BENEFEDS Sources Sought Notice.pdf

UNITED STATES OFFICE OF PERSONNEL

MANAGEMENT

SOURCES SOUGHT NOTICE #57092

BENEFEDS ENROLLMENT AND PREMIUM ADMINISTRATION SERVICES

(BENEFEDS)

DISCLAIMER:

THE GOVERNMENT DOES NOT INTEND TO AWARD A CONTRACT ON THE

BASIS OF THIS RFI OR TO OTHERWISE PAY FOR THE INFORMATION

SOLICITED.

This RFI does not constitute a solicitation for proposals or the authority to enter into negotiations to award a contract. This RFI is for planning purposes only and shall not be considered as a Request For Proposal or as an obligation on the part of the Government to acquire any products or services. No entitlement to payment of direct or indirect costs or charges by the Government will arise as a result of contractor submission of responses to this RFI or the Government’s use of such information. Any information you submit in response to this notice is voluntary. All information will become the property of the Government. The Government will not reimburse respondents for any costs incurred in preparation of a response to this notice.

Purpose:

The U.S. Office of Personnel Management (OPM) is seeking industry input on the development, enhancement, implementation, and deployment of the existing BENEFEDS

United States Office of Personnel Management

Sources Sought Notice BENEFEDS Number #57092

Portal functionality. The BENEFEDS Portal is used for enrollment, payroll deductions and premium reconciliation for voluntary benefit programs offered by OPM. This source sought notice is also to identify small businesses capable of providing BENEFEDS Enrollment and Premium Administration Services in order to assist in determining the appropriate acquisition method, including whether a small business set-aside is possible.

Background:

OPM is responsible for setting benefits and human resources policies government-wide and providing guidance to agencies, as well as for procuring and managing the contractual relationships with carriers for the various benefit programs. Please visit www.opm.gov/healthcare-insurance for more information about OPM and the benefits we administer.

BENEFEDS was implemented to perform enrollment and premium administration functions for the Federal Employees Dental and Vision Insurance Program (FEDVIP).

This centralized system was designed to eliminate the need for each FEDVIP carrier to establish its own enrollment/premium administration interface with a multitude of Federal agencies. To further consolidate the number of interfaces, BENEFEDS began administration of participant allotments for the Federal Flexible Spending Account Program (FSAFEDS), receiving enrollment information from the FSAFEDS third-party administrator. Today the BENEFEDS portal is responsible for managing over six million FEDVIP enrollments, administering over 500,000 FSAFEDS participant allotments, and processing approximately 260,000 Federal Long Term Care Insurance Program (FLTCIP) premium payments, interfacing with thirteen FEDVIP carriers, the FSAFEDS carrier, the FLTCIP carrier and more than fifty payroll providers, including working with the Defense Enrollment Eligibility Reporting System (DEERS) on an ongoing basis.

All Federal benefit programs are administered in accordance with applicable Federal laws and regulations. Responses to this sources sought notice must demonstrate an understanding of each Federal benefit program’s law and regulations to ensure compliance. This would include The Federal Employee Dental and Vision Enhancement Act of 2004 (Chapters 89A and 89B of title 5 U.S.C.), the Internal Revenue Code for Cafeteria Plans under (I.R.C., Sections 105, 125, and 129), and the Long Term Care Security Act (Chapter 90 of title 5, Part III, Subpart G, U.S.C).

Required Services:

A. Premium Administration

Responses must explain how businesses would interface with payroll and annuity providers for payment and premium administration. Continued support and development with the four e-Payroll providers is expected.

http://www.opm.gov/healthcare-insurance

Premium/allotment administration activities for FEDVIP, FLTCIP and FSAFEDS include calculating premium or allotment amounts due (rules vary by program), requesting and receiving payments from payroll and annuity providers, and in some instances requesting and receiving payment directly from financial institutions or enrollees. When premium or allotment amounts must be adjusted because of missed premium or allotment payments, the Contractor would be responsible for applying premium calculation rules that have been reviewed and approved by OPM. The Contractor would be responsible for remitting payment to carriers and OPM, reconciling payment with funds received, and resolving those instances in which requested amounts were not remitted or the wrong amount was remitted.

Under FEDVIP, premiums must be taken from pay or annuity, except in limited circumstances (for example, if the enrollee’s pay or annuity is insufficient). When payroll deductions of premiums are not possible, the Contractor must offer other payment options, including automatic bank withdrawal and direct bill. With the inclusion of certain members of the military population in FEDVIP, a larger percentage of enrollees are now using automatic bank withdrawal and direct bill. FSAFEDS allotments must be taken from pay. FLTCIP premium administration must offer similar payment options for FLTCIP enrollees. Currently, these include payroll deduction, automatic bank withdrawal, and direct bill. Other payment options, such as online payment, may be offered with the mutual agreement of the Contractor, the FLTCIP carrier, and OPM.

Under both FEDVIP and FSAFEDS, the Contractor is expected to offer enrollees, as appropriate, the ability to accelerate their premium/allotment payments. FLTCIP enrollees on direct bill may choose to pay their premiums annually.

B. Enrollment

The BENEFEDS system must be capable of recognizing sometimes very subtle nuances with respect to enrollment such as certain classes of employees and annuitants (e.g., temporary employees, former spouses receiving annuities) and different program eligibility criteria, which can mean the difference between an individual or group of individuals being eligible for a particular benefit or not.

1.1. Website

The BENEFEDS website must be available to users 24/7 for open season enrollment activities, new hires/newly eligible enrollments, qualifying life event changes, and demographic changes. Particular focus should be placed on usability (the website is visually pleasing, intuitive and easy to use); ease of enrollment, length of the enrollment process, and that the system leverages information already provided by the user for subsequent visits. In addition, the website must be able to handle a high volume of concurrent users.

Please note that BENEFEDS is the system of record for enrollments, not the carrier(s), and all data is owned by the Government. Further, note the Contractor will be required to comply with direction from OPM regarding use of the appropriate domain name in accordance with Office of Management and Budget (OMB) Memorandum M-23-22 Delivering a Digital-First Public Experience (Sept. 22, 2023), and with event logging requirements under OMB Memorandum M-21-31, Improving the Federal Government’s Investigative and Remediation Capabilities Related to Cybersecurity Incidents (Aug. 27, 2021).

There is no government-wide central eligibility file, which is a significant challenge associated with the performance of this contract. The Contractor would be responsible for managing the validation of enrollments with a self-certification system. BENEFEDS currently uses the Enterprise Human Resources Integration System (EHRI) and OPM’s annuity look-up tool post-enrollment to help validate information provided by certain enrollees whose information is not otherwise validated after the self-certification process.

Companies should include in their responses how they would manage enrollment validation with a self-certification system including proposing its own specific solutions.

The eventual scope of the services required may include the potential to interface with additional OPM e-Gov initiatives, such as the Human Resources Line of Business (HR LOB), Shared Service Centers and retirement systems modernization efforts. Interfaces may also be explored with the employee self-service systems such as Employee Express, MyPay, Employee Benefits Information System (EBIS), PostalEase and others.

1.2. Customer Service Call Center

Objective: To provide BENEFEDS users with trained call center Customer Service Representatives (CSRs) to answer enrollment questions, provide enrollment assistance and/or perform enrollments. Billing and pay inquiries must also be serviced, as well as redirecting unrelated/misdirected calls and inquiries (For example, annuitants may call BENEFEDS when they meant to call OPM’s Retirement Services with a question about their annuity payments.).

1.2.1 Staffing

Performance shall focus on solutions with primarily human-based services rather than relying primarily on chatbot/AI based solutions. The Contractor would be responsible for staffing a call center and training customer service representatives fluent in both English and Spanish to support enrollment activities at least ten hours per day Monday through Friday, with expanded hours during open season. Responses must detail how written or telephonic inquiries from employees and annuitants working and living overseas would be handled. Responses must also include information regarding on-call alternate language translation support in the event a language other than English or Spanish is used. Potential languages include, but are not limited to: French, Italian, German, Farsi, Arabic, Japanese, Urdu, Greek, Russian, Chinese (Mandarin and Cantonese), and Korean.

The BENEFEDS call center is an important component to customer service during open season. Due to the high volume and demand, open season requires increased staff and extended service hours. After open season ends, BENEFEDS customer service quickly returns to normal service levels.

In addition to answering general and even misdirected questions, the customer service team will be expected to respond timely to emails and other correspondence from users, as well as service calls in response to communications from BENEFEDS, carriers or

OPM.

1.3 Costs Consideration

Responses should take into consideration that BENEFEDS call center expenses have accounted for a significant percentage of BENEFEDS’ costs. Performance shall focus on solutions with primarily human-based services rather than relying primarily on chatbot/AI based solutions. Chatbot/AI tools may be offered as available options for participants to choose if they prefer, but participants should not be forced to use them, and contacting a human should be equally available as an option and just as easy to access. In the past year, the average number of calls during the last week of Open Season, averaged roughly 15,600 per day. The majority of these costs are driven by three factors:

• Call volume

• Average handle time (AHT) required to service calls

• Complexity of calls

Companies must describe their staffing model, training program (including ongoing training) and procedures they will utilize in the call center. OPM is interested in the company’s quality assurance (QA) process, and especially how they will monitor calls for quality. Other than brochures, Benefit Administration Letters (BALs), regulations that can be found at https://www.opm.gov/healthcare-insurance/healthcare/reference-materials/, OPM provides no training materials or resources.

1.4 OPM Expectation

https://www.opm.gov/healthcare-insurance/healthcare/reference-materials/ https://www.opm.gov/healthcare-insurance/healthcare/reference-materials/

OPM is most interested in receiving responses that include innovative ideas and processes on utilizing technology to minimize costs while maintaining excellent customer service including:

• successfully managing call center volume, including “spikes”

• providing enhanced Voice Response Unit (VRU) capabilities

• providing first call resolution

• matching call types to CSR capabilities

• expanding/adding customer service staff in a short period of time

C. System Administration and Architecture Requirements

Objective: To provide BENEFEDS with architecture flexible enough to support technical, business, and mandatory Federal requirements without inhibiting or limiting functionality or user experience.

OPM has a variety of system administration and architecture requirements necessary to support a system as large and complex as BENEFEDS. These requirements comprise hosting, security, usability, systems development, Federal Enterprise Architecture, and regulatory mandates.

D. Program Management

Objective: To provide a variety of program support activities to manage BENEFEDS infrastructure, systems, processes, and stakeholders. This includes:

• developing various outreach mechanisms to communicate with enrollees, employing agencies, OPM, payroll providers and carriers about BENEFEDS service offerings, latest events, and updates to plans impacting service to enrollees;

• developing project plans, charters, schedules, management plans, a risk management approach, action item tracking and resolution;

• configuration management, including a Systems Development Lifecycle (SDLC), development of a Configuration Management Plan, and a Configuration Control Board Charter, which should include OPM’s participation, and Change Request approach;

• developing and managing relationships with payroll providers, carriers, employing agencies, OPM and other stakeholders.

Response Requirements:

We encourage interested parties to respond to this sources sought notice. However, be advised that generic responses are not sufficient for effective evaluation of respondents’ capability to perform the above required services. Responses must directly demonstrate the company’s capability to satisfy the minimum requirements.

We are requesting information from firms who provide enrollment and premium administration services for insurance programs. Firms must have experience providing enrollment and premium administration services for insurance programs of an equivalent size and scope.

Response Instructions:

Electronic format (Microsoft Word or Adobe Portable Document Format) is required.

Responses to this sources sought notice must be limited to no more than twenty (20) single-spaced pages.

Each company’s response to this SSN should contain the following:

1. Company Name.

2. Company Address

3. Contact Person, including name, title, telephone number, and email address.

4. Associated Contract Vehicle

5. Company UEI #

6. Company’s Small Business Size Standard / Classification – You must identify your small business size standard relative to North American Industry Classification System (NAICS) codes 541611 and 524292 for this requirement.

Include whether or not you are classified as a small business, veteran-owned small business, service-disabled veteran-owned small business, HUBZone small business, small disadvantaged small business, women-owned small business, or 8(a) small business. Indicate whether your SAM registration currently includes Reps & Certs / Assertions relative to this NAICS code.

You should not include proprietary information in the response. We will not return responses to this notice.

Interested parties must address the following, in the order that it appears below, when responding:

1. Company History.

2. Description of all the types of services provided by your company.

3. Identification of past and present contracts for the required services, including agency/company name, point of contact, dollar value, period of performance, contract type.

4. Description of the company’s understanding and knowledge of OPM’s requirements and the capacity of performing current and future BENEFEDS functions.

5. Description of your experience working with Federal agencies.

6. Description of the company’s experience working with health insurance plans.

7. Descriptions of the company’s experience with enrollment and eligibility requirements as they relate to health insurance and the Internal Revenue Code, Section 125 (Cafeteria Plans)?

8. Description of the company’s ability to support over two million customers?

9. Description of the company’s employees’ qualifications to perform the required services.

10. Identification of current staff members who have led efforts for the required services.

11. Documentation of current staff available to perform the required services. If the company does not have current staff to perform the required services, how soon could you recruit them?

12. Explanation as to whether the company currently has an enrollment website/portal that provides the required functionality. If not, how soon could the company stand up and operate an enrollment website that provides the required functionality? Please provide an estimate of the start-up and cost associated with this process.

13. Explanation as to whether the company currently has a premium administration system that provides the required functionality. If not, how soon could the company stand up and operate a premium administration system that provides the required functionality? Please provide an estimate of the start-up and cost associated with this process.

14. Explanation as to whether the company currently has a call center that meets the stated requirements. If not, how soon could the company stand up and operate a call center that meets the stated requirements?

15. Description of your company’s Quality Assurance (QA) process. OPM is interested in the company’s ability to monitor call quality and respond to customer inquiries (including email and written correspondence) in a timely manner.

16. If the Government issues an RFP for this requirement, would you submit a proposal? If yes, how much time would you need to respond?

Response Submission and Due Date:

All responses to this sources sought notice must be submitted electronically (via email) to the following contact person:

Name: Erica Randall Title: Contract Specialist Email Address: erica.randall@opm.gov

All responses must be in Microsoft Word or Adobe Portable Document Format (PDF) and submitted by 3:00 PM Eastern Standard Time (EST) on March 04, 2025. We must receive all responses by the specified due date and time.

Responses to this notice do not affect a potential offeror's ability to respond to any future solicitation, which may or may not follow. The collection of this information does not obligate the Government to the incorporation of solicited comments in any future solicitation, nor does it obligate the Government to the procurement of any services related to this notice.

The Government will not provide reimbursement for any information that may be submitted in response to this notice. Respondents are solely responsible for all expenses associated with responding.

It is the responsibility of potential offerors to monitor the Sam.gov website for the release of any future information.

Unless otherwise stated herein, no additional information is available at this time, and any request for additional information will be disregarded.

mailto:Cheryl.Allen@opm.gov

AFTER YOU SUBMIT YOUR RESPONSE:

A confirmation email will be sent to the provided POC email with confirmation that your response has been received.

Additionally, industry is welcome to provide comment / feedback on the draft documents as well as submit a list of questions that the Government should ensure are addressed in the forthcoming PWS or other documents in order to provide greater clarity when the RFP is released. Please be advised that any questions /comments presented during the RFI phase will not be answered back to individual respondents.