Common use of BENEFICIARY SERVICES Clause in Contracts

BENEFICIARY SERVICES. 5.1 The TOP contractor shall achieve the highest level of beneficiary satisfaction possible in the overseas environment. This shall be accomplished by developing qualified purchased care sector provider networks (complemented by non-network purchased care sector providers as necessary), ensuring timely access to purchased care sector care, providing TOP information/education/training to beneficiaries and purchased care sector providers, and processing claims in a timely, accurate manner. 5.2 In addition to the beneficiary education requirements outlined in Chapter 11, Sections 1 and 2, the TOP contractor may be required to conduct beneficiary education/enrollment activities for arriving/deploying units in accordance with the enrollment protocols established in the MOU between the TOP contractor and the MTFs.‌‌‌ 5.3 The TOP contractor shall maintain up-to-date lists of purchased care sector network providers, and shall make this information available at all TOP TSCs and via web-based access. Web-based network provider listings shall include information regarding authorization requirements that are applicable to TOP Prime and Prime Remote enrollees. 5.4 The TOP contractor’s beneficiary education activities and materials shall include information for TOP Prime and Prime Remote enrollees regarding care received in the 50 U.S. and the District of Columbia. This process shall include information regarding referrals/authorizations while stateside, TOP POS policy, and the recommended process for accessing care while stateside. TOP Prime and Prime Remote enrollees traveling stateside shall be encouraged to utilize MTF care whenever possible. If MTF care is not available, beneficiaries should be encouraged to seek care from a network provider before obtaining care from a non-network provider. 5.5 The requirement in Chapter 11, Section 2, paragraph 1.1, is superseded for the TOP contractor by a requirement for a total of nine three-day TRICARE training courses per contract option period (two per option period within the TRICARE Eurasia-Africa area; two within the TRICARE Pacific area; two within the TRICARE Latin America/Canada (TLAC) area; and three additional courses that may occur in any stateside or overseas location at the direction of the Contracting Officer (CO)).‌ Note: Only the frequency requirements of Chapter 11, Section 2, paragraph 1.1 are superseded; all other requirements of the referenced paragraph apply to the TOP contractor.‌ 5.6 The requirement for mailing TRICARE handbooks, in Chapter 11, Section 1, paragraph 4.1, is superseded for the TOP contractor by a requirement for “on-demand” processes for distributing TRICARE handbooks upon beneficiary request (including, at a minimum, web-based requests, telephone requests, and on-site requests at a TSC).‌

BENEFICIARY SERVICES. 5.1 The TOP contractor shall achieve the highest level of beneficiary satisfaction possible in the overseas environment. This shall be accomplished by developing qualified purchased care sector provider networks (complemented by non-network purchased care sector providers as necessary), ensuring timely access to purchased care sector care, providing TOP information/education/training to beneficiaries and purchased care sector providers, and processing claims in a timely, accurate manner. 5.2 In addition to the beneficiary education requirements outlined in Chapter 11, Sections 1 and 2, the TOP contractor may be required to conduct beneficiary education/enrollment activities for arriving/deploying units in accordance with the enrollment protocols established in the MOU between the TOP contractor and the MTFs.‌‌‌MTFs. 5.3 The TOP contractor shall maintain up-to-date lists of purchased care sector network providers, and shall make this information available at all TOP TSCs and via web-based access. Web-based network provider listings shall include information regarding authorization requirements that are applicable to TOP Prime and Prime Remote enrollees. 5.4 The TOP contractor’s beneficiary education activities and materials shall include information for TOP Prime and Prime Remote enrollees regarding care received in the 50 U.S. and the District of Columbia. This process shall include information regarding referrals/authorizations while stateside, TOP POS policy, and the recommended process for accessing care while stateside. TOP Prime and Prime Remote enrollees traveling stateside shall be encouraged to utilize MTF care whenever possible. If MTF care is not available, beneficiaries should be encouraged to seek care from a network provider before obtaining care from a non-network provider. 5.5 The requirement in Chapter 11, Section 2, paragraph 1.1, is superseded for the TOP contractor by a requirement for a total of nine three-day TRICARE training courses per contract option period (two per option period within the TRICARE Eurasia-Africa area; two within the TRICARE Pacific area; two within the TRICARE Latin America/Canada (TLAC) area; and three additional courses that may occur in any stateside or overseas location at the direction of the Contracting Officer (CO)).‌ CO)). Note: Only the frequency requirements of Chapter 11, Section 2, paragraph 1.1 are superseded; all other requirements of the referenced paragraph apply to the TOP contractor.‌contractor. 5.6 The requirement for mailing TRICARE handbooks, in Chapter 11, Section 1, paragraph 4.1, is superseded for the TOP contractor by a requirement for “on-demand” processes for distributing TRICARE handbooks upon beneficiary request (including, at a minimum, web-based requests, telephone requests, and on-site requests at a TSC).‌TSC).

BENEFICIARY SERVICES. 5.1 The TOP contractor shall achieve the highest level of beneficiary satisfaction possible in the overseas environment. This shall be accomplished by developing qualified purchased care sector provider networks (complemented by non-network purchased care sector providers as necessary), ensuring timely access to purchased care sector host nation care, providing TOP information/education/training to beneficiaries and purchased care sector providers, and processing claims in a timely, accurate manner. 5.2 In addition to the beneficiary education requirements outlined in Chapter 11, Sections 1 and 2, the TOP contractor may be required to conduct beneficiary education/enrollment activities for arriving/deploying units in accordance with the enrollment protocols established in the MOU SORs between the TOP contractor and the MTFs.‌‌‌MTFs. 5.3 The TOP contractor shall maintain up-to-date lists of purchased care sector network providers, and shall make this information available at all TOP TSCs and via web-based access. Web-Web- based network provider listings shall include information regarding authorization requirements that are applicable to TOP Prime and Prime Remote enrollees. 5.4 The TOP contractor’s beneficiary education activities and materials shall include information for TOP Prime and Prime Remote enrollees beneficiaries regarding care received in the 50 U.S. United States and the District of Columbia. This At a minimum, this process shall include information regarding referrals/authorizations while stateside, TOP POS policy, and the recommended process for accessing care while stateside. TOP Prime and Prime Remote enrollees beneficiaries traveling stateside shall be encouraged to utilize MTF care whenever possible. If MTF care is not available, beneficiaries should be encouraged to seek care from a network provider before obtaining care from a non-network provider. 5.5 The requirement for a quarterly three-day TRICARE training course, as outlined in Chapter 11, Section 2, paragraph 1.1, is superseded for the TOP contractor by a requirement for a total of nine three-day TRICARE training courses per contract option period (two per option period within the TRICARE Eurasia-Africa area; two within the TRICARE Pacific area; two within the TRICARE Latin America/Canada (TLAC) area; and three additional courses that may occur in any stateside or overseas location at the direction of the Contracting Officer (CO)).‌ CO)). Note: Only the frequency requirements of Chapter 11, Section 2, paragraph 1.1 are superseded; all other requirements of the referenced paragraph apply to the TOP contractor.‌contractor. 5.6 The requirement for mailing TRICARE handbooks, as outlined in Chapter 11, Section 1, paragraph 4.1, is superseded for the TOP contractor by a requirement for “on-demand” processes for distributing TRICARE handbooks upon beneficiary request (including, at a minimum, web-web- based requests, telephone requests, and on-site requests at a TSC).‌TSC).

BENEFICIARY SERVICES. 5.1 The TOP contractor shall achieve the highest level of beneficiary satisfaction possible in the overseas environment. This shall be accomplished by developing qualified purchased care sector host nation provider networks (complemented by non-network purchased care sector host nation providers as necessary), ensuring timely access to purchased care sector host nation care, providing TOP information/education/training to beneficiaries and purchased care sector host nation providers, and processing claims in a timely, accurate manner. 5.2 In addition to the beneficiary education requirements outlined in Chapter 11, Sections 1 and 2, the TOP contractor may be required to conduct beneficiary education/enrollment activities for arriving/deploying units in accordance with the enrollment protocols established in the MOU Memorandum of Understanding (MOU) between the TOP contractor and the MTFs.‌‌‌MTFs. 5.3 In addition to the requirements outlined in Chapter 11, Section 2, all beneficiary satisfaction activities (including beneficiary surveys conducted in accordance with Chapter 11, Section 2) shall be coordinated with the three TAOs to achieve a coordinated, uniform approach to Department of Defense (DoD) customer services overseas. 5.4 The TOP contractor shall maintain up-to-date lists of purchased care sector host nation network providers, and shall make this information available at all TOP TSCs and via web-based access. Web-based network provider listings shall include information regarding authorization requirements that are applicable to TOP Prime and Prime Remote enrollees. 5.4 5.5 The TOP contractor’s beneficiary education activities and materials plan shall include information address their process for educating TOP Prime and Prime Remote enrollees beneficiaries regarding care received in the 50 U.S. United States and the District of Columbia. This At a minimum, this process shall include information regarding referrals/authorizations while stateside, TOP POS policy, and the recommended process for accessing care while stateside. TOP Prime and Prime Remote enrollees beneficiaries traveling stateside shall be encouraged to utilize MTF care whenever possible. If MTF care is not available, beneficiaries should be encouraged to seek care from a network provider before obtaining care from a non-network provider. 5.5 5.6 The requirement for a quarterly three-day TRICARE training course, as outlined in Chapter 11, Section 2, paragraph 1.1, is superseded for the TOP contractor by a requirement for a total of nine three-day TRICARE training courses per contract option period (two per option period within the TRICARE Eurasia-Africa area; two within the TRICARE Pacific area; two within the TRICARE Latin America/Canada (TLAC) area; and three additional courses that may occur in any stateside or overseas location at the direction of the Contracting Officer (CO)).‌ CO)). Note: Only the frequency requirements of Chapter 11, Section 2, paragraph 1.1 are superseded; all other requirements of the referenced paragraph apply to the TOP contractor.‌contractor. 5.6 5.7 The requirement for mailing TRICARE handbooks, as outlined in Chapter 11, Section 1, paragraph 4.1, is superseded for the TOP contractor by a requirement for “on-demand” processes for distributing TRICARE handbooks upon beneficiary request (including, at a minimum, web-web- based requests, telephone requests, and on-site requests at a TSC).‌TSC).

BENEFICIARY SERVICES. 5.1 The TOP contractor shall achieve the highest level of beneficiary satisfaction possible in the overseas environment. This shall be accomplished by developing qualified purchased care sector host nation provider networks (complemented by non-network purchased care sector host nation providers as necessary), ensuring timely access to purchased care sector host nation care, providing TOP information/education/training to beneficiaries and purchased care sector host nation providers, and processing claims in a timely, accurate manner. 5.2 In addition to the beneficiary education requirements outlined in Chapter 11, Sections 1 and 2, the TOP contractor may be required to conduct beneficiary education/enrollment activities for arriving/deploying units in accordance with the enrollment protocols established in the MOU between the TOP contractor and the MTFs.‌‌‌MTFs. 5.3 In addition to the requirements outlined in Chapter 11, Section 2, all beneficiary satisfaction activities (including beneficiary surveys conducted in accordance with Chapter 11, Section 2) shall be coordinated with the three TAOs to achieve a coordinated, uniform approach to Department of Defense (DoD) customer services overseas. 5.4 The TOP contractor shall maintain up-to-date lists of purchased care sector host nation network providers, and shall make this information available at all TOP TSCs and via web-based access. Web-based network provider listings shall include information regarding authorization requirements that are applicable to TOP Prime and Prime Remote enrollees. 5.4 5.5 The TOP contractor’s beneficiary education activities and materials plan shall include information address their process for educating TOP Prime and Prime Remote enrollees beneficiaries regarding care received in the 50 U.S. United States and the District of Columbia. This At a minimum, this process shall include information regarding referrals/authorizations while stateside, TOP POS policy, and the recommended process for accessing care while stateside. TOP Prime and Prime Remote enrollees beneficiaries traveling stateside shall be encouraged to utilize MTF care whenever possible. If MTF care is not available, beneficiaries should be encouraged to seek care from a network provider before obtaining care from a non-network provider. 5.5 5.6 The requirement for a quarterly three-day TRICARE training course, as outlined in Chapter 11, Section 2, paragraph 1.1, is superseded for the TOP contractor by a requirement for a total of nine three-day TRICARE training courses per contract option period (two per option period within the TRICARE Eurasia-Africa area; two within the TRICARE Pacific area; two within the TRICARE Latin America/Canada (TLAC) area; and three additional courses that may occur in any stateside or overseas location at the direction of the Contracting Officer (CO)).‌ CO)). Note: Only the frequency requirements of Chapter 11, Section 2, paragraph 1.1 are superseded; all other requirements of the referenced paragraph apply to the TOP contractor.‌contractor. 5.6 5.7 The requirement for mailing TRICARE handbooks, as outlined in Chapter 11, Section 1, paragraph 4.1, is superseded for the TOP contractor by a requirement for “on-demand” processes for distributing TRICARE handbooks upon beneficiary request (including, at a minimum, web-web- based requests, telephone requests, and on-site requests at a TSC).‌TSC).