TMEP
contractor shall comply with all TRICARE requirements noted in
Chapter
11 regarding Communications and Customer Service unless
specifically changed, waived, or superseded by this section (as
indicated below), the TRICARE Policy Manual (TPM), TRICARE Reimbursement
Manual (TRM), TRICARE Systems Manual (TSM) or TMEP contract.
1.0 Education
Requirements
1.2 A
collaborative effort between Defense Health Agency (DHA) Communications
and the contractor shall address the communication and education
requirement of TMEP beneficiaries and associated providers. The
intent is to make sure TRICARE benefit information is effectively communicated.
TMEP educational activities include targeted beneficiary and provider
education related to specific issues. Issues may be identified by
the Government or the contractor.
1.3 The
contractor shall participate in various work group meeting(s) to
be held in the Washington, DC area. The contractor shall also participate
in other meetings to address communication and education activities
in support of the TRICARE Benefit, to include print and web content.
Meetings may be attended via teleconference, video telecommunications
or in person (for up to 4 meetings/year), as directed by the Government.
The purpose of these meetings are to develop, review, or revised
core educational materials for the following calendar year, discuss
observations from the previous year and discuss possible changes
in education and communication activities.
1.4 The
contractor shall coordinate with DHA communications on development
of content that addresses how individuals may identify and report
fraudulent practices and to develop messaging and content for use
in beneficiary and provider education products.
1.5 The
contractor shall work with DHA to ensure beneficiaries receive unified,
timely, accurate, consistent, and effective products and tools.
1.6 The
Government will furnish the TMEP contractor printed TMEP, beneficiary-
focused educational materials. The Government will develop materials
based on recommendations by contractors, program managers, the Uniformed
Services, DHA leadership and others with interests and concerns
about information shared with TRICARE beneficiaries and other stakeholders.
DHA Communications will review all recommendations and prioritize
products in accordance with funding availability. DHA Communications
will have final approval authority for TMEP products. The contractor shall
discuss ordering of initial and subsequent educational materials
with the Government. The contractor shall ensure the Memorandum
of Understanding (MOU) with DHA Communications Division outlines
the procedures.
1.7 The
contractor shall provide staff to perform timely reviews and provide
input to content developed by DHA Communications on a regular basis.
Reviews shall include printed products, web content, responses to
query for media requests, customer service scripts, senior leader
talking points, briefings, and other products identified by the
DHA.
1.8 The contractor shall distribute
TRICARE information using industry best practices (for example, email,
telephone, media, social media, text messaging, chat and other contemporary
methods) to ensure timely delivery and receipt to TMEP beneficiaries.
1.9 Upon
request, the contractor shall furnish claim forms, claim completion
instructions, the TRICARE materials, Defense Enrollment Eligibility
Reporting System (DEERS) information and other TMEP related materials
to beneficiary, provider and Congressional offices. The contractor
will establish and maintain effective communications with all TRICARE/Medicare
dual eligible beneficiaries.
1.10 The
contractor shall submit an education plan, outlining how it intends
to conduct targeted-TMEP education for beneficiaries and providers.
The Program Office and DHA Communications will review the plan and
provide appropriate feedback for recommended changes. Details for
submission of the Education Plan are identified by DD Form 1423,
Contract Data Requirements List (CDRL), located in Section J of
the applicable contract. If the contractor intends to exhibit at
conferences, the contractor shall submit a yearly exhibition plan
for approval as well.
1.11 The
contractor shall provide a quarterly report outlining provided and
planned targeted beneficiary and provider education in accordance
with DD Form 1423, CDRL, located in Section J of the contract.
1.12 DHA
Communications will review and approve education or communication
materials developed by the contractor (for example; facts sheets,
news releases, talking points, and public affairs guidance). The
contractor’s timeline for submission shall include sufficient time,
as determined by the Government, for Government review for audience
appropriateness, accuracy, timeliness, use of plain language, 508
compliance, and any other criteria identified by the Government.
DHA Communications and the TMEP contractor shall work closely to
address completion of items with a short suspense. DHA Communications
requires a two business day minimum to review and approve materials.
2.0 Government
Staff And Beneficiary Education
2.2 The
contractor shall not maintain public web content about TRICARE benefits.
The contractor may have a secure portal that contains transactional
content (e.g., explanation of benefits, referrals, bill pay, provider
education, and other online business items), but unsecured portions
of their site shall contain simply the login page and a series of
links to TRICARE.mil for the informational content (e.g., costs,
eligibility, covered services, qualifying life events, etc.).
2.3 The
contractor shall ensure the public login page and secure portal
portions of web presence follow the TRICARE.mil look and feel as
closely as possible. DHA will provide Cascading Style Sheets (CSS)
files on request to make the adoption of the TRICARE.mil look and
feel easier.
2.4 The
contractor shall adopt a DHA approved TRICARE Uniform Resource Locator
(URL) for proposed websites. DHA will own and manage the domain
and license its use to the contractor. TRICARE URL examples are
www.TRICARE-West.com,
www.TRICARE-East.com,
www.TRICARE-overseas.com.
The contractor shall not use corporate URLs for TRICARE customer
websites.
2.5 The
contractor shall follow Department of Defense (DoD) and Federal
Government website rules, including guidance on 508 compliance,
mobile responsiveness, NIST-compliance, and plain language writing.
2.6 The
Government will not accept information contained on the contractor’s
web site as a substitute for written or telephonic communication
with the beneficiary if those communication tools are in the best
interest of the beneficiary.
2.7 The
contractor shall recommend messages and placement on Government
managed platforms to reach the target audience. Examples include
social media posts, additional web content, recommendations for
articles, and information for inclusion in press releases or media
pitching.
2.8 The
contractor shall not use TRICARE trademarks, logo, brand, name,
or any aggregate Government or personal TRICARE data collected as
a TRICARE contractor to explicitly promote non- TRICARE related
products and services to TRICARE beneficiaries. The contractor may
state their TRICARE contractor status in company marketing/promotional
activities as long as U.S. Government, MHS, or DHA endorsement of
the contractor is not implied.
2.9 The
contractor shall monitor and report on customer access assistance,
customer support hour usage and web analytics in accordance with
DD form 1423, CDRL, located in Section J of the applicable contract.
3.0 Beneficiary, Congressional,
Media, Beneficiary Counseling And Assistance Coordinator (BCAC),
And Debt Collection Assistance Officer (DCAO) Relations
3.1 The
requirements in
Chapter 11, Section 3, paragraph 3.1.2, specific
to Market/Military Treatment Facility (MTF) Prime Service Areas
(PSAs) do not apply to TMEP except the contractor shall provide
sufficient telephone lines addressed in that paragraph to meet the
requirements in
Chapter 20, Section 1.
3.2 Media
The requirements in
Chapter 11, Section 3, paragraphs 5.0 through
5.4, are superseded by the following:
3.2.1 DHA
Communications and the TMEP contractor will work together to support
media-related activities. Media relations programs implemented by
the Government and the contractor on behalf of the Government will
have three objectives: educate beneficiaries about changes to their TRICARE
benefit, respond to media queries quickly and accurately and inform
the American public about Government activities related to the TRICARE
program. The contractor shall conduct a media-relations program
in accordance with the DoD guidelines and guidance provided by DHA Communications.
The contractor shall provide regular feedback to DHA Communications
regarding their media activities, including coordination of proposed
responses to media queries for sensitive and controversial issues.
The contractor shall keep DHA Communications, the Contracting Officer,
and the Program Office aware of public and beneficiary perceptions
regarding TRICARE policies and procedures, and advise DHA on proposed
communication strategies for responding to these issues.
3.2.2 All
published materials will communicate consistent TRICARE program
messages with one voice and tone. The contractor shall perform the
following in their media relations program, with approval from the
Government, unless otherwise directed:
3.2.2.1 Respond to media questions
about contractor roles, responsibilities and actions on behalf of
the Government in support of the TRICARE program.
3.2.2.2 Follow-up media contacts by
sending copies of information provided to the media and a summary
of any discussions to DHA Communications when immediate action was
required.
3.2.3 The
TMEP contractor shall speak only on issues for which it has direct
responsibility and shall not speculate on issues beyond the scope
of the support they are providing to the Government.
3.2.4 The
TMEP contractor shall alert the Contracting Officer Representative
(COR), Program Office, and DHA Communications on any situations
that have or may be likely to result in heightened or public media
visibility. The contractor shall identify one point of contact to
support timely awareness and interaction. The contractor shall obtain
DHA Communications approval for items posted in a public forum.
3.3 Social
Media
3.3.1 The
contractor shall solely rely on DHA Communications social media
platforms and leverage those mediums of education and communication.
The contractor shall provide appropriate content for posting in
response to identified educational opportunities on an ad hoc basis
or as requested by the Government.
3.3.1.1 The contractor shall identify
a primary and an alternate contact in support of
paragraph 3.3.1 to
create written input for social media messaging and craft responses
to social media inquiries within a defined period of time (usually
not to exceed one business day).
3.3.1.2 The contractor shall identify
a primary and at least one alternate customer service support staff
to contact beneficiaries and providers identifying specific issues/concerns
on the social media platform to assist with resolution. The Government
will provide the inquiry to the contractor via the Government designated
web-based customer relations management system.
3.3.2 The
contractor shall assist DHA Communications in planning, designing,
and implementing a comprehensive communications program that incorporates
diverse functions and issues, serves numerous distinct and specialized
audiences and responds rapidly in crisis conditions to changing demands.
3.3.3 The
contractor shall submit information, including news releases, fact
sheets, talking points, communications plans, and public affairs
guidance to DHA Communications for approval. The contractor’s timeline
for submission of ongoing materials shall include sufficient time
for government review for accuracy, timeliness, use of plain language,
508 compliance and any other criteria as determined by the government.
The contractor shall work closely with DHA Communications to address
completion of items with a short suspense.
6.0 Telephone
Inquiries
6.1 The TMEP contractor shall comply
with the requirements in
Chapter 11, Section 6,
with the changes noted below.
6.2 The
requirements in
Chapter 11, Section 6, paragraph 1.1, are
superseded by the following: The TMEP contractor shall provide a
toll-free telephone inquiry system with 24-hour, seven days a week, nationally
accessible service. The contractor shall fully and continuously
staff the system and provide callers with the option to speak with
a customer service representative between the hours of 6:00 am and
11:00 pm EST (except weekends and federal holidays). The contractor
may use an IVR unit to meet telephone access standards outside of
these hours. The contractor shall furnish responses within the time
frames noted in
Chapter 20, Section 1.
6.3 The
requirements in
Chapter 11, Section 6, paragraph 1.2, are
superseded by the following: The contractor shall ensure that after
hours, the telephone system indicates the hours customer service representatives
are available. The contractor shall handle calls in the order they
are received. The contractor shall advertise the toll-free service
using available media including the Explanation of Benefits (EOB)
and other appropriate sources.
6.5 The
TMEP contractor shall comply with the requirements in
Chapter 11, Section 6, paragraph 3.0, with
the exception of the noted normal business hours and the requirement
to be staffed and operational on Federal Holidays which fall during
open season. Business hours for TMEP are noted in
paragraph 6.2.
6.9 The
requirements in
Chapter 11, Section 6, paragraph 6.0, are
superseded by the following: the contractor shall collect and report
customer support data, operational data and analytics in accordance with
DD Form 1423, CDRL, in section J of the contract.
6.10 The
TMEP contractor shall comply with the requirements in
Chapter 11, Section 6, paragraph 7.0, with
the exception of providing access to information for staff outside
the Market/MTF.