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TEL. – 2702501-508 FAX – 0141 – 2702537 GRAM – DAIRYFED E-MAIL – RCDFHO_JP1 @ SANCHARNET.IN –
FO & AH E-Mail – foahrcdf@gmail.com/Fax-0141-2700783
No. RCDF/FO&AH/F.10 (414-SSABY-VIII)/2013/ Dated 17/06/2013
REGISTERED
______________________
______________________
______________________
______________________
Dear Sir,
Sub : Offers regarding health insurance of milk producers of Dairy Co-operative
Societies of Milk Unions affiliated to RCDF (Saras Samuhik Arogya Bima Yojna
– Phase – VIII).
A Scheme to provide health insurance to the milk producers of Dairy Co-operative
Societies of different 21 Milk Unions of the State is under implementation since 2005-06
namely “Saras Samuhik Arogya Bima Yojna”.
Approximately One lakh members are likely to be covered under the Scheme for
Phase – VIII. If your company is interested to provide health insurance services under “Saras
Samuhik Arogya Bima Yojna – VIII”, please send the Technical Details with terms &
conditions and draft of MOU & draft of policy duly signed and sealed as token of acceptance
without any alteration and Financial Offer (Annual Premium rates) in the enclosed format in
two sealed envelops separately for technical offer (Part – I) & Financial offer (Part – II) latest
by 2 nd July, 2013 positively to undersigned.
Pre bid conference shall be held on dated 25 th June, 2013 at 3:00 PM in conference
hall of RCDF HQ. Saras Sankul, Jaipur.
Details of terms & conditions, draft MOU is available on our website:
www.sarasmilkfed.coop.in
Thanking you,
Encl. : As above.
Yours faithfully,
(Dr. R.S. Tomar)
General Manager (FO & AH)

TEL. – 2702501-508 FAX – 0141 – 2702537 GRAM – DAIRYFED E-MAIL – RCDFHO_JP1 @ SANCHARNET.IN –
FO & AH E-Mail – foahrcdf@gmail.com/Fax-0141-2700783
SARAS SAMUHIK AROGYA BIMA YOJNA - VIII
Stage – I : Technical Offer (details) for Health Insurance.
Name & Address of the Firm/Company/Organization …………………………………
………………………………………………………………………………………………
……………..
Tel. No. ………………………Fax. No. …………………………E-Mail
ID…………..………..
Name of authorized person of the firm/Company/with contact No.
………………………………………………………………………………………………
……………..
S.N. Items Information
1. No. of Years of Experience
2. Experience of the company in medical insurance
(Furnish details)
3. No. of Mediclaim passed and amount of payment
made for last five years.
4. Name of the TPAs (IRDA approved) & list of
Pvt. Hospitals with whom the tie up arrangement
has been done for cashless facility (enclose list of
TPAs as per format –‘A’ enclosed & list of
hospitals)
5.
Year of registration of Insurance Company with
IRDA (Enclose certified copy) (Mandatory)
6. Turnover for last three years (year-wise) (In
Crore)
2010-11 2011-12 2012-13
7. Claim settlement time normally taken by the
company
8. List of Offices located in Rajasthan
10. On line Information system of Claims & other
information accessible to client (RCDF/Milk
Union) is available or Not. If not, then whether
Insurance Company commits to provide the same
at the onset of the Policy (Mandatory)
Signature of Authorized Representative with Seal
Please enclose documents in support of your claim and terms & conditions and draft MOU duly signed
& sealed.

RAJASTHAN CO-OPERATIVE DAIRY FEDERATION LIMITED,
SARAS SANKUL, JLN MARG, JAIPUR – 302017
SARAS SAMUHIK AROGYA BIMA YOJNA - VIII
TERMS AND CONDITIONS REGARDING APPOINTMENT OF APPROVED IRDA
INSURANCE COMPANY FOR SARAS SAMUHIK AROGYA BIMA YOJNA - VIII
1. RCDF intends to insure the registered Members of Primary Dairy Co-operative
Societies/Members of proposed Dairy Co-operative Societies. The Societies are registered
under Rajasthan Co-operative Societies Act, 1965.
2. The Insurance Company should be approved by IRDA. The Company should possess
adequate experience and infrastructure in the field of health insurance.
3. MOU will be signed by the Insurance Company with all Milk Unions separately. The
contract will be initially for a period of one year. On satisfactory performance, it can be
renewed for another two years, one year at a time, with mutual consent.
4. The Insurance Company will provide health insurance services to the registered members
of 21 District Milk Co-operative Unions in the milk shed area at Ajmer, Alwar, Banswara,
Barmer, Bharatpur, Bhilwara, Bikaner, Chittorgarh, Churu, Jaipur, Jalore, Jhalawar,
Jodhpur, Kota, Nagaur, Pali, Sikar, Sawaimadhopur, Sriganganagar, Tonk & Udaipur.
5. Approximately 1,00,000 pourer milk producers are likely to opt for the scheme, number
can be increased or decreased.
6. Pourer milk producer is defined as a regular pourer of milk at any registered/proposed
Dairy Co-operative Society.
7. The period of the Insurance / policy shall commence from the date & time of deposit of
premium and shall be effective for one year period from the deposit of money.
8. The scheme shall be applicable to the Milk Producers affiliated with DCS / PDCS of the
concerned milk unions of Rajasthan.
(Signed & Sealed by the Ins. Co.
RCDF
in token of acceptance of above) 2013-14
1

9.1 Insured Group : -
Beneficiaries sponsored by Rajasthan Co-operative Dairy Federation and or its affiliated
Milk Unions for providing Health Insurance coverage for the Milk Producers families viz.
i) Individual – Male or female members (individual shall mean who is either unmarried or
has no live family members of his own).
ii) Family : Family consisting of 1 + 1 + 2 (Husband, Wife and two dependent children)
(First two only)
9.2 Age Group : -
The age of insured milk producer/family member should not be less than 3 months or
more than 65 years on the date of commencement of the Scheme.
9.3 Group Size : -
The total group size is approximately 1,00,000 families / individual.
9.4 Plan Period : - Initially for a period of one year from the date of inception of policy and
extendable for a further period of two years, one year at a time, on mutual consent, on satisfactory
reports from the Milk Unions & field as given at point No. 3 above.
9.5 Scope of Cover : -
The policy covers reimbursement of hospitalization expenses or cashless facility for
illness/diseases or injury sustained up to Rs. 1.0 Lakh and up to Rs. 2.0 Lakh per family/individual
for major surgeries/diseases as listed in number 9.6(G) below.
9.6 Benefits : -
A) Room, Boarding Expenses as provided by the Hospital/Nursing Home.
B) Nursing expenses
C) Surgeon, Anesthetist, Medical Practitioner, Consultant, Specialist Fees.
D) Anesthesia, Blood, Oxygen, Operation Theatre Charges, Surgical Appliances,
Medicines and Drugs, Diagnostic Materials and X-Ray, Dialysis, Chemotherapy,
Radiotherapy, Cost of Pacemaker, Artificial Limbs and cost of organs and similar
expenses.
(Signed & Sealed by the Ins. Co.
RCDF
in token of acceptance of above) 2013-14
2

E) Hospitalization expenses for illness/diseases/injuries upon the advice of a Medical
Practitioner, due to contracting of any disease or suffering from any one illness or
sustaining of any bodily injury through accident during the policy period.
F) Pre-existing diseases are to be covered.
G) List of major surgeries/diseases wherein sum insured will be double (up to Rs. 2.0
Lakhs) than normal sum insured :-
Medical & Surgical Treatment for Heart, Cancer, Kidney & Neurological
diseases/ailments
Stroke
Multiple Sclerosis, Cirrhosis, Meningitis
Major Organ transplants like Kidney, Lung, Pancreas or Bonemarrow
Transplantation & Joint Replacement like Hip, Knee etc.
H) TPA services shall be available and cash less facility shall be available at the network
private empanelled hospitals while reimbursement of claims shall be settled within a
month. TPA fee shall be payable by Insurance Co. after hearing from RCDF / Milk
union.
I) Cashless / Reimbursement claims process, settlement & payment shall be made by the
office of the Insurance company/TPA located in the state of Rajasthan.
J) Maternity benefits shall be available subject to waiting period of 9 months only for 2
live child in case of new insured members and waiting period will not be applicable
for the members insured / covered under SSABY – VII. Premature delivery [Live]
shall be considered.
K) Insurance Company will cover all diseases excluding, Sexually transmitted diseases,
HIV/AIDS, Self Injury, Diseases arising out of War, Invasion, Riots, Circumcision,
Naturopathy, Homeopathy, Ayurvedic, Ayurvedic massage and like cosmetic or aesthetic
treatment, plastic surgery other than as may be necessitated due to any accident or any
illness etc.
L) The relevant medical expenses incurred during the period up to 7 days prior to the
hospitalization and up to 15 days after hospitalization of diseases/illness/injuries
sustained will be treated as pre and post hospitalization respectively and will be
considered as a part of the claim.
M) The Insurance Companies will appoint Third Party Administrator (TPA) as Health
Insurance Administrator in consultation with RCDF/Milk Unions. The Health
Insurance Administrator so appointed, is also required to sort out the problems related
to the cashless / reimbursement of the claims.
N) The Insurance Company shall arrange for Workshop jointly with Milk Unions for Executive,
Union/DCS/Beneficiaries to brief them about Risk coverage’s and Modus Operandi for
implementation of the scheme and claims procedure and monthly meetings at Milk Unions
shall be organized to review claim cases.
O) Translites highlighting the details of coverage will be provided by the insurer for each district
milk co-operative union.
(Signed & Sealed by the Ins. Co.
RCDF
in token of acceptance of above) 2013-14
3

P) Appropriate advertisement printout/Posters containing salient features of the Scheme and
contact person for claim intimation shall be displayed at each and every office of the society by
the Insurance Company.
Q) Media publicity shall be arranged by Milk Unions and the Insurers.
10. Company should either have its network throughout the state or should be in a position to deploy
sufficient manpower at each Milk Union for proper implementation of the Scheme.
11. Company & TPA must have online information system of claim status and other information,
which must be accessible to RCDF & All Milk Unions at all time.
12. (a) Insurance Company & TPA are bound to provide any information to RCDF & all Milk
Unions asked by them.
(b) Insurance Company will provide MIS of the reimbursement/cashless claims disposals
status on fortnightly basis to RCDF & concerned Milk Unions as per desired format.
(c) Disease-wise, system-wise, Age-wise MIS will also be provided by the Insurance Co. to
RCDF & all Milk unions on monthly basis.
13. ID Cards of Member insured & family will be prepared & provided by the Insurance Co. within 15
days of availability of data & photos.
14. The Offer is required to be submitted in two sealed envelopes method, one envelope should contain
Technical Offer with terms and conditions and draft MOU & policy duly signed & sealed (Part – I)
and second envelope should contain Financial Offer (Part – II).
15. Total premium will be payable to the insurance company in four equal installment i.e. on quarterly
basis. The first installment will be payable after signing of MOU & before start of policy.
16. Mediclaim facilities will be provided through
1. All Govt. Hospitals/Medical College Hospitals.
2. All private hospital empanelled by Govt. of Rajasthan for state Govt. employees.
3. Private empanelled Hospitals by mutual consent of insurance company & concerned Milk
Union for the State and outside the State. In addition to it, MD, RCDF has right to add some
multi / Specialty Private Hospitals to the list of Private empanelled hospitals as per the need of
milk producers. List of empanelled hospital shall be prepared & finalized before signing of
MOU.
17. Insurance Company shall provide all the benefits at the same rates/terms & conditions to the retired
employees (Self & Spouse) of RCDF and Milk Unions of age group up to 75 years.
18. In case of any dispute concerning the implementation and interpretation of the terms and conditions
mentioned herein and terms & conditions of MOU, the decision of the MD, RCDF will be final and
binding to all.
19. Managing Director, RCDF reserves the right to reject any or all the Offers in part or full without
assigning any reason thereof.
(Signed & Sealed by the Ins. Co.
RCDF
in token of acceptance of above) 2013-14
4

Format – A
INFORMATION REGARDING TPA AFFILIATED TO INSURANCE COMPANY - (SHOULD BE FILLED IN SEPARATE SHEET, IF MORE THAN ONE TPA)
S.N. Name of TPA Whether IRDA
approved, if
yes, kindly
mention Reg.
No & Date
(enclose)
Experience of TPA in handling
mediclaim & No. of Claims handled
for previous three years
Name of
Insurance
Company
Year
No. of
Claims
handled
List of
permanent
employees
(enclose)
List of
Permanent
Doctors.
(Mention
Qualification,
Specialization
& Working
Experience
List of Panel of
Medical Experts
(Cardiologist,
Gynaecologist,
Orthopeadic
Surgeon,
Gastroentrologist,
Urologist,
Neurologist, ENT,
Opthamologist &
Gen. Medicine)
attached to TPA-
Enclose
Amount of
Bank
Guarantee
kept at Ins.
Co.
Remarks

MEMORANDUM OF UNDERSTANDING
……………………………………… INSURANCE CO. LTD.
AND
………………. ZILA DUDGH UTPADAK SAHAKARI SANGH LIMITED, ……………….
This Memorandum of Understanding ("MOU") executed at ………… on this 15 th day of July,
2013.
BETWEEN:
INSURANCE COMPANY, licensed under terms of the Insurance Act, 1938 and licensed by the
Insurance Regulatory and Development Authority to carry out the General Insurance business and
having its State Office at Jaipur (hereinafter referred to as INSURANCE COMPANY which
expression shall, unless it be repugnant to the subject or context thereof, include its successors and
permitted assigns) of the One Part.
AND
………………ZILA DUDGH UTPADAK SAHAKARI SANGH LIMITED, a Society incorporated
under the provisions of the Co-operative Societies Act 1965, having its registered office at
“………….., (hereinafter referred to as “District Cooperative Milk Union, …………….”, which
expression shall, unless it be repugnant to the subject or context thereof, include its successors and
permitted assigns) of the Other Part.
(…………………………. Insurance Company Limited and …………… ZILA DUDGH UTPADAK SAHAKARI
SANGH LIMITED hereinafter collectively referred to as “the Parties" and individually as "Party").
(Signed & Sealed by the Ins. Co.
RCDF
in token of acceptance of above) 2013-14
1

WHEREAS
A. ………………..Insurance Co. is authorized to carry on the business of General Insurance under
Insurance Act 1938.
B. District Cooperative Milk Union is a Milk Union of Dairy Co-operative Societies in the Districts of
Rajasthan and renders help in the co-operative tradition to its members in all spheres of dairy
i.e. from the welfare of milk producers, to the collection and distribution of milk and milk
products,
C. Rajasthan Dairy Cooperative Federation, herein after called RCDF has invited tenders for
providing insurance coverage for the active milk producers of the Dairy cooperative societies of
milk unions which are affiliated to milk union under the title Saras Samuhik Arogya Bima
Yojna – Phase – VIII.
D. ………………..Insurance Co. and District Cooperative Milk Union ……………. in pursuance of the
Scheme finalized by RCDF agreed to enter into a Mememorandum of Understanding covering
the Members of District Cooperative Milk Union …………, Who Opted For Scheme for a
premium of Rs. ………../- (inclusive of Service Tax) per family (member + three
dependents) per annum on floater basis & Rs………/- (inclusive of Service Tax) per
person per annum on individual basis.
E. …………………Insurance Co. having agreed to issue Master Policy for the Insurance in the name of
District Cooperative Milk Union ………. to provide Health insurance product to active milk
producers of Dairy Co-operative Societies who are affiliated to District Cooperative Milk Union,
…………….. & their dependents (1+1+2) affiliated to Milk Union as per the Health Insurance
Policy specified in this Agreement.
F
Whereas, the Parties are desirous of setting out the process for settlement of claims, under the
Health Policy, this Memorandum of Understanding shall operate for the Group Health Insurance
Policy (Annexure – I SSABY – VIII) effective from 15 th July, 2013. The terms & condition of
Group Insurance policy will not supersede any term & condition of this MOU and offer submitted
by Insurance Company.
G The terms & condition of the Draft policy submitted by the Insurance Co. with technical offer shall
be remain same throughout the policy period, unless any change is made with prior consent of
RCDF / Milk union.
NOW THEREFORE THIS MOU WITNESSETH AS UNDER:
1.0 Definitions
In this MOU, unless repugnant to the context the words indicated hereunder will have the same
meaning as assigned to them herein.
“Act” means the Insurance Act, 1938 and the rules and regulations made there under
and shall include any amendments made thereto from time to time;
“Effective Date” means the date of this agreement or such other date as may be
agreed between the Parties.
“Health Insurance Product” shall mean Insurance provided by Insurance Co. to the
active milk producers of the dairy cooperative societies of District Cooperative Milk Union.
(Signed & Sealed by the Ins. Co.
RCDF
in token of acceptance of above) 2013-14
2

1.4. An “Insured Group” means beneficiaries sponsored by the Milk Union for providing
Health Insurance coverage for the Milk Pourer/Producers families/ Retired employees of
RCDF & its Units & Milk Unions.
1.4.1 Individual – Male or female members (individual shall mean a person, who
is either unmarried or has no live family members of his own).
1.4.2. Family - Family consisting of 1 + 1 + 2 (Husband, Wife and two wholly
dependent children up to age of 21 years) and in case of Retired employee family means
insured plus spouse.
1.5. Plan Period means - Initially for a period of one year from the date of inception of
policy (15/07/2013) and extendable for a further period of two years with prior
permission of the MD, RCDF, one year at a time, on mutual consent on satisfactory
report from the MD of the Milk Unions and ……………. Insurance Co.
1.6 Day Care Treatment Expenses : -
On Hospitalization for minimum period of 24 hours are admissible. However, this time
limit is not applied to daycare treatment, i.e. Dialysis, Chemotherapy, Radiotherapy, Eye
Surgery, Dental Surgery in case of accidents, Lithotripsy (Kidney Stone removal), D&C,
Tonsillectomy, Dog bite & Snake bite taken in the approved Hospital/Nursing Home and
the Insured is discharged on the same day, the treatment will be considered to be taken
under Hospitalization Benefit more particularly defined in the Group Health Insurance
Policy of SSABY – VIII.
1.7 Hospital: Mediclaim facilities will be provided through all Government Hospitals/
Medical college Hospitals and Private empanelled hospitals by mutual consent
of insurance company and concerned milk union for the state and outside the
state as under:
(a) All the CHC, District hospitals, Government hospitals / Medical College Hospitals in
the State of Rajasthan.
(b) All private hospitals empanelled by the Govt. of Rajasthan for treatment of state
Govt. employees for cashless & reimbursement purpose.
(c) Private Hospitals within the state of Rajasthan forming part of the network as per
Annex –II which will be applicable for all the Milk Unions. New hospitals may be
added/replaced with mutual consent of ………..& Milk union.
(d) Hospitals outside Rajasthan as per Annex-III on reimbursement basis only
(However the TPA may provide cashless benefit if hospital is in the network of TPA)
(e) In addition to such listed hospitals, MD, RCDF has the right to add some multi /
Specialty Private Hospitals as per the need of the active milk producers.
(f) Empanelled hospitals will be changed by the ……..IC with prior consent of RCDF /
Milk union in case there is any complaint against the concerned hospital during the
Policy period for which a set procedure shall be followed.
(g)
Insurance company will convene meeting in consultation with MD, milk union to
discuss the issue of depanelment of any network hospital and decision regarding
depanelment of any network hospital will be taken by the committee of the insurance
(Signed & Sealed by the Ins. Co.
RCDF
in token of acceptance of above) 2013-14
3

(h)
(i)
(j)
company, RCDF & concerned milk union after hearing the concerned network
hospital. New Pvt. Hospital of same category shall be empanelled within 5 days in
place of concerned depanelled Pvt. Hospital with prior consent of the milk union /
RCDF.
TPA nominated by the insurance company will enter in to an agreement with each of
the empanelled hospitals for providing cash less & reimbursement facility in terms of
IRDA regulations and in respect to decide modalities for smooth running of scheme.
In case of non-availability of network hospitals, member can avail treatment at any
Govt. hospital of his choice, make upfront payment and thereafter claim for
reimbursement.
Treatment taken in non- Network Private Hospital is not covered under the policy.
1.8 „TPA‟ means a Third Party Administrator who, for the time being, is licensed by the
Insurance Regulatory and Development Authority.
1.9 IRDA‟ Insurance regulatory and development authority of India
2.0 Scope
2.1 The District Cooperative Milk Union runs a scheme for their active milk producers of
Dairy Co-operative Societies in the District of Rajasthan, India for providing the Medical
facilities.
2.2 Insurance Company will provide Health Insurance cover for the scheme to Milk Union
ON Cashless / Reimbursement basis.
2.3 The maximum Sum Insured is Rs. 1, 00,000/- per insured individual or family on a
floater basis in respect of diseases other than major surgeries/diseases as defined under
Para 2.7 (H) of this MOU& Rs. 2, 00,000/- per insured individual or family in case of
major surgeries/diseases including of normal diseases sum insured of Rs.1, 00,000.
2.4. Insurance Company will cover all diseases excluding Congenital Diseases, (except
Congenital heart diseases) Sexually Transmitted Diseases, HIV/AIDS, Self Injury,
Diseases arising out of war or invasion.
2.5 Circumcision, Ayurvedic treatment, naturopathy, massages and like treatment, cosmetic
or aesthetic treatment, plastic surgery other than as may be necessitated due to any
accident/illness etc. will be out of scope of cover of policy.
2.6 Age Group: Age of all the group members will be between 3 months to 65 years only
and in case of retired employees it will be up to 75 years.
2.7 Benefits:
The policy covers reimbursement of hospitalization expenses for illness/diseases as per
conditions & sub-limits mentioned in Annexure - I.
A) Room, Boarding Expenses as provided by the Hospital/Nursing Home.
B) Nursing expenses
C) Surgeon, Anesthetist, Medical Practitioner, Consultant, Specialist Fees.
(Signed & Sealed by the Ins. Co.
RCDF
in token of acceptance of above) 2013-14
4

D) Anesthesia, Blood, Oxygen, Operation Theatre Charges, Surgical Appliances,
Medicines and Drugs, Diagnostic Materials and X-Ray, Dialysis,
Chemotherapy, Radiotherapy, Cost of Pacemaker, Artificial Limbs and cost of
organs and similar expenses.
E) Hospitalization expenses for illness/diseases/injuries upon the advice of a
Medical Practitioner, due to contracting of any disease or suffering from any
one illness or sustaining of any bodily injury through accident or otherwise
during the policy period.
F) Minimum limit payable for each disease/surgical
operation/treatment/diagnostic test etc. will be as per latest available CGHS
package rates for cashless and reimbursement both. In case of trauma,
neurological diseases, surgeries, eye implant, heart implants, (coronary drug
eluting stent FDA approved) actual expenses shall be payable as per advise of
the treating doctor.
G) Pre-existing diseases are also to be covered.
H) List of major surgeries/diseases where in sum insured will be up to Rs. 2.00
Lakhs:-
I. Medical & Surgical Treatment for Heart, Cancer, Kidney & Neurological
diseases/ailments
II. Stroke
III.
IV.
Multiple Sclerosis, Cirrhosis, Meningitis
Major Organ transplants like Kidney, Lung, Pancreas or Bone-marrow
Transplantation & Joint Replacement like Hip, Knee etc.
I) TPA services shall be available for cashless / reimbursement claims in network
hospitals & reimbursement claims of Govt. Hospitals.
J) Reimbursement claim may be submitted at the nearest office of the Insurance
co. within the State of Rajasthan or to the TPA. However the claim will be
processed and settled by the TPA only.
K) Maternity benefits shall be available subject to waiting period of 9 months
only for 2 live children. Members existing in phase-VI will be exempted from
this waiting period. Termination of pregnancy due to accident on medical
advice will be covered under the scheme.
L) The relevant medical/diagnostic expenses incurred during the period up to 7
days prior to the hospitalization/up to 15 days after hospitalization of
diseases/illness/injuries sustained will be treated as pre and post
hospitalization respectively and will be considered as a part of the claim
subject to limit of sum insured.
3. 0 RIGHTS AND OBLIGATIONS OF ………… ZILA DUDGH UTPADAK SAHAKARI
SANGH LIMITED
3.1. Details of Members
It is hereby agreed and declared that the District Co – operative Milk Union ……….
shall submit to the Insurance Company, “Society wise list of beneficiaries” indicating
therein the name, age, photograph, residence address and their supporting proofs of
documents duly verified and attested Name/s of family members to be insured shall
be furnished at the time of taking insurance cover and latest by 16 th August,
2013.
(Signed & Sealed by the Ins. Co.
RCDF
in token of acceptance of above) 2013-14
5

3.2. Insured Members
The policy shall cover all eligible beneficiaries of District Cooperative Milk Union
………… affiliated Dairy Cooperative Societies . Whose premium at Rs. ____/-
(inclusive of Service Tax) per family per annum / Rs. /- (inclusive
of Service Tax) per person per annum will be paid by the milk unions.
3.3 District Cooperative Milk Union, ………… shall be liable to perform the following
obligations: -
(a) Shall ensure that the people being covered in the Scheme are the beneficiaries of
the RCDF & milk Unions, active milk producers.
(b) Permit the Personnel’s, representatives and Agents of INSURANCE COMPANY to
occupy certain designated space at its offices, out reach center, outlets, and other
contact places.
3.4 Group Size: - The total group size is likely to be 1 Lakh families approx.
4. 0 GOVERNING LAW AND ARBITRATION
4.1 The provisions of this MOU shall be governed by, and construed in accordance with the
Indian laws.
4.2 Any dispute, arising out of or in connection with the MOU or the breach, termination or
invalidity thereof, shall be settled by arbitration in accordance with the provisions of the
Indian Arbitration and Conciliation Act, 1996 and shall include any amendment made time to
time.
4.3 The dispute / controversy or claims arising out of or in correction with this agreement shall
be referred to an arbitrator appointed by the MD, RCDF, Jaipur which will be binding on the
Insurance Company and milk union.
4.4 The place of arbitration shall be Jaipur.
4.5 The award of the arbitrator shall be final and conclusive and binding upon the Parties, and
the Parties shall be entitled (but not obliged) to enter judgment thereon in any one or more
of the highest courts having jurisdiction. The parties for the agree (to the maximum extent
possible and allowed to them.) that such enforcement shall be subject to the provisions of
the Indian arbitration & conciliation act 1996 and neither parties shall seek to register the
enforcement of any award in India on the basis that award is not subject to such provision.
The rights and obligations of the parties under, or pursuant to, this clause, including the
arbitration agreement in this clause, shall be governed by and subject to Indian Law.
4.6 A claims Redressal Committee consisting of three members i.e. one Executive each from
INSURANCE COMPANY, RCDF, District Cooperative Milk Union, ………. will be constituted.
Serving TPA will assist the committee. The Claims Redressal meeting conducted every
month at the Office of the MD, District Cooperative Milk Union, ……….. The Committee may
review any complaint regarding claims and its decision shall be final to the insurer & binding
on all the parties.
4.7 The details of insured person and premium thereof will be made available to the Insurance
Company Office before inception of the cover.
4.8 Risk will commence from the date of receipt of premium by Insurance Company
(Signed & Sealed by the Ins. Co.
RCDF
in token of acceptance of above) 2013-14
6

4.9 The Identity card shall have the photograph of family/its member and individual along with
other details as required and the same will be issued by the TPA within 15 days of
submission of data to insurance company.
4.10 The provisions, terms and conditions of offer dated_______/2013________ shall be part of
the MOU, which have already agreed by the Insurance Company.
4.11 At the Milk unions having enrolled more than 10,000 milk producers, a help desk shall be
established in milk union’s premises with one representative from the insurance co. and TPA
each to facilitate & coordinate pre authorization / final approval for providing cashless facility
at network hospitals, receiving of reimbursement claim files claims intimation etc. &
settlement of claims.
5. 0 PUBLICITY
5.1 The Insurance Company will arrange holding of Workshops jointly with District Cooperative
Milk Union’s Office and selected office bearers of DCS will be organized at the Milk Unions
to brief them about the risk coverage and modus operandi for implementation of the
Scheme and claims procedure as per provisions of the MOU.
6.0 REVIEW
6.1 A meeting with District Cooperative Milk Union constituted committee under the
Chairmanship of MD, Milk Union shall be held regularly on quarterly basis to appraise him
about the progress of the scheme as well as settlement of claims.
6.2 The MOU may be reviewed on quarterly basis with a provision for suitable modification, if
required in accordance with the changing requirements and with the mutual written consent
of both the parties.
7.0 TIE UP ARRANGEMENTS :
In the real spirit of togetherness the employees and beneficiary members of RCDF / Milk
Union shall be given a preferential treatment in all the offices of the Insurance Company.
Similarly, the employees of the Insurance Company shall be given a preferential treatment
in all the offices of RCDF/District Cooperative Milk Union …………..
8.0 CANCELLATION CLAUSE :-
In case RCDF / Milk union find any violation of terms & condition of offer and MOU resulting
unsatisfactory services to insured, RCDF / Milk union may cancel MOU signed between
Insurance Co. & milk union by giving 30 days notice to the Insurance Co. and the milk union
will have right to stop subsequent premium installments and Insurance Co. will have to clear
all the pending claims within 30 days.
9.0. MISCELLANEOUS
(A) Amendments; No Waivers
(i)
(ii)
Any provision of this MOU may be amended or waived with the mutual consent insurance
company of both the parties if, and only if such amendment or waiver is in writing and
signed. In case of an amendment to the MOU , the same will be signed by MD, Milk Union
and Insurance Company and in case of a waiver; the same will be signed by the Party
against whom the waiver is to be effective.
No failure or delay by any Party in exercising any right, power or privilege hereunder shall
operate as a waiver thereof nor shall any single or partial exercise of any other right, power
or privilege. The rights and remedies herein provided shall be cumulative and not exclusive
(Signed & Sealed by the Ins. Co.
RCDF
in token of acceptance of above) 2013-14
7

of any rights or remedies provided by law.
(B) Notices :- All notices, requests and other communications to any Party hereunder shall be in
writing and shall be given to such Party at its address or fax number as such Party may
hereinafter specify to the other at the address or fax number set forth in the written
instrument executed. Each such notice, request or communication shall be effective:-
(i)
(ii)
(iii)
If given by fax, when such fax is transmitted to the fax number specified herein and
the appropriate answerback is received, or
If delivered by air courier service, 72 hours after such communication is delivered to
the courier service, shipping charges paid and properly addressed, and
If given by any other means, when delivered at the address specified herein.
Designated Office of the Insurance Company General Insurance Company Limited
Designated Office of the …………… ZILA DUDGH UTPADAK SAHAKARI SANGH LIMITED
(C)
Captions
The captions herein are included for convenience of reference only and shall be ignored in the
construction or interpretation hereof.
(D) Schedules, Part of Agreement
This Agreement together with all Schedules hereto forms a single Agreement between the Parties
hereto.
(E) Counterparts
This Agreement has been signed in duplicate, each of which shall be deemed to be an original.
ANNEXURE I - Group Health Insurance Policy - SSABY - VIII
ANNEXURE II & III- List of Panel Hospital
(F) Claim procedure: Both the parties agree to follow the claim procedure as set out in
Annexure IV of this agreement.
(G) Mutual cooperation
As a Complementary, the Insurance Company shall provide in all the benefit at the same rate/terms
& conditions to the retired employees of RCDF/Milk Unions.
As and when RCDF / Milk Union opts for coverage of serving RCDF/Milk Union’s employees along
with their dependent parents, the same would be accepted by Insurance Company General
Insurance Company Limited with additional premium to be mutually agreed at that point of time.
(Signed & Sealed by the Ins. Co.
RCDF
in token of acceptance of above) 2013-14
8

Similarly, as and when RCDF / Milk Union opts for coverage of dependent parents of insured milk
producers, the same would be accepted by Insurance Company General Insurance Company
Limited Insurance Company Ltd. with additional premium to be mutually agreed at that point of
time.
In witness whereof the parties hereby sign at Jaipur on this 15 th day of July, 2013.
( …………………… ) (………………………..)
Managing Director,
…………. Zila Dugdh Utpadak Sahakari Sangh Ltd.
Authorised Signatory
……. Insurance Company Ltd.
Witness (1): Witness Witness (1):
………………………
…………………………….
(2): Witness Witness (2):
……………………….
……………………………..
(Signed & Sealed by the Ins. Co.
RCDF
in token of acceptance of above) 2013-14
9

ANNEXURE-II-A
List of private hospitals empanelled by GOR for State Govt. employees - SSABY-VIII
(Signed & Sealed by the Ins. Co.
RCDF
in token of acceptance of above) 2013-14
10

ANNEXURE-II-B
List of empanelled private hospitals in district Milk union - SSABY-VIII
(Signed & Sealed by the Ins. Co.
RCDF
in token of acceptance of above) 2013-14
11

ANNEXURE-III
List of hospitals for treatment outside Rajasthan for SSABY – VIII.
(Signed & Sealed by the Ins. Co.
RCDF
in token of acceptance of above) 2013-14
12

ANNEXURE IV
Claim Procedure:
Protocol for availing Cashless treatment to the members under Saras Samuhik
Arogya Bima Yojana – VIII
Beneficiary along with.TPA ID card approaches Network Hospital.
Hospital to provide intimation as per the intimation clause below to the TPA
Network hospital will send initial intimation to TPA with estimate and all the supporting
documents and evidence
TPA raises query if any, within 2 Hours
Hospital responds to the query within 2 Hours
TPA will issue online authorization for cashless treatment under intimation to
The __IC & MILK UNION within 1 Hours of receiving complete information
Network hospital extends cashless treatment
Beneficiary places signature on the claim form and gets discharged
Network Hospitals forwards all the bills and documents to TPA within 7 days
TPA scrutinizes the claim for medical and financial eligibility.
TPA raises query if any, within 5 days
Hospital responds to the query within 5 days
TPA makes payment to the Hospital within 30 days from the date of submission of
complete documents or satisfying the query if any.
Note : In case of emergency the protocol for preauthorization must be regularized within 4
hours of hospitalization.
(Signed & Sealed by the Ins. Co.
RCDF
in token of acceptance of above) 2013-14
13

Protocol for Reimbursement claims by members under Saras Samuhik Arogya
Bima Yojana – VIII
Beneficiary along with.TPA ID card approaches to Hospital.
Beneficiary / Hospital to provide intimation as per the intimation clause below to the TPA
Beneficiary makes the payment, collects all the documents from the hospital and gets
discharged
Member submits the claim to TPA within 45 days from the date of discharge
TPA scrutinizes the claim for medical and financial eligibility.
TPA raises query if any, within 5 days however if query raised after 15 days of receipt of
claims documents, insured shall not be liable to reply the query
Insured responds to the query within 30 days
TPA makes payment to member within 30 days from the date of submission of complete
documents or satisfying the query if any.
Note:
1. In case of Emergency, the protocol for pre – authorization must be regularized within 04 Hrs of
admission.
2. Incase of non-availability of network hospitals, member can avail treatment at any Govt.
hospital of his choice, make upfront payment and thereafter claim for reimbursement.
3. Intimation in all the cases shall be given to servicing TPA within 24 hrs. of hospitalization
through letter/SMS/Telephone/fax/mail by concerned Pvt. empanelled hospital. In case there is
delay in intimation and valid / justified reason of delay is communicated to TPA / Insurance
Company, the Insurance Co. shall consider the same sympathetically & claim shall not be
rejected / disallowed. In case the member insured is hospitalized in the network hospital
(empanelled) even on payment basis (Reimbursement method), network hospital shall be
responsible for intimation to TPA / Insurance Company.
4. Intimation shall not be necessary in case insured avail treatment at Govt. hospital / medical
college.
4. TPA will provide online facility to the Hospitals providing cashless facility as well as to __IC,
RCDF Hq., Jaipur & or Milk Unions so that TPA, __IC, RCDF & Milk Unions gets
information of the admission of the Patient in the Hospital concerned immediately and all
data/MIS related to claims.
Claim Management
1. The processing of claims will be completed & submitted for payment to __IC within 13
days by TPA. However, in case of any dispute, clarification or verification of facts, the
time can be extended.
(Signed & Sealed by the Ins. Co.
RCDF
in token of acceptance of above) 2013-14
14

2. IC will release payment within ten days after receipt of the requisition of the funds
/sanction for releasing the payment.
3. After receiving payment/sanction from Insurance Company General Insurance
Company Limited, TPA will release payment of the claims to concerned insured
/hospital within a week.
4. TPA will have separate team of doctors and processing executives for handling the
claims of this insured group.
5. The claim payment & processing will be at TPA Jaipur Branch office.
6. TPA experienced staff will adjudicate the claims and will adopt IT integrated claims
processing.
Documents required for in – patient claim processing:
1. Discharge Summary: Containing member detail, Diagnosis, Line of treatment, treating
doctor’s signature and Hospital stamp.
2. Consolidated bill with break up.
3. Reports of investigation (if not mentioned in the Discharge summary) duly prescribed
4. Bills duly supported by receipts and prescription by the treating Doctor (in case of pre &
post hospitalization only).
5. Copy of TPA authorization in case of Network hospital claim/ copy of Member ID card
(Shapata Patra duly attested and forward by the Milk Union will be submitted if member
ID card is not issued by the TPA) in case of member reimbursement claim.
6. Copy of prescription / report/ bill of medicine, investigation, procedure performed
outside the network hospital (due to non – availability of such services in the network
hospital).
7. Claim form as per Insurance Company General Insurance Company Limited norms duly
signed by the claimant.
8. Any other document as required by the TPA to substantiate the claim
Document for Pre - & Post hospitalization Claim processing:
1. Copy of Discharge summary of the hospital.
2. Prescription for medicine, investigation, procedure.
3. Bill of the above.
4. Report for Investigation.
5. Any other relevant document as required by the TPA to substantiate the claim
Considering the location of end user it is proposed to accept all the above documents i.e.
Prescription, report finding and bill as a part of the same document.
Payment of Claim:
The claims cheque shall be released directly by the TPA to the network hospitals or the
insured as the case may be. In case IC / TPA fails to pay the claims within one
month’s time from submission of required documents insurance co. shall be liable to pay
10% penalty of outstanding claims amount which will be recoverable from insurance co.
(Signed & Sealed by the Ins. Co.
RCDF
in token of acceptance of above) 2013-14
15

RAJASTHAN CO-OPERATIVE DAIRY FEDERATION LIMITED,
SARAS SANKUL, JLN MARG, JAIPUR - 302017
SARAS SAMUHIK AROGYA BIMA - VIII
Stage - II : Financial Offer for Health Insurance
Name & Address of the Firm/Company/Organization ------------------------------------------------------------------------------------------
---
FACILITIES TO BE
PROVIDED
COVER FOR PER FAMILY PER
ANNUM
SUM INSURED Rs. 1,00,000 ***
RATE FOR INDIVIDUAL PER
ANNUM **
SUM INSURED Rs. 1,00,000 ***
Cashless hospital facilities +
Reimbursement* facilities +
Maternity**** + Pre existing
diseases
Annual Premium Rate
Annual Premium Rate
* Insured member can choose any empanelled pvt. hospital any where in India,
of his/her own choice where he/she pays the hospital
bill and doctor's fees first and lodges the claim with the Insurance Company for reimbursement.
** i) Individual - Male or female members (individual shall mean who is either unmarried or has no live family
members of his own).
ii) Family : Family consisting of 1 + 1 + 2 (Husband, Wife, first two dependent Children)
*** Please refer point no. 9.6 (G) under Benefits of terms & conditions.
**** Maternity coverage would intend to include (Please refer 9.6 (J)
i) Normal institutional deliveries
ii) Caesarian sections
iii) Complications arising during/post pregnancy
Signature of Authorized Representative with Seal
(Signed & Sealed by the Ins. Co.
RCDF
in token of acceptance of above) 2013-14
1

(Signed & Sealed by the Ins. Co.
RCDF
in token of acceptance of above) 2013-14
1