REQUEST FOR COMMENTS -- PEACE CORPS HEALTH BENEFITS PROGRAM PEACE CORPS HEALTH BENEFITS PROGRAM -- REQUEST FOR COMMENT BACKGROUND Peace Corps' volunteer health care delivery system is administered by its Office of Medical Services which is located at 1111 20th St, NW, Washington, DC. Peace Corps manages health care services for more than 15,000 individuals each year. These individuals are categorized as follows: Applicants; Peace Corps Volunteers; and Returned Peace Corps Volunteers [RPCVs]. Peace Corps' health care delivery system is unique in that Peace Corps functions as a direct service provider and as a payer for health care services. That is, routine health care overseas is provided by medical professionals under contract with Peace Corps. Non-routine health care overseas and health care services in the US are provided by practitioners and organizations whose costs are paid for, or are reimbursed to, the beneficiary by Peace Corps through a self-insured health care benefit program. PLAN I: Applicants to Peace Corps Peace Corps establishes a fee schedule for eligible Plan I Applicant medical, dental, and vision examinations. These exams are for the purpose of evaluating the health status of the applicants. For reimbursement applicants submit an authorization form supplied with the Peace Corps application. Applicants or providers are reimbursed up to the maximum allowed under the fee schedule. Number of Claims In FY 98 -- approximately 8,500 PLAN II: Peace Corps Volunteers Peace Corps manages the course of evaluation and treatment of Peace Corps Volunteers or, in extraordinary circumstances, of their dependent spouses and/or children, who receive medical or dental evaluation and treatment in the US or at intermediate locations world-wide. This includes routine medical care, preventive health services, and health promotion. Overseas, medical professionals who are under contract to Peace Corps provide these services. Medical and dental care may be provided to Peace Corps Volunteers who are on home leave or away from official duty and who are in need of evaluation or treatment for conditions related to Peace Corps service. These services are paid for using a standard national fee schedule. Non-routine, often emergency, medical, mental health, or dental evaluation and treatment of Peace Corps Volunteers, (services, known as "medevac" services), are provided in the US in Washington, DC or Honolulu, HI or at intermediate locations world-wide. These services are paid for by Peace Corps using a fee schedule. Providers submit claims and copies of the "Peace Corps Authorization For Payment of Medical/Dental Services" form. Claims are reimbursed according to a fee schedule. Number of Claims In FY 98 -- approximately 7,500 PLAN III: Returned Peace Corps Volunteers [RPCVs] Peace Corps manages the course of evaluation and treatment of eligible RPCVs or, in extraordinary circumstances, of their dependent spouses and/or child/ren, who receive medical, mental health, or dental evaluation in the US or at intermediate locations world-wide. Providers submit claims and copies of the "Peace Corps Authorization For Payment of Medical/Dental Services" form. Claims are reimbursed according to a fee schedule. Number of Claims In FY 98 -- approximately 9,500 CURRENTLY A CONTRACTOR PROVIDES THE FOLLOWING SERVICES: I. Claims Processing and Contract Management The contractor provides complete claims processing and reimbursement and payment services for Peace Corps' health care benefit program. All claims are processed, administered and paid by the contractor. The contractor provides administrative and financial management of the service provider network in Washington, DC, the prescription drug service and the claims processing services. This includes the resolution of appeals, management of customer inquiries and complaints, credentialing of the network of health care providers, preparation of financial and management reports, and the services of a dedicated account manager. II. Open Panel of Health Care Providers in Washington, DC for Plan II participants The contractor administers a network of qualified physicians and ancillary service providers, mental health professionals, dentists, and diagnostic and treatment facilities with the capacity to meet the health care needs of Peace Corps Volunteers medevaced to the Washington, DC Metro area. Services provided include inpatient and outpatient care. This network is an open panel of professionals and institutions that are selected in cooperation with Peace Corps. The contractor negotiates contracts that assure acceptance of the fee schedule and prompt access by Peace Corps, verifies the credentials of the members of the panel, manages appeals and complaints, and administers the claims. This network also includes medical, mental health, and dental specialists who are available for the purpose of professional consultation with Peace Corps' medical staff managing the care of beneficiaries of its health care benefit program. III. Prescription Drug Service The contractor provides a managed prescription drug service for use by approximately 500 Peace Corps Volunteers medevaced each year to the Washington, DC Metro area and Honolulu, HI. PEACE CORPS REQUESTS INDUSTRY COMMENT ON THE FOLLOWING: The three components of the Peace Corps Health Benefits Program described above (Sections I, II and III) are currently managed as three individual Line Items under a single contract. Peace Corps is considering soliciting proposals in a manner that would allow interested contractors to offer to furnish any one, or all of the three services (i.e. any or all of the three Line Items). Peace Corps is inviting industry comments on the efficiency and economy of separating into three separate components the Peace Corps Health Benefits Program on an "any or all" basis. What are the advantages and disadvantages to Peace Corps? What are the advantages and disadvantages to bidders? Deadline for Receipt of Comments is January 31, 2000. Please send your comments to: Kimberley M. Atsalinos, Contracting Officer By Mail: Peace Corps, Office of Contracts 1111 20th Street, Room 4414 Washington, DC 20526 Or by Fax: (202) 692-1621 Posted 12/29/99 (W-SN412083).

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