RFI QA Responses HT940226RFI0255 Supplemental Pilot.pdf

DHA T-5 Procurement

RFI Questions HT9402-26-RFI-0255

# Question Government Response

Does the Department envision this pilot as a mechanism to provide access to services, treatments, or support programs not otherwise covered by TRICARE (e.g. non-FDA approved?)

No. The TRICARE program is a comprehensive health care benefit that combined with Departmental and community resources minimizes, if not eliminates, the financial burden of serious, life-altering medical conditions on members and their families – including cancer. As a statutory federal health care benefit program, TRICARE is prohibited from paying for any non-FDA approved treatments, but several exceptions to non- FDA approved services, treatments, and programs, such as clinical trials, are written into law allowing beneficiaries to receive the same access to services.

2 Would the Department extend pilot eligibility to Reserve Component or Coast Guard members?

No. The NDAA defines the covered individuals to include a regular component member of the Army, Navy, Marine Corps, Air Force or Space Force and their dependents who are enrolled in TRICARE.

Does the Department have established KPIs or a scorecard for measuring pilot outcomes (e.g., clinical outcomes, utilization, cost avoidance, access to care, participant satisfaction, readiness/force retention, and financial protection for military families)?

No.

4 Does the Department anticipate holding an Industry Day? Yes. DHA is currently planning an industry event anticipated in November. All related information will be posted on SAM.gov.

Will the enrollment process for the Supplemental Cancer Pilot Program be confined to an open enrollment period, or allow for a continuous enrollment set-up?

DHA recommends a continuous enrollment set-up but is open to industry input.

Does the Department anticipate utilizing an Other Transaction Authority (OTA), a FAR-based contract, or another acquisition vehicle?

To be determined.

7 What role, if any, will the Department and DHA play in participant education and enrollment? The Department does not expect to play a role in educating or enrolling participants.

Does the DHA anticipate any restrictions on the carrier's ability to communicate enrollment, events/awareness, or service related activities?

Unknown.

Does the Department anticipate issuing a federal preemption determination to ensure uniform administration across all states and territories?

No. Current policy does not support preemption determinations for insurance products providing coverage or reimbursement for care and services outside the scope of the TRICARE benefit.

11 Is the Department seeking cancer-navigation or advocacy services in addition to financial benefits? No. This initiative is directed by the FY26 NDAA and was not a result of an identified need or gap in coverage.

Is enrollment currently projected to begin by the statutory deadline of September 2027, in January 2028, or another timeframe?

The pilot is anticipated to meet the statutory deadline.

Does the Department intend for all participating carriers to offer identical coverage and pricing, or will carriers be permitted to offer differing plan designs and premium rates?

To be determined. Per the NDAA, carriers are required to develop TRICARE specific products but specifications are not provided.

Does DHA envision the statutory requirement of agreements with "not fewer than two companies" as two carriers each operating a full, independent national plan available to every eligible member regardless of duty station, or as some regional or blended division of responsibility among carriers?

DHA envisions the statutory requirements as at least two companies operating a full, independent, national, TRICARE specific plan available to every eligible member regardless of duty station, occupation, or other discriminatory factors.

How does the Department intend to structure the tax treatment of benefits provided under this program? Does the Department anticipate the coverage being offered on a pre-tax or after-tax basis, and are there any program-specific tax considerations that participating insurers should incorporate into their plan designs, benefit structures, or member communications?

Coverage must be offered on an after-tax basis due to the "other health insurance" requirements outlined in policy.

16 Will rates vary by military grade or another eligibility category? Rates are to be determined by the carrier.

17 When does DHA anticipate issuing the formal RFP and requesting pricing? Unknown.

Has DHA developed enrollment or participation assumptions for the pilot, including any estimates based on historical claims, medical-plan benchmarks, or other data?

Not at this time.

Can DHA provide demographic information for the eligible population, including age and gender, as well as cancer diagnosis counts and corresponding patient demographics?

Yes. DHA will provide limited demographic information on the eligible population upon receiving the requisite agreements for privacy and information sharing expectations. These requirements will be discussed during the industry event.

20 Can DHA provide medical claims, utilization, or other relevant data to support pricing assumptions?

Yes. DHA will provide limited demographic information on the eligible population upon receiving the requisite agreements for privacy and information sharing expectations. These requirements will be discussed during the industry event.

21 What enrollment model is contemplated: evergreen, an annual enrollment period, or another approach? DHA recommends a continuous enrollment set-up but is open to industry input.

22 Will DHA provide enrollment support, or will carriers be responsible for all enrollment functions? No. Carriers will be responsible for all enrollment functions.

How will eligibility be verified, transmitted and maintained? Will DEERS connectivity or similar integration be required?

To be determined.

24 What reporting requirements will carriers be expected to support?

Per the NDAA, carriers will be expected to provide the number of covered individuals who enrolled as well as feedback and examples of use cases by such individuals. Additional reporting requirements are expected.

What DHA cybersecurity, data-handling, and onshoring requirements will apply? Example: is the DHA anticipating requirements similar to TRICARE Dental which far exceed the normal Privacy laws which insurance companies are already subject to?

See response to #10.

Is there a proven need or demonstrated interest from the beneficiary population in a supplemental insurance product?

No. This pilot was mandated in the FY26 NDAA without demonstrated interest or gap analysis.

27 Does the Department anticipate extending the pilot duration or making it permanent? No. DHA intends to follow the requirements of the NDAA.

28 Does DHA anticipate any barriers to implementing the pilot based on current contract terms?

Yes. The proposed systems integration capabilities may be cost prohibitive, and there is concern for the appropriateness of the messaging received by the beneficiaries.

How will the relationship with and services provided by the carriers be portrayed (e.g. safe, vetted, recommended, etc.) in Departmental messaging?

The Department does not expect to suggest any relationship with the carriers involved in the pilot or promote any products beyond the requirements in the NDAA.

Does DHA envision revising the statutory requirement of agreements with "not fewer than two companies" if only one viable vendor exists?

No. DHA envisions the statutory requirement of at least two vendors being upheld to comply with federal acquisitions guidance.

32 Does the Department intend for all participating carriers to offer guaranteed coverage? See response to #13.

10 What cybersecurity, privacy, and HIPAA requirements will apply to participating carriers?

Security requirements to safeguard covered defense information (see DFARS 252.207-7012) that reside or transverse a non-DoD system are defined in DFARS 252.204-7008, DFARS 252.204-7012, DFARS 252.204-7021, DFARS 252.204-7025. The required Cybersecurity Maturity Model Certification (CMMC) Level will be prescribed in the solicitation.

29 Does DHA envision providing plan options for minor dependents as "covered individuals"? See response to #13.

General Questions from Industry