Tender Notice Dt - Department of Health , J&K

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22. Standardization of Formats:The Insurance Company shall use the standardized formats for cashlesstransactions, discharge summary, billing pattern and other reports inconsultation with the State Government / Nodal Agency.23. IEC and BCC interventions:Insurance Company in consultation with State Nodal Agency will prepareand implement a communication strategy for launching/ implementing theRSBY. The objective of these interventions will be to inform the beneficiariesregarding enrolment and benefits of the scheme.Insurer need to share a draft IEC and BCC plan with the Nodal Agencywithin 15 days of signing of the contract. The cost of IEC and BCC activitieswill be borne by the Insurer.24. Capacity Building interventions:The Insurance Company shall design training/ workshop / orientationprogramme for Health Care Providers, Members of the Hospital ManagementSocieties, District Programme Managers, Doctors, GP members,Intermediary, Field Agents etc. and implement the same with support ofNodal Agency/ other agencies. The training packages shall be jointlydeveloped by the Nodal Agency and the Insurance Company.Insurer need to share a draft Capacity Building plan with the NodalAgency within 15 days of signing of the contract. The cost of theseCapacity Building interventions will be borne by the Insurer.25. Medical Audit:The Insurance Company shall also carry out regular inspection of hospitals,periodic medical audits, attend to complaints from beneficiaries, hospitalsetc and also to ensure proper care and counseling for the patient at networkhospital by coordinating with hospital authorities.26. Commitments of State Government:26.1 Government of [State]/ Nodal Agency commits to provide the followingfor successful implementation of the scheme:i. Prepare BPL data and other non-BPL beneficiaries database in thespecified format and send to Government of India for internalconsistency checking so that it can be uploaded on the website25
for the insurer to download.ii. District Key Managers (DKM) as mentioned in Annexure 16 shall bein place at the time of signing of the agreement with the Insurer.iii. Providing DKMA Server at District Headquarter within 7 days ofsigning of the agreement with the Insurer.iv. Field Key Officers (FKOs) as mentioned in Annexure 16 shall beidentified at the time of signing of the agreement with the Insurer.v. Providing assistance to the insurer through district administrationin the preparation of villagewise enrolment schedule.vi. Providing assistance to the insurer in empanelment of the publicand private providersvii. Providing premium payment to the Insurer as per clause 11.viii. Conduct third party evaluation schemes at periodic intervals.27. Service Arrangements by the Insurance CompanyIn case the Insurance Company plans to outsource some of the functionsnecessary for the implementation of the scheme it needs to give anundertaking that it will outsource only to such agencies which fulfill thequalifying criteria as prescribed herein. The qualifying criteria for the TPAshave been given in Annexure 10 and the qualifying criteria for the SmartCard agencies have been given in Annexure 11.28. Commitments of Insurance Company:28.1 Among other things insurer shall provide following which arenecessary for successful implementation of the scheme:i. Having agreement with other insurance companies regardingusability of the same Smart card across India at any of thenetworked hospital. This will ensure that beneficiary can use his/her smart card across India.ii. Sending data related to enrollment, hospitalization and otheraspects of the scheme to the Central and State Government as maybe decided later.iii. Collecting beneficiary feedbacks and sharing those with StateGovernment/ Nodal Agency.iv. In the districts where scheme is being renewed for the second yearor subsequent years thereafter, it will be the responsibility of theInsurance Company, selected for the second year or subsequentyears as the case may be, to ensure that the hospitals alreadyempanelled under the scheme do not have to undertake anyexpenditure for the transaction software. The concerned insurancecompany will also ensure that the hardware installed already in thehospitals are compatible with the new/ modified transaction26
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 and 12: iii) Those facilities undertaking s
Page 13 and 14: ased on basic quality criteria as g
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: The parties shall refer such disput
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
Page 81 and 82:
Annexure IHospital Services- Admiss
Page 83 and 84:
Case 3: In case of in-sufficient fu
Page 85 and 86:
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
Page 93 and 94:
• Licensed system software• Cer
Page 95 and 96:
chip personalization. It is mandato
Page 97 and 98:
Annexure 17Guidelines for the RSBY
Page 99 and 100:
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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