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Government of Assam . GOVERNMENT OF ASSAM Selection of “Insurance Companies” for implementation of RSBY in 25 districts of Assam Office of the Mission Director, National Health Mission, Assam Address: Saikia Commercial Complex, Srinagar Path, Christianbasti, G.S. Road, Guwahati-05 Phone: 0361 2340236 E-mail: [email protected] 1 TENDER DOCUMENT Implementation of “Rashtriya Swasthya Bima Yojana” In the State of Assam NATIONAL HEALTH MISSION, ASSAM Released on 27.10.2014 2 Fact Sheet NHM/RSBY/Insurance Tender/2237/14-15, Dated 27th Tenderreference No Oct ,2014. DateofissueofTender Document 27.10.14 Office of the Mission Director, National Health Mission, Saikia Commercial Complex, Srinagar Path, Pre-bidmeeting venue Christianbasti, G.S. Road, Guwahati-05 DateandTimeforpre-bidmeeting 10.11.14 at 2 PM Last DateandTimeforsubmissionofBids 19.11.14 at 2 PM 19.11.14 at 3 PM. Venue: Office of the Mission Director, National Health Mission, Saikia Commercial Complex, Venue,Date&TimeofopeningFinancialBids Srinagar Path, Christianbasti, G.S. Road, Guwahati-05 ContactPerson,PhoneNo. Utpal Kr. Chakravorty, Ph: 9085072606 ( O ) Email id [email protected] RSBY Cell, Office of the Mission Director, National Health Mission, Saikia Commercial Complex, Srinagar Path, Address for Communication: Christianbasti, G.S. Road, Guwahati-05 Complete Tender details As given below. Complete sets of tender documents will be available for free download by interested bidders centrally empanelledby Ministry of Labour and Employment (MoLE) from web portal of the State Governmentat the website www.nrhmassam.in • The bidders are advised to submit the bids well in advance of the deadline as NHM, Assamwill 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. 3 OFFICE OF THE MISSION DIRECTOR, NATIONAL HEALTH MISSION, ASSAM TENDER NOTICE RASHTRIYA SWASTHYA BIMA YOJANA (A scheme to provide health insurance coverage to the unorganized sector workers) Competitive Quotations are invited from Insurance Companies (Licensed with Insurance Regulatory and Development Authority and centrally empanelled by Ministry of Labour and Employment (MoLE), GoI , to carry on the health insurance for implementation of Rashtriya Swasthya Bima Yojana (RSBY) for approved category of families in 25 Districts namely Dibrugarh, Tinsukia, Sivasagar, Jorhat, Golaghat, Lakhimpur, Dhemaji, Nagaon, Morigaon, Darrang, Sonitpur, Kamrup (Rural & Metro), Goalpara, Nalbari, Dhubri, Barpeta, Bongaigaon, Kokrajhar, Karbi Anglong, N.C.Hills, Cachar, Karimganj, Hailakandi and Baksa. The tender document for this may be downloaded from the website www.nrhmassam.in The financial bid should be submitted as detailed in the tender document. The Financial bids will be evaluated by the Bid/Tender Evaluation Committee duly constituted by the State Government . Financial bids of only the centrally empanelledbidders shall be opened by the State Government for awarding of the contract. The following schedule will be observed in this regard. 1. Notice Inviting Tender: 27.10.2014 2. Pre-Bid Meeting: 10.11.2014 (14:00 hrs) 3. Last date for submission of bid:19.11.2014(14:00 hrs) 4. Opening of financial bids: 19.11.2014 (15:00 hrs) All correspondence/communicationregarding the scheme should be made at the address given in the fact sheet. 4 TENDER DOCUMENT NATIONAL HEALTH MISSION, ASSAM RASHTRIYA SWASTHYA BIMA YOJANA A number of studies have revealed that the risk owing to low level of health security is endemic for workers, especially those in the 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 workers do 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. A large number of these unorganized workers are entangled in debt traps 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” announced by the Central Government attempts to address such issues. State Government is inviting bids for 25 districts namely Dibrugarh, Tinsukia, Sivasagar, Jorhat, Golaghat, Lakhimpur, Dhemaji, Nagaon, Morigaon, Darrang, Sonitpur, Kamrup (Rural & Metro), Goalpara, Nalbari, Dhubri, Barpeta, Bongaigaon, Kokrajhar, Karbi Anglong, N.C.Hills, Cachar, Karimganj, Hailakandi and Baksa from Insurance Companies, registered by IRDA,and centrally empanelled by Ministry of Labour and Employment (MoLE), GoI, for implementation of RSBY. For effective operation of the scheme, a strong 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 identifying and empaneling the Government/Private hospitals, fixing of treatment protocol and costs and treatment authorization, so that the cost of administering the scheme is kept low, 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, equipment, 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 the scheme and its clauses need to participate in the bidding. Any disagreement in this regard is liable for disqualification/rejection of bid. Hence all the companies are expected to go through the scheme carefully and submit their acceptance in the specific format given in the bid document. 5 Table of Contents Glossary ....................................................................................................................................... 10 PART I- Information to the bidder ........................................................................................ 16 1. The Scheme ....................................................................................................................... 16 2. Objective ............................................................................................................................ 16 3. Beneficiaries ..................................................................................................................... 16 4. Enrolment unit and its definition ............................................................................... 17 4.1 Unit of Enrolment ........................................................................................................................ 17 4.2 Size of Family ................................................................................................................................ 18 4.3 Definition of Family .................................................................................................................... 18 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 ........................................................ 22 6.6 Additional Benefits to be provided by Healthcare Providers ......................................... 22 6.7 Additional Responsibilities of the Healthcare Providers ................................................ 22 6.8 Number of Healthcare Providers to be empanelled .......................................................... 23 6.9 Process for Empanelment of Healthcare Providers .......................................................... 23 6.10 Agreement with Empanelled Healthcare Providers ....................................................... 24 6.11 De-empanelment of Healthcare Providers ........................................................................ 24 6.12 List of Empanelled Healthcare Providers to be submitted ........................................... 25 6.13 Services beyond service area ................................................................................................ 25 7. District Key Manager and Field Key Officer ............................................................. 26 8. Payment of premium and registration fee ............................................................... 26 8.1 Refund of Premium
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