RSBY-Tender (Addendum-Corigendum-2)

142 Pages·2016·3.81 MB·English

Minutes of pre-bid meeting held on 16.11.2016
at meeting hall of old DHS, l't Floor, Old Nurses Hostel,
Behind DKS Bhawan, Raipur, Chhattisgarh.
Pre-bid meeting of RSBY-MSBY short tender for selection of insurance company was held on 16.11.2016 at
Old Nurses' Hostel, Raipur, Chhattisgarh under the chairmanship of Additional Chief Executive Offtcer,
RSBY Chhattisgarh. Representatives of nine insurance companies were also participated'in the meeting:
1.
The Oriental lnsurance Company Ltd.
2.
Bajaj Allianz GIC Ltd.
3.
Religare Health Insurance Co. Ltd.
4.
United lndia Insurance Co. Ltd.
5.
Star Health & Allied lnsurance Co. Ltd.
6.
ICICI Lombard GIC Ltd.
7.
Reliance GIC Ltd.
8.
IFFCO-TOKIO GIC Ltd.
9.
The New India Assurance Co. Ltd.
10. Medicare TPA
Additional Chief Executive Officer, RSBY Chhattisgarh clarified the doubts of the representatives of
insurance companies and replied to their queries, Few suggestions were also given by the participants for
consideration. Following suggestions are considered by the State Nodal Agency, RSBY-MSBY Chhattisgarh
& accordingly an addendum will be uploaded in the websites and corrections in the RSBY-MSBY Short
Tender Document.
Corrigendum / Addendum
A. Eligibility criteria: As notified by Ministry of Health & Family Welfare, Government of India,
New Delhi.
B. Premium: Quoted premium should be inclusive of cost of SMART CARD i.e. Rs.60!. In case of
renewal of smart cards Rs. 601 shatl be deducted per card from the premium,
Premium sharing - State Government 40% & Government of India 60Yo
C. Jurisdiction: Raipur, Chhattisgarh
D. New enrolment: Pro-rata premium shall be paid for new enrolment by State Nodal Agency.
E. Manpower: One MBBS doctor to be posted in each district where ten private hospitals are exists.
F. Claims: Claim processing data must be hit on RSBY server installed at NIC,
G. Actuary certificate - As per format.
H. Data: Three years' Scheme wise, Round wise & District wise data has been uploaded in our
website: rsbycg.nic.in.
I. Amended Tender Document is attached herewith for ready reference.
dditional Chief Executive Officer
RSBY-MSBY Ch hattisgarh
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.

GOVERNMENT OF CHHATTISGARH

Department of Hea lth & Family Welfare
State Nodal Agen cy- RSBY & MSBY

TENDER DOCUMENT

Selection of “Insurance Companies” for implementation of
Implementation of
RSBY & MSBY in all 27 Districts

“Rashtriya Swasthya Bima Yojana

&

“Mukhyamantri Swasthya Bima Yojana”
Office of the Chief Executive Officer

State Nodal Agency (RSBY)

2nd Floor, Old Nursing Hostel
In the State of Chhattisgarh
Behind DKS Bhawan, Raipur-492001, Chhattisgarh

Phone: [phone]
e-mail: rsb [email protected]

Government of Chhat tisgarh

Department of Health & Family Welfare

Chhattisgarh

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Released on 05/11/2016

File reference no. 40/2014/3-1/4 / 627
Date of issue of tender document 5 November, 2016
Date and time for pre-bid meeting 16 November, 2016 at 11:00 AM
Meeting Hall, State Nodal Agency
Pre-bid meeting venue
1st floor, Old nurses Hostel, Raipur
Last date for receiving queries 18 November, 2016
Last date and time for online submission of bids
(Technical bid in envelop-A & Financial bid in 26 November, 2016 time 17:00 PM
envelop-B) separately
Website for submission of online bids
http://eproc.cgstate.gov.in
(From 08.11.2016, 14.00 hrs. to 26.11.2016, 17.00 hrs.
Venue, Date & Time of Opening State Nodal Agency, RSBY & MSBY
Of Technical Bids 29 November, 2016 at 12:30 PM
Venue, Date & Time of Opening Financial Bids TBA
Additional Chief Executive Officer,
Contact Person, Phone No.
Ph- 07714095198
Email id [email protected]
Office of the Chief Executive Officer
State Nodal Agency (RSBY)
Address for Communication:
2nd Floor, Old Nursing Hostel
Behind DKS Bhawan, Raipur-492001
www.rsbycg.nic.in, cghealth.nic.in,
Detailed tender document may be downloaded
cgmsc.gov.in,

Helpdesk no. 1800 258 2502

Interested bidders may download complete set of tender document from the web
portal of the State Government at the website mentioned above.

• It will be in the interest of the Tenderers to familiarize themselves
with the e Procurement system to ensure smooth preparation and
submission of the tender documents.

• The Bidders are advised to submit the Bids well in advance of the deadline
as the State Nodal Agency for RSBY & MSBY will not be liable or
responsible for non submission of the bids on account of any technical
glitches or any problems in connectivity services used by the bidder.

Note: All eligible/ interested Insurance Companies (Bidders) are required to get enrolled on
the eProcurement portal (http://eproc.cgstate.gov.in)and the tender will also be
available on the same portal in order to download the tender documents and
participate in the subsequent bidding process.

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SHORT TENDER NOTICE

RASHTRIYA SWASTHYA BIMA YOJANA &
MUKHYAMANTRI SWASTHYA BIMA YOJANA

(A scheme to provide health insurance coverage to eligible families of Chhattisgarh
state)

Competitive bids are invited from Insurance Companies (which have been pre-
qualified by the RFQ process undertaken by Ministry of Health and Family Welfare, GoI for
implementation of Rashtriya Swasthya Bima Yojana (RSBY)) for defined category of families
in 27 districts namely - 1. Rajnandgaon, 2. Durg, 3. Bemetara, 4. Balod, 5.Bilaspur,
6.Mungeli, 7.Sarguja, 8.Surajpur, 9.Balrampur, 10.Raipur, 11.Balodabazar,
12.Gariyaband, 13.Bastar, 14. Kondagaon, 15.Narayanpur, 16.Kanker, 17.Dhamtari,
18.Raigarh, 19.Korba, 20.Janjgir, 21.Jashpur, 22.Dantewada, 23.Sukma, 24.Bijapur,
25.Mahasamund, 26.Kawardha and 27.Koria districts of Chhattisgarh State. The policy
period for all these 27 districts would be 6 months initially and can be extended upto 1
year.

(A scheme to provide health insurance coverage to unorganized sector workers belonging
to BPL families and other non-BPL beneficiaries) The tender documents can be
downloaded from the Department’s Sub-Portal ( www.rsbycg.nic.in, cghealth.nic.in,
cgmsc.gov.in).

Note: All eligible/ interested Insurance Companies are mandated to get enrolled on the
eProcurement portal (http://eproc.cgstate.gov.in and the tender will be available on the
same portal in order to download the tender documents and participate in the
subsequent bidding process.

Chief Executive Officer
State Nodal Agency RSBY
Directorate of Health Services
Old Nurses Hostel, Mantralaya Campus,
Raipur, Chhattisgarh
Tel: [phone]
Email:- [email protected]

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SHORT TENDER DOCUMENT
STATE GOVERNMENT
DEPARTMENT OF HEALTH & FAMILY WELFARE
STATE NODAL AGENCY-RSBY & MSBY CHHATTISGARH

A number of studies have revealed that risk owing to low level of health security is endemic
for individuals, especially those in unorganized sector. The vulnerability of these workers
increases when they have to pay out of pocket for their medical care with no subsidy or
support. On the one hand, such a worker does not have the financial resources to bear the
cost of medical treatment, on the other; the public owned health infrastructure leaves a lot to
be desired. Large number of persons borrows money or sells assets to pay for treatment in
hospitals. Thus, Health Insurance can be a way of overcoming financial handicaps,
improving access to quality medical care and providing financial protection against high
medical expenses. The “Rashtriya Swasthya Bima Yojana & Mukhyamantri Swasthaya Bima
Yojana” announced by the Central Government and Mukhyamantri Swasthaya Bima Yojana
attempts to address such issues.

State Government is inviting bids for all the 27 Districts namely - 1. Rajnandgaon,
2. Durg, 3. Bemetara, 4. Balod, 5. Bilaspur, 6. Mungeli, 7.Sarguja, 8.Surajpur,
9. Balrampur, 10.Raipur, 11. Balodabazar, 12.Gariyaband, 13.Bastar, 14.Kondagaon,
15.Narayanpur, 16.Kanker, 17.Dhamtari, 18.Raigarh, 19.Korba, 20.Janjgir, 21.Jashpur,
22.Dantewada, 23.Sukma, 24.Bijapur, 25.Mahasamund, 26.Kawardha and 27.Koria
districts of Chhattisgarh State from the Insurance Companies registered by IRDA for
implementation of RSBY & MSBY. The bids are invited for 6 months initially and policy can
be extended for another 6 months for all the districts.

For effective operation of the scheme, partnership is envisaged between the Insurance
Company, public and the private sector hospitals and the State agencies. State
Government/Nodal Agency will assist the Insurance Company in networking with the
Government/Private hospitals, fixing of treatment protocol and costs, treatment
authorization, so that the cost of administering the scheme is kept at the lowest, while
making full use of the resources available in the Government/Private health systems. Public
hospitals, including ESI hospitals and such private hospitals fulfilling minimum qualifications
in terms of availability of inpatient medical beds, laboratory, equipments, operation theatres,
smart card reader etc. and a track record in the treatment of the diseases can be enlisted for
providing treatment to the identified families under the scheme.

Only such companies as are in agreement with scheme and its clauses, only need to
participate in the bidding. Any disagreement in this regard is liable for
disqualification/rejection of bid at technical level. Hence all the companies are expected to
go through the scheme carefully and submit their acceptance in specific format given in the
bid document.

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Table of Contents

Glossary 12
PART I- Information to the bidder 17
1. The Scheme 17
2. Objective 17
3. Beneficiaries 17
4. Enrolment unit and its definition 17
4.1 Unit of Enrolment 17
4.2 Size of Family 17
4.3 Definition of Family 17

5. Benefits 18
5.1 Benefit Package 18
5.2 Package Rate 19

6. Healthcare Providers 20
6.1 Eligible healthcare providers 20
6.2 Empanelment of healthcare providers 20
6.3 Criteria for Empanelment of Public Healthcare Providers 21
6.4 Criteria for Empanelment of Private Healthcare Providers 21
6.5 IT Infrastructure needed for Empanelment in RSBY 21
6.6 Additional Benefits to be provided by Healthcare Providers 22
6.7 Additional Responsibilities of the Healthcare Providers 22
236.8 Process for Empanelment of Healthcare Providers 23
6.9 Agreement with Empanelled Healthcare Providers 23
6.10 De-empanelment of Healthcare Providers 23
6.11 List of Empanelled Healthcare Providers to be submitted 24
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6.12 Services beyond service area 24
6.13 Assessment of Health Care Providers 25

7. District Key Manager and Field Key Officer 25

8. Payment of premium and registration fee 25
8.1 Payment of registraiton fees 27
8.2. Payment and installment of premium for the renewed cards 27
8.3. Refund of premium 27
8.4 Penalties 28

9. Period of Contract and Insurance 30
9.1 Term of the Contract 30
9.2 Issuance of Policy 30
9.3 Enrolment of beneficiaries 31
9.4 Commencement & renewal of policy in districts 34

10. Cashless access service 34

11. Repudiation of claims 35

12. Delivery of services by intermediaries 35
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12.1 Third Party Administrators, Smart Card Service Providers or Similar
Agencies 35

13. Project office and district office 36

14. Management information systems (MIS) service 37

15. KIOSK 37

16. Call Center Services 38

17. Procurement, installation and maintenance of smart card related hardware and
software in empanelled healthcare providers 38
17.1 Public Healthcare Providers 38
17.2 Private Healthcare Providers 39

18. Grievance Redressal 40
18.1 District Grievance Redressal Committee (DGRC) 40
18.2 State Grievance Redressal Committee (SGRC) 40
18.3 National Grievance Redressal Committee (NGRC) 40
19. Penalty clause and termination42 42
20. Standardization of formats 43
21. IEC and BCC interventions 43
22. Capacity building interventions 43
23. Audit mechanism 43
23.1 Medical Audit 43
23.2 Beneficiary Audit 44
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24. Obligations of State Government 44
25. Service arrangements by the Insurance Company 46
26. Obligations of insurance company 46
27. Insurer undertaking with respect to provisioning of services 47
28. Business Continuity Plan 48
29. Claim management 48
29.1 Payment of Claims and Claim Turnaround Time 48
29.2 Right of Appeal and reopening of claims 49

PART II – Instructions to bidders 50

1. Eligibility criteria 50
1.1 Qualification Criteria 50
1.2 Fraud and corruption 50
1.3. Canvassing 51
1.4 Conflict of interest 51
1.3 Misrepresentation by the Bidder 51

2. Cost of Bidding 52
3. Verification of information and interpretation 52
4. Clarifications and queries; addenda 53
5. Preparation and submission of bids 55
5.1 Language of Bid 55
5.2 Validity of Bids 55
5.3 Premium 55
5.4 Formats and Submission of online Bid 55
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6. Bid submission 56
6.1 Technical Bid Submission 56
6.2. Financial Bid Submission 56
6.3 General Points for Bid Submission 56
6.4 Time for Submission of Bids 57

7. Opening of bids 57

8. Evaluation of bids and selection of successful bidder 57
8.1 Responsiveness of Financial Bids 58
8.2 Clarifications on Bids 58
8.3 Selection of Successful Bidder 59

9. Award of contract 59
9.1 Notification of Award 59
9.2 Structure of the Contract 59
9.3 Execution of the Contract 59

10. Rights of State Nodal Agency 60

11. General Instructions 60
7011.1 Confidentiality and Proprietary Data 60
11.2 Governing Law and Dispute Resolution 61
11.3. Event of Force Majeure 61

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