Tender Notice Dt - Department of Health , J&K

The parties shall refer such dispute to the redressal committee constitutedat the District level under the chairmanship of concerned Districtmagistrate, authorized representative of the insurance company and arepresentative of the health care providers as members. This committee willsettle the dispute.If either of the parties is not satisfied with the decision, they can go to theState level committee which will be chaired by Principal Secretary /Secretary, Department of Health and Family Welfare, Government ofJ&K with representative of the Insurance Company, representative of thehealth care providers and representative of the State Nodal Agency asmembers.Note: If State redressal committee is unable to resolve the dispute,mentioned in 20a and 20b, within 60 calendar days of it being referred tothem, then it will be settled as per procedure given in para 20c below.c. Dispute between Insurance Company and the State GovernmentA dispute between the State Government / Nodal Agency and InsuranceCompany shall be referred to the respective Chairmen/CEO’s/CMD’s of theInsurer for resolution.In the event that the Chairmen/CEO’s /CMD’s are unable to resolve thedispute within {60 } days of it being referred to them, then either Party mayrefer the dispute for resolution to a sole arbitrator who shall be jointlyappointed by both parties, or, in the event that the parties are unable toagree on the person to act as the sole arbitrator within 30 days after anyparty has claimed for an arbitration in written form, by three arbitrators,one to be appointed by each party with power to the two arbitrators soappointed, to appoint a third arbitrator.21. Penalty Clause and Termination:21.1. Failure to abide with the terms will attract penalty related but notlimited to the following:• Failure in following the guidelines specified in Annexure 16.• Claim Servicing• Grievance Redressal21.2. In case of termination of the contract following process will befollowed:i) The Insurer will pay back to the Nodal Agency within one week theunutilized amount of premium after settlement plus service taxii) In addition to above, the Insurer will pay the total package amountfor all the cases for which amount has already been blocked.24