SOW SHIP INSURANCE PLAN DRAFT 5.1.2025.pdf

United States Merchant Marine Academy (USMMA) Statement of Work

Student Health Insurance Plan (SHIP) pg.1

1. Introduction

United States Merchant Marine Academy is a Federal Service Academy that educates and graduates licensed Merchant Marine officers of exemplary character who serve America’s marine transportation and defense needs in peace and war. With 95 percent of the world's products transported over water, these leaders are vital to the effective operation of our merchant fleet for both commercial and military transport during war and peace.

USMMA Department of Health Services (DHS) is responsible for the overall management of the Midshipmen medical care, dental care, and Midshipmen emergency services. DHS works to help midshipmen maintain all medical standards for United States Coast Guard (USCG) Licensing and United States Naval Commissioning requirements. Further information is available at:

USMMA Department of Health Services

USMMA Midshipman Counseling & Personal Development

2. Objective

The U.S. Merchant Marine Academy (USMMA) is interested in utilizing a PPO (Preferred Provider Organization) approach to offer a Student Health Insurance Policy (SHIP) that will provide healthcare insurance coverage to the general population of USMMA students (hereby referred to as Midshipmen/Plebes/Plebe Candidates). Coverage will need to encompass on or off campus care 24 hours a day, 7 days a week, worldwide.

Under a hard waiver program, USMMA requires all full-time undergraduate Midshipmen to carry health insurance coverage through the option of either a) health insurance policy obtained through personal means; or b) the contractor offered SHIP. Midshipmen are required to purchase the SHIP plan unless they demonstrate having health insurance coverage that meets USMMA requirements.

The USMMA (DHS) provides limited medical and dental service to Midshipmen in accordance with Code of Federal Regulations 46, § 310.62 (Title 46, Part 310, Subpart 3C: Allowances and Expenses, Required Deposit) at no charge. The scope and use of this policy will be limited to medical services received which are beyond the scope of services provided on board the Academy by the USMMA Department of Health Services.

PROOF OF COMPLIANCE WITH FECA (Federal Workers Compensation Act) WORKERS’

COMPENSATION COVERAGE MUST BE PROVIDED.

3. Period of Performance

The USMMA begins its Academic Year on 1 July. The required health insurance coverage period will start on January 1 at 12:01am and continue through 11:59pm 31 December of each calendar year. In order to make certain Midshipmen have USMMA required insurance coverage in place, insurance enrollment or waiver periods will be announced during the month of August or September annually in order to provide ample time for Midshipmen to make enrollment/waiver decisions in time for a January 1 policy start date.

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Three option year periods in addition to the base year will be available upon concurrent agreement between the contractor and the Government.

4. Scope of Coverage

The SHIP will protect USMMA Midshipmen who have enrolled in the plan up to the minimal acceptable coverage allowed per insured in a policy year as per State and Federal Requirements.

Coverage will be in effect while they are at home, on board the Academy, or wherever he or she may be, 24 hours a day, worldwide.

Coverage for services must include but are not limited to preventive care, doctor visits, emergency care, non-emergency care, prescription medications, mental health services, health screenings/ immunizations, maternity/reproductive care, hospitalization/surgery and offer both in-network and out-of-network options for care.

Coverage plan details must describe co-payments, deductibles, and coverage limits, network providers and facilities, process for student claims and reimbursements.

If a Midshipman graduates or leaves the Academy for any reason the coverage will continue in effect until the expiration of coverage for that premium payment period except in the following circumstances: If the Midshipman enters military service, coverage will terminate immediately upon receipt of written request / documentation. A prorated policy refund will be made if applicable.

5. Locality Requirements

Any existing polices and the SHIP policy must be accepted by healthcare providers in the New York Long Island area. USMMA also requires that in addition to meeting coverage needs in New York/Long Island that coverage includes providers who practice within 10 Miles of the USMMA within the Nassau County area. Finally, all health insurance plans must provide coverage in all 50 USA States and internationally. This includes emergency & non-emergency coverage.

All plans must be PPO based and not require a primary care provider visit to obtain authorized referrals for specialty care. Any existing policies meeting the minimal coverage needs will be accepted. Any polices not meeting minimal coverage needs will be rejected and the incoming Plebe Candidate would then be required to purchase a Student Health Insurance Plan provided by a third-party insurance company (the contractor).

6. Financial Hardship

If a Midshipman/Plebe or Plebe Candidate has a financial hardship and is unable to afford primary insurance coverage, the insurance vendor will make the final determination to waive the insurance verification process. Upon approval, the Midshipman/Plebe or Plebe Candidate will then be afforded the opportunity to apply for financial aid to be used towards purchasing the USMMA sponsored SHIP to satisfy the mandatory primary insurance requirement. USMMA requests that the potential contractor for this process will provide a deferred payment system where a Midshipman waiting for financial aid awards would be insured and able to suspend payment for the contractor provided SHIP in lieu of receipt of financial aid dollars when received to be used to satisfy any deferred payment.

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7. Policy and Premiums

For students who enroll in the contractor provided SHIP and pay the premium, a bona fide insurance contract will exist between the Midshipman and the insurance company. The Midshipmen will be responsible for the payments of the policy premiums directly to the Carrier. USMMA will not be a party to this reference contract between the Midshipmen and the insurance company. The Carrier will be responsible for obtaining and tracking all payments.

The contractor will have every right to collect unpaid insurance premiums using appropriate means up to and including placing a Midshipman/Plebe or Plebe Candidate into a collections process.

8. Claims Processing and Management Requirements

A working, online user-friendly website is required to service the account for both USMMA DHS and Midshipmen/Plebe or Plebe Candidate for management of claims, EOB, etc.

USMMA requires the contractor to process claims, respond to questions and correspondence within 30 days, and to assist with the effective operation of this program.

Midshipmen/Plebe or Plebe Candidates should receive a response to questions within 48 hours, and must receive an Explanation of Benefits (EOB) within 30 days of submitting a claim.

The Carrier is required to designate a specific individual as a customer service representative for USMMA DHS utilizing services from the SHIP as well as provide a customer service staff, call center, or other operations directly available to Midshipmen/Plebe or Plebe Candidates and their families for assistance with enrollment/waiver processes, claims, coverage, and other related inquiries.

9. Reporting

The contractor will provide special reports on specific claims data upon request. The contractor must be able to monitor illness claims, injury claims, and insured categories to be able to provide USMMA with detailed claim data analysis upon request. The contractor shall provide such reports within a 2-week period. These types of reports do not require Personal Identifiable Information (PII) or Protected Health Information (PHI) that would release the identity of a covered person.

The contractor is responsible for the development, printing, and expenses of pertinent reports (claim history, denied claims, provider data etc.). The contractor is responsible for and will provide informational brochures or policy summaries via online that are downloadable.

USMMA requests online access to reports for waivers (attempted, denied) enrollments, and claims.

10. Brochures, ID Cards, other Printed Materials

The contractor is responsible for the production and printing of the brochure and associated enrollment materials, and all costs associated with the brochure and associated enrollment materials.

On line website access is the required method of delivery.

The contractor will deliver any printed materials to the Department of Health Services (DHS) designee.

The brochure will be completed no later than 6 months prior to open enrollment offerings.

11. Identification cards:

Cards will be made available for Midshipmen/Plebe or Plebe Candidates enrolled in the SHIP no later than 3 weeks after the start of the first Trimester of enrollment in the plan. Contractor must pg.4 honor request from USMMA for emergency activation and temporary ID cards for students with medical necessities prior to the date permanent ID cards are mailed or otherwise available.

The following processes are required:

o A web/internet-based distribution process for temporary or permanent insurance cards accessible to Midshipmen/Plebes & Plebe Candidates as well as DHS designated staff.

o A web-based process to track which Midshipmen/Plebe or Plebe Candidates have obtained their cards o A process to mail or download a permanent insurance card to covered persons Midshipmen o Contractor must have a working web-based waiver/enrollment submission system easily accessible to Midshipmen/Plebe or Plebe Candidates for enrolling in SHIP or waiving SHIP in favor of a privately-owned insurance plan, including email and online confirmation of waiver submissions, acceptances, rejections, audits results, and tracking. Ability to notify Midshipmen by email of confirmation and/or required next steps in waiver audit process.

o Access to telephonic and/or virtual real time health care support providing:

reliable health information in response to health concerns and questions;

and assistance in decisions on the appropriate level of care for an injury or sickness.

Access 24/7/365 days, globally and within the United States. Virtual care to be accessible on Android and IOS operating systems.

Staff who are experienced licensed healthcare providers (registered nurse, Physician Assistant, Nurse Practitioner, Mental Health Counselor/Psychologist or Physician) who have been specifically trained to handle telephone/virtual health inquiries.

Access to licensed behavioral health clinicians 24/7/365.

12. Enrollment or Waiving Enrollment in SHIP - Midshipmen Eligibility and New Midshipmen (Plebes & Plebe Candidates)

There are no part time students at the USMMA. Midshipmen/Plebes/Plebe Candidates will be afforded the opportunity to purchase the contractor provided SHIP or have any existing primary personal/privately purchased insurance policies reviewed. If this review determines a privately purchased health insurance plan meets all regulatory requirements as well as USMMA requirements, Midshipmen/Plebes/Plebe Candidates may waive purchase of the SHIP in favor of their approved private health insurance plan. This review and determination will be conducted by the contractor using a web-based registration system accessible to all Midshipmen/Plebes & Plebe Candidates. The contractor will act as a clearinghouse for verification of insurance coverage.

The USMMA begins its Academic Year on 1 July. To make certain Midshipmen/Plebe or Plebe

Candidates have USMMA required insurance coverage in place, enrollment or waiver periods will be announced during the month of August or September annually to provide ample time for Midshipmen/Plebe or Plebe Candidates to make enrollment/waiver decisions for a January 1, 12:01 am policy start date thru 11:59pm policy end on 31 December of the same calendar year.

Midshipmen First Class or Seniors participating in the August-September annual enrollment/waiver process will graduate in June of the 12-month policy year. Accordingly, this group of Midshipmen pg.5 will have a 6-month option (from 1 January through 30 June of the same policy year) for enrolling in the SHIP plan at 50% premium rate or waive enrollment in favor of a private plan that meets enrollment requirements.

USMMA will inform Midshipmen how to access the contractor-provided website and what period to do so. The website will provide access for enrollment in the SHIP, waiver of the SHIP in favor of privately supplied insurance and all brochures, forms etc.

USMMA Midshipmen are deployed for “sea duty” by class status (sophomores, juniors) at regular intervals during the Academic Year. These deployments occur in November, March & June.

There is a group of new students or “Plebe Candidates” who join USMMA in July each year. Incoming Plebe Candidates will require separate access to an on-line enrollment/waiver website during the months of April, May & June. This group will be insured for a 6-month period from 12:01am 1 July thru 11:59pm on 31 December of the same coverage year. While this group will enroll/waive insurance in April, May & June for this 6-month coverage period, they will also participate in the full year open enrollment in August-September for the upcoming new calendar 12-month policy year that starts on 1 January. Accordingly, this group of Plebe Candidates will have a 6-month option (from 1 July through 31 December of the same policy year) for enrolling in the SHIP plan at 50% premium rate or waive enrollment in favor of a private plan that meets enrollment requirements.

Interaction with the USMMA DHS and other appropriate USMMA stakeholders as part of enrollment process:

o Provide USMMA access to reports that do not contain PII/PHI on utilization, waivers, enrollments, and access to claims filed o Send and receive daily scheduled and secure file transfers. Contractor is required to provide:

Insurance brochures Consumer/plan information from their websites Midshipmen access to customer service needs

The contractor will be responsible for collection of premium payments from Midshipmen;

Communicate regarding Midshipman who are waiting for financial aid awards and would be insured while able to suspend payment for the contractor provided SHIP in lieu of receipt of financial aid dollars.

13. USMMA Coverage Requirements for Waiver of SHIP

The contractor will be responsible for providing online waivers and enrollment in SHIP and must have a communication plan to let the students know the status of waiver submissions and enrollment acceptances

Waivers & enrollment status must be reported to USMMA upon request for the entire waiver enrollment process period and then continue after the waiver enrollment site closes

14. Conditions allowing for waiver of The Student Health Insurance Plan (SHIP) and use of an existing health insurance plan that meets USMMA waiver requirements.

The following insurance plans are not acceptable: HMO's, Tri Care Prime (Tricare Select is accepted), Kaiser Permanente, Medicaid/Medicare or Christian Healthcare Ministries plans.

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The following health insurance benefits coverage conditions must be met and verified as in place by the contractor for Midshipmen to waive enrollment in the SHIP. An online check off form will be provided by the contractor as a “litmus test” for Midshipmen to complete and the contractor to verify/accept waiver/reject waiver based on the following (all conditions apply, waivers are not otherwise accepted):

1. Any healthcare plan requiring a referral to a primary care provider before specialty care can be obtained (such as an HMO) is not acceptable coverage.

2. Providers are located within 10 miles of USMMA in the Nassau County, NY Area

3. Coverage is provided for Lab work and X-Rays

4. Coverage is provided for Coverage for Prescription Drugs

5. Coverage for Hospitalization (including room & board, physician fees and surgical expenses)

6. Coverage for Outpatient hospital services and outpatient ambulatory & or office care

7. Coverage for Mental Health Care

8. Coverage for Emergency Room care

9. Policies must be in effect for the entire coverage period at USMMA from 1 January through

31 December of the calendar year. Midshipmen must agree to notification of any plan changes/be responsible for providing plan that continues to meet USMMA requirements.

10. Insurer must be headquartered in the United States with a US claims address and customer service phone number

11. Provide both emergency and non-emergency benefits for medical and mental health treatment?

12. Provide inpatient hospital, outpatient physician visits laboratory services, radiology and outpatient/inpatient mental health benefits (coverage limited to emergency care only does not satisfy this)

13. Provide coverage in all 50 states of the United States of America as well as provide coverage internationally?

14. For international coverage, does your policy include: -Medical Benefits of at least $250,000 - Repatriation Expenses Benefit of at least $50,000 -Medical Evacuation Benefits of at least $50,000 -Coverage for Pre-Existing Conditions?

The contractor shall provide an online demonstration of their web-based waiver/enrollment system to the USMMA. The demo site will replicate the environment the contractor would provide to USMMA Midshipmen if awarded the contract.

DOT/MARAD requires contractor release a common form that will help ensure the software producers who partner with the federal government leverage minimum secure development techniques and toolsets.

The contractor must complete the Secure Software Development Attestation Form and provide it with the proposal. Please click here for a copy of the form and additional information:

Secure Software Development Attestation Form | CISA pg.7