Attachment 4 PSHBS TO PWS_Amendment 2.docx

RFP 24322623R0004 Postal Service Health Benefits System (PSHBS) Indefinite Delivery, Indefinite Quantity (IDIQ) Contract Office of Personnel Management (OPM) Postal Service Health Benefits Central Enrollment System and Customization Services Performance Work Statement (PWS)

Table of Contents

1.0 GENERAL

As the Federal government’s human resources agency, the United States Office of Personnel Management (OPM) administers health insurance benefits for over 8 million Federal employees, retirees (“annuitants”) and their families. The Federal Employees Health Benefits (FEHB) Program covers a majority of those employed and retired from the Executive, Legislative and Judicial Branches of the Federal government, including employees and retirees of the United States Postal Service, temporary wildland firefighters and fire protection personnel, employees of Federally recognized Indian tribes, tribal organizations, and urban Indian organizations (tribal employer), and their eligible family members. Offerors can find more information about OPM and the benefits we administer on www.opm.gov/insure.

1.1 Background

Title I, Section 101 of The Postal Service Reform Act (PSRA, Pub. L. 117-108) requires OPM to establish the Postal Service Health Benefits (PSHB) Program, a health insurance program that will operate with a separate risk pool from the FEHB Program. The PSHB Program will offer coverage to the current FEHB-eligible Postal population of an estimated 1.7 million United States Postal Service (USPS) employees, annuitants, and their eligible family members currently enrolled in the FEHB Program. OPM is also responsible for enrolling Postal employees and annuitants in the PSHB Program. Under the Act, certain Postal Service annuitants are required to enroll in Medicare Part B, necessitating an eligibility determination based on partner Federal agency data.

1.2 Scope

Effective January 1, 2025, all current FEHB-eligible USPS employees, annuitants, individuals receiving workers compensation (“compensationers”), and their family members will only be eligible for health insurance coverage through the PSHB Program. During the initial open season in the fall of 2024, all PSHB eligible individuals will have the opportunity to enroll in a PSHB health plan of their choosing. If no choice is made during the initial open season, FEHB-enrolled PSHB eligible individuals will be auto-enrolled into a PSHB plan based on criteria in the Postal Service Reform Act (PSRA). PSHB coverage will begin in plan year 2025.

To meet PSRA statutory requirements, the contractor will work with OPM to develop and deliver a Postal Service Health Benefits System (herein referred to as PSHBS, or “the system”). Although the initial user base will include 1.7 million USPS enrollees, the PSHBS system will be built using scalable, flexible technology that enables OPM to (potentially) service approximately 6.5 million federal employees, annuitants, and eligible family members.

Starting in the fall of 2024, the system will process all enrollments and changes in enrollments for PSHB, including open season transactions, qualifying life events, and enrollments for newly eligible. The fully functional system will provide an account-based, one-stop-shop where enrollees can: 1) compare and learn about PSHB plan options, including benefits, provider networks, formulary, cost-sharing, and total out-of-pocket expenses, 2) select a plan that fits the unique needs of their family, and 3) complete the enrollment process. The system will also serve as the authoritative source for PHSBP enrollment data, ensure enrollee eligibility by exchanging data with relevant Federal agencies, and provide real-time enrollment and premium transaction information to all employing agencies and participating PSHBP health insurance issuers (herein referred to as Carriers).

The system will include a web-based portal for self-service enrollment transactions and robust decision support tools to assist enrollees. The system will also support enrollment transaction processing and ongoing reconciliation of enrollment and premiums.

1.3 Relevant Federal Laws and Regulations

Section 101 of the Postal Service Reform Act of 2022 (PSRA), Pub. L. 117-108, added new section 8903c to chapter 89 of title 5, United States Code, and directs OPM to establish the Postal Service Health Benefits (PSHB) Program for Postal Service employees, Postal Service annuitants, and their eligible family members. OPM will administer the PSHB Program in accordance with Chapter 89 of Title 5, United States Code and implementing regulations (title 5, parts 890 and 892, and chapter 16 of title 48, Code of Federal Regulations).

The contractor must be intimately familiar with the laws and regulations of the PSHB Program, to ensure contractual operations are in full compliance. Changes in the laws and regulations may affect system requirements and the PSHBS system must be updated to accommodate any such changes. OPM will evaluate offerors capabilities and insights through evaluation of their Corporate Experience and as a non-functional requirement to the RTM.

2.0 SPECIFIC REQUIREMENTS

2.1 Overview

OPM has a requirement to procure and deliver specific capabilities outlined below and integrate them into a solution with a seamless user experience. As noted above, the system will be built using scalable, flexible technology that enables OPM to (potentially) service approximately 8.5 million federal employees, annuitants and eligible family members.

Please refer to the attached Requirements Traceability Matrix (RTM) for all functional and non-functional requirements related to PSHBS and associated services.

In summary, through delivery of this Core Task Order, the PSHBS must have the capability to perform the following:

I. Eligibility Determination- PSHB annuitant enrollment requires routine exchange of enrollment data with the Social Security Administration, OPM Retirement Services, Department of Labor, Department of Veterans Affairs, and Indian Health Service to determine exceptions to the Medicare Part B enrollment requirement for Medicare eligible Postal Service annuitants and Medicare eligible family members. The PSHB will allow users to upload additional eligibility documentation.

II. Decision Support - Provide information to assist enrollees in making informed plan selection decisions. A primary component of the decision support process will be a web, tablet, and mobile-optimized tool allowing users to search and compare various PSHBP plan options.

III. Enrollment Processing - Create, operate, and maintain an enrollment portal and database to accept and process enrollment actions. Perform verification of family member eligibility.

IV. Enrollment Reconciliation - Ensure program integrity through enrollment data matching with Carriers and employing agencies.

V. Payment Processing – Collect premium payment confirmation data to ensure accurate accounting of payments by enrollees.

VI. Premium Reconciliation - On a regular schedule as proposed, maintain a record of premiums due for each enrollee, Payroll Office, and Plan Code, and communicate the balance and transaction details of records, and reconcile against actual premium amounts transferred between Payroll Offices, OPM, and Carriers.

VII. Data Analytics and Reporting – Capable of providing robust analysis of data housed in a data warehouse to include reporting and analytical tools.

In addition, the contractor must deliver the following minimal viable product (MVP) capabilities by the dates listed:

Definition of Minimum Viable Product (MVP):

Sept 30, 2024 for Open Season (which begins in November 2024)

Decision Support

· The PSHBS shall have the ability for customers to search key health plan characteristics including premium, cost sharing (including for those with Medicare), with link to health plan brochure for more detailed information.

· The PSHBS shall follow industry best practices for modern, intuitive, similar decision support tools.

· The PSHBS shall provide anonymous shopping capability.

· The PSHBS shall have the ability to ingest and process carrier-specific information from OPM Systems (e.g., Carrier Connect).

Sept 30, 2024 for Open Season

Eligibility (All)

· The PSHBS shall have the ability to receive, ingest, and process necessary data from USPS to determine employee eligibility status.

· The PSHBS shall have the ability to receive, ingest, and process necessary information from OPM RS to determine current annuitant status.

· The PSHBS shall have the ability to exchange Flat Files on a predetermined schedule using secure means of transmission.

September 30, 2024

Data Analytics

· The PSHBS shall have the ability to analyze enrollment data using BI software, including standard reporting, query building capability, and (for certain analysts) open access using preferred analytic software.

· Per the PWS and RTM, OPM will own all PSHBS data; the vendor provides the data to OPM, as directed.

Oct 31, 2024

Reporting

· The PSHBS shall have the ability to create one-off reports, as needed.

· The PSHBS shall have the ability to release reports through the regular release cycle.

· The PSHBS will provide specific reports as defined in the RTM.

Oct 31, 2024 for Open Season

Enrollment Processing (w/ Carriers)

· The PSHBS shall be able to capture enrollee selection and send information to Carriers participating in PSHBP, using current processes with Data Hub (vendor to connect to Data Hub and not to all carriers).

· The PSHBS shall also provide the capability to send to RS, USPS and NFC for withholdings and contributions to premiums, including the financial management systems and programmatic systems.

Dec 15, 2024

Premium Payment

· The PSHBS shall enroll individuals paying directly using the National Finance Center to collect direct payments .

Dec 15, 2024 Immediately following Open Season

Auto-enrollment

· For individuals who do not select a PSHB plan, the system shall automatically enroll said individuals in a similar plan using criteria from PSRA and Interim Final Rule.

((OPM to provide vendor with crosswalk table showing FEHB plan and equivalent PSHB Plan (or default plan). Notifications will be provided, as delineated in the RTM)).

Mar 1, 2025

Enrollment Reconciliation

· The contractor shall create and pull required reports to validate enrollment and have a mechanism for the carriers to access this data (either through roles / privileges in PSHBS or exporting the reports into the Carrier Connect).

October 30, 2025

Premium Reconciliation

· The contractor shall use existing processes for premium payment and reconciliation (at the agency level).

Please refer to the attached Requirements Traceability Matrix (RTM) for ALL functional and non-functional requirements related to PSHBS, the MVP and associated services.

3.0 Key Personnel

The following personnel utilized in performance of the services described herein are considered “Key Personnel.” Key Personnel changes and substitutions shall be kept to an absolute minimum and shall be in accordance with clause 1752.209-71 Contractor’s Key Personnel (July 2005). Key Personnel changes within the first year of performance will be negatively reflected on contractor’s performance evaluation report. Communication is key to a strong positive relationship. Refer to Key Personnel Clause for additional information.

If the contractor personnel will be performing any of the duties described in the descriptions below, they are considered Key Personnel, regardless of the title used by their employer.

3.1 Key Personnel

Experience and Expertise: 15+ years’ experience managing large scale programs, maintaining strict adherence to deadlines through an agile approach to product and program management, and coordinating across multiple stakeholders. Experienced in deploying customized solutions, including experience in overseeing the deployment of complex benefits systems. Has led large initiatives to develop strategies for business and technology transformation for public and private healthcare organizations and managed large and complex business transformation projects for public and private healthcare clients to implement new and evolving technologies.

Experience and Expertise: 10+ years’ experience in delivering tailored solutions for clients to including the deployment of large, complex systems.

Experience and Expertise: 5+ years’ experience leading the deployment of technology systems and introducing and championing the implementation of risk mitigation strategies which have resulted in timely release deliveries, and improved customer experience.

Experience and Expertise: More than 15 years expertise in health benefits consulting (government or otherwise)

Experience and Expertise: Experience in providing a portfolio strategy and vision for the implementation of a new product or solution.

4.0 PERIOD(S) OF PERFORMANCE

The contractor shall customize and deliver a fully functional system, as described above, to support Open Season 2024. The period of performance for this task order is 24 months consisting of a two (2) year base period and no option periods.

5.0 DELIVERABLES

A series of key tasks and deliverables will support the development of system functionality. The contractor shall provide Systems Development Lifecycle (SDLC) documentation, as required by OPM, for each stage of the development lifecycle. This includes a Project Management Plan, as described below. The primary deliverables are the development and delivery of a system that specifically addresses the unique requirements as outlined in the PWS and RTM for enrollment, premium administration, and related services.

The contractor must review, revise and distribute SOPs, manuals and training materials for the PSHBS system at least once per year, including upon publication of new, relevant regulations and/or statutes. The Government will review any edits before the contractor finalizes each new version.

During performance of the contract, the contractor must deliver upon the following according to the solution they have described in their technical proposal, as approved by OPM prior to award. Any changes from the approved technical proposal shall require approval by the Contracting Officer prior to the contractor executing those changes.

A plan for documenting, reporting, implementing approved changes and requests (includes change control requests [CCRs] from OPM, users, stakeholders, and contractors).

Address the Configuration Control Board (CCB) and its members, regular and emergency CCBs, and the method for submitting and documenting change requests.

Describe the methodology used to ensure documentation stays updated and accurately reflects the production system, including all change requests.

Describe how the system will remain in compliance with security and other Federal IT policies and OPM’s IT policies and procedures.

A detailed map of how SAFe can coexist within OPM’s SDLC and how it will be managed.

RFP 24322623R0004 Postal Service Health Benefits System (PSHBS) Indefinite Delivery, Indefinite Quantity (IDIQ) Contract

Amendment 2 Attachment 4 Page 2 of 2

7.0 QUALITY ASSURANCE SURVEILLANCE PLAN (QASP)

The contractor’s performance shall be evaluated against a QASP tailored to the requirements and deliverables of this PWS, as well as agreed upon SLAs.

1. Monitoring Performance QASP Performance Standards are measured quarterly, and performance is evaluated annually. The contractor must report current standing of all QASP-referenced measures to OPM monthly by the end of the second full week following that month. A quarterly summary roll-up is to be provided by the contractor to OPM by the end of the second full week following the end of quarter. Reports may be required more frequently upon OPM’s request if there are performance concerns.

Standards are to be measured quarterly and evaluated annually by the contractor. The contractor must report current standing of these measures to OPM monthly by the end of the second full week following that month. A quarterly summary roll-up shall be provided by the end of the sixth full week following that. Reports may also be provided more frequently upon OPM’s request.

8.0 PLACE(S) OF PERFORMANCE

The primary place of performance shall be at a contractor-designated facility or facilities within the 50 United States or District of Columbia. None of the services of the contractor or any subcontractor may be conducted outside these geographic limitations. No services may be “off-shored.” Performance of this contract may not include any performance (permanent, or temporary, full time or part time) which takes place outside the 50 United States or District of Columbia.

The contractor is responsible for providing place(s) of performance appropriate and conducive to the work, performance standards and activities required under this contract, including providing the necessary space and security to house special equipment and/or other items as necessary to meet the needs of the Government. The contractor (and subcontractor) employees will also be required to acquire public trust security clearances for specialized staff handling Intelligence Community data.

10.0 HOURS OF OPERATION

The contractor points of contact must be available to OPM during OPM’s core business hours. Core business hours are Monday through Friday from 8:00 A.M. – 5:00 P.M. Eastern Time. The contractor must support extended business hours as determined by OPM.

11.0 CONSTRAINTS

The contractor must be aware of the following constraints that may have an impact on the services required in performance of this contract. The contractor’s solution must describe in detail the method it will use to address these constraints.

1. Section 508 Compliance – All applications to be used by enrollees or potential enrollees must be Section 508 compliant; this includes test sites. This compliance is subject to review by OPM.

2. Federal Security and Privacy – There are several constraints that may have an impact on the services the contractor must provide:

a. Compliance with Federal Information Security Management Act (FISMA) to include the National Institute of Standards and Technology (NIST) and the Office of Management and Budget (OMB) guidance

b. C&A process must be successfully completed, and C&A status maintained

c. Compliance with the Privacy Act of 1974 and related OMB guidance

d. Compliance with the privacy provisions of the e-Government Act and related OMB guidance

e. Refer to OPM Clause 1752.224-74 Privacy Act (Dec 2015) for additional information

f. Multi-factor Authentication

g. Continued Performance through Government Furloughs and Shutdowns

12.0 TRAVEL

The Government anticipates travel under this effort. Travel must be pre-approved in writing by the COR and in accordance with Federal Travel Regulations. Each contractor invoice must include copies of all receipts that support the travel costs claimed in the invoice. Local travel within a 50-mile radius from the contractor’s facility is considered the cost of doing business and will not be reimbursed. This includes travel, subsistence, and associated labor charges for travel time. Travel performed for personal convenience and daily travel to and from work at the contractor’s facility will not be reimbursed. Travel, subsistence, and associated labor charges for travel time for travel beyond a 50-mile radius of the contractor’s facility are authorized for reimbursement on a case-by-case basis and must be pre-approved by the COR and must be planned and executed according to Federal Travel Regulations. General and Administrative expenses will not be reimbursed. The Federal Travel Regulations can be located at: http://www.gsa.gov/portal/ext/public/site/FTR/file/FTRTOC.html/category/21865/hostUri/ portal.

Building and maintaining good working relationships with the contractor’s many stakeholders and partners is crucial to the long-term success of this initiative. Regular contact with stakeholders/ partners, including face-to-face meetings, conference calls, etc., is key to developing these relationships. While regular contact is important, we encourage using alternatives to onsite meetings wherever appropriate and practicable to save money.

12.1 Travel

All travel will be defined and priced as Not to Exceed. Travel by air shall be negotiated at a fair and reasonable price, not to exceed coach fare. The costs for meals and incidental expenses incurred by Contractor(s) personnel shall be considered reasonable and allowable to the extent they do not exceed, on a daily basis, the per diem rates set forth in the Federal Travel Regulations (FTR). Travel by privately owned vehicle shall be at the current GSA approved mileage rate. Except as indicated above, the Contractor(s) will be reimbursed for actual travel expenses incurred, in accordance with the FTR and FAR Part 31.205-46 - Travel costs. Contractor(s) or its representatives who incur travel costs that are more than the amount negotiated and agreed upon for each activity do so at its own expense.

The contractor should budget and plan for travel to meet with various PSHB stakeholders. The contractor should anticipate that onsite meetings may be necessary and more frequent in the first few years of the contract performance as relationships are developed.

Travel costs for the Task Order’s period of performance shall include the costs of all travel required including but not limited to:

· On Site Meetings with OPM – Allow for four trips per year to OPM’s location, at intervals mutually agreed upon by the parties.

· Annual visits to the major payroll and annuity providers (e-payroll providers and OPM annuity) as necessary and appropriate

· Ad-hoc visits to other payroll providers as needed

· Open Season Activities - The contractor may take up to ten (10) trips annually related to open season activities.

· One-on-one meetings with individual PSHB carriers, as necessary or desired

· Attendance at OPM-sponsored meetings and conferences for agency benefits officers

· Visits to subcontractors’ locations as necessary and appropriate Each travel event should include and budget for no more than three (3) contractor staff members.

If the contractor has scheduled travel to Washington DC for contract-related purposes, the contractor must inform OPM of its intent to do so. OPM reserves the right to request an additional visit at OPM Headquarters be added to any contract -related travel to Washington DC, to the extent such visit is reasonable and practical. If OPM requests an additional OPM Headquarters visit be added to any Washington DC trip, that visit shall not replace any of the four (4) on-site meetings with OPM budgeted per year.

12.2 Travel Related to Service Failures

The Government shall not be responsible for the expense of any travel required by OPM in connection with service failures by the contractor; travel required for service failures will be at the contractor’s expense. Additionally, service failure related travel will not replace any of the four OPM Headquarters On-Site Meetings allowance noted in the section above.

13.0 GOVERNMENT FURNISHED PROPERTY (GFP)

OPM will provide office space and reasonable accommodation, including all necessary identification to ease building access and communications, to include badges, phones, and computers.

14.0 INCIDENT REPORTING

The contractor must report those incidents that the contractor believes could have significant adverse impact to enrollee satisfaction, or OPM constituencies.

· Incidents which do not constitute a breach or potential breach shall be reported to the CO and COR (by email) within two hours of the contractor becoming aware, including nights, holidays, and weekends.

· The contractor must provide a preliminary incident report within 24 hours.

· The contractor must report any breach or potential breach to OPM Cyber solutions and the CO within 30 minutes of becoming aware of the risk – regardless of the time, or day of the week.

· Thereafter, the contractor must monitor and track the incident and provide the CO and COR with updates, new information and corrective plan of action at least weekly until final resolution.

ALL breaches must be reported, even if it is believed the breach is limited, small, or insignificant.

15.0 SECURITY CLEARANCES AND BACKGROUND INVESTIGATION

As previously noted, a limited number of contractor (and subcontractor) employees will require background investigations and security clearances to perform their duties.

16.0 CONTRACTING OFFICER’S REPRESENTATIVE (COR)

The COR will be assigned upon the award of this task order. The COR monitors all technical aspects of the contract and assists in contract administration. The COR is authorized to perform the following functions: assure the contractor performs the technical requirements of the contract; perform inspections necessary in connection with contract performance; maintain written and oral communications with the contractor concerning technical aspects of the contract; issue written interpretations of technical requirements, including Government drawings, designs, and specifications; monitor the contractor's performance and notify both the CO and the contractor of any deficiencies; coordinate availability of Government-furnished property; and provide site-entry of contractor personnel. A letter of designation issued to the COR, a copy of which is sent to the contractor, states the responsibilities and limitations of the COR, especially with regard to changes in cost or price, estimates, or changes in delivery dates. The COR is not authorized to change any of the terms and conditions of the contract.