PILOT PROGRAM TO ASSIST CERTAIN MEMBERS OF THE ARMED FORCES AND DEPENDENTS WITH ADDITIONAL SUPPLEMENTAL COVERAGE RELATING TO CANCER HT9402-26-RFI-0255

The Defense Health Agency (DHA) is currently in the planning phase for partnering with carriers of supplemental insurance focused on cancer coverage. This Request for Information (RFI) is intended to initiate market research efforts as the Government considers structuring processes to meet Congress’ intent.

Section 734 of the National Defense Authorization Act (NDAA) for Fiscal Year (FY) 2026 (Enclosure 1) requires DHA to establish a pilot program not later than September 30, 2027, under which members of the regular component of the Army, Navy, Marine Corps, Air Force, or Space Force and their dependents enrolled in TRICARE may obtain supplemental cancer insurance for noncovered expenses under a fixed indemnity supplemental benefit. The supplemental coverage is intended to provide financial assistance for noncovered expenses related to cancer screening, diagnosis and treatment that are not otherwise covered by the health care benefits the individuals receive under chapter 55 of title 10, United States Code, or any other benefit provided by the Secretary of Defense.

https://www.congress.gov/119/plaws/publ60/PLAW-119publ60.pdf

RFI Instructions:

Prepare and submit a written response addressing each of the questions below. This response shall not exceed 20 pages in length and should not be solely your company’s general capability statement but instead specifically address the Government’s topics listed in this RFI. Please send your responses to the Defense Health Agency, Managed Care Contracting Division james.goddard22.ctr@health.mil by Close of Business 18 September 2026.

RFI Questions:

Plan Types and Coverage Scope

• Describe how a TRICARE specific plan would differ from current commercially available plans.
• What non-covered services under TRICARE would be covered?
• Would there be portability options if a beneficiary is no longer eligible for TRICARE?
• How could your company intend to add value to TRICARE beneficiaries? Describe an applicable case scenario.

Coverage Details and Exclusions

• Detail general coverages provided in similar plans.
• Would there be any key coverage exclusions and limitations, including but not limited to: Acts of War, specific cancer types, pregnancy, and state-based restrictions?
• What annual or lifetime maximums on benefits would apply, and what conditions or treatments would be subject to caps or exceptions?
• What coverage would be provided for non-FDA approved drugs, participation in clinical trials, or other emerging and unproven treatments?
• Would pre-existing conditions be covered? If yes, what conditions would be included? Would there be any coverage limitations for a recurring diagnosis (remission or new)?
• In which states does your company offer coverage, and are there any state specific exceptions or restrictions that would apply to a TRICARE specific plan? How would this impact our mobile beneficiary population?
• Do your company’s plans provide coverage for beneficiaries residing or receiving care overseas?

Eligibility and Enrollment

• Per the NDAA, the Government will not be subsidizing this pilot. To be financially viable, is there a minimum required enrollment threshold for such an unsubsidized, “no cost,” 100% beneficiary paid, group plan to be offered by your company?
• Is there a preferred eligibility verification process?
• What would prevent a member from being eligible?
• Describe the enrollment process and the expected burden on the beneficiary.
• When would coverage be effective? Any limitations?
• How would beneficiaries make premium payments?
• How are premiums structured today (in similar policies)? How would your company structure TRICARE premiums based on pilot requirements?
• Would premium rates be locked in for the duration of the pilot?
• Describe the termination of coverage process and the expected burden on the beneficiary.

Claims and Payments

• How are claim payments determined and processed, including if lump sum payments are one-time or recurring, and any applicable limitations? Would payments be taxable as income?
• How would beneficiaries submit claims/receive payments, and what is the expected burden on the beneficiary?
• Would there be any third-party liability? If so, please explain.
• Describe the claims submissions and processing experience, including the average processing time and the availability of digital tools (such as online portals or mobile apps) for beneficiaries to submit and track claims.

Reporting and Oversight

• What beneficiary data would your company provide to the Government/employer (e.g. cost, number of enrollees, denials, customer satisfaction, use case data)?
• Are there any limitations to data your company would be willing to share?
• Does your company recommend any specific data metrics DHA should track to accurately report the program’s success, beneficiary satisfaction, and programmatic feasibility to Congress?
• What board or organization oversees the supplemental insurance industry? Give some examples of standards, grievances, or reporting at a state or federal level.  

 Qualifications

• How many years of experience does your company have providing supplemental insurance plans?

• What is your company’s claims acceptance/denial rate? What are the top 10 reasons for denials?

• How will your company protect beneficiaries’ personally identifiable information?

Acquisition Strategy

• What are ways to participate via “no-cost” or similar means?
• Does your company anticipate any barriers to participating in the pilot based on “no-cost” contract terms?

The Government may publish future RFIs or hold an industry day. Communication for both will be made under the same announcement as the RFI. The Government appreciates the time and expense related to this posting.

Disclaimer:

This announcement does not constitute a commitment, implied or otherwise, to ensure that a solicitation or contract will be issued. Issuance of the RFI is for planning purposes only and does not commit the Government to any contractual agreements or arrangements. The Government is not soliciting proposals with this request.

Responses to this announcement will not be returned. The Government is not liable to pay any costs associated with companies responding to this announcement.

Issuance of the RFI is intended to provide interested parties with information and provide an opportunity for industry feedback into the preliminary programmatic design. All information received resulting from this RFI will be used by the DHA for market research purposes and programmatic design. However, responses may be releasable to the public under the Freedom of Information Act (FOIA) unless appropriately marked.

 The DHA, at its discretion, may request respondents to elaborate on information in their written response in writing or through other means. Respondents will not be notified of any results derived from a review of the information provided.

Any responses from the Government are subject to change, interested parties will have opportunity to seek clarification from the Government for any remaining questions.

CONFIDENTIALITY:

No proprietary, classified, confidential, or sensitive information should be included in your response. Industry responses will be shared with DHA staff for the purpose of market research. The Government reserves the right to use any non-proprietary technical information in any resultant solicitation(s).

Potential offerors are instructed to use the question matrix provided in the attachments section for any additional comments or questions for the Government.  Responses will be provided at a later date.

PRIMARY DHA POINT OF CONTACT:

email: marcus.r.webb.civ@health.mil