Health Care Benefits Services

Request for Information (RFI)

This RFI seeks information regarding Health Care Benefits Services. It is for market research purposes and is not a Request for Quotes or Proposals. The government is not obligated to pay for any information received.

• Company Capabilities: Description of company, capabilities, and approach to the Draft PWS requirements.

• Historical Information: Description and duration of providing similar services, and relevant NAICS codes.

• Business Type: Classification (e.g., small, large, woman-owned) under NAICS 524292 (Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds).

• Scope Capability: Whether the company can provide the entire scope of requirements or specific parts.

• Suggestions: Recommendations for improving the scope of services for better government value.

• Potential Risks: Identification of performance, technical, or cost risks.

• Scope Issues: Any issues with the scope that might limit performance or increase costs.

• Format: Cover letter with company name, POC, phone, email, and submission date. Respond to all RFI questions, indicating "no response" if applicable. Include a capabilities package.

• Pricing: Rough Order of Magnitude (ROM) pricing information is requested for planning purposes only.

• Attachments: Marketing/reference materials may be included in an appendix.

• Length: Responses not to exceed 30 pages.

• Formatting: Microsoft Word (.doc/.docx), Times New Roman 11 or 12-point font, 1-inch margins.

Responses must be submitted via email to jsevere@peacecorps.gov and acmdomestic@peacecorps.gov by June 5, 2026, 5:00 PM EST.

This RFI is for information and planning purposes only. It does not constitute a solicitation, and no contract will be awarded based on this RFI. Information received may be used to develop a Performance Work Statement. The requirement may be set-aside for small businesses or procured through full and open competition based on responses.

Performance Work Statement (PWS)

This PWS outlines the requirements for a Health Care Benefits contract to support Peace Corps Volunteers, Invitees, and Returned Volunteers. The goal is to provide comprehensive healthcare administrative services, including claims processing, provider network access, and short-term health insurance.

The contract encompasses four plans:

• Plan 1: Invitee Cost Reimbursement for medical, dental, and vision examinations required for medical clearance.
• Plan 2: Health Care Administrative Services for Trainees and Volunteers, covering routine and emergency care, including medical evacuation services when authorized.
• Plan 3: Health Care Administrative Services for Returned Peace Corps Volunteers, providing limited medical evaluations for service-related conditions and readjustment counseling.
• Plan 4: Short-Term Group Health Insurance for Returned Peace Corps Volunteers and eligible dependents for up to three months post-service.

Key contractor responsibilities include managing financial assistance for examinations, providing access to domestic and international healthcare networks, delivering medical and pharmacy support, processing authorized claims, and providing access to a short-term group medical insurance policy.

Key performance objectives include prompt and accurate claims processing, high customer satisfaction, comprehensive program management, establishment and maintenance of robust provider networks, provision of affordable short-term health insurance, and seamless transition of services.

The PWS covers services for Peace Corps operations in over 60 countries worldwide, with domestic and international provider networks.

Contractors must manage financial assistance, provide network access (including international air ambulance and medical evacuation), process claims, offer pharmacy support, and ensure data privacy and security in compliance with HIPAA and Privacy Act. Specific reporting requirements are detailed, including monthly and annual reports on various aspects of contract performance.

Form / Attachment / Pricing Sheet

This document, "Attachment J.9 - SHIFTT Coverage," details the Short-Term Health Insurance for Transition & Travel (SHIFTT) coverage for Returned Peace Corps Volunteers (RPCV). It outlines the benefits, coverage limits, deductibles, coinsurance, and exclusions of the insurance plan.

• Benefit Summary: Details coverage limits, deductibles (individual and family), coinsurance percentages, and out-of-pocket maximums for various medical expenses, categorized by In-Network, Out-of-Network, and International.
• Pre-Certification Requirements: Outlines specific services (e.g., transplants, inpatient hospitalization, surgery) that require pre-certification and the general process for compliance.
• Eligible Medical Expenses: Lists specific medical services and supplies that are covered, including hospital charges, surgery, physician services, diagnostic testing, prescription drugs, and emergency services.
• Exclusions: Details a comprehensive list of services, conditions, and circumstances that are not covered by the insurance plan, such as war, terrorism, pre-existing conditions (for non-returning volunteers), cosmetic surgery, and certain experimental treatments.
• Specific Coverage Areas: Includes detailed information on Emergency Medical Evacuation, Emergency Reunion, Return of Mortal Remains, Emergency Dental, Maternity and Newborn Care, Public Health Emergencies, and Transplant coverage.

This attachment provides crucial details about the health insurance coverage provided to Returned Peace Corps Volunteers. Bidders should review this document to understand the scope and limitations of the health benefits offered, which may be a significant factor in their proposal strategy and cost estimations if the opportunity involves providing services to RPCVs or requires understanding their benefits.