HT940222R0001_Conformed_Amend 0001.pdf

HT940222R0001

SOLICITATION, OFFER AND AWARD

4. TYPE OF SOLICITATION2. CONTRACT NUMBER 3. SOLICITATION NUMBER

7. ISSUED BY CODE 8. ADDRESS OFFER TO (If other than Item 7)

ORDER UNDER DPAS (15 CFR 700)

6. REQUISITION/PURCHASE NUMBER

NOTE: In sealed bid solicitations "offer" and "offeror" mean "bid" and "bidder".

NEGOTIATED (RFP)

SEALED BID (IFB)

5. DATE ISSUED

1. THIS CONTRACT IS A RATED RATING PAGE OF PAGES

1 128

C. E-MAIL ADDRESS

EXT.NUMBERAREA CODE

B. TELEPHONE (NO COLLECT CALLS)A. NAME

10. FOR

INFORMATION

CALL:

CAUTION: LATE Submissions, Modifications, and Withdrawals: See Section L, Provision No. 52.214-7 or 52.215-1. All offers are subject to all terms and conditions contained in this solicitation.

(Date)(Hour) local timeuntildepository located in copies for furnishing the supplies or services in the Schedule will be received at the place specified in Item 8, or if hand carried, in the

SOLICITATION

9. Sealed offers in original and

PART IV - REPRESENTATIONS AND INSTRUCTIONS

OTHER STATEMENTS OF OFFERORS

EVALUATION FACTORS FOR AWARD

INSTRS., CONDS., AND NOTICES TO OFFERORS

REPRESENTATIONS, CERTIFICATIONS AND

LIST OF ATTACHMENTS

CONTRACT CLAUSES

PART III - LIST OF DOCUMENTS, EXHIBITS AND OTHER ATTACH.

I

J

K

L

M SPECIAL CONTRACT REQUIREMENTS

CONTRACT ADMINISTRATION DATA

DELIVERIES OR PERFORMANCE

INSPECTION AND ACCEPTANCE

PACKAGING AND MARKING

DESCRIPTION/SPECS./WORK STATEMENT

SUPPLIES OR SERVICES AND PRICES/COSTS

SOLICITATION/CONTRACT FORM

PART II - CONTRACT CLAUSESPART I - THE SCHEDULE

H

G

F

E

D

C

B

A

SEC. DESCRIPTION PAGE(S) (X) DESCRIPTION SEC. (X)

11. TABLE OF CONTENTS

18. OFFER DATE17. SIGNATURE

SUCH ADDRESS IN SCHEDULE.

IS DIFFERENT FROM ABOVE - ENTER

15C. CHECK IF REMITTANCE ADDRESS

EXT.NUMBERAREA CODE

15B. TELEPHONE NUMBER

(Type or print)AND

ADDRESS

OF

OFFEROR

CODE FACILITY

16. NAME AND TITLE OF PERSON AUTHORIZED TO SIGN OFFER15A. NAME

DATEAMENDMENT NO.DATEAMENDMENT NO.

and related documents numbered and dated):

amendments to the SOLICITATION for offerors

(The offeror acknowledges receipt of

14. ACKNOWLEDGEMENT OF AMENDMENTS

CALENDAR DAYS (%)30 CALENDAR DAYS (%)20 CALENDAR DAYS (%)10 CALENDAR DAYS (%)

(See Section I, Clause No. 52.232.8)

13. DISCOUNT FOR PROMPT PAYMENT

designated point(s), within the time specified in the schedule.

by the offeror) from the date for receipt of offers specified above, to furnish any or all items upon which prices are offered at the price set opposite each item, delivered at the

12. In compliance with the above, the undersigned agrees, if this offer is accepted within ______________ calendar days (60 calendar days unless a different period is inserted

NOTE: Item 12 does not apply if the solicitation includes the provisions at 52.214-16, Minimum Bid Acceptance Period.

OFFER (Must be fully completed by offeror)

IMPORTANT - Award will be made on this Form, or on Standard Form 26, or by other authorized official written notice.

28. AWARD DATE

(Signature of Contracting Officer)

27. UNITED STATES OF AMERICA

25. PAYMENT WILL BE MADE BY

26. NAME OF CONTRACTING OFFICER (Type or print)

CODE 24. ADMINISTERED BY (If other than Item 7)

ITEM

(4 copies unless otherwise specified)

23. SUBMIT INVOICES TO ADDRESS SHOWN IN

41 U.S.C. 253 (c) ( 10 U.S.C. 2304 (c) (

22. AUTHORITY FOR USING OTHER THAN FULL AND OPEN COMPETITION:

21. ACCOUNTING AND APPROPRIATION20. AMOUNT19. ACCEPTED AS TO ITEMS NUMBERED

AWARD (To be completed by government)

CODE

09/29/2022 X

HT9402

DEFENSE HEALTH AGENCY

DEFENSE HEALTH AGENCY-AURORA

16401 E CENTRETECH PARKWAY

AURORA CO 80011

1200 MT 10/31/2022

NICHOLAS R. CECILIANI 303

NICHOLAS.R.CECILIANI.CIV@

HEALT676-3997

X

X

X

X

X

X

X

X

X

X

X

X

X

PAGE(S)

NICHOLAS R. CECILIANI

AUTHORIZED FOR LOCAL REPRODUCTION

Previous edition is unusable

STANDARD FORM 33 (Rev. 9-97)

Prescribed by GSA - FAR (48 CFR) 53.214(c)

2-17

C1-C30 D1 E1 F1-F3 G1-G7 H1-H3

I1-I18

J1-J2

K1-K13

L1-L22

M1-M10

303-676-3997

NICHOLAS.R.CECILIANI.CIV@HEALTH.MIL

ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

NAME OF OFFEROR OR CONTRACTOR

2 17

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

HT940222R0001

(A) (B) (C) (D) (E) (F)

Solicitation for TRICARE Dental Plan 6

Delivery Location Code: HT9402

DEFENSE HEALTH AGENCY

DEFENSE HEALTH AGENCY-AURORA

16401 E CENTRETECH PARKWAY

AURORA CO 80011-9066 USA

Transition-In

1 December 2023 to 30 November 2024

0001 Transition-In 1 LO

Firm Fixed Price

0002 Reports, Contract Data Requirements List (DD Form 1 LO

1423)

(Not Separately Priced)

Ordering Period 1

1 December 2024 to 30 November 2025

1001 Single Enrollment Premium 2250000 EA

Ordering Period 1

1 December 2024 to 30 November 2025

100101 Junior Enlisted (E1-E4)

- Enrollee Share -- 25%

- Government Share -- 75%

- Total Premium -- 100%

Firm Fixed Price

(Qty:0)

Ordering Period 1

1 December 2024 to 30 November 2025

100102 E5 and above ranks

- Enrollee Share -- 40%

- Government Share -- 60%

- Total Premium -- 100%

Firm Fixed Price

Continued ...

3 17

CONTINUATION SHEET

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(A) (B) (C) (D) (E) (F)

(Qty:0)

1002 Family Enrollment Premium 5592000 EA

100201 Junior Enlisted (E1-E4)

- Enrollee Share -- 25%

- Government Share -- 75%

- Total Premium -- 100%

Firm Fixed Price

(Qty:0)

100202 E5 and above ranks

- Enrollee Share -- 40%

- Government Share -- 60%

- Total Premium -- 100%

Firm Fixed Price

(Qty:0)

1003 Survivor Benefit-Single Enrollment Premium 44100 EA

- Government Share -- 100%

Firm Fixed Price

1004 Survivor Benefit-Family Enrollment Premium 46620 EA

- Government Share -- 100%

Firm Fixed Price

1005 Reimbursement for Costs in Excess of Allowable 1 LO

Charges for OCONUS Claims

Cost Reimbursable, No Fee

1006 Reimbursement for Cost Shares and Additional 1 LO

Allowable Charges for Orthodontic Costs Charge for OCONUS Claims

Continued ...

694140 694140

3564988 3564988

4 17

CONTINUATION SHEET

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(A) (B) (C) (D) (E) (F)

Cost Reimbursable, No Fee

1007 NIST and Physical & Personnel Security 12 MO

(Sustainment Costs)

Firm Fixed Price

1008 Incentives 1 LO

(Reference Section H.4 which outlines criteria for earning Incentive monies. The Total Amount shown reflect the maximum incentive available.)

1009 Reports, Contract Data Requirements List (DD Form 1 LO

1423)

(Not Separately Priced)

1010 Transition-out 1 LO

Firm Fixed Price

Ordering Period 2

1 December 2025 to 30 November 2026

2001 Single Enrollment Premium 2272500 EA

Ordering Period 2

1 December 2025 to 30 November 2026

200101 Junior Enlisted (E1-E4)

- Enrollee Share -- 25%

- Government Share -- 75%

- Total Premium -- 100%

Firm Fixed Price

(Qty:0)

Ordering Period 2

1 December 2025 to 30 November 2026

1775000 1775000

5 17

CONTINUATION SHEET

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(A) (B) (C) (D) (E) (F)

200102 E5 and above ranks

- Enrollee Share -- 40%

- Government Share -- 60%

- Total Premium -- 100%

Firm Fixed Price

(Qty:0)

2002 Family Enrollment Premium 5647920 EA

200201 Junior Enlisted (E1-E4)

- Enrollee Share -- 25%

- Government Share -- 75%

- Total Premium -- 100%

Firm Fixed Price

(Qty:0)

200202 E5 and above ranks

- Enrollee Share -- 40%

- Government Share -- 60%

- Total Premium -- 100%

Firm Fixed Price

(Qty:0)

2003 Survivor Benefit-Single Enrollment Premium 44541 EA

- Government Share -- 100%

Firm Fixed Price

2004 Survivor Benefit-Family Enrollment Premium 47086.2 EA

- Government Share -- 100%

Firm Fixed Price

2005 Reimbursement for Costs in Excess of Allowable 1 LO

Charges for OCONUS Claims

Cost Reimbursable, No Fee

701081.40 701081.40

6 17

CONTINUATION SHEET

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(A) (B) (C) (D) (E) (F)

2006 Reimbursement for Cost Shares and Additional 1 LO

Allowable Charges for Orthodontic Costs Charge for OCONUS Claims

Cost Reimbursable, No Fee

2007 NIST and Physical & Personnel Security 12 MO

(Sustainment Costs)

Firm Fixed Price

2008 Incentives 1 LO

(Reference Section H.4 which outlines criteria for earning Incentive monies. The Total Amount shown reflect the maximum incentive available.)

2009 Reports, Contract Data Requirements List (DD Form 1 LO

1423)

(Not Separately Priced)

2010 Transition-out 1 LO

Firm Fixed Price

Ordering Period 3

1 December 2026 to 30 November 2027

3001 Single Enrollment Premium 2295225 EA

Ordering Period 3

1 December 2026 to 30 November 2027

300101 Junior Enlisted (E1-E4)

- Enrollee Share -- 25%

- Government Share -- 75%

Continued ...

3600637.88 3600637.88

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(A) (B) (C) (D) (E) (F)

- Total Premium -- 100%

Firm Fixed Price

(Qty:0)

Ordering Period 3

1 December 2026 to 30 November 2027

300102 E5 and above ranks

- Enrollee Share -- 40%

- Government Share -- 60%

- Total Premium -- 100%

Firm Fixed Price

(Qty:0)

3002 Family Enrollment Premium 5704399.2 EA

300201 Junior Enlisted (E1-E4)

- Enrollee Share -- 25%

- Government Share -- 75%

- Total Premium -- 100%

Firm Fixed Price

(Qty:0)

300202 E5 and above ranks

- Enrollee Share -- 40%

- Government Share -- 60%

- Total Premium -- 100%

Firm Fixed Price

(Qty:0)

3003 Survivor Benefit-Single Enrollment Premium 44986.41 EA

- Government Share -- 100%

Firm Fixed Price

3004 Survivor Benefit-Family Enrollment Premium 47557.06 EA

- Government Share -- 100%

8 17

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

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(A) (B) (C) (D) (E) (F)

3005 Reimbursement for Costs in Excess of Allowable 1 LO

Charges for OCONUS Claims

Cost Reimbursable, No Fee

3006 Reimbursement for Cost Shares and Additional 1 LO

Allowable Charges for Orthodontic Costs Charge for OCONUS Claims

Cost Reimbursable, No Fee

3007 NIST and Physical & Personnel Security 12 MO

(Sustainment Costs)

Firm Fixed Price

3008 Incentives 1 LO

(Reference Section H.4 which outlines criteria for earning Incentive monies. The Total Amount shown reflect the maximum incentive available.)

3009 Reports, Contract Data Requirements List (DD Form 1 LO

1423)

(Not Separately Priced)

3010 Transition-out 1 LO

Firm Fixed Price

Ordering Period 4

1 December 2027 to 30 November 2028

4001 Single Enrollment Premium 2318177.25 EA

Continued ...

708092.21 708092.21

3636644.26 3636644.26

9 17

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

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(A) (B) (C) (D) (E) (F)

Ordering Period 4

1 December 2027 to 30 November 2028

400101 Junior Enlisted (E1-E4)

- Enrollee Share -- 25%

- Government Share -- 75%

- Total Premium -- 100%

Firm Fixed Price

(Qty:0)

Ordering Period 4

1 December 2027 to 30 November 2028

400102 E5 and above ranks

- Enrollee Share -- 40%

- Government Share -- 60%

- Total Premium -- 100%

Firm Fixed Price

(Qty:0)

4002 Family Enrollment Premium 5761443.19 EA

400201 Junior Enlisted (E1-E4)

- Enrollee Share -- 25%

- Government Share -- 75%

- Total Premium -- 100%

Firm Fixed Price

(Qty:0)

400202 E5 and above ranks

- Enrollee Share -- 40%

- Government Share -- 60%

- Total Premium -- 100%

Firm Fixed Price

(Qty:0)

4003 Survivor Benefit-Single Enrollment Premium 45436.27 EA

- Government Share -- 100%

10 17

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(A) (B) (C) (D) (E) (F)

4004 Survivor Benefit-Family Enrollment Premium 48032.63 EA

- Government Share -- 100%

Firm Fixed Price

4005 Reimbursement for Costs in Excess of Allowable 1 LO

Charges for OCONUS Claims

Cost Reimbursable, No Fee

4006 Reimbursement for Cost Shares and Additional 1 LO

Allowable Charges for Orthodontic Costs Charge for OCONUS Claims

Cost Reimbursable, No Fee

4007 NIST and Physical & Personnel Security 12 MO

(Sustainment Costs)

Firm Fixed Price

4008 Incentives 1 LO

(Reference Section H.4 which outlines criteria for earning Incentive monies. The Total Amount shown reflect the maximum incentive available.)

4009 Reports, Contract Data Requirements List (DD Form 1 LO

1423)

(Not Separately Priced)

4010 Transition-out 1 LO

Firm Fixed Price

Continued ...

715173.14 715173.14

3673010.70 3673010.70

11 17

CONTINUATION SHEET

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(A) (B) (C) (D) (E) (F)

Ordering Period 5

1 December 2028 to 30 November 2029

5001 Single Enrollment Premium 2341359.02 EA

Ordering Period 5

1 December 2028 to 30 November 2029

500101 Junior Enlisted (E1-E4)

- Enrollee Share -- 25%

- Government Share -- 75%

- Total Premium -- 100%

Firm Fixed Price

(Qty:0)

Ordering Period 5

1 December 2028 to 30 November 2029

500102 E5 and above ranks

- Enrollee Share -- 40%

- Government Share -- 60%

- Total Premium -- 100%

Firm Fixed Price

(Qty:0)

5002 Family Enrollment Premium 5819057.62 EA

500201 Junior Enlisted (E1-E4)

- Enrollee Share -- 25%

- Government Share -- 75%

- Total Premium -- 100%

Firm Fixed Price

(Qty:0)

500202 E5 and above ranks

- Enrollee Share -- 40%

- Government Share -- 60%

- Total Premium -- 100%

12 17

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

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(A) (B) (C) (D) (E) (F)

Firm Fixed Price

(Qty:0)

5003 Survivor Benefit-Single Enrollment Premium 45890.64 EA

- Government Share -- 100%

Firm Fixed Price

5004 Survivor Benefit-Family Enrollment Premium 48512.96 EA

- Government Share -- 100%

Firm Fixed Price

5005 Reimbursement for Costs in Excess of Allowable 1 LO

Charges for OCONUS Claims

Cost Reimbursable, No Fee

5006 Reimbursement for Cost Shares and Additional 1 LO

Allowable Charges for Orthodontic Costs Charge for OCONUS Claims

Cost Reimbursable, No Fee

5007 NIST and Physical & Personnel Security 12 MO

(Sustainment Costs)

Firm Fixed Price

5008 Incentives 1 LO

(Reference Section H.4 which outlines criteria for earning Incentive monies. The Total Amount shown reflect the maximum incentive available.)

5009 Reports, Contract Data Requirements List (DD Form 1 LO

1423)

(Not Separately Priced)

Continued ...

722324.87 722324.87

3709740.81 3709740.81

1755000 1755000

13 17

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(A) (B) (C) (D) (E) (F)

5010 Transition-out 1 LO

Firm Fixed Price

FAR 52.217-8, Option to Extend Services

6 months

1 December 2029 to 31 May 2030

6001 Single Enrollment Premium 1182386.31 EA

(Option Line Item)

FAR 52.217-8, Option to Extend Services

6 months

1 December 2029 to 31 May 2030

600101 Junior Enlisted (E1-E4)

- Enrollee Share -- 25%

- Government Share -- 75%

- Total Premium -- 100%

Firm Fixed Price

(Qty:0)

(Option Line Item)

FAR 52.217-8, Option to Extend Services

6 months

1 December 2029 to 31 May 2030

600102 E5 and above ranks

- Enrollee Share -- 40%

- Government Share -- 60%

- Total Premium -- 100%

Firm Fixed Price

(Qty:0)

(Option Line Item)

6002 Family Enrollment Premium 2938624.1 EA

(Option Line Item)

14 17

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(A) (B) (C) (D) (E) (F)

600201 Junior Enlisted (E1-E4)

- Enrollee Share -- 25%

- Government Share -- 75%

- Total Premium -- 100%

Firm Fixed Price

(Qty:0)

(Option Line Item)

600202 E5 and above ranks

- Enrollee Share -- 40%

- Government Share -- 60%

- Total Premium -- 100%

Firm Fixed Price

(Qty:0)

(Option Line Item)

6003 Survivor Benefit-Single Enrollment Premium 23174.77 EA

- Government Share -- 100%

Firm Fixed Price

(Option Line Item)

6004 Survivor Benefit-Family Enrollment Premium 24499.04 EA

- Government Share -- 100%

Firm Fixed Price

(Option Line Item)

6005 Reimbursement for Costs in Excess of Allowable 1 LO

Charges for OCONUS Claims

Cost Reimbursable, No Fee

(Option Line Item)

6006 Reimbursement for Cost Shares and Additional 1 LO

Allowable Charges for Orthodontic Costs Charge for OCONUS Claims

Cost Reimbursable, No Fee

(Option Line Item)

Continued ...

364774.06 364774.06

1873419.11 1873419.11

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(A) (B) (C) (D) (E) (F)

6007 NIST and Physical & Personnel Security 6 MO

(Sustainment Costs)

Firm Fixed Price

(Option Line Item)

6008 Incentives 1 LO

(Reference Section H.4 which outlines criteria for earning Incentive monies. The Total Amount shown reflect the maximum incentive available.)

(Option Line Item)

6009 Reports, Contract Data Requirements List (DD Form 1 LO

1423)

(Option Line Item)

(Not Separately Priced)

6010 Transition-out 1 LO

Firm Fixed Price

(Option Line Item)

Phase-Out CLINs

7001 Residual Services Phase-Out 1 LO

The Government intends to only exercise one phase out CLIN in the performance of this contract.

This CLIN represents phase-out costs following

Ordering Period 1.

Firm Fixed Price

7002 Residual Services Phase-Out 1 LO

The Government intends to only exercise one phase out CLIN in the performance of this contract.

This CLIN represents phase-out costs following

Ordering Period 2.

887500 887500

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(A) (B) (C) (D) (E) (F)

Firm Fixed Price

7003 Residual Services Phase-Out 1 LO

The Government intends to only exercise one phase out CLIN in the performance of this contract.

This CLIN represents phase-out costs following

Ordering Period 3.

Firm Fixed Price

7004 Residual Services Phase-Out 1 LO

The Government intends to only exercise one phase out CLIN in the performance of this contract.

This CLIN represents phase-out costs following

Ordering Period 4.

Firm Fixed Price

7005 Residual Services Phase-Out 1 LO

The Government intends to only exercise one phase out CLIN in the performance of this contract.

This CLIN represents phase-out costs following

Ordering Period 5.

SECTION B

SUPPLIES OR SERVICES AND PRICES/COSTS

TDP6

HT9402-22-R-0001 Page 17 of 17

1.0 GUARANTEED CONTRACT MINIMUM AND CONTRACT MAXIMUM: The

resultant contract will be an Indefinite Delivery/Indefinite Quantity (ID/IQ) type contract with Firm Fixed Price (FFP) Task Orders.

1.1 Minimum Guarantee: The guaranteed minimum is $7,500,000.00 and will be satisfied under the first task order.

1.2 Maximum Contract Value: The value of all task orders placed under the resultant contract may not exceed $3,500,000,000.00.

(End of Section)

SECTION C

DESCRIPTION/SPECIFICATIONS/STATEMENT OF WORK

TDP6

HT9402-22-R-0001 C1 of C30

Department of Defense Defense Health Agency

Performance Work Statement

TRICARE Dental Program Six Generation (TDP6)

J-10/Deputy Assistant Director, Health Care Operations Dental Program Section

Solicitation Number: HT9402-22-R-0001

Date: September 29, 2022

HT9402-22-R-0001 C2 of C30

PART 1

1.0 GENERAL INFORMATION

C.1.1 This is a non-personal services contract to provide the TRICARE Dental Program sixth generation (TDP6).

C.1.2 Description of services/introduction: The TDP6 contractor shall provide comprehensive dental care services worldwide to eligible TRICARE beneficiaries. The contractor shall provide all personnel, equipment, supplies, facilities, transportation, tools, materials, supervision, and other items and non-personal services necessary to fulfill the requirements of TDP6 as defined in this Performance Work Statement (PWS) except for those items specified as government furnished property and services. The contractor shall perform to the standards in this PWS.

C.1.3 Background: The TRICARE Dental contract supports the delivery of the Department of Defense (DoD) dental benefit, which is codified in 10 U.S.C. Chapter 55 § 1076a. The TRICARE Dental contract serves to integrate affordable dental health services to DoD Military Health System (MHS) beneficiaries, by private sector contractors, and driven by greater integration of dental business processes across the MHS. The Defense Health Agency (DHA) supports the MHS in its mission to provide dental health services through TRICARE dental care coverage for all eligible family members of Uniformed Service active duty, members of the Selected Reserve and Individual Ready Reserve (IRR) and their eligible family members.

C.1.4 Objectives:

• The contractor shall provide worldwide cost effective dental care services for enrollees.

• The contractor shall promote the value of utilizing diagnostic and preventive services.

• The contractor shall provide data systems in which to monitor dental health plan data and outcome measures for all dental care rendered.

C.1.5 Scope: The TDP offers worldwide dental coverage to all eligible family members of Uniformed Service active duty personnel, and to members of the Selected Reserve, the Individual Ready Reserve (IRR), the National Guard, and their eligible family members. Active duty service members, former spouses, parents, in-laws, disabled veterans, foreign personnel, and retirees and their families are not eligible for the TDP. The TDP geographic area of coverage for the Continental United States (CONUS) includes the 50 United States, the District of Columbia, Puerto Rico, Guam and the U.S. Virgin Islands. Outside the Continental United States (OCONUS) service area includes all other countries, island masses and territorial waters.

In order to fulfill DHA’s mission, TDP6 requires the contractor to establish and maintain a provider network in the 50 United States, District of Columbia, U.S. Virgin Islands, Guam, and Puerto Rico. In addition the contractor shall develop and maintain a list of Outside of the Continental United States (OCONUS) providers, referred to as TRICARE OCONUS Preferred Dentists (TOPDs).

The contractor shall be responsible for program operations and administration. TDP6 includes all associated administrative services, such as eligibility verification and enrollment, premium

HT9402-22-R-0001 C3 of C30 collection, customer service, claims processing, and beneficiary and provider education, which are at a minimum, consistent with the contractor’s commercial practices and industry standards.

C.1.6 Period of Performance (PoP):

Base Period/Transition-In: 12/01/2023 - 11/30/2024

Ordering Periods (OP) 1 through 5 will be:

OP 1: 12/01/2024 - 11/30/2025

OP 2: 12/01/2025 - 11/30/2026

OP 3: 12/01/2026 - 11/30/2027

OP 4: 12/01/2027 - 11/30/2028

OP 5: 12/01/2028 - 11/30/2029

The Residual Phase-Out CLIN (700X), will follow the last dental care delivery/transition out PoP.

Residual Phase-Out will begin after the last dental care delivery PoP (OP1, OP2, OP3, OP4, or OP5). The Government will exercise only one Residual Phase-Out CLIN (700X), which will depend on the last OP. The Residual Phase-Out CLIN’s period of performance will have a one year PoP. The Residual Phase-Out PoP is for the contractor to complete processing of all claims, grievances, and appeals from the last OP of dental care delivery.

C.1.6.1 Transition-in/transition-out periods.

C.1.6.1.1 Transition-in period: Full performance start date is, 1 December 2024 Transition-in performance is defined at C.5.4.1 and Section J, Attachment J-11, Transition-In.

C.1.6.1.1.1 The contractor shall comply with transition-in requirements of the DHA, as listed in paragraph C.1.11.1, for contractors needing to be issued Common Access Card (CAC) identification, including Department of Defense (DoD) and DHA-directed training and forms submission, prior to network access.

C.1.6.1.2 Transition-out period: Transition-out performance is defined at C.5.4.2 and Section J, Attachment J-12, Transition-Out and Residual Services.

C.1.6.1.2.1 The contractor shall comply with transition-out requirements of the DHA for contractors who have been issued a CAC or who generate “records”, as defined by C.5.5.

Records Management.

C.1.7 Administrative Specifications

C.1.7.1 Place of performance: The contractor shall perform work at at the contractor’s facility or in a remote environment as long as the required security precautions are documented and followed.

C.1.7.2 Recognized Federal holidays: The contractor is not required to perform services on the following holidays:

HT9402-22-R-0001 C4 of C30

New Year’s Day Labor Day Martin Luther King Jr.’s Birthday Columbus Day President’s Day Veteran’s Day Memorial Day Thanksgiving Day Juneteenth Day Christmas Day Independence Day

C.1.7.3 Hours of operation: The contractor shall conduct business Monday thru Friday, with Federal holidays at the contractor’s discretion or when the Government facility is closed due to local or national emergencies, administrative closings, or similar Government directed facility closings. The contractor’s customer service center shall be available in accordance with Section J, Attachment J-5, Program Operations. The contractor shall at all times maintain an adequate workforce for the uninterrupted performance of all tasks defined within this PWS when the Government facility is not closed for the above reasons.

C.1.8 Contractor travel: The contractor shall be required to travel to meetings hosted by DHA in CONUS and OCONUS regions. The Government will provide a 14-day notice for all meetings hosted by DHA at one of its Government locations. The Government will host up to a maximum of four meetings as determined by the Government, per OP at its CONUS Government locations. In addition, the Government will host up to a maximum of two meetings as determined by the Government, per OP at each of its OCONUS regions: TRICARE Eurasia/Africa, TRICARE Latin America/Canada, and TRICARE Pacific. The Government will provide at least a 2-month notice for all OCONUS meetings that require travel. These meetings are in addition to those stated in Section J, Attachment J-11, Transition-In; and Attachment J-12, Transition-Out and Residual Services. All contractor travel costs associated with any of these meetings shall be the responsibility of the contractor.

C.1.10 Quality

C.1.10.1 Quality Control (QC): The contractor shall develop and maintain an effective QC program to ensure services are performed in accordance with this PWS. The contractor shall develop and implement procedures to identify, prevent, and ensure nonrecurrence of defective services. The contractor’s QC program is the means by which the work complies with stated requirements. See C.5.6 Quality for additional information.

C.1.10.2 Quality assurance (QA): The government will evaluate the contractor’s performance under this contract in accordance with the Quality Assurance Surveillance Plan (QASP). This plan provides a systematic method for the Government to evaluate performance and to ensure that the contractor has performed in accordance with the performance standards. It defines how the performance standards will be applied, the frequency of surveillance, and the minimum acceptable defect rate(s). See C.5.6.2 Contract Surveillance for additional information.

C.1.11 Contractor personnel

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C.1.11.1 Contractor Common Access Card (CAC) requirements: For all contractors performing work on behalf of the Goverment, the Facilities Security Officer (FSO)/Company's Security point of contact (POC) shall provide the Government all the required information per the DHA CAC request process current version 2.1, January 2018, or more recent when updated. See Section J, Attachments J-13a, DHA CAC Request Process and J-16, TRICARE Service Manual (TSM), Chapter 1, Section 1.1. A CAC is the standard identification for eligible DoD contractor personnel.

C.1.11.2 Physical Security: The contractor shall be responsible for safeguarding all government information provided for contractor use (see C.5.2 System Security and TRICARE Operations Manual (TOM) Chapter 1, Section 5).

C.1.12 Contract Management and Administration: The contractor shall establish clear organizational lines of authority and responsibility to ensure adequate, effective resources are assigned to the contract requirements. The contractor shall have primary and alternate points of contact who are authorized to negotiate with the Government and commit to contract implementation and compliance (see Section G.3, Contract Administration). The contractor shall notify the Government within 5 business days of personnel changes to the contractor’s leadership (e.g. president, vice president, etc.) and/or any changes to the primary and alternate points of contact.

C.1.12.1 The contractor shall establish and maintain effective management strategies, staff education and training programs, and coordination interfaces with the Government. The contractor shall comply with the directives cited in Part 2, paragraph C.2.3, Applicable Directives.

C.1.12.2 Out of Office and Closures: The contractor shall notify the the Contracting Officer’s Representative (COR) 24 hours in advance (unless an emergency) when its primary and alternate points of contact will be out of the office for a full day or more.

C.1.13 Data rights: The contractor shall identify its proprietary data in accordance with the TOM, Chapter 9 Records Management and Section J, Attachment J-12, Transition-Out and Residual Services.

C.1.14 Reporting

C.1.14.1 Government’s COR: The COR monitors all technical aspects of the contract and assists in contract administration. The COR is authorized to perform the following functions:

assure that the contractor performs the technical requirements of the contract; perform inspections necessary in connection with contract performance; maintain written and oral communications with the contractor concerning technical aspects of the contract; issue written interpretations of technical requirements, including Government drawings, designs, specifications; monitor contractor's performance and notifies both the CO and contractor of any deficiencies; coordinate availability of government furnished property; and provide site entry of contractor personnel. A letter of designation issued to the COR, a copy of which is sent to the contractor, states the responsibilities and limitations of the COR, especially with regard to

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C.1.14.2 Post award conference/periodic progress meetings: The contractor shall attend any post award conference convened by the contracting activity or contract administration office in accordance with FAR Subpart 42.5. The Contracting Officer (CO), COR, and other Government personnel, as appropriate, may meet periodically with the contractor to review the contractor's performance (typically conducted via telephone). At these meetings the CO will apprise the contractor of how the government views the contractor's performance and the contractor will apprise the Government of problems, if any, being experienced. Appropriate action shall be taken to resolve outstanding issues. These meetings shall be at no additional cost to the government.

C.1.15 Contractor Identification

C.1.15.1 Contractors, including subcontractors at all tiers, shall provide for a clear distinction from Government personnel. Contractor employees shall not act, advertise, or presume to be Government employees, agents, or representatives. Contractor employees are required to appropriately identify themselves as contractor employees at all times, including in telephone conversations, formal and informal written correspondence, paper and electronic, and in any other situation where their actions could be construed as acts of Government officials, unless, in the judgment of the Government, no harm can come from failing to identify themselves.

Contractor employees shall be introduced as contractor personnel and display distinguishing visible identification at all times whether in conversations, meetings, or other forms of communication with Government personnel.

C.1.15.2 Contractor personnel, while performing in a contractor capacity, shall refrain from using their retired or reserve component military rank or title (if applicable) in written or verbal communications associated with the contracts for which they provide services.

C.1.15.3 The contractor shall incorporate the substance of this requirement in all subcontracts awarded under this contract.

C.1.16 Contractor Access to Health Affairs (HA)/DHA Network(s)

C.1.16.1 FSO/Company's Security POC shall notify the DHA Personnel Security Office after being awarded a contract that requires access to a DoD system in accordance with Section J, Attachment J-16 TSM, Chapter 1, Section 1.1. Contractor personnel requiring access to the HA/DHA networks for performance of their tasks require a background investigation and the security awareness training. The contractor shall be prepared for this process as it could take two

(2) or more weeks. The FSO/Security POC shall submit a Standard Form (SF) 85 to DHA's Personnel Security Office for a background investigation.

C.1.16.2 Company's FSO/Security POC must notify the Personnel Security Office when the contractor has submitted the SF-85. The FSO/Security POCmust notify the DHA Personnel

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Security Office in writing of a contractor's termination from the contract, including the termination date (see Section J, Attachment J-16 TSM, Chapter 1, Section 1.1).

C.1.17 Personnel Security

C.1.17.1 The contractor shall comply with DoDI 8582.01, “Security of Non-DoD Information Systems Processing Unclassified Non-Public DoD Information”, dated December 9, 2019; DoD Manual (DoDM) 6025.18, “Implementation of the HIPAA Privacy Rule in DoD Health Care Programs” dated March 13, 2019, DoDI 8580.02 Security of Individually Identifiable Health Information in DoD Health Care Programs, August 12, 2015; and DoDI 5200.02 “DoD Personnel Security Program (PSP),”March 21, 2014 (see Section J, Attachment J-16 TSM, Chapter 1, Section 1.1). Contractor responsibilities for ensuring personnel security include, but are not limited to, meeting the following requirements:

C.1.17.1.1 Follow the DHA Personnel Security Office guidelines for submittal of security clearances. Contact the DHA Personnel Security Office for guidance on the appropriate background investigation required for personnel on the contract. The DHA Personnel Security Office can be reached at (703) 275-6038.

C.1.17.1.2 Initiate, maintain, and document personnel security investigations appropriate to the individual’s responsibilities and required access to Controlled Unclassified Information (CUI) (see C.5.2 System Security).

C.1.17.1.3 DHA Personnel Security Office does not deny any access to any automated information system (AIS), network, or Controlled Unclassified Information (CUI). If a contractor receives an unfavorable background investigation, the request for access will be sent back to the FSO for further action. Any unfavorable adjudication will result in DHA Personnel Security Office not signing off on any access request.

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PART 2

2.0 DEFINITIONS, ACRONYMS, AND APPLICABLE

PUBLICATIONS/INSTRUCTIONS

C.2.1 Definitions: See Section J, Attachment J-1, Definitions and Acronyms, 32 CFR 199.13(b) and the TRICARE Operations Manual, Appendix A (http://manuals.health.mil).

C.2.2 Acronyms: See Section J, Attachment J-1, Definitions and Acronyms, and the TRICARE Operations Manual, Acronyms (http://manuals.health.mil).

C.2.3 Applicable Directives: The following documents form an integral part of this contract and have the same force and effect as if set forth in full text. The TRICARE Manuals provide instruction, guidance and responsibilities to establish contractual requirements for implementation of federal statutes and regulations. In the event of a conflict between the manuals and either statute or regulation, which are incorporated into this contract, the statute or regulation takes precedence. If there is a conflict between the manuals, the order of precedence is (1) TRICARE Policy Manual (TPM); (2) TRICARE Systems Manual (TSM); and (3) TRICARE Operations Manual (TOM). The TRICARE Manuals are located at http://manuals.health.mil. If the contractor believes that a conflict exists between the incorporated documents, the contractor shall inform the /CO.

C.2.3.1 Title 10, United States Code (U.S.C.)., Chapter 55, Section 1076a.

C.2.3.2 32 Code of Federal Regulations (CFR) Part 199.3, 199.6, 199.9, 199.10 and 199.13.

C.2.3.3 36 CFR Part 1222 (data created or received and maintained for the Government by contractors).

C.2.3.4 45 CFR Parts 160, 162 and 164 (the Health Insurance Portability and Accountability Act of 1996 (HIPAA) security and privacy standards, transaction and code set standards, National Provider Identifier (NPI) requirements and implementation specifications).

C.2.3.5 National Institute of Standards and Technology (NIST) Special Publications (SP) 800- 171.

C.2.3.6 TRICARE Policy Manual (TPM) 6010.60-M, April 1, 2015 through change 99. The following TPM Sections apply:

• Chapter 8, Section 13.1 Adjunctive Dental Care

• Chapter 8, Section 13.2 Dental Anesthesia

• Chapter 10, Section 5.1 paragraph 2.10 Dental Coverage

• Chapter 10, Section 9.1 – Early Eligibility Benefits for the Reserve Components (RCs)

• Chapter 10, Section 10.1 TRICARE Coverage for Certain Members of the National

Guard (NG)

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C.2.3.7 TRICARE Systems Manual (TSM) 7950.3-M, April 1, 2015, through change 61. The following TSM chapters apply:

• Chapter 1, General Automated Data Processing (ADP) Requirements (Section J, Attachment J-16, TSM Chapter 1, Section 1.1 will be utilized by the TDP contractor until it is published in the TSM.)

• Chapter 3, Defense Enrollment Eligibility Reporting System (DEERS) (Section5.2 does not apply to TDP)

Note: The TRICARE Encounter Data (TED) requirement as stated in the TSM does not apply to

TDP.

C.2.3.8 TRICARE Operations Manual (TOM) 6010.59-M, April 1, 2015, through change 110.

The following TOM chapters apply:

• Chapter 1, Section 1 - Organization of the Defense Health Agency (DHA) Section 2 - Contract Administration and Instructions (excluding paragraph 4.0 and 5.0) Section 4 - Management (excluding paragraphs 2.2, 2.3, 2.4, 3.1, 3.2, 3.4 and 4.0) Section 5 - Compliance with Federal Statutes Section 6 - Legal Matters

• Chapter 2, Section 10 Other Requirements (only paragraph 6.0 Appeals and Hearings applies per Contract Data Requirements List (CDRL) R130 Appeals Processing Guidelines, Desk Instructions, and Reference Materials)

• Chapter 9, Records Management ( Section 5, paragraph 3.0 Transfer to Other Contractors/Records Center, does not apply to TDP per Section J, Attachment J-12, Transition-Out and Residual Services, paragraph 3.18 Records Disposition)

• Chapter 11, Section 8 - Grievances and Grievance Processing Addendum A TRICARE Logo

• Chapter 12, Appeals and Hearings

• Chapter 13, Program Integrity

• Chapter 14, Section 1 - Contract Data Requirements Lists (CDRLs), Plans and Access

• Chapter 19, Health Insurance Portability and Accountability Act (HIPAA) of 1996

• Chapter 24, Section 12 - TRICARE Overseas Program (TOP) Point of Contact (POC)

Program

• Chapter 28 – Prescription Monitoring Program (PMP)

• Appendix A, Definitions

• Acronyms and Abbreviations may be located at http://manuals.health.mil

C.2.3.9 When a statute, regulation, or manual changes, the contract requirements shall not change until the Contracting Officer modifies the contract to incorporate the change. The contractor shall utilize the most current version of the TRICARE manuals for the requirements stated above (paragraphs C.2.3.6 through C.2.3.8). When a manual change is applicable to the contract, a contract modification will be issued to incorporate the change and update the manual references to reflect the latest manual change number. Manual change numbers may also be

HT9402-22-R-0001 C10 of C30 updated when other modifications are issued. In the event there are no applicable manual changes during an OP, an administrative modification may be issued annually to update the manual references to the most current manual change number.

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PART 3

3.0 GOVERNMENT FURNISHED PROPERTY, EQUIPMENT, AND SERVICES

The Requiring Activity Authority has assessed the need for Government Furnished Property, Equipment, and Services and determined:

C.3.1 Services: The Government will NOT provide Government Furnished Services in support of this contract/task order.

C.3.2 Facilities: The Government will NOT provide Facilities in support of this contract/task order.

C.3.3 Utilities: The Government will NOT provide Utilities in support of this contract/task order.

C.3.4 Equipment: The Government will NOT provide Equipment in support of this contract/task order.

C.3.5 Materials: The Government IS providing Materials in support of this contract/task orders.

The Government-provided Materials are described below:

C.3.5.1 The Government will provide the contractor electronic data files containing relevant information pertaining to all sponsors. The Government will provide to the contractor a list of these data files and delivery times at the transition-in meeting with DMDC (see Section J, Attachments J-11, Transition-In). These data files will assist the contractor in determining their provider network adequacy and with beneficiary educational purposes. The contractor shall comply with the security requirements stated in C.5.2 prior to receiving the data files.

Thereafter, a list of newly identified sponsors will be furnished Quarterly every OP.

C.3.5.2 The Government will provide the contractor the appropriate application software required to access the Defense Manpower Data Center's (DMDC) Defense Eligibility Enrollment Reporting System (DEERS) to perform eligibility inquiries and enrollments. The Government will grant the contractor access to DEERS only after the contractor's staff and all subcontractors' staff who will utilize systems which access and maintain TDP data, are compliant with the safeguarding methods for unclassified DoD information, personnel security and clearance requirements stated in C.5.1. The contractor and its subcontractors shall comply with C.5.1, no later than 120 days after award.

C.3.5.3 DMDC will notify all TDP enrollees that a new enrollment card is available on the milConnect.com site. Upon award of a new TDP contract, a new enrollment card will be generated for existing enrollees only if the TDP contract is awarded to a non-incumbent contractor.

C.3.5.4 The Government will print and provide to the contractor educational documents as identified in Section J, Attachment J-5, Program Operations.

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PART 4

4.0 CONTRACTOR FURNISHED ITEMS AND SERVICES

C.4.1 Services: The Contractor will NOT provide Contractor Furnished Services in support of this contract/task order.

C.4.2 General: The contractor shall furnish all supplies, equipment, facilities and services required to perform work listed under Part 5 of this PWS.

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PART 5

5.0 SPECIFIC TASKS

C.5.1 PERFORMANCE REQUIREMENTS

C.5.1.1 The contractor shall provide worldwide cost effective dental care services for enrollees.

C.5.1.1.1 The contractor shall comply with the most current version of American Dental Association's (ADA) Current Dental Terminology (CDT) manual for covered services and update its required systems.

Performance Standards

a) Standard: Whenever the ADA issues an updated CDT manual, the contractor shall identify CDT codes to be added, deleted and/or revised for Section J, Attachment J-2, Benefits, Exclusions and Limitations. The contractor shall provide the DHA Dental Program Section with its recommended changes for approval. The ADA updates CDT codes approximately once a year and the revisions are effective January 1 of the following year.

Acceptable Quality Level (AQL): The contractor shall submit its CDT recommendation within 30 calendar days of the release of the ADA’s updated CDT manual.

b) Standard: The contractor shall update its systems to reflect the DHA Dental Program Section’s approved CDT code changes no later than January 1 of the following year.

AQL: System updates shall be completed no later than January 1 100% of the time.

C.5.1.1.2 The contractor shall offer multiple avenues of access for continuous and open enrollment. Minimum avenues of access will be telephone, paper, and on-line enrollment. The members’ enrollment must be able to transfer between active duty, Selected Reserve, IRR and National Guard status (see Section J, Attachments J-3, TDP Coverage Plans and J-5, Program Operations).

Performance Standards

a) Standard: Enrollment actions shall be processed and monitored in accordance with the TSM Chapter 3 and Section J, Attachment J-5, Program Operations.

Acceptable Quality Level (AQL): 99% of entries for telephone and paper enrollments will be accurate and complete.

b) Standard: If an enrollment application and premium payment are received after the 20th day of the month, enrollment will begin on the first day of the second month after the month in which the contractor received the application.

AQL: 95% of applications will be processed in accordance with the standard.

Deliverables M010 Management Report M070 Enrollment and Fee Reconciliation Analysis Report Q030 Enrollment Activity Summary Report

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S050 Survivor Covered Lives and Utilization Report

C.5.1.1.3 The contractor shall provide and maintain access to general and specialty network providers for enrollees.

Network compliance shall be determined based off the network provider’s fixed structure location. “Driving miles” do not include alternative means of transportation (e.g. ferries, trains, or planes) in order for the beneficiary to access the provider’s office. DHA defines:

• “Very Rural” is defined as less than 300 residents per square mile.

• “Rural” is defined as more than 300 to 1,000 residents per square mile.

• “Suburban” is defined as more than 1,000 to 3,000 residents per square mile.

• “Urban” is defined as more than 3,000 residents per square mile.

The contractor may utilize the Census Bureau for determining the number of residents of the above stated areas. See Section H.3.1.3, Network Provider Retention incentive, and Section J, Attachment J-5, Program Operations for provider requirements.

Performance Standards

a) Standard: The contractor shall establish networks for general dental care in the 50 United States, District of Columbia, U.S. Virgin Islands, Guam, and Puerto Rico.

AQL: (1) For Very Rural: 95% of enrollees shall have access to one general dentist within 21 calendar days of requesting a periodic or initial (non-emergency) appointment and within 35 driving miles of their place of residence.

(2) For Rural: 95% of enrollees shall have access to two general dentists within 21 calendar days of requesting a periodic or initial (non-emergency) appointment and within 25 driving miles of their place of residence.

(3) For Suburban: 96% of enrollees shall have access to three general dentists within 21 calendar days of requesting a periodic or initial (non-emergency) appointment and within 15 driving miles of their place of residence.

(4) For Urban: 96% of enrollees shall have access to four general dentist within 21 calendar days of requesting a periodic or initial (non-emergency) appointment and within 5 driving miles of their place of residence.

b) Standard: The contractor shall establish networks for specialty dental care in the 50 United States, District of Columbia, U.S. Virgin Islands, Guam, and Puerto Rico.

AQL: (1) 90% of enrollees shall have access to an orthodontist within 28 calendar days of requesting an appointment and within 35 driving miles of their place of residence.

(2) 95% of enrollees shall have access to an oral surgeon within 28 calendar days of requesting an appointment and within 35 driving miles of their place of residence.

(3) 85% of enrollees shall have access to an endodontist within 28 calendar days of requesting an appointment and within 35 driving miles of their place of residence.

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(4) 85% of enrollees shall have access to a periodontist within 28 calendar days of

(5) 60% of enrollees shall have access to a prosthodontist within 28 calendar days of

c) Standard: The contractor shall maintain a network provider retention rate in accordance with Section J, Exhibit A, Contract Data Requirements List (CDRL) M020, Provider Network Access Report. For OP 1 the COR will validate the baseline 6 months after start of dental care delivery.

The baseline shall be reset at the beginning of each OP, and the Contracting Officer Representative (COR) will re-validate at the end of the OP.

AQL: 95% of network providers shall be retained annually.

d) Standard: The contractor shall deploy Mobile Dental Units (MDUs) in accordance with Section J, Attachment J-5, Program Operations for areas in which there are no practicing dentists.* AQL: MDUs shall be deployed once in each OP for up to five consecutive days to a centrally-located area within each identified county to serve those 200 or more enrollees whose closest practicing dentist is located 50 or more miles from the enrollee’s place of residence or the enrollees reside in a non-compliant area.

*The standard applies until such time a practicing dentist (network or non-network) resides in the location and access standards are met. A minimum of 30% of TDP enrollees must be scheduled for mobile care in each location per event for a mobile unit to be deployed and the standard to apply.

Deliverables M020 Provider Network Access Report

C.5.1.1.4 The contractor shall develop, maintain and make available to enrollees, providers and Government representatives an up-to-date directory of network providers.

Performance Standard

a) Standard: The contractor shall post the updated directory on the contractor’s website in accordance with Section J, Attachment J-5, Program Operations.

AQL: 100% updated within 5 business days of receipt of the updated information.

Deliverables M020 Provider Network Access Report

C.5.1.1.5 The contractor shall develop and maintain agreements with TRICARE OCONUS Preferred Dentists (TOPDs).

Performance Standards

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a) Standard: The contractor shall complete agreements with providers identified by the Government and for any new providers identified each OP in accordance with Section J, Attachments J-6a, OCONUS Program Operations, and J-11, Transition-In.

AQL: The contractor shall complete agreements with 95% of providers identified by the DHA COR prior to OP 1 and any new providers identified each OP.

b) Standard: The contractor shall make available to enrollees, TOPDs and Government representatives an up-to-date list of TOPDs in accordance with Section J, Attachment J-6a, OCONUS Program Operations.

AQL: 100% updated within 5 business days of receipt of the updated information.

Deliverables W010 Transition-In Status Report M010 Management Report

C.5.1.1.6 The contractor shall process claims to completion for enrollees and providers.

Process to completion is defined in the TOM, Appendix A.

Performance Standards

a) Standard: Process CONUS claims to completion in accordance with Section J, Attachment…