Retirement_Services_Open_Season_Program_Management_and_Support_Services_PWS.pdf

1. BACKGROUND

The Office of Personnel Management (OPM) provides Federal employees, retirees, and their families with a benefit program and services that offer choice, value, and quality to help maintain the government’s position as a competitive employer.

The Postal Service Health Benefits (PSHB) and Federal Employee Health Benefits (FEHB) programs, administered by OPM’s Health Insurance (HI), is the world's largest voluntary employer-sponsored health benefits insurance program and currently covers about 9 million individuals. These include active employees, annuitants, and eligible dependents. HI contracts with health benefits carriers and negotiates rates and benefits with the carriers to provide eligible employees and annuitants with a wide choice of health benefits coverage. HI also administers an annual "Open Season" to give employees and annuitants the opportunity to change their enrollments.

The Federal Employee Health Benefits Act (FEHBA) mandates an annual health benefits Open Season enrollment period. OPM regulation specifies that the Open Season enrollment period must be held from the Monday of the second full workweek in November through the Monday of the second full workweek in December unless the Director of OPM specifies a different date.

The statute also requires OPM to notify all employees and eligible annuitants of the Open Season enrollment period and to provide health plan information to all employees and eligible annuitants so that the selection of a health benefits plan and option can be made with as much information as possible.

Retirement Services (RS) is the Program Management Office that administers the health and life insurance benefits for Federal annuitants/survivors under the Civil Service Retirement System (CSRS) and the Federal Employees Retirement Systems (FERS). RS programs consist of the Retirement Operations DC, which reports directly to the Deputy Associate Director. RS is committed to providing quality service and customer care to the group of PSHB program participants. For annuitants that change enrollment, RS is charged with processing each individual change so that the annuitant’s check will reflect the proper premium deduction each month.

The annual Open Season enrollment period is one of the most critical components of administering the health benefits insurance program for Federal annuitants and their eligible dependents. Most of the annuitant population comprises elderly individuals on fixed incomes, many of whom have severe medical considerations and need their requests processed immediately so that the notification is sent to their new insurance carrier to ensure access to medical benefits services on January 1 of the upcoming year. Using a database of approximately between 1.7 million individuals and data on approximately 295 health options that are primarily state-specific, the contractor must distribute all Open Season materials to annuitants in a timely manner so that each annuitant receives current health plan information specific to the

Performance Work Statement(1) geographical area in which the annuitant resides.

RS is also responsible for notifying all eligible annuitants and dependents of the Federal Employees Dental and Vision Insurance Plan (FEDVIP) through the initial mailing and separate mailings. There are approximately 635,965 annuitants and dependent survivors eligible to receive FEDVIP notification.

The annuitant population consists of a group of retirement-aged and medically disabled individuals whose usage of their health benefits services is great. This population notably expresses their concerns and confusion when Open Season information they expect to receive is delayed and/or their requests are processed erroneously. The annuitant's concerns and confusion translate into follow-up letters, telephone calls, and/or calls from their representatives, which include a member of Congress. The Federal Open Season process is under constant Congressional scrutiny and is of considerable interest to the media. Therefore, the distribution of Open Season materials must be accomplished within the specified time frames so that the annuitant's annuity payments will accurately reflect the health benefits change requests in a timely manner (i.e., January 1).

There are four major workload factors:

2. SCOPE

In support of its mission, RS requires a contractor to provide call center support, printing, distribution, and processing of health benefits enrollments in support of the Health Benefits Open Season and other related retirement notices for Federal annuitants and survivor annuitants and their dependents. These services must be performed in compliance with the Patient Protection and Affordable Care Act, Public Law 111-148 (the Affordable Care Act or ACA), Federal Employees Health Benefits Act (FEHBA) of 1959 (5U.S.C. 8901), Postal Service Reform Act (PSRA) of 2022 (HR 3076), and the Federal Employee Dental and Vision Insurance Program (FEDVIP) governed by 5 USC 8955 (b) and 8985 (b) and Code of Federal Regulations 5

CFR894.

3. APPLICABLE CONDITIONS

The services are required to ensure OPM’s compliance with the dates set forth in the Federal regulation below:

The Code of Federal Regulations 5 CFR Chapter 1, Part 890, establishes how the PSHB program, in the Open Season, is to be conducted by OPM. The Open Season is the opportunity for PSHB Program participants to change health plans on an annual basis.

Title 5 United States code (5 U.S.C) 8955(b) and 8985(b) and code of Federal Regulations 5 CFR 894 established the FEDVIP, which affords Federal employees and annuitants the opportunity to enroll in dental and vision benefits plans.

Number of annuitants requesting information and changes● Processing time● Number of plans● The amount of variation in rates and benefits from the previous year●

4. GOVERNMENT FURNISHED MATERIAL/INFORMATION

The Government shall furnish the following:

5. SUMMARY OF REQUIREMENTS

The Contractor shall be fully aware that the basic components of the Open Season process in terms of the number of plans, options, and participants are fluid, and may change within the period of the contract, identify affected individuals, complete special mailings, as well as completing the other tasks specified concurrently within the strict time frames with a high level of accuracy. The contractor shall be required to maintain quality standards; and also adhere to the strict timeframes within this contract.

To ensure the effective and efficient execution of the annual Open Season enrollment period the contractors shall be required, but not be limited to the following:

5.1 Printing, Distribution, and Contact Center Services

The contractor shall be required to print, distribute, and mail Open Season materials within the time frames specified without exceptions to ensure that annuity payments to the individuals will accurately and timely reflect their health benefits change requests. These services shall include the following activities for our annuitants during the Open Season enrollment period, but are not limited the following:

Camera Copy for Open Season Health Benefits State Guide● 1 InDesign file of Open Season Guides● 1 PDF for 74-State Specific Guide● 1 PDF file for Former Spouses (Retirement Information (RI) 70-5) and CSRS and FERS enrollees (RI 70-9)

Text for messages and notices● Master File of Plans● Master File of active Annuitant/Survivor names and addresses● Master File of active Annuitant/Survivor Ex- spouses’ names and addresses

Continuous New Case File● Brochure and Initial Mailing Notification Request● Electronic file for annuitants who have suspended FEHBP enrollment● Electronic file for ex-spouse annuitants who have suspended FEHBP enrollment

Electronic file of elected survivors● Electronic file for annuitants/survivor eligible for FEDVIP announcement●

Print letters, guides, notices and envelopes including FEDVIP notifications. ● Use postage for overseas and other mailings.● Personalize or individualize certain notices.●

The contractor shall process a variety of requests made by annuitants to include address changes, requests for cancellation of coverage, requests for suspension of coverage, requests for re-enrollment from suspension of coverage, requests for other information related to the PSHB Program, including the plan accreditation or requests to change health benefits enrollment coverage using available health plan options, each containing three to six enrollment category types.

The contractor shall process information and change requests using the World Wide Web with the demonstrated capability of successfully performing the specialized functions and addressing security and privacy issues; and at a minimum a toll-free Interactive Voice Response (IVR) technology, Web Chat (including Co-Browsing), mobile application, email, or other advanced technologies.

5.2 Data Collection and Data Reporting

Data Collection: The contractor must closely adhere to the estimated data collection dates below for the processing of the first PSHB Open Season Enrollment. Subsequent Open Season enrollment periods will be identified in later contract modification. In the event that these dates shall change, OPM will immediately notify the contractor of the change. The printing is expected to be completed five (5) days after receipt of the complete printing package from OPM.

Date Description September OPM delivers Annuitant, Spouse

Equity, Suspended, Non-FEHB (FEDVIP) and Elected Survivor

Coordinate and conduct large scale mailings. ● Receive mail via a U.S. Post Office Box.● Process thousands of enrollments and request for information. ● Provide enrollment change information to OPM and to the various health plans including dependent and other insurance information.

Provide management information system data and reports.● Perform enrollment within the Postal Service Health Benefits and Federal Employees Health Benefit systems.

Provide contact center performance and health benefits enrollments reports. ● Set up a call center to respond to annuitants inquires staffed with an appropriate number of trained Customer Service Specialists; Call Center shall operate during each annual open season period Monday through Friday 7:40am - 8:00pm, EST; additionally, for PSHBP Pre-Open Season, 2 weeks before the beginning of Open Season and Post-Open Season, 16 weeks after the end of Open Season.

Receive and transmit encrypted data electronically.● Provide continuous monitoring of data.● Enter data transmitted for address and enrollment changes within the Postal Service Health Benefits and Federal Employees Health Benefit systems.

Store responses within the time frame specified in this contract.●

Master File.

September OPM to deliver camera copy for Open Season

Benefits Guide and state list.

October Continued New Cases File sent daily by OPM.

October-December Brochure Request & New HB Enrollee file sent daily by OPM

October Initial Mailing of Foreign Annuitant, Spouse Equity, Suspend, Non-FEHB (FEDVIP) and Elected Survivor notifications by Contractor.

October Initial mailing of Domestic Annuitant, Spouse Equity, Suspend, Non- FEHB (FEDVIP) and Elected Survivor notifications by Contractor.

October-December Brochure Requests & New HB Enrollee file sent daily by OPM.

November Bulk quantities of Health Benefits Plan Brochures to Contractor.

November Start PSHBP Pre-Open Season Support November Start of the Open Season period. (Monday of the 2nd full work week in November)

December End of the Open Season period. (Monday of the 2nd full work week in December)

December-March Start PSHBP Post-Open Season Support

Data Reporting: The Contractor shall provide data reporting services through the annual Open Season processing period. This data will enable RS to monitor and analyze the quantity and type of processing activity performed. The data collection requirement is of critical importance to the agency's management of future Open Seasons. For example, the number of annuitants who changed enrollment to a plan whose brochure they requested is useful information. When compared to the number of brochure requests for each plan, the analysis of the comparison could indicate future trends in annuitant preference for certain types of health plans. The hard copy data collection and data reporting required should be submitted in a MS Word, MS Excel or PDF format and is comprised of two types of submittals: 1) ongoing reports, as specified below, during Open Season processing and 2) a final report after Open Season processing is completed.

The Contractor shall submit the following reports during the contract period:

IVR Statistics Report: Daily during the Open Season enrollment period. This report shall include total number of calls, call duration, total number of early hang-ups, total busy time, total call time, total enrollment changes made, and other beneficial statistical information.

Open Season Survey Results: Annually, within 5 days of the completion of Open Season enrollment period. This report shall contain all responses to survey questions relating to customer satisfaction.

Reconciliation Information Report: Upon the completion of each transmission of a file. This report must accompany each transmission to ensure that the number of transactions transmitted by the Contractor and the number of transactions received by OPM are in agreement.

Workload and Processing Reports: Every Monday and/or upon the Contracting Officer's Representative (COR) request, this report shall capture all requests received by the contractor during the Open Season enrollment period that is processed and unprocessed. The unprocessed items should estimate the number of pieces of mail on-hand. This estimate should be based on the number of trays of mail or another methodology that has been explained by the Contractor and approved by the COR. The format of this report will be agreed upon after contract award.

Open Season Year End Report: Annually, within 5 days of the completion of the Open Season enrollment period. This report shall contain the PSHBS following information, if available:

5.3 Specific Tasks

The Contractor shall be required to strictly adhere to the Performance Standards and Acceptable Quality Levels for the specific tasks indicated in the Quality Assurance Surveillance Plan (Table

2) during performance of the contract. These Performance Standards and Acceptable Quality

Number of annuitants who change address only and through what source.● Total number of address changes● Number of annuitants who changed type of enrollment (self only to self plus one or vice versa; self only to self & family or vice versa; self & family to self plus one and vice versa) and through what source.

Total number of enrollment changes and through what source● Number of annuitants using the web defined by age (year of birth)● Number of change requests processed by week (weeks numbered consecutively) and number processed. Changes processed should equal the number reflected on data records sent to OPM.

Number of new enrollees generated via OPM file.● Total number of new enrollees generated from all sources.● Number of requests referred to OPM for denial because of untimely filing.● Number and nature of complaints about the materials, processing, or any other type of information with the potential of being useful for internal planning purposes.

Total number of cancellation requests and through what source.● Total number of direct premium payment requests and through what source● Total number of satisfaction survey requests and through what source● Total number of reenrollments● Number of annuitants who made multiple enrollments change requests in a week and the total number of requests made by each annuitant

Levels will be closely monitored by the COR.

Sufficient printing for the Open Season must be completed in time to conduct the test of the complete process prior to the "Initial Mailing." The Initial Mailing shall consist of an auto-enrollment letter detailing annuitant health plan benefits. While FEDVIP information is provided to our annuitants in the initial mailing; there is also a separate mailing for annuitants and dependents eligible for FEDVIP but not PSHB, OPM will provide the contractor with a separate electronic data file with the information pertaining to these individuals.

The Contractor is required to provide proofs to OPM within five workdays, after OPM's approval of the basic design. Proofs shall consist of a composite printing showing registration of the colors, text, and data elements if applicable. More than one proof cycle may be required to develop information/instructions that meet program needs and are consistent with processing specifications. The information/instructions will enable the annuitant to:

The contractor shall be required to personalize all information/instruction, which incorporates data from the records (names and addresses) to ensure the preprinted information/instructions sent to each annuitant containing that annuitant's information. OPM will provide the Contractor with the specific data of all annuitants, survivor annuitants and former spouses active on the annuity roll. It is critical that the information/instructions to the annuitants is easy to follow and readily understood.

Printing Materials1.

Proofs2.

Make an enrollment status type change (from self only to self & family and vice versa, etc.)

1)

Make a coverage change (from one plan or option to another)2)

Make an address change (permanent or alternate address)3)

Request plan brochures4)

Request cancellation/suspend information5)

Request information about direct premium payments6)

Request satisfaction survey plan accreditation and customer satisfaction survey information

7)

Request re-enrollment from suspend status.8)

The contractor shall procure, design and print envelopes for all mailings (including foreign and return mailing). Last year, approximately 2 million of these were procured for the domestic mailing and foreign mailings.

Initial Mailing: The weight of the Initial Mailing may not exceed one ounce. The construction of the initial mailing envelope must be compatible with the automated machinery used by the Contractor for assembling Initial Mailing (See Section 5.4).

Foreign Mailing: It is estimated that 9,600 envelopes will be used for annuitants overseas. The contractor shall have the ability to send mail to overseas addresses.

Brochures: Another type of envelope is used in responding to annuitant requests for brochures. These envelopes should be large enough to hold up to five (5) 8 x 11inch health benefits plan brochures of between 100 and 180 pages, and 1 or more letters and/or notices. A comparable envelope, with air mail markings, should be procured for the annuitants overseas.

Return Envelopes: Shall be included in response to all annuitant requests for the mailing of Open Season materials. This number varies annually based upon current conditions (i.e. health plan carrier participation, premium increases, benefit changes etc.). The contractor shall have the capability to handle the potential volume of up to 1.7 million annuitant requests.

OPM provides annuitants with plan comparison/benefits information guides.

The Contractor shall be required to print as well as distribute these guides.

The guides must be printed within a two-week time frame, from receipt of the Adobe InDesign file provided by OPM. OPM will provide the contractor with the following information by September 30th to be printed and distributed upon request by the annuitants:

Envelopes3.

Open Season State Health Benefits Guide4.

The number of comparison guides for each state or region will be provided by OPM.

Approximately 55 pieces of text and the appropriate plans, rates, and benefits according to the state of residence

The Open Season guides shall be printed as a white offset book, basis size 25" x 38", 40 lbs. per 500 sheets, in accordance with the Joint Committee on Printing (JCP) Code A60 specifications see http://www.gpo.gov/pdfs/customers/sfas/voll l/007.pdf. OPM will examine and consider formats suggested by the Contractor which accommodate chart sizes as long as the weight of the entire Initial Mailing notification remains under one ounce. For the annuitants eligible to reenroll from an FEHB enrollment suspend status, OPM will furnish the Contractor with an inventory of Federal Benefits Guides, RI 70-5, and RI 70-9.

The Contractor shall provide all annuitants who make an enrollment change, cancel, or suspend the enrollment or reenroll in the FEHB program with a confirmation of the enrollment transaction. This shall include notification to the new health plan as well as the annuitant's former health plan. The Contractor shall mail confirmation notices on a weekly basis capturing enrollment changes processed during the entire week. However, if an annuitant makes multiple changes during the week, the Contractor will send the annuitant and the affected health plans acknowledgment/confirmation notices of only the last change made during that week. Text shall be provided by OPM.

The Contractor shall generate and mail three types of Initial Mailings notifications, based upon input provided by OPM prior to and during the duration of the contract:

The 2025 Open Season October initial mailing consisted of approximately 1.7M notifications. The Contractor must be able to do a postal Pre-Sort.

All items are to be mailed First Class Mail Carrier Route Presort, in compliance with United States Postal Services Presort First Class mail regulations. Any self-mailers will have a printed postage, and fees paid Presorted First-Class permit imprint for all domestic mail. Overseas addresses must carry an overseas Air Mail postage and fees paid imprint (a plate change will be required). All items mailed must conform to the appropriate regulations in the U.S. Postal Service manual for "Domestic Mail" or "International Mail" as applicable.

The Contractor will furnish OPM a plan of mailing and a report with the

Acknowledgment/Confirmation of Processed Enrollment Changes5.

Initial Mailings4.4

Standard.1) Special; and2) Email, which shall begin on or about the latter part of October and may continue through December.

3) http://www.gpo.gov/pdfs/customers/sfas/volll/007.pdf http://www.gpo.gov/pdfs/customers/sfas/volll/007.pdf following information upon completion of each mailing: 1) complete printout of the total number of pieces mailed to each zip code; 2) total number of domestic; and 3) total number of overseas. If any mail is rejected by the Postal Service, OPM must be notified within 12 hours of the rejection.

1.Standard Initial Mailing Notification

The standard Initial Mailing shall be comprised of information/instructions personalized with the CSRS or FERS annuity claim number, name and address of the enrollee and the enrollee's current health benefits enrollment code. The information/instructions must provide the annuitant the opportunity to change his/her mailing address and request brochures, request a cancellation/suspension letter, request information about direct premium payments, or change his/her health benefits enrollment.

The weight of the entire Initial Mailing must remain under one ounce. If the enrollee is currently enrolled in a plan that will not participate in the FEHB program for the next year, or the plan significantly changes its service area, or the annuity is not sufficient to cover the cost of the new premium, the information/instructions must also be personalized with a special message provided by OPM.

The contractor shall have the ability to personalize and mail approximately

1.7 million notices during the last week of October. OPM estimates that there will be approximately 32,000 additional notifications to be mailed, based upon the number of newly retired annuitants that occur during the Open Season enrollment period.

2.Special Initial Mailings

Concurrent with the Standard Initial Mailing, a spouse equity notification that must remain under one ounce of approximately 2,400 shall be made. Each notice consists of personalized information/instructions. OPM will supply the text.

Concurrent with the Standard Initial Mailing and the Spouse Equity Mailing, a Suspended Enrollment Mailing of

Federal Employees Dental and Vision Insurance Mailing Concurrent with the Standard Initial, approximately 455,965 notifications that must remain under one ounce shall be made.

OPM will supply the text.

a)

Spouse Equity Mailingb)

Suspended Enrollment Mailingc) approximately 83,200 will be made.

Each notification consists of personalized information/instructions.

OPM will supply the text.

Some plans may withdraw from participation in the FEHB program both before and during the Open Season period. The Initial Mailing to individuals currently enrolled in one of the withdrawing plans must include a special message, the content to be provided by OPM. For individuals enrolled in plans declining to participate in the FEHB program after the initial notification has been mailed, OPM will notify the Contractor of the plan's withdrawal from the FEHB program. The Contractor will identify the individuals and mail an initial notification, including a special message and an additional message granting an extension of time to file an enrollment change.

The Contractor shall identify annuitants who have submitted requests to change their enrollments to the withdrawn plan prior to or after OPM's notification and mail an Initial Notice to those individuals, including a special message and an additional message granting an extension of time to file an enrollment change.

3.Email Notification

The contractor shall personalize and email approximately 300,000 notices during the last week of October to all annuitants with valid email addresses. The email notification shall be comprised of the same Open Season enrollment information indicated in the standard Processing Requirements initial mailing. OPM will provide the contractor with the email addresses of record.

5.5 Annuitant Requests

The Contractor shall process Open Season requests from annuitants for address changes, cancellations, re-enrollment from suspension, enrollment changes, and other information related to the Open Season enrollment period within the time frames specified in the Quality Assurance Surveillance Plan (Table 2).

1. Plan Brochure Requests The plan brochure requests, because of the Initial Mailing, shall provide the annuitant the opportunity to change the health benefits enrollment, the requested plan brochures, and a message granting an extension of time to request an enrollment change. Plan brochures are the benefit information pamphlets each health benefits plan issues. Annuitants may request to review one or more brochures to make a fully informed

Withdrawn Plan(s) Mailingsd) decision as to which plan, they wish to elect for the next calendar year.

Annuitants may request a brochure for any plan, in any state, during the Open Season Enrollment period.

When the annuitant requests a brochure for a plan or enrollment option that has withdrawn or terminated from the FEHB program, the Contractor shall inform the annuitant immediately upon the request that the plan or option has been discontinued and that he/she may request other plan brochures.

When the annuitant requests a brochure for a plan with eligibility restrictions, the Contractor shall immediately inform the annuitant of that plan's eligibility requirements prior to sending the plan brochure.

The Contractor shall mail the plan brochures within two (2) business days from the date of request. OPM estimates that 40,000 requests (domestic and foreign) for plan brochures will be made periodically throughout the Open Season enrollment period.

The Contractor must have the capability to store large quantities of plan brochures on-site and be able to assemble kits containing the brochures within the two (2) business days from the date of request.

The Contractor shall be required to keep OPM informed of brochure non-receipts and/or out-of- stock brochures on a weekly basis. When brochures are out-of- stock, the Contractor shall either reproduce the out-of-stock items from legible brochure copies, electronic format or procure the stock.

If brochures are out-of-stock and cannot be reproduced locally, the Contractor must have a system to identify and later fill the brochure requests. The mailing with the previously out-of- stock brochures should be sent with a standard letter (text provided by OPM) and a further extension of time to file health benefits change.

2. Address Changes The Contractor shall be required to process annuitant's address changes within the PSHBS, Note: OPM requires address changes to be processed before any other request made by the annuitant is processed.

If an address changes to another state includes a request for an enrollment change to a managed fee-for-service plan the Contractor shall process both requests.

Address changes to another state which include a request for an enrollment change to a Point of Service or Health Maintenance Organization plan (located in the state of the former address) will be handled by processing the address change and informing the individual of the plans available in the new state. If an annuitant selects a plan that is available in his new state, the contractor shall process the enrollment change.

3. Requests for Cancellation/Suspend The Contractor shall be required to process requests for cancellation or suspension of their PHSB program coverage. This will require the Contractor to obtain supporting documentation and written confirmation from the annuitant.

Upon confirmation by the annuitant of the PSHB program coverage cancellation and receipt of the supporting documentation, the Contractor shall process the request with an effective date of January 1st of the following year and forward the action to OPM within the timeframe specified in the Quality Assurance Surveillance Plan (Table 2).

4. Requests for Direct Premium Payment The Contractor shall route annuitant requests to pay health benefits premiums directly to RS.

5. Enrollment Changes The processing of enrollment changes is fundamental to the entire Open Season. Annuitants may choose from the following three types of health plans: 1) managed fee-for-service type plan that annuitants are eligible to enroll in without regard to the annuitant's geographical location; 2) a Point of Service Product and 3) a Health Maintenance Organizations. The Point of Service Product and Health Maintenance Organizations require the annuitant to live within a certain geographical area in order to obtain medical benefits under the plan. Included in available plans options are the High Deductible and Consumer Driven Health Plans.

Within each plan the annuitant can choose either a self only, self plus one or a self and family enrollment and, in some cases, either a high, standard, or basic option of coverage. Please note that while OPM estimates receipt of up to 200,000 enrollment change requests during the year, changes in benefits or premium rates negotiated with the various PSHB program plans may result in more or less changes received. All annuitants enrolled in the program are eligible to change their enrollment.

The Contractor must have the capability to process all enrollment change requests received during the contract period within the time frames specified in this contract.

The Contractor must capture and store specific dependent information for the self plus one and self and family enrollments as well as other insurance information within the PSHBS. They shall also have the capability to make corrections to dependent information without requiring an enrollment change within the PSHBS.

The Contractor must have the capability to store records associated with processing of changes within the PSHBS which are acceptable to OPM until the date specified in this contract.

The Contractor shall process enrollment change requests from the annuitant/enrollee or an OPM approved representative only.

For enrollment change requests received after the Open Season period ends;

or after the authorized extension period; or after the cut-off date established by OPM, the Contractor shall indicate the date that the request was received and send to OPM in the next weekly transmittal.

6. Special Handling

Our past experience indicates that during Open Season, annuitants will send to the Contractor other forms, information and miscellaneous items that are not health benefits or Open Season related. In some cases, based upon OPM's instructions, the Contractor shall send a response directly to the annuitant using text provided by OPM and/or transmit these items to OPM. We estimate up to 40,000 items must be processed under these special handling procedures. In addition, the contractor may receive correspondence containing Open Season requests from Congressional offices, unions or other organizations which are time sensitive and must be handled in a more controlled and expeditious manner than the normal processing items.

During Open Season, annuitants will send to the Contractor other forms, information and miscellaneous items that are not health benefits or Open Season related. In some cases, annuitants will send Open Season Related forms that based upon OPMs instructions cannot be processed. For both of these cases the contractor shall scan and email the files to OPM with one file sent per email to limit email size or mail them of requested.

5.6 Timeliness Requirements

All references to timeliness or time frames within this contract shall mean workdays.

The Contractor shall process requests for enrollment changes only and provide the output to OPM within two days of receipt of the change request (160,000 expected).

1.

The Contractor shall process requests for address changes only and provide the output to OPM within two days of receipt of the request (40,000 expected).

2.

The Contractor shall process requests for both enrollment changes and address changes and provide the output to OPM within two days of receipt of the request (30,000 expected).

3.

The Contractor shall process and mail plan brochure requests within two days of receipt.4.

The Contractor shall generate personalized information/ instructions with a late authorization message, provided by OPM, and send it to the annuitant with the requested brochures placed into an envelope for mailing (120,000 expected).

5.

The Contractor shall process a request for both an address change and brochure request; mail the requested brochures along with information/instructions with a late authorization message and provide the output of the address change within two days of receipt (60,000 expected).

6.

The Contractor shall process requests for either an enrollment cancellation or suspension of PSHB program coverage only and obtain written confirmation if required, within two days of receipt (40,000 expected).

7.

The Contractor shall process requests to make direct premium payment only and obtain written confirmation if required within two days of receipt of the request (4,000 expected).

8.

The Contractor shall process requests for an address change, cancellation, suspension, 9.

The Contractor must already be FEDRAMP certified at the time of proposal submission.

All systems and programming undertaken for this contract, whether designed and/or developed by the Contractor, in whole or in part, shall become the property of the Government.

OPM is customer focused and strives towards meeting customer satisfaction through innovative technologies such as Interactive Voice Response (IVR) technology, the World Wide Web, SMS messaging option and Voice to Text capabilities. The chosen technology should have the capability to count IVR calls and IVR numbers in real time.

The Contractor must have these technologies available to annuitants and must conform to OPM's current web requirements and standards.

The Contractor shall be required to provide self-service enrollment transactions options via the web or telephone. The Contractor shall also be required to build and manage a website that interfaces with OPM's website and reflects FISMA compliance and OPM's branding and marketing strategy.

To ensure compliance with Office of Management and Budget (OMB) M-06-16 and with the NIST SP800-53 recommended security controls for Federal information systems and Personally Identifiable Information (PII) data files containing PII data transmitted to or from OPM must have the data encrypted as well as the connection.

The Contractor will always provide Continuous Monitoring of data (during transmission and at rest).

In late September, OPM will send the Contractor an annuitant master file containing records of all annuitants and survivors who are eligible to participate in the FEHB/FEDVIP Open Season. OPM will also send a separate file containing records for those annuitants who previously suspended enrollment but are eligible to reenroll in the program and a separate file for annuitants eligible for the FEDVIP notification. These annuitants will not have access to the Open Season IVR or Web.

and obtain written confirmation if required, within two days of receipt (40,000 expected).

The Contractor shall process requests for PSHB information within two days of request (700,000 expected).

10.

Systems Requirements4.7

The Contractor shall use this file to create a direct access file which will allow random as well as sequential retrieval of the records by either the annuitant's OPM claim number, by their name or their social security number for browsing, editing, updating and additions. This file will then serve as master reference file for the Contractor and will be kept current with data from each request for action received from annuitants and survivors. The Contractor shall update the annuitant master file daily with updates of all new cases processed by OPM since the last update file was received.

Updates shall be sent daily throughout the Open Season Enrollment period through electronic data format.

The Contractor shall produce an electronic data format of captured data from the processed requests (address and enrollment changes), which must be acceptable to OPM. The Contractor shall be responsible for the quality of the formatted data.

1.Processing System The contractor must have backup processing system capability at the primary processing site in the event of a systems failure or work stoppage so that this contract will not be delayed in any way.

2.Data Entry Requirements The Contractor must have data entry/key verification capability for meeting processing quality and timeliness requirements for the requests for enrollment and address changes, health benefits plan brochures, cancellation/suspension letters and direct premium payment elections. The Contractor must provide OPM access to the same data entry system.

3.Electronic Transmissions The Contractor must have the capability to electronically transmit enrollment information to a centralized location for disbursement to the various FEHBP carriers in a format specified by OPM. The electronic enrollment file must follow the Health Insurance Portability and Accountability Act (HIPAA) of 1996, format 834. The Contractor must transmit the same information to OPM in a format that may be different than that transmitted to the carriers.

4.Data Exchange Specifications OPM's method of exchanging data records currently is through electronic data formats of the type specified below. Only the specification required for this format is shown. However, OPM is open to other formats which are compatible with existing systems, and which meet the timeliness and quality requirements of this contract. Both the Contractor and OPM will use IBM standard EBCDIC data files.

Overview

The Office of Personnel Management uses IBM’s Connect:Direct software to transfer data to and from OPM and its partners. Connect:Direct is a robust secure method for securely transferring data between two systems. Connect:Direct runs on a variety of platforms, including enterprise servers and distributed systems, including Windows, Unix, Linus, etc. In order to do business with OPM, the partner needs to acquire from IBM the Connect:Direct software appropriate to the platform on which it will be installed. The Connect:Direct software is the only approved method of electronically transferring data to and from OPM.

Security and Encryption IBM also bundles with Connect:Direct a security module called Secure+. This provides session- level encryption using x509 PKS SSL/TLS certificates. The level of encryption provided meets the FIPS 140-2 standard. OPM requires that all partners turn-on the Secure+ utility to transfer data to or from OPM.

The Partner must obtain a third-party SSL certificate. Self-signed certificates are not allowed. The partner must provide OPM a copy of the following certificate files:

Paperwork requirements The Data Exchange Team (DAEX) requires two to three weeks to set up a connection after receiving the completed and signed Data Exchange Technical Questionnaire (DEQ).

Miscellaneous The partner/vendor is required to have Connect:Direct installed on their machines for both Test and Production environments.

The OPM Business Unit rep will provide separate and unique file names for OPM files and the type of access. Filenames are unique between test and production environments.

The partner will work in with the OPM’s Technical Staff to set up connectivity and validate the data has been successfully transmitted.

5. Data Records

OPM will provide the following six types of data records as part of the initial load files for the Contractor to populate into their database at the

CA Signer (Certificate Authority)● Root certificate● Any intermediate certificates.● start of each Open Season Enrollment period:

The Contractor shall provide data records to OPM using the formats prescribed in the attachments provided.

OPM will provide the Contractor with the following files daily (combined as a single file), beginning at the start of the Open Season Enrollment Period:

The contractor shall be required to submit a HB Changes file to OPM daily throughout the Open Season Enrollment period using the formats prescribed in attachments:

The Contractor shall provide data records to OPM using the Header Sequence record (one per file), two Address Change records (where applicable) and the Open Season transaction records.

6.Correction of Errors

Processing Errors

When errors exceed 1% of the processed work within any one area of the key tasks (distribution, printing, or processing) the COR may unilaterally decide to take either one of the two following courses of action to have them corrected:

Master File of Annuitant Name and Address (Attachment 3)1) Spouse Equity Master File (Attachment 4)2) Suspended Enrollment Master File (Attachment 5)3) Spouse Suspended Enrollment Master File (Attachment 6)4) FEDVIP Master File (Attachment 7)5) Elected Survivor File (Attachment 8)6)

HB New Enrollee Record (Attachment 9)1) HB Brochure Request (Attachment 10)2)

Change of Record Address Format (Attachment 11)1) Open Season Change Record Format (Attachment 12)2) Open Season Suspend Record Format (Attachment 13)3) Open Season Add Record Format (Attachment 14)4) Open Season Cancellation Record Format (Attachment 15)5)

Arrange with the Contractor to reprocess an entire batch or make annuitant corrections within a batch or batches. Contractor agrees to accept work for correction and to make corrections on batches at no charge to the Government. To ensure that errors have been corrected to OPM's satisfaction, a test of the Contractor's system

1)

If the latter alternative is chosen, a deduction will be made from the Contractor's invoice for that work. This deduction will be at the contract rate applicable to that job times the number of record errors in the batch(s) to be corrected. Contractor will be notified, in writing, each time this option is exercised. This notification will include the job name, cost code, batch number, date of delivery, and total number of records.

Missing or Incorrect Cases or Batches

When the COR determines that cases are missing within a batch or batches sent to OPM, a deduction will be made from the Contractor's invoice for that work. This deduction will be based on estimated costs incurred by the organization(s) that do/does the corrective work. The Contractor will be notified in writing each time this option is exercised.

The notification will include the date, cost code, cost of the deduction broken down by its elements, and the number of records recovered.

Contractor Review of Documentation

To personally verify the accuracy of the information provided, the Contractor may visit OPM's Washington Data Center during any regular OPM work hour (8:00 a.m. - 4:30 p.m., Monday through Friday), within a 48-hour period after receipt of the notification and review the available documentation. If the Contractor decides to make such a visit, notification must be made to the COR at least 24 hours prior to the scheduled visit.

Additionally, the requirement to correct rejected work will not relieve the Contractor from responsibility to complete all other work according to the terms of the contract. The provisions of this item are in addition to and not in lieu of any remedies available to the Government under the Default Clause referenced elsewhere herein.

5.8 Key Personnel

The Project Manager and Programmer/Computer Analyst have been identified as Key Personnel.

may be required before further processing of work continues. In addition, OPM may require the Contractor to furnish photocopies of source documents as part of this test.

Determine that OPM processing schedules will not permit the delay involved in returning work to be corrected by the Contractor. In this case, the COR may unilaterally have the corrections made through a source other than the Contractor.

2)

The Project Manager shall be responsible for notifying the COR, on a same day basis, of any difficulties or problems which result in either a processing delay or a re-processing of transaction. The Contractor must also provide a direct telephone contact to the COR and be able to provide case specific status information within 2 hours of receipt of such a request from OPM.

The Programmer/Computer Analyst shall provide on-going support to the Open Season processing. The Programmer/Computer Analyst serves as the contractor's direct point of contact for the OPM designated system analyst and is responsible for overseeing data record transfers, formatting, and encryption; handling program functionality issues, testing initial file loads, analyzing data, and providing feedback on Open Season system processing and data transfer concerns.

5.9 Phase-In/ Phase-Out Transition Continuation of Services

The transition period shall consist of two phases, Phase-ln for service transition between the incoming and outgoing contractors, and Phase-Out for service transition between the outgoing and incoming contractors, as required. The contractor shall prepare a detailed Phase-in/ Phase-out Operations Plan, not to exceed a period of 90 days from contract award, to be submitted with the proposal. The Phase-in/Phase-out Operations plan shall outline the significant transition steps and the associated timeframes for completing both the Phase-in/Phase-out periods to assure seamless, timely, effective, and efficient transition of the required services in the statement of objectives for each period. At the sole option of the Government, the phase-in/phase-out periods may commence either 30 days prior to the expiration or immediately upon termination of the contract term, or any extension thereof.

6. DELIVERABLES

The contractor shall provide all management, supervision, labor, materials, supplies and equipment (except as otherwise specified); and shall plan, schedule, coordinate, and assure the efficient performance of all Postal Health Benefits System, including management and operations described herein at the Performance Work Statement.

These services shall include, but not limited to the following:

6.1 Reports

OPM requires that management information system reports (i.e., data collection and data reporting) be provided by the Contractor to monitor and analyze the quantity and type of processing activity performed by the Contractor during the Annuitant Open Season. The data collection requirement is of critical importance to the agency's management of future Open Seasons. The contractor shall submit the reports identified below in both electronic and hard

Annual Open Season Printing Serviceso Annual Open Season Distribution Services o Annual Open Season Health Benefits Processing Serviceso copy format during the contract period as follows:

Daily Reconciliation Information Report Call Center Statistics Report

Weekly Workload and Processing Reports Statistics Report:

Workload and Processing Reports

Annually Open Season Survey Results Open Season Year End Report

Data Files The contractor shall submit the following data files daily:

Change of Record Address Format (Attachment 11) Open Season Change Record Format (Attachment 12) Open Season Suspend Record Format (Attachment 13) Open Season Add Record Format (Attachment 14) Open Season Cancellation Record Format (Attachment 15)

End of Open Season The contractor should provide the following metrics in autogenerated reports:

6.2 Subcontracting/Teaming Agreement Changes

The contractor shall provide letters of commitments with the following information to the Contracting Officer within 15 days prior to the substitution/addition of the proposed change:

The Offeror shall request a confirmation receipt, if required, from the Contracting Officer with the submittal of proposed subcontracting and/or teaming agreement change.

All transactions completed1.

Special Handling2.

Split Transactions3.

Carrier Plan Changes4.

Errors5.

Mailed vs. Emailed Transaction6.

Signatures of the principles and/or owners of the respective parties; and1.

Statements on the division of tasks, relationship of…