professional consultation with Peace Corps’ medical staff. g) Administer a procedure for credentialing physicians, mental health professionals, and dentists affiliated with the Service Network. Re-credentialing of Washington D.C. Service Network providers shall occur no less than once every three years. h) Establish, administer, and facilitate a procedure that permits other qualified physicians, mental health professionals, and dentists referred to the Washington D.C. Service Network

by Peace Corps who agree to accept the fees and meet other requirements of the Washington D.C. Service Network to affiliate with the network. These providers will be known as the Open Panel. Re-credentialing of Open Panel providers shall occur no less than once every three years. i) Administer a procedure for assuring that hospitals, diagnostic and treatment facilities affiliated with the Washington D.C. Service Network maintain appropriate accreditation and/or certification. In the event that a facility within the Washington D.C. Service Network loses its accreditation, certification, and or state license, the Contractor shall give written notice to Peace Corps within 24 hours of learning of the loss of accreditation or certification. j) Assure that practitioners and facilities affiliated with the Washington D.C. Service Network and Open Panel accept payment for services made in accordance with Peace Corps’ Health Benefits Program fee schedules as payment in full and that these practitioners and facilities refrain from billing or otherwise attempting to collect any balance that exceeds authorized payment or reimbursement amounts for services provided to PLAN II PCVs or PLAN III RPCVs beneficiaries. k) Inform the Washington D.C. Service Network and Open Panel providers of Peace Corps’ service requirements and policies prior to contract implementation and do so again within thirty days following any subsequent contract renewal or contract modification that affects service requirements or operating procedures. l) Should Peace Corps’ medical staff make a referral for service to an out-of-network provider, the Contractor assure that staff and persons and facilities affiliated with the Washington D.C. Service Network and Open Panel cooperate with and do not impede the Peace Corps’ effort to undertake the referral. C.3.1.3Contract Requirements for the National PPO The Contractor shall provide access to a National PPO for services provided to all beneficiaries with proper authorization. A National PPO shall operate in all 50 states in the US. Contractor shall: a) Assure access to the managed prescription drug services 24 hours a day, 365 days a year; b) Provide Peace Corps with identification cards for the National PPO to be issued to eligible beneficiaries to provide a mechanism that permits individual access to providers in the network anywhere in the US including Alaska and Hawaii. c) Inform National PPO providers of Peace Corps’ service requirements and policies prior to contract implementation and again within thirty days following any subsequent contract renewal or contract modification that affects service requirements or operating procedures. d) Ensure that the National PPO complies with HIPAA requirements, as applicable at all times during the performance of this Contract and any Subcontracts to this Contract.

C.3.1.4 Contract Requirements for International PPO To provide access to a Preferred Provider Network (PPO) of hospitals, physicians, ancillary service providers, mental health professionals, dentists, and diagnostic and treatment facilities with the capacity to meet the healthcare needs of PCVs[, and their dependents,] and RPCVs[, and their dependents,] internationally, when requested. C.3.1.5 Quality Assurance of the Network Provider Component The Contractor shall provide and maintain a quality assurance and improvement program, which shall be approved by Peace Corps, 30 days after contract award. This program shall include, but not be limited to, 1) a procedure for reviewing and resolving complaints regarding the Washington D.C. Service Network, and National PPO and 2) a procedure for terminating affiliation with hospitals, physicians, ancillary service providers, mental health professionals, dentists, and diagnostic and treatment facilities affiliated with the Washington D.C. Service Network Service Network, and National PPO. In the event that the Contractor terminates affiliation with practitioners or facilities within the Washington D.C. Service Network Service Network, The Contractor shall give written notice to Peace Corps within 24 hours of terminating the affiliation. Such notice shall identify the Contractor’s replacement affiliate/Subcontractor and any new benefits that exceed those stated in this Contract. At no time shall the Contractor affiliate with a replacement provider for benefits that do not meet or exceed the requirements in this Contract. C.3.1.6Procedures and Reports of the Network Provider Component Procedures Thirty days after contract award and every 180 days thereafter, the Contractor shall provide Peace Corps with 1 hard copy and electronic access to an updated procedures manual that contains, but is not limited to: a) the names of the Contractor's account representative and other key personnel, their phone and fax numbers, and their mailing addresses; b) a physical and electronic directory listing the members of the Washington D.C. Service Network and Open Panel providers, their specialties, their phone and fax numbers, and their mailing addresses; c) a description of routine and emergency procedures for accessing the Washington D.C. Service Network; d) a description of routine and emergency procedures for accessing the National PPO Service Network; e) a description of the procedure for issuing identification cards to eligible beneficiaries of Peace Corps’ Health Benefit Program;

f) a description of the procedure for receiving, monitoring, and resolving complaints that may be brought by Peace Corps to the Contractor's attention regarding Washington D.C. Service Network Service Network, the National PPO Network and Open Panel providers; and g) a description of the Contractor's procedure for credentialing, for affiliating with, and for terminating affiliation between practitioners and facilities affiliated with the Washington D.C. Service Network, the National PPO Network and the International PPO Network

Reporting Requirements a) The Contractor shall provide Peace Corps with access to an electronic directory of Peace Corps Washington D.C. Service Network, Open Panel providers, National PPO Network and shall notify the COTR of changes as they occur. b) Annually, the Contractor shall provide Peace Corps with credentialing, accreditation or certification reports pertaining to Washington D.C. Service Network, and the National PPO Network c) Quarterly, the Contractor shall provide to Peace Corps a quarterly activity report which must include estimated cost savings and enhanced service levels of contract activities obtained through the use of the National PPO Network and claims re-pricing

Records of Complaints The Contractor shall maintain accurate and complete records of complaints regarding the Washington D.C. Service Network, National PPO Network, and International PPO Network. ―Complaints‖ are defined as verbal or written notices of dissatisfaction with service providers. These records shall be made available to Peace Corps upon the formal written request of the COTR and or the Contracting Officer. Meetings Annually, the Contractor shall meet with Peace Corps COTR and others as appropriate to present the findings of the Contractor’s quality assurance and improvement program. Intermittently, upon the formal written request of the COTR, the Contractor shall organize and attend meetings between Peace Corps personnel and representatives and/or providers affiliated with the Washington D.C. Service Network and/or Subcontractors. Administration of the RPCV Health Insurance Program The administration of the program shall include: a) Process for notifying RPCVs of their health insurance benefits.

b) Process for election for continued coverage beyond first month. c) If any restrictions on enrollment exist, the process for determining eligibility to enroll for extended coverage d) Process for payment of the first month's premium by the Peace Corps to the insurer for all Volunteers at COS. e) Process for identifying individuals who are beneficiaries and "activating" extended coverage. f) Process for notifying RPCVs of the need to pay premiums after first month's coverage. g) Process for allowing RPCVs to pay insurer directly for subsequent premiums for month(s) beyond the first month. h) Process for coordination of benefits with the FECA program, Medicare and other payers. i) Process for handling telephone questions, mail and email from beneficiaries Process for confirming enrollment with an identification card. j) 24-hour telephone service for emergency phone calls and other 24-hour mechanisms for emergency contact where telephone service is not available Reports a) The Contractor shall provide monthly and quarterly Administrative reports to the Contracting Officer and the COTR which detail, at a minimum, the number of premium months provided and claims experience and such other information that is typically included in such reports. The reports must also include information pertaining to the post and regional location of the eligible and enrolled RPCVs and/or their dependents. b) The Contractor shall provide quarterly customer service satisfaction reports based on RPCVs feedback, claims processing time, and appeal activity C.3.2 PHARMACEUTICAL COMPONENT C.3.2.1Contract Requirements of the Pharmaceutical Component The Contractor shall provide access to a managed prescription drug service for use by PLAN II PCVs who are med-evaced to the US or who are on authorized leave in the US. , the Contractor is not required to provide prescription drug services for PLAN I Applicants, for PLAN II PCVs in overseas locations, or for PLAN III RPCVs. C.3.2.2Service Requirements of the Pharmaceutical Component The Contractor shall designate an account representative to serve as ongoing liaison to Peace Corps. This account representative, or a designee duly authorized to act in the account representative's absence, shall be available to handle inquiries made by Peace Corps’ personnel between the hours of 9:00 a.m. and 6:00 p.m. Eastern Time on established US government workdays. In addition, the Contractor shall: a) Assure access to the managed prescription drug services 24 hours a day, 365 days a year; b) Provide the Peace Corps with identification cards to be issued to eligible beneficiaries of managed prescription drug services;

c) Provide a mechanism that permits managed prescription drug providers to ascertain individual eligibility for pharmaceutical services at point of service; and d) Inform managed prescription drug service providers of Peace Corps’ service requirements and policies prior to contract implementation and again within thirty days following any subsequent contract renewal or contract modification that affects service requirements or operating procedures.

C.3.2.3Quality Assurance of the Pharmaceutical Component The Contractor shall establish and maintain a quality assurance and improvement program, which shall be approved by Peace Corps. This program shall include, but not be limited to appropriate standards for and procedures for 1) monitoring and improving pharmaceutical claims made/paid turnaround times; 2) monitoring and improving customer service response times; 3) monitoring and reducing the rates of pharmaceutical claims denied; 4) monitoring and reducing financial and non-financial error rates; 5) documenting and resolving customer service complaints.

C.3.2.4 Procedures and Reports of the Pharmaceutical Component Procedures Thirty days after contract Date of Award and every 180 days thereafter, the Contractor shall provide the Peace Corps with 1 hard copy and electronic access to an updated procedure manual that contains, but is not limited to: a) the names of the Pharmaceutical Contractor's account representative and other key personnel, their phone and fax numbers, and their mailing addresses; b) a description of the procedure for issuing identification cards to eligible beneficiaries of the Peace Corps Health Benefits Program; c) a description of the procedure for accessing the Pharmaceutical Contractor's managed prescription drug service; and d) a summary of benefits and access instructions suitable for distribution to the Peace Corps Health Benefit Program members. C.3.2.5 Reports The Contractor shall deliver 1 hard copy and electronic access to a monthly drug utilization report to Peace Corps, Beginning 30 days after contract Date of Award and every 30 days thereafter during the term of the Contract,. The utilization report shall identify the names of drugs provided and the therapeutic classification of those drugs ranked in order of 1) number of prescriptions filled and 2) cost to Peace Corps. The report shall also summarize: 1) number of claims processed, 2) number of claims denied, 3) number of claims paid, 4) number of paid single source brand claims, 5) number of paid multi-source brand claims, 6) number of paid

generic claims, 7) percent of generic use, 8) percent of generic conversion, 9) savings from generic substitution, 10) number of generic conversions missed and 11) report claims trends. Ninety days after the end of a fiscal year and every year thereafter during the term of the Contract, the Contractor shall deliver 2 copies of an annual drug utilization report to Peace Corps. C.3.2.6Records The Contractor shall maintain an accurate and complete claims record for each individual beneficiary. C.3.3 CLAIMS COMPONENT C.3.3.1Contract Requirements of the Claims Component The Contractor shall accurately and promptly process, reimburse/pay, or deny in accordance with Peace Corps’ Health Benefit Program policy all claims for authorized healthcare submitted on behalf of eligible Peace Corps’ Health Benefits Program PLAN I Applicants, PLAN II PCVs and their dependents, and PLAN III RPCVs and their dependents. The Contractor shall not charge a deductible fee nor charge a co-payment to any Peace Corps Health Benefits Program participant. The Contractor shall not, however, assume any liability for deductibles, co-payments, or bills for the balance between claims made and claims paid. The Contractor shall, however, be held liable for reimbursement or payment of any fraudulent, wasteful, or abusive claim, for reimbursement or payment of an unauthorized or unallowable claim or of a payment or reimbursement made on behalf of an ineligible person. C3.3.2Service Requirements for Fully Insured Claims The Contractor shall designate a claims account representative to serve as ongoing liaison to Peace Corps. This claims account representative, or a designee duly authorized to act in the claims account representative's absence, shall be available to handle inquiries made between the hours of 9:00 a.m. and 6:00 p.m. Eastern Time on established US Federal Government workdays. The Contractor shall provide a message system to record inquiries made at all other times. In addition, the Contractor shall-a) Provide customer service agents and email address(es) sufficient to respond to inquiries regarding participant eligibility, claims processing, fee schedules, and reimbursements/payments in a timely manner. These customer service agents shall be dedicated solely to responding to RPCVs, Peace Corps personnel, and service providers. They shall be available for inquiry between the hours of 9:00 a.m. and 6:00 p.m. Eastern Time on established US Federal Government workdays. The Contractor shall provide a

message system to record inquiries made at all other times. b) Provide appropriate office equipment, scanners, on-line access, systems and claims processors sufficient to review and adjudicate claims in a timely manner. These claims processors shall be dedicated solely to the PC health insurance program. c) d) Provide toll-free telephone service to receive inquiries regarding eligibility, claims processing, and reimbursements/payments. e) f) Provide prompt claims processing for reimbursements/payments, refunds and voids. g) The Contractor shall establish and maintain a quality assurance and improvement program. This program shall include, but not be limited to, appropriate standards and procedures for 1) monitoring and improving claims made/paid turnaround times; 2) monitoring and improving customer service response times; 3) monitoring and reducing the rates of claims denied; 4) monitoring and reducing financial and non-financial error rates; 5) documenting and resolving customer service complaints. h) Attach an appropriate Explanation of Benefits (EOB) notice to each reimbursement/payment i) Administer a claims appeal procedure that enables RPCVs and service providers to dispute and to resolve disagreements over claims payments. j) Maintain secure, automated healthcare claims processing and accounting systems that provide the following minimal features: documentation of responsibilities for system security and for administration; documentation of claims system policies and procedures; security monitoring procedures, user account and password security; data center security; daily backup procedures; disaster recovery plan procedures; a business continuity plan; limited access to programs and the ability to change programs based on various levels of system operators' needs to know and utilize the same; and limited access to eligibility, beneficiary, and provider information based on various levels of system operators' needs to know and utilize the same. k) Comply with HIPAA Electronic Health Care Transactions and Code Sets standards. Provide, with Peace Corps’ coordination, secure procedures that permit Peace Corps to transmit eligibility data, authorize healthcare services, and obtain all Peace Corps health insurance program information held in the healthcare claims processing system. Maintain, in the healthcare claims processing system, accurate, current as of 30 days provider information. l) Provide and maintain capacity to receive Peace Corps eligibility data via Secured File Transfer Protocol (SFTP). m) Utilize and report for each claim the most current HCFA (Healthcare Financing Administration) Common Procedural Codes, CMS (Centers for Medicare and Medicaid), revenue codes, CPT (Current Procedural Terminology), ICD (International Classification of Diseases) diagnosis and procedure, DSM (Diagnostic and Statistical Manual), and ADA (dental) codes for all health services referenced in the claim. n) Have the capacity to identify potential instances of fraudulent, abusive, or wasteful claims. m) Have the capacity to process claims under subrogation and claims involving no-fault. Have the capacity to and identifies potential workers' compensation claims. The Claims Contractor shall refer such claims to the designated Peace Corps’ Federal Employees'

Compensation Act (FECA) liaison and assist that liaison in the determination of eligibility as needed. n) Have the translation and currency conversion capacity to and does manage financial transactions that occur as a result of healthcare services provided in foreign countries and shall report these transactions to Peace Corps in terms of US dollars only. p) Have the ability to make electronic international bank transfer payments via correspondent US financial institutions. q) Conduct an internal audit of all claims in amounts greater than $10,000 made for services provided to a single payee on behalf of a single beneficiary for a single incident., r) Monitor and report cost and utilization information associated with claim reimbursement and payment and recommend and/or implement at Peace Corps’ direction measures to control or reduce costs for medical treatment provided. s) Produce, print, distribute and update program brochure materials and other relevant program materials based on supply levels and plan changes. t) Make available, via website or other electronic access, plan outlines, certificates, enrollment process, renewal notices and payment options. u) Provide payment options that include credit card, month-to-month billing and utilization of Peace Corps RPCV readjustment allowances. v) Have the capacity to identify potential instances of fraudulent, abusive, or wasteful claims. Thus, the healthcare claims processing system shall be automated to the degree that it: (1) assures individual eligibility for benefits; (2) assures only claims for allowable services are reimbursed/paid; (3) assures reimbursements/payments do not exceed established schedules; (4) eliminates reimbursement/payment of duplicate claims; (5) reconciles diagnosis codes to procedure and gender codes; (6) compares the number of inpatient facility days on each claim against admission and discharge dates; and (7) compares claims made to claims reimbursed/paid. C.3.4 SERVICE REQUIREMENT FOR SELF-INSURED CLAIMS The Contractor shall designate an account representative to serve as ongoing liaison to Peace Corps. [This should be a key personnel position. We need to identify the key personnel. This account representative, or a designee duly authorized to act in the account representative's absence, shall be available to handle inquiries made by Peace Corps between the hours of 9:00 a.m. and 6:00 p.m. Eastern Time on established US Federal Government workdays. The Contractor shall provide a message system to record inquiries made at all other times. In addition, the Contractor shall-a) Provide customer service agents sufficient to respond to inquiries regarding participant eligibility, claims processing, fee schedules, and reimbursements/payments in a timely manner consistent with commercial standards They shall be available for inquiry between the hours of 9:00 a.m. and 6:00 p.m. Eastern Time on established US Federal Government workdays. The Contractor shall provide a message system to record inquiries made at all other times. b) Provide claims processors to review and adjudicate Peace Corps’ Health Benefits

c) Provide toll-free telephone service to receive inquiries regarding eligibility, claims processing, and reimbursements/payments. d) Log all claims and supporting documentation received into the healthcare claims processing system within 24 hours of receipt from beneficiary. e) Adjudicate all claims for services provided in the US within ten business days of receipt; f) Pay ―clean‖ claims within 20 business days of receipt. For the purposes of this Contract, a ―clean‖ claim is defined as one submitted on behalf of an eligible PLAN participant for authorized, allowable healthcare services that were provided in the US and are appropriately documented; and g) Adjudicate claims for services provided outside of the US within thirty business days of receipt.

h) Administer timely procedures for reviewing and resolving claims pended or denied due to: (1) lack of authorization; (2) questions regarding participant eligibility; (3) incomplete itemization; (4) non-standard claims information; (5) balance billing; (6) excess charges; and (7) Questions regarding whether services are allowable under Peace Corps’ Health Benefit Program. i) Attach an appropriate Explanation of Benefits (EOB) notice to each reimbursement/payment made under one of the Peace Corps’ three health benefit plans. The EOB shall include notice: (1) that the reimbursement/payment is made according to Peace Corps’ Benefit Program fee schedules and shall be considered payment in full for services; (2) for PLAN II and PLAN III, that Peace Corps’ Health Benefit Program prohibits billing beneficiaries for differences between claims made and claims paid; and (3) of claimants' rights to appeal disputed claims. j) Administer a claims appeal procedure that enables Peace Corps’ Health Benefit Program members and US service providers to dispute and to resolve disagreements over claims payment in amounts of $250 or less. k) Maintain secure, automated healthcare claims processing and accounting systems that provide the following minimal features: documentation of responsibilities for system security and for administration; documentation of claims system policies and procedures; security monitoring procedures, user account and password security; data center security; daily backup procedures; disaster recovery plan procedures; a business continuity plan; limited access to programs and the ability to change programs based on various levels of system operators' needs to know and utilize the same; and limited access to eligibility, beneficiary, and provider information based on various levels of system operators' needs to know and utilize the same. Comply with HIPAA Electronic Health Care Transactions and Code Sets

standards. Provide, with Peace Corps’ coordination, secure procedures that permit Peace Corps to transmit eligibility data, authorize healthcare services, and obtain all Peace Corps Health Benefits Program information held in the healthcare claims processing system. l) Maintain, in the healthcare claims processing system, accurate, up-to-date provider information. m) Utilize and report for each claim the most current HCFA Common Procedural Codes, CMS, revenue codes, CPT, ICD (International Classification of Diseases) diagnosis and procedure, DSM (Diagnostic and Statistical Manual), and ADA (dental) codes for all health services referenced in the claim. n) Have the capacity to identify potential instances of fraudulent, abusive, or wasteful claims. Thus, the healthcare claims processing system shall be automated to the degree that it: (8) assures individual eligibility for benefits; (9) assures only claims for allowable services are reimbursed/paid; (10) assures reimbursements/payments do not exceed established schedules; (11) eliminates reimbursement/payment of duplicate claims; (12) reconciles diagnosis codes to procedure and gender codes; (13) compares the number of inpatient facility days on each claim against admission and discharge dates; and (14) compares claims made to claims reimbursed/paid. o) Have the capacity to process claims under subrogation and claims involving no-fault. p) Have the capacity to and identifies potential workers' compensation claims. The Adjudicator shall refer such claims to the designated Peace Corps’ Federal Employees' Compensation Act (FECA) liaison and assist that liaison in the determination of eligibility as needed. A description of the Peace Corps’ FECA procedures appears in Section J.10. Confirm attachments are correctly labeled. q) Have the translation and currency conversion capacity to manage financial transactions that occur as a result of healthcare services provided in foreign countries and shall report these transactions to Peace Corps in terms of US dollars only. r) Have the ability to make electronic international bank transfer payments via correspondent US financial institutions. Conduct an internal audit of all claims in amounts greater than $10,000 made for services provided to a single payee on behalf of a single beneficiary for a single incident s) Monitor and report cost and utilization information associated with claim reimbursement and payment and recommend measures to control or reduce costs for the medical treatment services provided beneficiaries of Peace Corps’ Health Benefits Program.

C.3.4.1Quality Assurance of the Claims Component The Contractor shall establish and maintain a quality assurance and improvement program, which shall be approved by Peace Corps. This program shall include, but not be limited to, appropriate standards and procedures for 1) monitoring and improving claims made/paid turnaround times; 2) monitoring and improving customer service response times; 3) monitoring and reducing the rates of claims pended; 4) monitoring and reducing the rates of claims denied; 5) monitoring and reducing financial and non-financial error rates; 6) documenting and resolving customer service complaints. Procedures and Reports of the Claims Component

C.3.4.2Procedures The Contractor shall, 30 days after contract Date of Award, provide the Peace Corps with 1 copy and electronic access to a procedures manual that conforms to a format mutually agreed upon by the Contractor and Peace Corps. Every one-hundred eighty (180) days thereafter, the Contractor shall update the procedures manual and provide Peace Corps with 1 copy and electronic access. This procedures manual shall include, but is not limited to: the names of the Claims Contractor’s account representative and other key Contract personnel, their phone and fax numbers, and their mailing addresses description of the appeals procedure to be used to resolve disputed claims in amounts of $250 or less a description of the procedure for resolving complaints between Peace Corps personnel or Peace Corps’ Health Benefits Program members and the Claims Contractor’s healthcare claims processing system personnel or customer service agents regarding authorizations or claims inquiries; a) a description of the business rules used to program the healthcare claims processing system logic for eligibility, allowable benefits, and reimbursement/payment rates for claims made under three benefit PLANs; b) examples of the Explanation of Benefits used for Peace Corps’ three health benefit PLANs;

c) a description of the procedure and medium to be used by Peace Corps to transmit eligibility information to, authorize services, and obtain information from the healthcare claims processing system;

d) a description of the procedure to be used by Peace Corps to access health plan information via electronic interface;

e) a description of the procedures to be undertaken in the event of electronic interface failure or healthcare claims processing system shut-down f) a timetable for the delivery of monthly, quarterly, and annual reports; and g) the dates of quarterly and annual meetings scheduled between the Contractor and Peace Corps.

Reports The Contractor shall deliver to Peace Corps one hard copy and electronic access to each of the following reports— Monthly: (1) A summary of the claims paid, aggregate dollar amounts of claims made and of claims paid, and average claim cost by fiscal year for each of the three health benefit PLANs. To permit reconciliation with payments made to the Contractor, this report shall be generated from the Contractor’s accounting system; (2) for the past month, a report of the findings of the Contractor’s internal audits of claims in amounts greater than $10,000; (3) a fiscal year-to-date report of claims made/paid turnaround times for three health benefit PLANs; (4) a current report of claims pended, categorized by benefit PLAN, that identifies each claim, dollar value of the claim made, provider name, date of service, date of claim, member name, and reason for claim pended; (5) for the past month, a report of claims denied, categorized by benefit PLAN, that describes the numbers, reasons, and dollar value of claims denied; (6) for the past month, a report of customer service inquiries made to the Contractor that describes the number, means, and reason for inquiry; and (7) a fiscal year-to-date report of aggregate amounts paid to individual service providers listed alphabetically in order of the payee’s name that includes the payee’s specialty, address, zip code and Federal Identification Number or other identifier for foreign providers for the past month reports on specific groupings to include, but not limited to Med-evac, a summary of the claims paid, aggregate dollar amounts of claims made and of claims paid, and total claim cost by fiscal year for each of the categories requested. (8) for the past month, and aggregate year to date, Mental Health Report organized by month, PLAN and provider. (9) for the past month, a summary report of total paid PLAN I, II and III the amount paid for inpatient, outpatient, med-evac and aggregate year to date. (10) For the past month, a summary report of the top 25 diagnoses by dollar and claim volume, organized by PLAN and provider. Quarterly: (1) Electronic access to a database and/or electronic copy of the database organized by

(2)

(3)

PLAN that summarizes services provided to beneficiaries and that is organized in alphabetical order of the member’s last name. Detail shall include each beneficiary’s Social Security Number, date of birth, gender, country of service, ICD (International Classification of Diseases) diagnosis codes or DSM (Diagnostic and Statistical Manual) codes, CPT codes reflecting the services provided, the state or country in which services were provided, and the aggregate amount of reimbursements and/or payments made on behalf of the beneficiary; and a hard copy fiscal year-to-date report of PLAN II and PLAN III beneficiaries’ institutional utilization rates that is organized alphabetically by facility that includes the number of admissions by ICD (International Classification of Diseases) diagnosis codes or DSM (Diagnostic and Statistical Manual) code, the average length of institutional stay, the average cost per day of stay, and the cost per admission. electronic access to or hard copy of newly created or revised reporting formats, functions or features.

Annually: (1) a report that describes significant aspects of Peace Corps’ Health Be nefits Program including but not limited to a summary of claims made, claims reimbursed/paid, and administrative costs paid; (2) a report that identifies the 25 most common diagnoses of PLAN II and PLAN III beneficiaries by diagnosis code and descriptor, the frequency of the diagnoses, the ages and genders of the beneficiaries served, and the aggregate amount of reimbursements and/or payments made on behalf of the beneficiaries; and (3) a report that describes the outcomes of the Contractor’s quality assurance and improvement efforts.

At the time of contract award, and annually thereafter, submit one copy of the accreditation from a nationally recognized accrediting organization and/or certification by Medicare/Medicaid, and state licensing if appropriate Written notification of the completion of the update of the MDR* fee schedule. *MDR – Medical Data Research (trademarked) – is an industry recognized fee schedule used by health care insurers, which establishes rates for health care services by geographic location of service providers It also provides the basis against which the discounts shown herein are applied. Records The Contractor shall— a) Maintain online an accurate eligibility record for each Peace Corps Health Benefit Program participant. These records shall reflect the eligibility information provided by Peace Corps, and in cases where Peace Corps may extend benefits to a dependent spouse or child of a participant, the dependent’s eligibility record shall be linked to the participant’s unique identifying number.

b) Maintain a procedure and medium for archiving data and information used in the administration of Peace Corps’ Health Benefit Program, in a manner and medium acceptable to Peace Corps.

c) Maintain a claims record for each individual beneficiary online during the term of the member’s eligibility and until the end of the two succeeding fiscal years. When this period has elapsed, the member’s claims record shall be retired by removing it from online status and transferring it to the specified data archive medium. The Contractor shall deliver two archival copies of retired individual claims payment records to Peace Corps within 90 days after the close of each fiscal year during the term of the Contract and shall maintain at least one archive copy on its own premises for a period of three fiscal years. d) Systematically inventory, file, and securely store all claims submitted for reimbursement or payment under Peace Corps’ Health Benefits Program on its premises. The Contractor shall deliver on computer disc, archival copies of the claims inventory to Peace Corps within 90 days after the close of each fiscal year and shall maintain at least one archive copy of the inventory on its premises for a period of four fiscal years. Meetings The Contractor shall attend quarterly meetings with Peace Corps. Up to 3 of these meetings may be held in Washington, D.C. These meetings shall be designed to review service requirements and performance and to resolve service delivery issues. . C.4 SERVICES SUMMARY Performance Requirements Washington D.C. Service Network

Reference

National PPO Online reference updates quarterly International PPO Response for assistance with international ppo provider within 36 hours Required Reports Customer service Peace Corp staff inquiries Claim adjudication process

Threshold Addition of new providers in service network within 4 weeks of request by Peace Corps 100% of the time 100% of time

95 % on accuracy and on 100% timeliness No more than 5 complaints per month Respond within 4 hours 100 % percent processing rate

h)

C.5 DELIVERABLE TABLES

Item Quality Plan Electronic Access Manual All annual reports All Quarterly reports Monthly summary of claims paid (self insured program) Monthly drug utilization reports (pharmacy component) Monthly report of audit of claims > 10K Monthly report of rejected claims (self insured program) Quarterly customer satisfaction report (self insured and fully insured programs) Tri-Annual credentialing report of DC Service network and open panel providers Annual in person meeting with COTR Monthly and quarterly reports of # of premium months provided (fully insured program) m)

Delivery Date/ 10 days after contract award 30 days after contract award and 180 days thereafter 90 days after end of the fiscal year 30 days after the end of the quarter 5 days after month end

5 days after month end 5 days after month end 5 days after month end 30 days after quarter end 90 days after award of contract and one month after tri-annual rotation end As mutually agreeable 5 days after months end; 30 days after quarter end

C.6 PAYMENTS TO THE CONTRACTOR C.10.1 Payments/Invoicing for fully insured program

Present to Peace Corps a detailed invoice for premium payment costs due the Contractor for services rendered under the Contract on a monthly basis beginning the month following the first month of service and every month thereafter. The invoice details will include the month of coverage, invoice number, contract number and list of names and premium amounts for the covered individuals. The Claims Contractor for the self-insured program shall--

A) Present to Peace Corps a detailed invoice for administrative costs due the Contractor for services rendered under the Contract on a monthly basis beginning the month following the first month of service and every month thereafter. Include the cost of

the Pharmaceutical component in this invoice. B) Present to Peace Corps no less frequently than on a weekly basis, an itemization of the amounts due beneficiaries and service providers for allowable, authorized claims. This itemization shall be organized by benefit PLAN, within the fiscal year accrued and shall show the aggregate amounts claimed under each PLAN. Within each benefit PLAN, the claims presented shall include: the name, address, zip code and Federal Identification Number or Social Security Number of the payee, the payee's invoice number if an invoice has been provided, the beneficiary's name and Social Security Number, the CPT codes and a description of the services provided, the amount of the claim made and the amount of the claim reimbursed/paid. Procedures for transferring these payments to the Claims Contractor and for issuing Peace Corps Health Benefit checks to claimants shall be proposed by the Claims Contractor and established by Peace Corps at the time of contract award.

C.7. TRANSITION AND IMPLEMENTATION After the contract Date of Award, the Contractor shall a) Designate an account representative to serve as ongoing liaison to Peace Corps. b) Attend such meetings as are necessary to the effective implementation of the Contract. c) Assure an effective transition to any new systems, procedures and collateral materials. This would include an outline of steps and methods to ensure successful transfer of data and system access if required. d) Reach agreement with Peace Corps’ COTR regarding the actions the Contractor shall undertake to inform the Network and the managed prescription drug service providers of Peace Corps’ service requirements and undertake the same. e) Reach agreement with Peace Corps’ COTR regarding the actions the Contractor shall undertake to inform the Washington D.C. Service Network, existing Open Panel, the National PPO Network and the managed prescription drug service providers of Peace Corps’ service requirements and undertake the same. f) Assure access to telephone services that shall be used to receive inquiries made by Peace Corps, Health benefit members and RPCVs. g) Deliver to Peace Corps’ COTR 1 hard copy and electronic access to a basic procedures manual that describes: (1) the names of the Contractor's account representative and other key Contract personnel, their phone and fax numbers, and their mailing addresses; (2) as appropriate to the services to be provided, a link to or a directory of the service providers to be used under the Contract that includes the providers' names, specialties, phone and fax numbers, and their mailing addresses; and (3) routine and emergency procedures for accessing services provided by the Contractor. g) As appropriate to the services to be provided, conduct an orientation for Peace Corps’ Office Volunteer Support – Medical Services to explain eligibility information transfer procedures,

authorization procedures, claims inquiry procedures, procedures for accessing service providers, and other procedures necessary for the effective administration of the plan. h) Provide appropriate training to designated Peace Corps personnel and customer service agents on the service requirements. i) As appropriate to the services to be provided, outline the electronic and secured system method(s) that are available to be used to transmit claims activity and eligibility data. Reach agreement with Peace Corps on the method that will be used to transmit eligibility, claims and other pertinent information. . j) As appropriate to the services to be provided, reach agreement with Peace Corps on the format and design of printed materials to be used in the administration of service components and produce the same. k) Designate and train the Contractor's personnel and customer service agents on the service requirements of Peace Corps’ Health Benefits Program.

C.8

RESPONSIBILITIES OF PEACE CORPS

Peace Corps will-1. Provide a Contracting Officer's Technical Representative (COTR) for purposes of ongoing liaison with the Contractor during performance. 2. Maintain a self-insured health benefit program with three benefit PLANs. The PLANs are known as: PLAN I: Applicants; PLAN II: Peace Corps Volunteers (PCVs) and their minor dependents; and PLAN III: Returned Peace Corps Volunteers (RPCVs). This includes FECA claims as well as authorizations for evaluation of Peace Corps related conditions for up to six months post service. 3. Determine benefits allowable under each PLAN. 4. Establish eligibility for each benefit PLAN. 5. Authorize services for beneficiaries covered in each PLAN. 6. Convey to the Contractor via secure medium the eligibility roster for each of its benefit PLANs on a weekly basis. This roster will include the name, Social Security Number, and effective dates of coverage for each PLAN participant. 7. Annually approve fee schedules for reimbursements allowed beneficiaries and payments allowed service providers for eligible Health Benefits Program participant healthcare. 8. Annually approve any changes to the plan design, premium level and eligibility requirements. 9. Provide and administer: 1) an appeals procedure to review and render a final

determination on any reimbursement or payment denied by Contractor on any claim while acting in accordance with Peace Corps’ policy; and 2) an appeals procedure to receive, review, resolve, and make a final determination on disputes arising over claims made by Peace Corps’ Health Benefit Program members or by service providers. 10. Arrange for and will provide routine medical care, preventive health services, and health promotion to PLAN II PCVs serving overseas. 11. Arrange for and provide transportation and logistical support to PLAN II PCVs who are med-evaced from overseas assignments due to a need for medical, mental health, or dental evaluation and treatment in the US or at intermediate locations worldwide. 12. Manage the course of evaluation and treatment of PLAN II PCVs who receive medical or dental evaluation and treatment in the US or at intermediate locations worldwide. 13. Determine whether a PLAN II PCV will be returned to an overseas work assignment within 45 days of a PLAN II PCV's med-evac or evaluation and treatment in the US or at intermediate locations worldwide. 14. Designate a liaison for and manage all workers' compensation claims made on behalf of PLAN III RPCVs under the Federal Employees' Compensation Act (FECA). .

C. 9

RIGHTS RESERVED TO PEACE CORPS

Peace Corps reserves the right to-1. Establish eligibility requirements and reimbursement rates for its Health Benefit Program, including the right, to extend health benefits to the dependent spouses and/or child or children of PLAN II PCVs or PLAN III RPCVs 2. 3. Determine where and from whom Health Benefit Program beneficiaries receive medical or dental evaluation or treatment, including the right to make referrals outside the Contractor's Service Network. 4. Obtain and hold copies of beneficiaries' medical records and documents generated in the course of authorized health evaluation or treatment. Copies of these records and documents shall remain the property of Peace Corps. 5. Access all claims records and eligibility data held by the Contractor. These records and data shall remain the property of Peace Corps 6. Audit, or to cause to be audited by its designee, all claims, administrative, and financial records related to the management of its Health Benefits Program. 7. Make a final determination of disputed claims made by beneficiaries or by service

providers for reimbursement or payment made under its Health Benefit Program. 8. Deny any claim presented by the Contractor for reimbursement or payment. Reasons for denying claim reimbursement or payment to the Contractor include, but are not limited to, failure of a claimant to provide copies of requested medical records or reports to Peace Corps medical personnel; failure of a claimant affiliated with the Contractor's Washington D.C. Service Network to adhere to Peace Corps "no balance billing" requirement; claims presented on behalf of an ineligible person; claims presented that exceed established fee schedules; claims presented for unauthorized or disallowed services; claims presented that are duplicative or fraudulent. This does not limit the Contractor's rights under the Contract Disputes Act of 1978 (41 USC. 601-613), as implemented by FAR 52.233-1 & -4. 9. Make site visits to the Contractor and/or to providers and/or facilities affiliated with a Service Network throughout the term of the Contract.