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specifically changed, waived, or superseded by this section (as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.