All TRICARE requirements noted
in
Chapter 11 regarding
Communications and Customer Service (C&CS) shall apply to the
TMEP unless specifically changed, waived, or superseded by this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
The provisions of
Chapter 11, Section 1, are superseded by the
following:
1.1 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.
1.2 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 four 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.
1.3 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.
1.4 The contractor
shall work with DHA to ensure beneficiaries receive unified, timely,
accurate, consistent, and effective products and tools.
1.5 The Government
shall furnish the TMEP contractor printed TMEP, beneficiary-focused
educational materials. The Government shall develop materials based
on recommendations by contractors, program managers, the Services,
DHA leadership and others with interests and concerns about information
shared with TRICARE beneficiaries and other stakeholders. DHA Communications
shall review all recommendations and prioritize products in accordance
with funding availability. DHA Communications shall have final approval
authority for TMEP products. Ordering of initial and subsequent
educational materials shall be discussed with the Government and
outlined in the Memorandum of Understanding (MOU) with DHA Communications
Division.
1.6 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.
1.7 The contractor
shall be responsible for distribution of 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.
1.8 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.
1.9 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, a yearly exhibition
plan should be submitted for approval as well.
1.10 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 applicable contract.
1.11 DHA Communications
shall 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.
2.0 Government Staff and Beneficiary
Education
The provisions
of
Chapter 11, Section 2, are superseded by the
following:
2.1 The contractor shall not maintain
public web content about TRICARE benefits. They 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.).
2.2 The public login page and secure
portal portions of web presence shall 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.
2.3 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.
2.4 The contractor shall follow
Department of Defense (DoD) and Federal Government website rules, including
guidance on 508 compliance, mobile responsiveness, National Institute
of Standards and Technology (NIST)-compliance, and plain language
writing.
2.5 Information contained on the
contractor’s website will not substitute for written or telephonic communication
with the beneficiary if those communication tools are in the best
interest of the beneficiary.
2.6 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.
2.7 Use of
the 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
is prohibited. The contractor may state their TRICARE contractor
status in company marketing/promotional activities as long as Unites
States Government, Military Health System (MHS), or DHA endorsement
of the contractor is not implied.
2.8 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
The provisions of
Chapter 11, Section 3, paragraph 3.0, specific
to Market/Military Medical Treatment Facilities (MTFs) Prime Service
Areas (PSAs) are not applicable to TMEP except the contractor will
provide sufficient telephone lines addressed in this paragraph to
meet the requirements in
Section 1.
3.1 Media
The provisions of
Chapter 11, Section 6, paragraph 9.0 are superseded
by the following:
3.1.1 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 will conduct a media-relations program in accordance
with 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
will keep DHA Communications, the Contracting Officer (CO), 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.
3.1.2 All published
materials will communicate consistent TRICARE program messages with
one voice and tone. Contractors will perform the following in their
media relations program, with approval from the Government, unless
otherwise directed:
• Respond to media questions
about contractor roles, responsibilities and actions on behalf of
the Government in support of the TRICARE program.
• 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.
3.1.3 The TMEP
contractor will speak only on issues for which it has direct responsibility
and will not speculate on issues beyond the scope of the support
they are providing to the Government.
3.1.4 The TMEP
contractor will 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 contract will identify one point of contact to support timely
awareness and interaction. Items to be posted in a public forum
have to be approved by DHA Communications.
3.2 Social
Media
The following
additional provisions are applicable to TMEP.
3.2.1 The contractor will rely on
DHA Communications social media to leverage those means of education and
communication. The contractor will provide appropriate content for
posting in response to identified educational opportunities on an
ad hoc basis or as requested by the Government.
3.2.1.1 The contractor will identify
a primary and an alternate contact in support of
paragraph 3.2.1 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).
3.2.1.2 The contractor will 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.
3.2.2 The contractor
will 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.
3.2.3 The contractor
will 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 will include sufficient time for government
review for accuracy, timeliness, use of plain language, 508 compliance
and any other criteria as determined by the government. DHA Communications and
the contractor will work closely to address completion of items
with a short suspense.
5.0 Telephone
Inquiries
5.2 The provisions
of
Chapter 11, Section 7, paragraphs 1.1 through
1.5, are superseded by the following: The TMEP
contractor shall provide a toll-free telephone inquiry system. The
toll-free telephone inquiry system shall provide 24-hour, seven
days a week, nationally accessible service. The system shall be
fully staffed, continuous with callers having the option of speaking
with a customer service representative between the hours of 6:00
am and 11:00 pm EST (except weekends and federal holidays). Telephone
access outside of these hours may be accomplished through an IVR
unit. Responses shall be furnished within the time frames noted
in
Section 1.
5.3 The provisions
of
Chapter 11, Section 7, paragraph 1.6, are
superseded by the following: after hours, the telephone system shall
indicate the hours customer service representatives are available.
Calls shall be handled 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.
5.6 The provisions
of Chapter 11, Section 7, paragraphs 3.2.1.2.2 through 3.2.1.2.4,
are applicable to TMEP with the exception of providing network provider
availability/assistance.
5.7 The contractor shall refer
to
Section 1, for the Telephone Standards instead
of the provisions of
Section 1, paragraphs 3.5 through
3.7.
5.8 The contractor
shall follow
Section 1 and DD Form 1423, CDRL, located
in Section J of the applicable contract instead of the provisions
of
Section 1, paragraphs 3.7.1 through
3.7.2.1.
5.9 The provisions
of
Chapter 11, Section 7, 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, located in Section J of the applicable
contract.
5.10 The provisions of Chapter
11, Section 7, paragraph 7.0, are applicable to TMEP
with the exception of providing access to information for staff
outside the Market/MTF.