Exchanges Health Benefits Plan (ASPE)

The U.S. Department of State, Bureau of Educational and Cultural Affairs (ECA) seeks to procure a third-party administrator (TPA) for the Accident and Sickness Program for Exchanges (ASPE) health benefits plan.

Solicitation Summary

The U.S. Department of State, Bureau of Educational and Cultural Affairs (ECA) seeks to procure a third-party administrator (TPA) for the Accident and Sickness Program for Exchanges (ASPE) health benefits plan.

Solicitation in a Nutshell

Item

Details

Agency Department of State, Bureau of Educational and Cultural Affairs (ECA)
Solicitation Number SSASPE
Status Pre-RFP
Solicitation Date 09/2024 (Estimate)
Award Date 12/2024 (Estimate)
Contract Ceiling Value $11,343,000
Competition Type Undetermined
Type of Award Undetermined
Primary Requirement Financial & Business Services
Duration N/A
Contract Type TBD
No. of Expected Awards N/A
NAICS Code(s):
524292

Pharmacy Benefit Management and Other Third-Party Administration of Insurance and Pension Funds
Size Standard: $45.5 million annual receipts

Place of Performance:
  • District Of Columbia, United States
Opportunity Website: https://sam.gov/opp/759908d9beb94bd684123dc8bf45bd4b/view

Background

ECA is a Bureau in the Office of the Under Secretary for Public Diplomacy and Public Affairs (R). ECA’s mission is to increase mutual understanding between the people of the United States and the people of other countries through a wide range of academic, cultural, sports, and professional exchanges, as well as public-private partnerships.

ECA/EX plays a pivotal role in enabling ECA to deliver on its public diplomacy mission by providing support and resources to its customers and partners. EX is responsible for the overall administration and management of ECA, as well as providing general operational support to the Global Engagement Center (GEC), the Office of Policy, Planning, and Resources for Public Diplomacy and Public Affairs (R/PPR) within R. The effective functioning of EX is crucial for ensuring that ECA’s exchange programs operate efficiently, aligning with the Department of State’s goals of fostering mutual understanding and respect between the people of the United States and those of other nations.

ECA/EX Executive Director has been delegated the responsibility to implement the ASPE program and provide oversight for ASPE, ensuring all aspects of the program align with ECA’s mission and operational requirements. Managing ASPE includes ensuring the program’s alignment with strategic objectives, managing budget allocations effectively, and overseeing the selection and performance of third-party administrators.

ASPE is a key component of the health and safety support provided to participants in the Department of State’s exchange programs managed by ECA. ASPE provides limited health benefits for covered medical expenses that participants might incur due to accidents or illnesses during their exchange program. The primary purpose of ASPE is to ensure that exchange participants have access to necessary medical care without facing undue financial hardship, thereby allowing them to fully immerse themselves in their exchange activities and experiences.

ASPE is not a traditional health insurance plan; instead, it operates as a self-funded, limited health care benefits plan specifically tailored to meet the needs of exchange participants. It covers an expansive array of medical services, including emergency medical expenses, aimed to support the well-being of participants while they are engaged in ECA-sponsored programs. Engineered as a safety net, the plan offers coverage up to a specified limit per covered injury or sickness.

It is important to note that ASPE does not cover routine healthcare and should be considered secondary to any primary insurance carried by the participant.

Additionally, ASPE coverage remains active for the entirety of the participant’s stay in the host country, including most travel directly to and from the host country for program orientations and activities. For participants on incoming exchanges funded by ECA, ASPE complies with the J-visa regulations, which mandates specific health coverage for exchange visitors to the United States. This ensures participants meet the necessary regulatory requirements for health coverage during their exchange experience.

By securing the services of a TPA for ASPE, the Department of State aims to continue EX efforts to enhance the efficiency and effectiveness of this crucial support mechanism. The TPA will be responsible for managing enrollment, verifying eligibility, processing claims, and providing customer support, among other duties. This partnership is intended to ensure exchange participants receive timely and appropriate medical care, supporting the overall objective of ECA’s exchange programs to promote mutual understanding and respect through educational and cultural exchanges.

Requirements

  • This summary reflects a comprehensive and detailed approach to the administration of the ASPE, emphasizing a participant-centered model that ensures efficient, accessible, and high-quality health benefits management for ECA exchange participants worldwide.
    • Comprehensive Health Benefits Management:  Conduct detailed analysis and payment of claims across medical care, mental health, crisis support, pharmacy services, and more, ensuring alignment with the ASPE program policy.  This includes advanced data management for reporting on all paid and denied claims, supported by specific categorization for analytical and reporting precision
    • Global Pharmacy and Medical Benefit Services Management:  The scope includes managing pharmacy claims and medical services both within the U.S. and internationally, ensuring participants receive authorized care without unnecessary hurdles, regardless of their location
    • Healthcare Consultation and Support:  A crucial service is providing pre-departure and ongoing advice to participants regarding healthcare accessibility in their host countries.  This includes advice on prescription medications, medical services, and alternative solutions when standard options are unavailable
    • Emergency and Routine Medical Evacuation and Repatriation:  Oversee robust medevac services with global operational capability, including medical escort services when necessary, and managing the sensitive process of repatriation of mortal remains
    • Extensive Provider Networks:  Access to an extensive network of healthcare providers worldwide is critical.  The TPA must manage both primary and secondary networks and ensure providers receive  guaranteed payment, thus facilitating seamless access to healthcare for participants
    • 24-Hour Multilingual Support:  A foundational requirement is around-the-clock support in multiple languages for medical, mental health, and crisis management, accessible through modern communication methods including virtual platforms and call centers
    • Digital Engagement and Data Management:  Implementing a mobile application and online platform will enable participants to actively manage their health benefits, submit and track claims, and efficiently access support services.
    • Participant Engagement and Feedback:  Bi-annual electronic surveys will collect participant feedback on the quality of service and effectiveness of the ASPE Health Benefits Plan, ensuring continuous improvement based on participant experiences
    • Adaptability to Service Needs:  Provide a tiered range of services, capable of adapting to diverse participant needs, and simultaneously manage multiple tiers of service coverage
    • Compliance and Accessibility Expertise:  Specialists knowledgeable in the Americans with Disabilities Act (ADA) and similar legislation will provide critical advice and support, ensuring the program’s accessibility and inclusiveness
    • Communication:  Communication strategies will be executed across various platforms to ensure clear, consistent, and accessible dissemination of information.  This includes the development of easy-to-understand materials for participants on accessing healthcare services, regular updates to implementing partners about policy changes and procedural guidelines, and engaging with healthcare providers and local support networks to ensure they are prepared to effectively assist participants
    • Training/Information Sessions:  Implement targeted information sessions, feedback mechanisms, and a comprehensive crisis communication plan will be established

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