Draft PWS - 2027 Health Care Benefits.docx

Performance Work Statement (PWS) [Recompete 2027 v.2] For Health Care Benefits Contract For Office of Volunteer Health

1.0 General

1.1 Background

The Peace Corps is an independent executive agency of the federal government established in 1961 by President John F. Kennedy to promote world peace and friendship through the service of American Volunteers abroad. Peace Corps Volunteers and host community partners advance and embody Peace Corps mission, values, and three goals in communities around the globe, including:

· To help the countries interested in meeting their needs for trained people

· To help promote a better understanding of Americans on the part of the peoples served and

· To help promote a better understanding of other peoples on the part of Americans.

The Peace Corps currently supports approximately 3,030 Volunteers across more than 60 countries worldwide. Over the life of this contract, the Volunteer population is expected to grow to approximately 8,000.

Estimated Target Number of Beneficiaries Under Each Plan by Contract Year

The Department of Global Operations, Office of Volunteer Health is responsible for determining whether applicants are medically qualified for Volunteer service and for operating a comprehensive international health system that supports Invitees, Trainees, Volunteers, and, when authorized, Returned Peace Corps Volunteers. To fulfill this mission, the Office of Volunteer Health assesses applicants’ medical needs and qualifications; provides clinical and preventive health services; delivers clinical supervision, technical guidance, training, and education; and ensures essential administrative support. These functions are carried out by a multidisciplinary team of trained health professionals dedicated to maintaining and improving Volunteer health throughout their service.

1.2 Scope

The Health Care Benefits contract supports the Peace Corps’ healthcare benefits program, which includes both self‑insured and commercially insured components. The contract supplements services provided by Peace Corps’ internal medical staff operating in more than 60 countries and ensures that the Peace Corps community has access to domestic and international healthcare networks and comprehensive healthcare administrative services.

To provide clarity and eliminate redundancy throughout this Performance Work Statement, standard Beneficiary categories are defined in a consolidated section. These Beneficiary groups—Applicants, Invitees, Trainees, Volunteers, and Returned Peace Corps Volunteers—represent distinct stages of Peace Corps service. Each health care plan within this contract applies only to the specific Beneficiary groups designated for that plan. Accordingly, Plans 1 through 4 provide different benefits, services, and administrative requirements tailored to the eligibility status of each Beneficiary group, and all references to plan coverage shall be interpreted in alignment with these defined categories.

The Peace Corps defines titles for the stages of service:

· Applicant – person who applies for service

· Invitee – person who is invited to serve

· Trainee – entered service not yet sworn-in as Volunteer

· Peace Corps Volunteer – sworn-in to a typical two-year or limited shorter service agreement

· Returned Peace Corps Volunteer – ended service

Under this contract, the contractor shall:

· Manage financial assistance to Beneficiaries’ authorized medical, mental health, dental, and vision examinations to support the Office of Volunteer Health medical clearance process.

· Provide access for Beneficiaries to national and international healthcare provider networks and consultants, including international air ambulance and accompaniment medical evacuation services.

· Deliver medical and pharmacy support services, including online authorization management, guarantees of payment, and access to claims data.

· Process and adjudicate authorized claims in accordance with contract requirements for eligible Beneficiaries.

· Provide access to a short-term group medical insurance policy for Beneficiaries.

1.3 Objective

The primary outcomes of the Health Care Benefits contract are as follows.

1.3.1 Objective 1 – Claims Processing

The Contractor shall provide prompt, efficient, and accurate processing and adjudication of all claims within the scope of the contract, including claim development, coding, processing, medical and dental review, verification of Peace Corps authorizations, accuracy and completeness checks, troubleshooting customer support, and data record submission and maintenance.

1.3.2 Objective 2 – Customer Satisfaction

The Contractor shall achieve the highest level of customer satisfaction by delivering accurate, timely, and efficient health care claims processing; responsive and courteous customer support; user‑friendly online portals and chat tools; accessible provider search capabilities; clear benefits information; and prompt handling of air ambulance and guarantee of payment requests.

1.3.3 Objective 3 – Management

The Contractor shall provide comprehensive program management and operational oversight to ensure effective administration of all Health Care Benefits contract activities. This includes establishing governance structures, maintaining quality assurance and compliance systems, coordinating subcontractors and service components, overseeing claims processing accuracy, managing customer service performance, ensuring timely reporting, applying fraud‑prevention controls, and maintaining all systems, processes, and communication channels required to fulfill contract requirements.

1.3.4 Objective 4 – Provider Networks

The Contractor shall establish, maintain, and continuously improve robust national and international healthcare provider networks that ensure timely access to credentialed hospitals, physicians, ancillary service providers, behavioral health professionals, dentists, pharmacies, diagnostic and treatment facilities, air ambulance and medical accompaniment services, and telemedicine/telehealth resources. The Contractor shall ensure network adequacy, currency, credentialing, and provider cooperation with Peace Corps requirements, including no‑balance‑billing protections and acceptance of authorized payment as payment in full.

1.3.5 Objective 5 – Short Term Group Health Insurance

The Contractor shall provide an affordable short‑term health insurance policy that meets the minimum requirements established by the contract.

1.3.6 Objective 6 – Transition

The Contractor shall ensure all systems and processes are fully operational at the start of health care delivery, enabling minimal disruption and a seamless transfer of services from and to any predecessor or successor contract.

2.0 Performance Requirements

2.1 Technical Requirements

The Contractor shall perform all technical requirements of the Health Care Benefits contract in accordance with all applicable statutes, regulations, and policies, including those referenced in Section H.24, Statutory and Regulatory Authority. All work shall be carried out in a manner that upholds the Peace Corps’ commitment to doing no harm, delivering services in good faith, and preserving the agency’s reputation for goodwill, integrity, and public trust.

The Contractor shall provide high‑quality, responsive, and timely health care and administrative services that meet the needs of all eligible Peace Corps Beneficiaries and shall execute all requirements in a manner that supports and preserves the Peace Corps’ relationship with those it serves.

The Contractor shall provide, at a minimum, the services and capabilities described in the subsections that follow.

2.2 Health Care Benefits Program Plans 1-4

2.2.1 PLAN 1: Invitee Cost Reimbursement Administrative Services

2.2.1.1 Plan 1 Benefit Definition

Services provided under this coverage are referred to as Plan 1 and apply to Peace Corps Invitees who are United States citizens, including those residing outside the United States.

An Invitee is an applicant who has received and accepted an invitation to serve as a Volunteer and is undergoing the medical clearance process prior to becoming a Peace Corps Trainee. The Contractor shall provide reimbursement administrative services for Invitees during their Plan 1 eligibility period and shall not pay for any services provided or paid for prior to the Invitee’s invitation date.

2.2.1.2 Plan 1 Reimbursable Medical Expenses

Beneficiaries must complete required medical, behavioral health, dental, and vision examinations, as well as all necessary immunizations, to obtain medical clearance for service. Beneficiaries shall submit required documentation after services are rendered and after paying out‑of‑pocket or cost‑sharing through their personal insurance. Cost‑reimbursement eligibility is based on predetermined eligibility of Invitee status under Plan 1 and proof of out‑of‑pocket expense.

The Contractor shall process reimbursements based on the required documentation submitted for examinations and immunizations and shall issue payment directly to the Beneficiary. The Contractor shall develop a standardized claim form for Peace Corps approval prior to use.

Peace Corps Invitee Medical Reimbursement Form collects invitee identification information (name, CRN number, date of birth) and enables invitees to request reimbursement for eligible pre‑service medical expenses not covered by their primary insurance, including medical exams, dental exams, eye exams, and required immunizations. It requires submission of itemized provider bills containing patient and provider details, CPT and diagnosis codes, service dates, and itemized charges, along with proof of payment such as receipts or bank/credit card statements. The form also mandates completion of direct‑deposit banking information—account holder name, account number, routing number, bank name, and address—as reimbursements are issued electronically. Invitees must sign an authorization allowing the contractor to deposit reimbursements, and the form includes mandatory HIPAA and Privacy Act disclosures governing the handling of personally identifiable and medical information.

Required claim documentation shall include:

· Itemized bill detailing services provided, including diagnosis and procedure codes

· Proof of payment for services rendered

· Completed claim form

· Summary of benefits and coverage, if applicable

· Documentation of applicable cost‑sharing obligations (deductibles, copayments, coinsurance)

· Identification of any exclusions or restrictions relevant to the claim

· Certified translation documents, if applicable

· Proof of administrative fees were required for authorized Peace Corps medical clearance requirements and align with dates of services rendered, if applicable

· Banking and accounting information for reimbursement

The Contractor shall reimburse Beneficiaries for Peace Corps‑required services up to the applicable usual and customary amount. The Peace Corps typically covers 100% of required medical services, examinations, diagnostic tests, immunizations, and administrative tasks, subject to limits based on prevailing charges for the same services within the geographic region. Limits prevent excessive billing and ensure alignment with standard market rates. Services that are not requested or authorized by the Peace Corps are not covered.

Treatment of any kind, except immunizations, is not reimbursable under Plan 1.

Items eligible for full reimbursement are categorized as the following:

· Medical examinations, including specialty evaluations

· Dental examinations and X-rays

· Mental health evaluations

· Required immunizations

· Laboratory tests and diagnostic work

· Vision screenings and examinations

· Administrative fees for completing Peace Corps issued specific medical clearance paperwork

· Certified language translations of required medical records

Reimbursable Examples:

· Medical exams, labs, X‑rays, and immunizations required by the Peace Corps.

· Specialist evaluations requested by the Peace Corps.

· Certified translations of medical documents required for Peace Corps review.

· Administrative fees directly related to completing Peace Corps medical forms.

Non‑Reimbursable Examples:

· Any service not required or authorized by the Peace Corps.

· Routine or elective medical care unrelated to clearance or treatment authorization.

· Services completed before the Invitee’s official invitation date.

· Non‑certified or informal translations.

· Administrative or clinic fees not tied to Peace Corps requirements.

Administrative fees are charges imposed by a healthcare provider or facility for non‑clinical, non‑treatment administrative activities necessary to complete Peace Corps–required medical clearance or evaluation processes. Administrative fees are not payments for medical treatment or clinical procedures. Instead, they cover provider administrative work directly tied to Peace Corps requirements.

Certified language translation of medical documents refers to a formally verified, accurate translation of medical records, clinical notes, diagnostic reports, laboratory results, imaging summaries, prescriptions, or other health‑related documentation originally written in a non‑English language.

When necessary to make a medical clearance determination, the Peace Corps will reimburse an applicant up to the usual and customary amounts for all Peace Corps required medical examinations, including specialist evaluations; dental examinations and x- rays; mental health examinations; required immunizations based on country of assignment, laboratory work and diagnostic tests; and vision examinations. The Peace Corps will cover 100% of the cost.

2.2.1.3 Plan 1 Contractor Requirements

· The Contractor shall provide all personnel, supplies, services, and facilities necessary to deliver health care administrative services for Beneficiaries.

· The Contractor shall provide access to a network of qualified providers capable of delivering all required medical, dental, behavioral health, diagnostic, and immunization services.

· The Contractor shall issue, manage, administer, track, and distribute reimbursements.

· The Contractor shall ensure all reimbursement decisions comply with Peace Corps requirements, including usual and customary limits.

· The Contractor shall provide the Government with a monthly report summarizing all activities, in accordance with CDRL A016.

2.2.2 Plan 2: Health Care Administrative Services for Peace Corps Volunteers

2.2.2.1 Plan 2 Benefit Definition

Services provided under this coverage are referred to as Plan 2 and apply to Peace Corps Trainees and Volunteers.

While overseas in their country of service, Trainees and Volunteers receive routine and emergency medical care, preventive services, health promotion, disease‑prevention support, and referrals to international healthcare providers directly from Peace Corps medical staff. Each Peace Corps country program operates a Health Unit staffed by locally employed, international, and/or U.S. medical professionals, with oversight from Regional Medical Officers and Office of Volunteer Health staff in Peace Corps/Washington. Medical staff may include registered nurses, nurse practitioners, and medical doctors, and Regional Medical Officers—licensed physicians—are assigned to hubs in Morocco, Peru, South Africa, and Thailand.

Routine and emergency medical care provided directly by Peace Corps in‑country medical staff, or through services arranged by the Peace Corps post is funded and managed by the Peace Corps. However, when directed by the Peace Corps Office of Volunteer Health, the Contractor may be required to identify, credential, and compensate overseas providers under Plan 2.

When authorized by the Office of Volunteer Health, Plan 2 applies to Peace Corps Trainees and Volunteers who require non‑routine or emergency medical, behavioral health, or dental evaluation or treatment that may result in medical evacuation (“medevac”) to the United States or to designated regional locations worldwide. Washington, D.C. is the primary U.S. medevac site, followed by the Beneficiary’s home of record. Internationally, the Peace Corps primarily utilizes its Medical Hubs for medevacs, though Trainees and Volunteers may be transported to other locations when necessary.

While most medevac travel is arranged directly by the Peace Corps, the Peace Corps may require air ambulance services to safely transport a Beneficiary in situations where standard medical evacuation arrangements are not feasible. Because these services may be needed in any global location, the Peace Corps maintains current information on all countries in which Volunteers serve, available at https://www.peacecorps.gov/what-we-do/where-we-serve/.

When authorized by the Office of Volunteer Health, Trainees and Volunteers may also receive Plan 2 care in the United States while on authorized leave, on official business or in training, or on medical leave, including emergency air ambulance services when required.

The Contractor shall, when required, provide a guarantee of payment or establish a pre‑arranged relationship with a medical facility to ensure the timely delivery of patient care or transport.

2.2.2.2 Coverage and Access

Beneficiaries on personal leave or official travel status may access the National Network within all 50 states, the District of Columbia, and Puerto Rico. During Peace Corps service, Beneficiaries may require air ambulance services from their country of service or from any other country to which they travel.

When in the United States or abroad on leave or official travel status, Beneficiaries requiring routine or non‑routine medical or dental care shall receive services from providers whose costs are paid by the Peace Corps through the Health Care Benefits contract, including pharmacy needs. The Contractor shall ensure that all health care services provided to a Beneficiary is pre‑authorized by the Peace Corps. Authorizations may be issued by qualified Peace Corps clinical staff, domestic or international, including medical doctors, nurses, and dentists.

2.2.2.3 Contractor Requirements

· The Contractor shall provide all personnel, supplies, services, and facilities necessary to deliver health care administrative services for Beneficiaries.

· The Contractor shall provide access to a network of qualified providers capable of delivering all required medical, dental, behavioral health, and diagnostic services.

In addition, the Contractor shall provide services for Beneficiaries as follows.

2.2.2.3.1 Provider Network Component

The Contractor shall provide and maintain a national provider network within the fifty United States, the District of Columbia, and Puerto Rico, as well as an international provider network. Each network shall consist of credentialed hospitals, physicians, ancillary service providers, behavioral health professionals, dentists, and diagnostic and treatment facilities capable of meeting the authorized health care needs of Beneficiaries in the United States or abroad.

The Contractor shall maintain an accurate, current, and readily accessible searchable directory of all network providers.

The Contractor shall issue identification cards to Beneficiaries for use within the national network, enabling access to network providers throughout the United States, including Alaska, Hawaii, and Puerto Rico. The identification mechanism shall remain valid while Beneficiaries are traveling domestically or internationally.

The Contractor shall ensure that all practitioners and facilities within the national and international networks, and all entities with whom claims are negotiated, accept the authorized payment amount as payment in full. Practitioners and facilities shall not bill, balance bill, or otherwise attempt to collect from Beneficiaries any amount that exceeds the authorized payment for covered services.

If Peace Corps medical staff refer a Beneficiary to an out‑of‑network provider, the Contractor shall ensure that all practitioners and facilities within the national network cooperate fully and do not impede or delay Peace Corps efforts to facilitate the referral.

To support priority care for Beneficiaries, the Contractor shall coordinate with the providers identified in a list of “Panel Providers” who offer additional or pre‑arranged discounts and prioritized care for medevac’d Beneficiaries.

Sample Panel Providers List:

Priority care includes, but is not limited to:

· Providing 24‑hour phone access for emergency inquiries and 24‑hour access to emergency evaluation and treatment facilities, 365 days per year.

· Providing priority in‑network referrals for evaluation and treatment.

· Providing paper or electronic consultations, including:

· A complete response to a telephone inquiry or written report within 24 hours of evaluation or treatment; and

· A written report within 5 business days following completion of a course of evaluation or treatment.

· Establishing, administering, and facilitating procedures that allow access to other qualified physicians, mental health professionals, and dentists referred by the Peace Corps who agree to these priority‑care requirements.

· Informing panel providers of Peace Corps service requirements and policies prior to contract implementation and again within 30 days of any subsequent contract renewal or modification affecting service requirements or operating procedures.

· Offering telemedicine or telehealth services where available.

2.2.2.3.2 Pharmaceutical Component

The Contractor shall provide a mechanism that allows managed prescription drug service providers to verify individual eligibility for pharmaceutical services at the point of service. The Contractor shall ensure that any prescription exceeding a 30-day supply or exceeding $1,000.00 is dispensed only with prior approval from the Peace Corps. The Contractor shall develop and maintain a pre-approval process and troubleshooting procedures to contact the Peace Corps for authorization of prescriptions that exceed these thresholds or where issues arise.

The Contractor shall cover Peace Corps authorized vaccines administered to Beneficiaries in the U.S. for medevac care, authorized leave, or official purposes. Vaccine claims shall process at point of sale using the same eligibility system.

2.2.2.3.3 Air Ambulance/Aeromedical Evacuation Services Component The Contractor shall, when medically necessary and appropriate, arrange worldwide emergency medical evacuation, logistics support, and clinical documentation for Beneficiaries. The Contractor shall serve as the primary source for international medical evacuations; however, the Government reserves the right to use alternative evacuation options when they are faster, more feasible, or more efficient. Such alternatives may include, but are not limited to, the Department of Defense, the Department of State, or Peace Corps hospital vendors providing inter‑system or intra‑post transfers. Notwithstanding these exceptions, the Contractor shall continue to provide the majority of international air ambulance services for Beneficiaries.

When logistically feasible to arrange transport to a Peace Corps preferred medical treatment destination listed in a “Preferred Air Ambulance Destinations” list, the Contractor shall facilitate such transport when requested by an authorized Peace Corps representative (as identified in “Authorized Air Ambulance Callers” list). Evacuation services shall include land and/or air medical evacuation from the Beneficiary’s location to an appropriate medical treatment facility. The Contractor shall:

· Maintain an up‑to‑date database of credentialed and accepting medical facilities to enable rapid identification of an appropriate receiving destination.

· Provide trained medical personnel and medical equipment sufficient to maintain the clinical stability of a critically ill Beneficiary from initial acceptance through transfer to the receiving facility.

· Facilitate all required immigration and customs processes for the Beneficiaries.

· Provide medical management services, relevant technology, case consultation, timely and accurate communication, and protection of medical confidentiality in accordance with this PWS.

Example Preferred Air Ambulance Destinations List:

City and Country

Bangkok, Thailand

Rabat, Morocco

Pretoria, South Africa

Washington, D.C., United States

Example Authorized Air Ambulance Callers List:

Field Support Coordinator

Field Support Coordinator

Emergency air evacuations are used for acute, life‑threatening conditions and require a coordinated effort between the Contractor and Peace Corps. In such cases, Peace Corps will request Contractor services through a designated authorized representative (as listed in Authorized Air Ambulance Callers List). The Contractor shall respond to all referrals for emergency air evacuation services 24 hours per day, 365 days per year via telephone or other secure electronic means.

Air ambulance evacuation services may include issuing guarantees of payment to the receiving facility, making medical arrangements, and providing health care management throughout the evacuation process.

In certain instances, the Peace Corps may arrange and fund commercial travel for a Beneficiary outside the contract while requiring accompaniment services from the Contractor. The Contractor shall provide accompaniment on commercial airlines when clinically or logistically appropriate and when requested by an authorized Peace Corps representative. The Contractor shall ensure availability of medical accompaniment, trauma‑informed accompaniment, or a non‑medical escort, as needed, and shall coordinate all travel arrangements required for the accompaniment. The Contractor shall coordinate all travel arrangements needed for the accompaniment and meet the timelines in Section 2.2.2.3.3.1 or as otherwise agreed with the Contracting Officer Representative.

2.2.2.3.3.1 Peace Corps Procedures for Administration of Air Ambulance Transportation and Logistics An authorized Peace Corps representative (as listed in Authorized Air Ambulance Callers List) will contact the Contractor to request air ambulance transportation and logistics services. Verbal notification is sufficient to authorize issuance of a guarantee of payment and to begin coordination of services. All verbal authorizations will be followed by written authorization within three days.

The Peace Corps is responsible for providing updated clinical information, case summaries, and any required medical documentation needed to initiate an evacuation request, including translations of medical records when available. The Contractor is responsible for obtaining all operational details required to coordinate the evacuation, including provider quotations, flight and logistics information, and any additional documentation or translations necessary to complete transport arrangements.

The authorized Peace Corps representative will provide, at a minimum:

· Demographic and clinical information, including the Beneficiary’s name, date of birth, and Volunteer ID number.

· Case summary, diagnosis, current health status, and treatments initiated.

· Points of contact for relevant Peace Corps medical staff, including telephone numbers, email addresses, and fax numbers.

· Geographic location of the Beneficiary.

· Peace Corps preferred evacuation location, if applicable.

· Name and telephone number of the local attending physician, hospital, or clinic.

· Contact information for the U.S. Embassy.

· Contact information for the intended receiving provider, whether the Beneficiary is able to travel to the preferred destination.

· Name and relevant information for any authorized accompanying individual.

The Contractor shall ensure the air ambulance provider is aware of all local flight logistics, including:

· Local airport hours of operation, runway length and surface, availability of night lighting, and other operational requirements.

· Flight permissions and landing rights, including procedures for obtaining airspace, immigration, and landing clearances.

· Visa requirements and procurement.

· Embassy assistance needs, if required.

· Landing fees and required payment methods.

· Refueling procedures, availability and cost of aviation fuel, and methods of payment.

· Ambulance protocols, including procedures to position an ambulance and attendants on the runway within two hours of initial contact.

The Contractor shall, at a minimum:

· Inform the authorized Peace Corps representative if evacuation cannot occur within 24 hours.

· Provide destination country and city, flight plan, receiving facility, and attending physician.

· Develop low-altitude flight plans when medically indicated.

· Provide aircraft type, tail sign, call sign, and names and nationalities of crew.

· Provide estimated arrival time at the Beneficiary’s location, estimated arrival time at destination, and periodic updates.

· Provide a comprehensive cost estimate, including all transportation costs; daily charges for medical and flight crew; medical equipment and medications; case or administrative fees; ground transportation; and telecommunications, ground handling, and airport fees. This shall include any and all current and potential charges associated with an emergent air ambulance/transportation medevac including but not limited to cancellation fees (and when the cancellation fees will be applied) and any other associated fees. Peace Corps shall agree to pay up to 100% of the cost of the initial transport quote as a cancellation fee in the event that cancellation fees are not provided at time of quote, and the air ambulance is cancelled after the aircraft/crew has been committed to Peace Corps. It shall be noted that submission of a cost estimate from a vendor to Peace Corps shall never be delayed due to a lack of the cancellation fee estimate. The Contractor’s commitment is to negotiate any cancellation fees in good faith on behalf of Peace Corps, with the objective of reducing or having said fees waived.

The Contractor shall provide at least three medevac options per request and transmit each quotation to the Peace Corps as soon as it is received, enabling timely evaluation of emergency transport options. The Peace Corps may support the process by providing logistical information when available.

Upon review and acceptance of the cost estimate, the authorized Peace Corps representative will direct the Contractor to initiate emergency evacuation services. If Peace Corps does not authorize the services, no associated costs shall be incurred by Peace Corps.

Once evacuation is initiated, Peace Corps will notify relevant overseas Peace Corps post and will receive the following from the Contractor:

· Verification that emergency evacuation services have been secured.

· Confirmation that the Contractor will contact the overseas post and the name of the coordinating physician.

· Evacuation destination, receiving facility, and attending physician (the Contractor shall make every effort to transport the Beneficiary to a Peace Corps preferred facility).

· Estimated flight times for arrivals and departures.

The Contractor shall maintain continuous communication with Peace Corps overseas medical staff, Medical Officers, and/or the Field Support Clinician assigned throughout the evacuation. This includes:

· Providing periodic updates approximately every two hours on evacuation status, aircraft availability, landing locations, and medical facility selection.

· Coordinating all ground ambulance transportation at departure and arrival locations.

· Providing updates upon takeoff, mid‑flight, and approximately one hour before landing.

· Having the coordinating physician contact Peace Corps medical staff to confirm contact information, obtain detailed case information, provide interim management guidance, and assess the Beneficiary’s status.

· Contacting the attending physician, as needed.

· Preparing a comprehensive written narrative of all medical care rendered during the patient movement. This narrative shall be translated into English (if required), digitized, and submitted via secure electronic means to the authorized Peace Corps representative (as listed in Authorized Air Ambulance Callers List), with a copy to the PCMO, within 96 hours of mission completion. Documentation shall include a cover sheet, preflight assessment, inflight medical documentation, treatment orders, and postflight handoff notes.

After arrival at the destination, Peace Corps will maintain communication between the overseas staff and the Contractor’s coordinating physician, authorize required services from receiving providers, and issue notification when Contractor services are to be discontinued.

2.2.2.3.3.2 Security, Travel and Other Unique Requirements

The Contractor shall, at initial contact, communicate to the authorized Peace Corps representative any travel, security, or documentation requirements that may affect performance of services, including the need to secure appropriate visas for the Beneficiary under the Contractor’s care. The Contractor shall ensure completion of all authorizations and documentation necessary to obtain passage through immigration, border control, and customs for air ambulance medical evacuations.

The Contractor shall provide Peace Corps with all pertinent information related to conditions at points of embarkation and disembarkation, including but not limited to local airport facilities, flight permissions, landing rights, hours of operation, runway length and surface, availability of night lighting, and local ambulance protocols.

The air ambulance vendor shall provide medical personnel who hold all required professional certifications and licenses, including but not limited to Advanced Cardiac Life Support (ACLS), International Trauma Life Support (ITLS), Trauma Nursing Core Course (TNCC), and applicable Drug Enforcement Agency (DEA) medication licenses. The vendor shall maintain credentialed aircraft and flight crews certified by the Commission on Accreditation of Medical Transport Systems (CAMTS) or the European Aeromedical Institute (EURAMI) and shall maintain all insurance required for medical evacuation operations.

The Contractor shall provide evidence of all required certifications and credentials upon request by the Agency at any time during the period of performance.

2.2.2.3.3.3. Medevac Medical Consulting Services (included in Plan 2) The Contractor shall provide medical consulting and contingency planning services to support Peace Corps deployment planning and health risk mitigation. These services support Duty of Care obligations, control medical and evacuation costs, and enable Peace Corps to respond to rapidly changing geopolitical conditions.

The Contractor’s clinical team shall perform contingency planning for Peace Corps identified locations. This assessment, conducted by a licensed nurse or physician, shall include risk mitigation recommendations, global border restriction advice, and any additional planning required for deployment.

Deployment Planning Services shall include:

· Air Ambulance Evacuation Planning: Upon request from the COR or designee, the Contractor shall research air ambulance availability and expected response times for a specified country, identify preferred evacuation destinations aligned with Peace Corps medical hubs, and provide recent operational history, including any medical evaluations or evacuations completed into or out of the specified countries within the prior three months. The Contractor shall identify potential delays or challenges, including those related to high-risk patients. A written summary including all required elements shall be provided within 1 to 5 business days. This requirement applies to both air ambulance entry into the country of service, transit points, and transport to the destination of care.

· Provider Network Research: Upon request from the COR, the Contractor shall research a specified hospital or air ambulance provider to determine capability, capacity, and suitability for use in expediting care or patient transfers. The Contractor shall recommend alternative hospitals or air ambulance providers if the reviewed provider is unable to meet Peace Corps requirements. A written summary of findings shall be provided within 1 to 5 business days.

2.2.3 Plan 3: Health Care Administrative Services for Returned Peace Corps Volunteers

2.2.3.1 Benefit Definition

Services provided under this coverage are referred to as Plan 3 and apply to Returned Peace Corps Volunteers.

For a period of six months following the end of a Beneficiary’s service, the Peace Corps may authorize medical evaluations only for conditions that resulted from, or were exacerbated by, Peace Corps service to Returned Peace Corps Volunteers. In addition, Returned Peace Corps Volunteers are eligible for three optional readjustment mental health counseling sessions upon close of service.

Under Plan 3, the Peace Corps authorizes evaluation services only; treatment is not authorized. Any ongoing or follow-up medical or mental health treatment must be pursued through Federal Employees’ Compensation Act or other noncontract programs unless explicitly approved as an exception by the Peace Corps

2.2.3.2 Coverage and Access

At the time of award, the Peace Corps will inform the Contractor of the specific evaluation services and conditions authorized under Plan 3. Treatment is not authorized. All approved services for Beneficiaries will be supported by Peace Corps–issued authorizations.

Standard authorizations include three optional readjustment counseling sessions. When not completed during service, standard authorizations may also include close‑of‑service medical exams, authorized by a PC-209B form and dental exams with x‑rays (excluding prophylaxis) authorized by a PC-127C form.

Form PC‑OMS‑127C (Authorization for Payment of Medical Services) This form provides the contractor with the essential data required to process Peace Corps medical service claims, including Volunteer identification, service dates, authorized providers, medical issues, and specific services approved for payment. It includes the authorizing official’s information and required dates, and instructs that all claims must be accompanied by the signed authorization, itemized bills, and proof of payment when applicable. The contractor must ensure that only authorized services are paid, no copays or balance billing are applied, and all processing complies with HIPAA and Privacy Act requirements.

Form PC‑OMS‑209B (Authorization for Medical Examination and Labs) This form authorizes post‑service medical examinations and laboratory tests for returned Volunteers and specifies the exact tests permitted, including physical exams, infectious disease screenings, imaging, and age‑based screenings. It provides volunteer identifiers and the authorized service window, which is limited to 60 days after the effective date. Contractors must validate that only the listed exams are billed, ensure claims include the required authorization and itemized documentation, and enforce Peace Corps rules prohibiting copays and balance billing while maintaining Privacy Act compliance.

Peace Corps may authorize additional mental health counseling or other evaluation or treatment on a case‑by‑case basis within or after the six‑month eligibility period, consistent with the Peace Corps Act and the Kate Puzey Act. Such exceptions require approval by Office of Volunteer Health staff in coordination with the COR. Beneficiary eligibility for these exceptions is determined individually. Beneficiaries who experienced a Peace Corps‑reported sexual assault are authorized a total of ten mental health counseling sessions.

The Contractor shall refer Beneficiaries to the FECA program at Peace Corps for any medical treatment, follow‑up care, or benefits that fall outside the limited evaluation services authorized under Plan 3. The Contractor is not responsible for coordinating, authorizing, or managing FECA benefits. Beneficiaries seeking coverage for non‑authorized conditions, ongoing treatment, or service‑related medical needs beyond the Plan 3 evaluation period must file a claim directly with the Department of Labor. The Contractor shall provide information or documentation to the Peace Corps, upon request, to support FECA referrals or claims, but shall not engage in FECA case management.

2.2.3.3 Contractor Requirements

· The Contractor shall provide all personnel, supplies, services, and facilities necessary to deliver health care administrative services for Beneficiaries.

· The Contractor shall provide access to a network of qualified providers capable of delivering all required medical, dental, behavioral health, and diagnostic services.

· The Contractor shall implement and maintain fraud prevention and detection controls, including procedures to identify, investigate, and report suspected fraudulent claims or documentation in accordance with applicable laws and contract requirements.

2.2.4 PLAN 4 (Short-Term Group Health Insurance Policy) –

2.2.4.1 Benefit Plan Definition

Services provided under this coverage are referred to as Plan 4 and apply to Returned Peace Corps Volunteers.

Peace Corps provides short‑term group health insurance to Returned Peace Corps Volunteers and eligible dependents for up to three months after close of service. Plan 4 is not required to duplicate Federal Employees Health Benefits Temporary Continuation of Coverage. However, it must be similar in structure by providing short‑term group health insurance with benefits, enrollment processes, and continuation provisions that meet or exceed the minimum requirements defined by the Peace Corps. The Contractor shall design Plan 4 to align with the intent of FEHB TCC—temporary coverage following separation—while allowing for differences in benefits, cost‑sharing, and limitations as specified in Attachment J.9.

2.2.4.2 Coverage and Access

The Contractor shall provide Short‑Term Health Insurance for Transition and Travel (SHIFTT) to Beneficiaries and eligible spouses/dependents, consistent with coverage similar to the Federal Employees Health Benefits Temporary Continuation of Coverage under 5 U.S.C. § 8905a. All eligible Beneficiaries and Dependents shall be enrolled effective 12:00 a.m. (EST) following their close of service, regardless of length of service.

Policy premiums, deductibles, and co‑payments must meet or exceed the current Plan 4 coverage defined in Attachment J.9.

At its discretion, Peace Corps will pay the first month’s premium for Beneficiaries and allow enrollment of eligible spouses/dependents. Beneficiaries and eligible dependents may elect to continue coverage for up to two additional months at their own expense, at the same monthly premium rate paid by Peace Corps for the first month. Beneficiaries are personally responsible for premium payments for their dependents for all coverage periods. A total of three months of coverage will be available under this plan.

Peace Corps may also authorize payment for additional months of premiums at its discretion. The COR or designee will notify the Contractor when such decisions occur and will specify both the length of extended coverage authorized (e.g., one or two additional months) and the Beneficiaries eligible for the additional premiums.

The Contractor shall provide payment options including credit card, month‑to‑month billing, and use of the Beneficiary’s readjustment allowance. Readjustment allowances are held by Peace Corps in a central account and may be remitted directly to the Contractor upon the Beneficiary’s request to cover one or both additional months of premiums. Peace Corps will transfer these funds via EFT, typically on a weekly basis, using the Contractor’s online portal and providing a payroll report identifying the Beneficiaries whose SHIFTT premiums are included.

2.2.4.3 Administrative Process Requirements

The Contractor shall establish and maintain processes and procedures to effectively administer Beneficiaries access to short-term health insurance. At a minimum, the Contractor shall provide:

· A process for notifying Beneficiaries of their health insurance benefits

· A process for Beneficiaries to elect to continue coverage beyond the first month

· A process for determining eligibility and applying any enrollment restrictions

· A process for receiving the first month’s premium payment from Peace Corps for all Beneficiaries at close of service

· A process for identifying eligible Beneficiaries and activating coverage

· A process for Beneficiaries to enroll and pay for coverage of eligible spouses/dependents

· A process for notifying Beneficiaries of premium obligations after the first month

· A process for allowing Beneficiaries to pay premiums directly to the insurer for subsequent months

· A process for coordinating benefits with Federal Employees’ Compensation Act, Medicare, and other applicable programs

· A process for confirming enrollment and issuing identification cards (distinct from identification cards issued under Plans 2&3)

The Contractor shall provide access to a short-term group health insurance policy that meets the following minimum requirements:

· A group health insurance policy with premiums, deductibles, and copayments meeting or exceeding current Plan 4 requirements as defined in Attachment J.9

· Customer service agents sufficient to respond to inquiries regarding eligibility, claims, fee schedules, and reimbursements/payments

· A toll‑free phone line, email address, online portal, and chat function for inquiries related to eligibility, claims, and reimbursements/payments

· Prompt claims processing for reimbursements, refunds, and voids, with all claims processed within 20 business days

· The Contractor shall document turnaround times for logging claims, adjudicating claims, and paying clean claims with an accompanying explanation of benefits

· A claims appeal procedure enabling Beneficiaries and providers to dispute and resolve claim related decisions

· Secure, automated health care claims processing and accounting systems, including an online portal for Peace Corps Office of Volunteer Health staff and individual members.

· Systems shall include security monitoring, breach notification, user access controls, data center security, daily backups, disaster recovery procedures, business continuity plans and align with security requirements of this contract.

· Compliance with Health Insurance Portability and Accountability Act electronic health care transactions and code sets standards and secure procedures (in coordination with Peace Corps) for transmitting eligibility data, authorizing services, and accessing all relevant program information

· Accurate, current provider information

· Production, distribution, and periodic updating of program brochures and related materials, in softcopy or hardcopy as needed

· Online or electronic access to plan outlines, certificates, enrollment procedures, renewal notices, and payment options

· A procedure and medium for archiving administrative data and maintaining individual claims online for at least the duration of each member’s eligibility period

The Contractor is not responsible for administering or coordinating benefits under FECA, Medicare, or any other non-Peace Corps program. When a Beneficiary may be eligible for coverage under another program, the Contractor shall identify the potential overlap, notify the Peace Corps, and provide relevant claims or enrollment information upon request. The Contractor shall not engage in benefit determination, case management, or claims processing for FECA, Medicare, or other external programs but shall cooperate with Peace Corps requests for documentation needed to support those programs’ processes.

2.2.4.5 Contractor Requirements

· The Contractor shall provide all personnel, supplies, services, and facilities necessary to deliver health care administrative services for Beneficiaries.

· The Contractor shall provide access to a network of qualified providers capable of delivering all required medical, dental, behavioral health, and diagnostic services.

2.2.5 MEDICAL CLAIMS Administration:

2.2.5.1 Contractor Requirements:

The Contractor is not required to underwrite the cost of health care services provided to eligible Beneficiaries. The Contractor shall process all authorized medical claims as passthrough costs and submit them to the Government for reimbursement in accordance with Section G. The Contractor shall ensure that invoices reflect only the actual, authorized cost of services, without markup, fee, or percentage-based charges. The Contractor shall maintain documentation supporting each billed amount and follow the reimbursement procedures, timelines, and financial reporting requirements defined in Section G to ensure accurate and auditable passthrough billing.

· The Contractor shall provide all personnel, supplies, services, and facilities necessary to deliver health care administrative services for Beneficiaries.

· The Contractor shall provide access to a network of qualified providers capable of delivering required medical, dental, behavioral health, and diagnostic services.

· The Contractor shall implement and maintain fraud prevention and detection controls, including procedures to identify, investigate, and report suspected fraudulent claims or documentation in compliance with applicable laws and contract requirements.

2.2.5.1.1 Restrictions on Profit or Fee

The Government will not pay profit or fee as a percentage of costs associated with medical claims. The Contractor shall not be obligated to pay invoices if doing so exceeds the ceiling price set forth in the schedule and the Government will not be obligated to pay the Contractor any amount more than the ceiling price in the schedule.

Because profit or fee may not be calculated…