Tender Notice Dt - Department of Health , J&K

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the BPL and other non-BPL identified (if applicable) beneficiaries related toidentified systems:i. Free OPD consultation.ii. Fixed discounts on diagnostic tests and medical treatment required forbeneficiaries even when hospitalization is not required.iii. The Provider shall display clearly their status of being an empanelledprovider of Rashtriya Swasthya Bima Yojana in the prescribed format attheir main gate and reception/admission desks along with the displayand other materials supplied by the Insurer for the ease of beneficiaries,Government and Insurer.iv. The Provider agrees to provide a help desk for providing the necessaryassistance to the RSBY beneficiaryv. Get at least two persons in the hospital trained in different aspects ofRSBY and related hardware and software.e. Process for Empanelment of Hospitals:The Insurance Company shall make sure that adequate number of bothpublic and private providers shall be empanelled in a district. They shallalso make efforts that the empanelled providers are spread to differentblocks of the district.A District workshop for the health care providers (both public andprivate) shall be organized separately by the insurance company ineach district to educate providers about the scheme before thecommencement of the enrolment process in the district.f. Assistance from the State Government for Empanelment:The Government will on their part render all possible assistance viz.a. To give all necessary support for organizing sensitization programmes forthe CHCs and Government Hospitals.b. Provide necessary support to the insurer in organizing separate districtworkshop for the health care providers in the district.c. To extend necessary support in providing space and other support forlocating RSBY Help Desks at CHCs/other Government Hospitals.g. Agreement with Network Hospital:The Insurer will be responsible for carrying out an empanelment process ofhealth Providers to provide the agreed Benefits under the scheme. This shallrequire service agreements between the Insurer and empanelled Providers,or networks thereof, to provide Benefits under RSBY. A provision will bemade in the Agreement of non-compliance/default clause while signing thesame. Such matter shall be looked into by the State Government/NodalAgency. Both public and private providers will be eligible to be empanelled11
ased on basic quality criteria as given in section 8 (a & b). Additionalcriteria may be decided jointly by State Government/ Nodal Agency and theInsurance Company. However, Insurance Company will make efforts tomake sure that a large number of public health care providers areempanelled. The providers will be paid as per the pre-defined package rates.These package rates will be same for both public and private providers.h. Draft Template for Agreement between Insurer and Hospital has beenprovided in Annexure 10. In case of any modification, the insurer willneed to take prior approval from the State Nodal Agency.i. Delisting of Hospitals:Network Hospital would be de-listed from the RSBY network if, it is foundthat guidelines of the Scheme are not followed by them and services offeredare not satisfactory as per laid down standards.j. List of Empanelled Health Facilities to be Submitted at the time ofSigning of Contract:At the time of signing of the contract with the State Government, the Insurershould provide list of empanelled health providers with the following details:a. A list of empanelled health facilities, within the State which have agreedto be a part of RSBY network, in the format given in Annexure 9. For thehospitals which will be empanelled after signing of the contract, theInsurer will need to submit this information related to empanelment atperiodic intervals of 1 month, 3 months and 6 months of agreement tothe State Government/ Nodal Agency.8. Services Beyond Service Area:8.1 The Insurer undertakes that it will, within one month of signature ofagreement with State Government, empanel health Providers beyondthe territory of the districts covered by this Tender for the purposes ofproviding benefits under RSBY to Beneficiaries covered by this Tender.Such providers shall be subject to the same empanelment process andeligibility criteria as provided within the territory of aforementioneddistricts, as outlined in Section 8 of this Tender. If the hospitals in theneighboring districts are already empanelled under RSBY, theninsurer shall provide a list of those hospitals to the StateGovernment/ Nodal Agency.8.2 To ensure true portability of smart card so that the beneficiary can getthe treatment anywhere across India in a RSBY empanelled hospital,the Insurer shall enter into arrangement with other Insurancecompanies for allowing sharing of network hospitals, transfer of claim& transaction data arising in areas beyond the service area. To ensure12
Page 1 and 2: GOVERNMENT OF J&KDEPARTMENT OF HEAL
Page 3 and 4: GOVERNMENT OF J&KDEPARTMENT OF HEAL
Page 5 and 6: Table of ContentsPART I - INFORMATI
Page 7 and 8: 4. Unit of Enrolment:4.1. The unit
Page 9 and 10: part of insured family member till
Page 11: iii) Those facilities undertaking s
Page 15 and 16: Insurance Act 1938.2. Premium payme
Page 17 and 18: (d)(e)(f)pre-defined fee.An enrollm
Page 19 and 20: ) Beneficiary has balance in his/ h
Page 21 and 22: intermediary institutions for the p
Page 23 and 24: to as the “Call Centre Service”
Page 25 and 26: The parties shall refer such disput
Page 27 and 28: for the insurer to download.ii. Dis
Page 29 and 30: esponsibility of the Insurer to ens
Page 31 and 32: 36. Notification of Award And Signi
Page 33 and 34: details of the scheme as mentioned
Page 35 and 36: SECTION B - FINANCIAL PROPOSAL(KIND
Page 37 and 38: SECTION D -DECLARATION BY THE BIDDE
Page 39 and 40: Annexure - 3UNDERTAKING BY THE BIDD
Page 41 and 42: Annexure 5Format for Providing Addi
Page 43 and 44: O.T. Charges, Medicines and Drugs,
Page 45 and 46: 34 FP00300010 J32 Ethmoidectomy - E
Page 47 and 48: 123 FP00500048 Q43 Duplication of I
Page 49 and 50: 212 FP00500137 K51 Ileostomy 7 17,5
Page 51 and 52: 301 FP00600020 D27 Ovarectomy/Oophr
Page 53 and 54: 390 FP00900048 K25 Vagotomy with Py
Page 55 and 56: 477 FP01100044Closed Reduction and
Page 57 and 58: 12 PAEDIATRIC565 FP01200001 Q79 Abd
Page 59 and 60: 653 FP01400045 N28 Repair of Ureter
Page 61 and 62: 743 FP01800016 B53744 FP01800017 B5
Page 63 and 64:
War like operations (whether war be
Page 65 and 66:
Draft MoU Between Insurance Company
Page 67 and 68:
4. Insurer has on the basis of desi
Page 69 and 70:
5. The Hospital shall ensure that m
Page 71 and 72:
2.5 Within a period of 12 hours fro
Page 73 and 74:
2. The hospital undertakes to uphol
Page 75 and 76:
All official correspondence, report
Page 77 and 78:
3. Notwithstanding anything to the
Page 79 and 80:
each of the terms of this Agreement
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Annexure IHospital Services- Admiss
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Case 3: In case of in-sufficient fu
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Qualifying Criteria for Smart Card
Page 87 and 88:
Annexure 14List of Public Hospitals
Page 89 and 90:
2. Smart card:2.1. OverviewA smart
Page 91 and 92:
esponsible for each of these to the
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• Licensed system software• Cer
Page 95 and 96:
chip personalization. It is mandato
Page 97 and 98:
Annexure 17Guidelines for the RSBY
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1.3.1. Re-issuance of a card: This
Page 101 and 102:
2. District Server1.3.4.4.1. The ca
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Tender Notice Dt - Department of Health , J&K

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