TRICARE Medicare Eligible Program Second Generation (TMEP2)

The Defense Health Agency seeks a contractor to provide health care claims processing, customer support, and associated administrative services for dual-eligible Medicare and TRICARE beneficiaries, with proposals due November 5, 2026. This is a full and open competitive acquisition using best value trade-off procedures; no set-aside applies.

Place of performance spans the United States, Puerto Rico, Guam, US Virgin Islands, American Samoa, and Northern Mariana Islands. The contract is Firm Fixed-Price, structured as one 12-month transition-in period, seven 1-year healthcare delivery periods, one 12-month transition-out period, and a potential 6-month extension under FAR 52.217-8, for a total period of up to 8.5 years.

Distinctive requirements include processing approximately 63.9 million electronic claims and 1.36 million paper claims in the first option period (with modest volume declines projected across seven option years); establishing two separate designated bank accounts for benefit disbursements; maintaining 24/7 call center operations with live agents available 6:00 AM to 11:00 PM EST; submitting TRICARE Encounter Data with escalating edit system pass rates from 80 percent in months 1–3 to 97 percent by month 24; achieving 98 percent processing of retained and adjustment claims within 30 calendar days and 100 percent within 90 days; processing all Medicare crossover claims electronically through a trading partner agreement with the Medicare Benefits Coordinator Recovery Center; and maintaining CMMC Level 2 (Self) cybersecurity certification by contract award. The contractor must enter into a Data Sharing Agreement with DoD and honor all outstanding authorizations from the outgoing contractor for 60 days post-transition. Offerors must submit completed Small Business Participation Commitment and Client Authorization Letters as mandatory proposal elements; past performance is emphasized as a significant evaluation factor and requires subcontractor consent letters in Volume III.

Historical claim receipts ranged from $57.8 million (2023) through $62.0 million (2025 through July); approximately 2.6 million TRICARE/Medicare dual-eligible beneficiaries were enrolled as of June 2026. Evaluation will apply best value trade-off methodology under FAR 15.2 as supplemented by Defense FAR Supplement and DoD Source Selection Procedures (August 2022). Amendment 0001, issued September 24, 2026, updated sensitivity labels on Section J Attachment J-5b and Exhibits L-7, L-8, and L-9 without modifying the offer receipt deadline. The NAICS code is 524292, Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds; PSC is Q201, Medical-Managed Healthcare.