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REQUEST FOR PROPOSAL (RFP) DOCUMENT

PROVIDING SUPPORT SERVICES FOR

IMPLEMENTATION OF

MUKHYAMANTRI AMRUTAM (MA) & MA VATSALYA

YOJANA

And

AYUSHMAN BHARAT-NATIONAL HEALTH

PROTECTION MISSION (AB-NHPM)

STATE NODAL CELL (SNC), COMMISSIONERATE OF HEALTH,

MEDICAL SERVICES AND MEDICAL EDUCATION, DR. JIVRAJ MEHTA

BHAVAN, BLOCK NO.-5, GANDHINAGAR

PUBLISHED ON 14TH OF JULY, 2018

Providing Support Services for Implementation of Mukhyamantri Amrutum ‘MA’ & MA Vatsalya & AB-NHPM Yojana

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GOVERNMENT OF GUJARAT

DEPARTMENT OF HEALTH AND FAMILY WALFARE

TENDER NOTICE

MUKHYAMANTRI AMRUTAM (MA), MA VATSALYA YOJANA & AYUSHMAN

BHARAT-NATIONAL HEALTH PROTECTION MISSION (AB-NHPM)

Competitive quotations are invited from the companies (registered under companies act 1956) associated with health care related activities, having

experience in medical claim processing and can provide IT support for claim processing for the implementation of Mukhyamantri Amrutam (MA), MA Vatsalya Yojana and Ayushman Bharat-National Health Protection Mission

(AB-NHPM) on a hybrid model in Gujarat for eligible families of all the 33 Districts namely; Ahmedabad, Amreli, Anand, Bhavnagar, Gandhinagar,

Junagadh, Kheda, Mehsana, Navsari, Panchmahal, Porbandar, Rajkot, Surat, Surendranagar, Vadodra, Valsad, Bharuch, Dahod, Jamnagar Kutch, Patan, Banaskantha, Dang, Narmada, Sabarkantha, Tapi, Chotaudaipur,

Devbhoomi-Dwarka, Mahisagar, Aravalli, Botadh, Gir-Somnath and Morbi districts of Gujarat. The tender document for this may be downloaded from

the website http://www.nprocure.com. The Tender document can also be obtained in person from the date of release 14.07.2018 from the below mentioned address on any working day between 10.30 A.M to 4.00 P.M.

The technical bids should be sealed by the bidder in a cover duly super-

scribed is to be put in a bigger cover which should also be sealed and duly

super-scribed. The Technical bids will be evaluated by the Technical Bid

Evaluation Committee. Financial bids of only the technically acceptable offers

shall be opened before the successful bidders by the SNC Agency for awarding

of the contract. Following schedule will be observed in this regard.

1. Pre bid meeting: 19/07/2018 (at 12.00 hrs)

2. Last date for physical & online Submission of bid: 04/08/2018 (up to 16:00

hrs)

3. Opening of technical bids: 06/08/2018 (at 15:00 hrs)

4. Opening of financial bids: 06/08/2018 (at 16:00hrs)

The completed technical bid & financial bid documents should be submitted

before 16.00 hrs. of 4th August, 2018, at the following address:-

Additional Director (MS)

Commissionerate of Health and Family Welfare, MS and ME

Block No. 5, Dr. Jivraj Mehta Bhavan, Gandhinagar

Phone:079-232-53337

Email: [email protected], [email protected]

All correspondence / communications regarding the scheme should be made

at the above address.

mailto:[email protected]


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Table of Contents Content Page

Instruction to Bidders 3

Appendix – A Agreement

1. General Provision

2. Commencement, Completion, Modification & Termination of Contract

3. Obligation of Service Agency

4. Agency’ Personnel

5. Obligation of State Nodal Cell (SNC)

6. Payment to the Agency

7. Fairness & Good faith

8. Settlement of Disputes

9. Overview of the Scheme

10. Scope of Work

11

11

14

21

27

30

31

33

33

35

48

Schedule- 1 Penalty for delay in execution of Work 53

Appendix - B Scope of work of the ISA

1. Servicing of the Claims

2. Claim Settlement

3. Advocacy , Patient facilitation & Support Services

4. Capacity Building

55

55

55

57

57

Appendix – C Covering Letter 58

Appendix – D Detail of Bidder 59

Appendix – E Format for Anti-Collusion certificate 60

Appendix – F Proof of Eligibility 61

Appendix – G Technical Proposal 63

Scoring of Technical proposal 65

Annexure – 1 Statement of Strategy for Implementation 66

Annexure – 2 Experience in handling hospitalization claims of families. 66

Annexure – 3 Experience of handling State/Central Government Health

Assurance Scheme.

66

Annexure – 4 Experience in Managing Hospitalization claims by volume 66

Annexure – 5 Curriculum Vitae of Technical & Management personnel – Key

Personnel’s & MBBS & Above Doctors on Payroll

66

Annexure – 6 Total claims Management capacity during the year 2017-18 67

Annexure – 7 Power Point Presentation to demonstrate Bidder’s capability in

relation to the main deliverable within the timeframes identified

67

Annexure – 8 Self declaration certificate 67

Appendix – H Financial Proposal for the project 68

Appendix – I Power of Attorney for signing the Bid 72

Appendix – J Performance Security 74


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REQUEST FOR PROPOSAL

IMPLEMENTATION SUPPORT AGENCY (ISA)

Instructions to Bidders

1. State Nodal Cell (SNC), Gandhinagar (herein after referred to as SNC)

intends to adopt a two cover bidding process for selection of the

Successful Bidder to provide support in implementation of

Mukhyamantri Amrutam (MA), MA Vatsalya and AB-NHPM devised by

the Government of Gujarat. In this regard, the detailed scope of work for

the Successful Bidder is set out in Appendix B.

2. Proposals are invited only from interested eligible Bidders in order to

identify the Successful Bidder. The Proposals would be evaluated on the

basis of the criteria set out in this Document. For the purpose of this RFP

Document, eligible Bidders shall mean companies which are:-

a) Registered under Companies Act 1956 and should be associated with

health care related activities for a minimum of 5 years prior to

31/03/2018.

b) Having Annual Turnover of Rs.50.00 crore in each of the previous

three (3) financial years(2015-16, 2016-17 & 2017-18)

c) Experience in handling health claims- should have processed at least

2,00,000 claims during the financial year 2017-18

d) Having experience in processing medical claims of not less than

Rs.200 Crores during year 2017-18 and should have minimum 10 full

time doctors on payroll with minimum MBBS qualification during last

financial year 2017-18.

e) Should be an income tax assesse.

f) Should not have been black listed by any State government/ Central

Government or their agencies

g) PF, ESIC, GST complaint

Eligible Bidders can submit their bid as a single entity only. Consortium

is not allowed to Bid.

3. Each Bidder shall submit a maximum of one (1) Proposal for the Project,

in response to this notification. Any Bidder who submits more than one

Proposal for the Project shall be considered as disqualified.

4. The Bidder shall be responsible and shall also pay for all of the costs

associated with the preparation of its Proposal and its participation in

the bidding process.


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5. At any time prior to the Proposal Due Date, for any reason, or in response

to clarifications requested by any Bidder or on department’s own

initiative, this document may be modified by the issuance of Addenda.

6. The Proposal shall remain valid for a period not less than six calendar

months from the Proposal Due Date (Proposal Validity Period). State

Nodal Cell reserves the right to reject any Proposal, which does not meet

this requirement.

7. Earnest Money Deposit (EMD):

7.1 Each Proposal shall be accompanied by EMD of Rs.10,00,000 (Rupees

Ten lakhs only).

7.2 The EMD shall be in the form of a crossed demand draft / banker’s

cheque drawn in favour of “State Nodal Cell Mukhyamantri Amrutam

Yojana”, on any scheduled bank, payable at Gandhinagar.

7.3 The EMD of unsuccessful Bidder would be returned within a period of

eight weeks from the date of announcement of the Successful Bidder.

The EMD submitted by the Successful Bidder would be released upon

furnishing of the Performance Security amounting to a value equal to

10 (Ten) percent of the total Service Charges mentioned in the financial

bid for the entire contract period.

8. Documents Comprising the RFP:

8.1 The Bidder would provide all the information as per this document. Only

those Proposals that are received in the required format and are complete

in all respects would be evaluated. Each Proposal shall comprise the

following:

A. Qualification Criteria:

a. Covering letter in the format set out in Appendix C , as applicable

b. Details of the Bidder in the format set out in Appendix D, as

applicable

c. Anti-collusion certificate in the format set out in Appendix E

d. Proof of Eligibility (Qualification Criteria) in the format set out in

Appendix F

e. Power of Attorney for signing the Bid in the format set out in Appendix

I.


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B. Technical Proposal:

Technical proposal in the format set out in Appendix G. The technical

proposal should be sealed in a separate envelope clearly marked in bold

“SECTION A – TECHNICAL PROPOSAL FOR IMPLEMENTING

“MUKHYAMANTRI AMRUTAM (MA) YOJANA” written on top of the

envelope. The bidder shall also upload the same on the website

http://www.nprocure.com).

The Proposal shall be typed or written in indelible ink and each page

shall be initialed by an Authorized signatory of the Bidder or Individual,

as applicable. All the alterations, omissions, additions, or any other

amendments made to the Proposal shall also be initialed by the person(s)

signing the Proposal.

C. Financial Proposal:

The Bidder is expected to quote the rates for 3 years (Three Years) for all

the components separately as per the format provided in Appendix H.

However, the Financial Proposal shall be evaluated as a whole.

a. The Financial bid submission should be done on the website (electronic

format) only on http://www.nprocure.com

b. The online bids should be submitted on or before the time stipulated in

tender notice at the website http://www.nprocure.com

No tender will be accepted after prescribed closing time for submission

of the same. The delay will not be condoned for any reason whatsoever

including Network /Postal / Transit delay. However, if the last date of

submission of tender is declared as a holiday by the government then it

will be extended to the next working day.

Note: In no cases, rates should be quoted anywhere except online in

Financial Bid.

8.2 Bidders are advised to study the Tender document carefully. Submission

of Tender shall be deemed to have been done after careful study and

examination of the Tender document with full understanding of its

implications. Failure to furnish all information required as mentioned in

the RFP document or submission of a proposal not substantially

responsive to the RFP document in every respect will be at the Bidder's

http://www.nprocure.com/




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risk and may result in rejection of the proposal and forfeiture of the Bid

Security.

9 Sealing and Marking of Proposal:

9.1 The Bidder shall seal “Section A envelope - containing Qualification

Criteria and Technical Proposal” in single sealed envelope.

9.2 The envelopes must be super-scribed with the following information:

a. Name and Address of Bidder.

b. Contact person and phone numbers.

c. "Technical Proposal for Providing support service for

MUKHYAMANTRI AMRUTAM (MA), MA VATSALYA & AB-NHPM

YOJANA”

d. To be opened in the presence of tender evaluation committee, only.

9.3 Bidder agrees and acknowledged that if the envelope is not sealed

and marked as instructed above, this office assumes no

responsibility for the misplacement or premature opening of the

contents of the Proposal submitted and such Proposal, may, at the

sole discretion of the committee, be rejected.

10 Proposal Due Date:

10.1 Complete bid document should be uploaded to

http://www.nprocure.com by 16:00 hrs on 4th day, of August,

2018. Bid documents received later than the prescribed date and

time will not be considered for evaluation. Proposals submitted by

either facsimile transmission or telex will not be accepted.

10.2 The State Nodal Cell may in exceptional circumstances, and at its

sole discretion, extend the above Proposal Due Date by issuing an

Addendum.

11 Pre Bid Meeting:

11.1 A Pre bid meeting will be held at 19/07/2018 (at 12.00 hrs), in the

Parivartan Hall of Commissionerate of Health, Block No.-5, Dr.

Jivraj Mehta Bhavan, Gandhinagar, Gujarat, to clarify any queries

the bidders may have, and for providing additional information if

any. No separate intimation of the Pre Bid meeting will be sent to



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the prospective bidders, unless there is a change in the time, date

or venue of the Pre bid meeting.

11.2 Request for clarifications from the bidders shall be received at State

Nodal Cell through email (at [email protected],

[email protected])/post not later than 18/07/2018 (by

12.00 hrs). All the requests shall be addressed to the contact person

in State Nodal Cell as mentioned above.

11.3 State Nodal Cell may incorporate any changes in the RFP based on

acceptable suggestions received during the interactive Pre Bid

Conference. The decision of State Nodal Cell regarding acceptability

of any suggestion shall be final in this regard and shall not be called

upon to question under any circumstances.

11.4 However, prospective bidders are free to raise their queries during

the meeting and responses will be conveyed to all the prospective

bidders (by way of hosting amendments/ clarifications on the

website i.e. at www.gujhealth.gov.in in accordance with the

respective clauses of the RFP shortly after the Pre Bid Conference

and no participant would be intimated individually about the

response.

12 Opening of Proposals and Clarifications:

12.1 The Qualification Criteria and Technical proposal (i.e., SECTION-A)

of the Proposals would be opened first. The Financial Proposal (i.e.,

SECTION-B) of only Technically Qualified Bidders would be opened

later.

12.2 The State Nodal Cell reserves the right to reject any Proposal not

submitted on time and which does not contain the

information/documents as set out in this document.

12.3 To facilitate evaluation of Proposals, The State Nodal Cell may, at its

sole discretion, seek clarifications in writing or in electronic format

from any Bidder regarding its Proposal.

13 Evaluation:

13.1 The criteria for eligibility, qualification and evaluation of Bidders are

set out in Appendix F & G respectively.

mailto:[email protected]


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13.2 As part of the evaluation, the Proposals shall be checked for

responsiveness with the requirements of this document and only

those Proposals which are found to be responsive would be further

evaluated in accordance with the criteria set out in this document.

13.3 The Proposal would be considered to be responsive if it meets the

following conditions:

a. It is received /deemed to be received by the Proposal Due Date

including any extension thereof.

b. It is signed, sealed and marked as stipulated in Clause 8 and Clause

9.

c. It contains all the information and documents as requested in this

document.

d. It contains information in formats specified in this document.

e. It mentions the validity period as set out in Clause 6.

f. There are no inconsistencies between the Proposal and the

supporting documents.

A Proposal that is substantially responsive is the one that conforms

to the preceding requirements without material deviation or

reservation.

A material deviation or reservation is one:

a) which affects in any substantial way, the scope, quality, or

performance of the Project, or

b) which limits in any substantial way, inconsistent with this

document, State Nodal Cell’s rights or the Bidder’s obligations

under the Agreement, or

c) Which would affect unfairly the competitive position of other

Bidders presenting substantially responsive Proposals.

13.4 The responsive proposals shall be evaluated as per the criteria set

out in Appendix F & G.

13.5 The Bidder shall submit the Technical Proposal as set out in

Appendix G

13.6 The format for quoting the Financial Proposal is set out in Appendix

H.


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13.7 The Financial Proposals of only the Technically Qualified Bidders

would be opened.

13.8 The Bidder making the lowest Financial Proposal i.e. lowest Service

Charges would be declared as the Preferred Bidder. State Nodal Cell

may either choose to accept the Proposal of the Preferred Bidder or

invite him/her for negotiations. The State Nodal Agency reserves the

right to reject any or all tenders without assigning any reason.

13.9 In case there are two or more Bidders quoting the same lowest

Financial Proposal, State Nodal Cell may in such case call all such

Bidders for negotiations and select the Preferred Bidder on the

outcome of the negotiations. The selection in such cases shall be at

the sole discretion of the State Nodal Cell. The information of

negotiations will be given to both the bidders.

13.10 The State Nodal Cell reserves the right to reject any Proposal, if:

a) at any time, a material misrepresentation is made or discovered; or

b) The Bidder does not respond promptly and diligently to requests for

supplemental information required for the evaluation of the

Proposal.

14. In the event of acceptance of the Preferred Bidder with or without

negotiations, The State Nodal Cell shall declare the Preferred Bidder as

the Successful Bidder. State Nodal Cell shall notify the Successful Bidder

through a Letter of Award (LoA) that its Proposal has been accepted.

15. The Successful Bidder shall enter into an agreement (“Agreement” – as

given in Appendix A) within 10 days of the issue of Letter of Award (LoA)

or within such further time as the State Nodal Cell may agree to, in its

sole discretion.

16. Period of Agreement:

The agreement with the Implementation Support Agency will be for a

period of 3 (Three) years (from the date of signing the agreement) initially

and may be extended for another period of 3 (Three) years by mutual

consent.

17. Payment of Service Charges:


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The State Nodal Cell will pay the Service Charges to the Implementation

Support Agency directly in 4 (four) equal quarterly installments of the total

service charge.

18. The Successful Bidder shall also furnish Performance Security by way of

an irrevocable Bank Guarantee, issued by a nationalised bank located in

India in favor of State Nodal Cell, Gandhinagar as per Appendix J, and

required under the Agreement. The Performance Security shall be kept

valid till the expiry of the Agreement.

19. Failure of the Successful Bidder to comply with the requirements of

Clause 15 or Clause 18 shall constitute sufficient grounds for the

annulment of the Letter of Award (LoA), and forfeiture of the EMD. In

such an event, The State Nodal Cell reserves the right to;

a. either invite the next lowest Bidder for negotiations, or;

b. take any such measures as may be deemed fit in its sole

discretion, including annulment of the bidding process.

20. Notwithstanding anything contained in this document, The State Nodal

Cell reserves the right to accept or reject any Proposal, or to annul the

bidding process or reject all Proposals, at any time without any liability

or any obligation for such rejection or annulment, without assigning any

reasons thereof.


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Appendix A

AGREEMENT

BETWEEN THE STATE NODAL CELL (SNC) AND THE IMPLEMENTATION

SUPPORT AGENCY FOR PROVIDING SUPPORT SERVICES FOR (IN) THE

IMPLEMENTATION OF MUKHYAMANTRI AMRUTAM (MA), MA VATSALYA

& AB-NHPM YOJANA

This Agreement (hereafter called The Agreement) is executed at Gandhinagar

on this ….. day of ……. 2018 between the State Nodal Cell (Herein after called

the State Nodal Cell and Party of the first part) represented by Project Director,

State Nodal Cell, Commissionerate of Health, Block No-5, Dr. Jivraj Mehta

Bhavan, Gandhinagar.

AND

................................(Name of the Implementation Support Agency) (herein

after called the Service Agency and the Party of the second part.) represented

by ...................

Whereas the State Nodal Cell has, after a due bidding process involving

technical and financial evaluation, awarded the contract of Services for

implementation of the Mukhyamantri Amrutam (MA), MA Vatsalya & AB-

NHPM Yojana in all the 33 Districts namely; Ahmedabad, Amreli, Anand,

Bhavnagar, Gandhinagar, Junagadh, Kheda, Mehsana, Navsari,

Panchmahal, Porbandar, Rajkot, Surat, Surendranagar, Vadodra, Valsad,

Bharuch, Dahod, Jamnagar Kutch, Patan, Banaskantha, Dang, Narmada,

Sabarkantha, Tapi, Chotaudaipur, Devbhoomi-Dwarka, Mahisagar, Aravalli,

Botadh, Gir-Somnath and Morbi districts of Gujarat to the Service Agency and

the Party of the second part.

This agreement witnesses as follows:

GENERAL CONDITIONS OF AGREEMENT

1. General Provisions:

1.1. Definitions:

Unless the context otherwise requires, the following terms whenever

used in this Contract have the following meanings:


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(a) "State Nodal Cell" means State Nodal Cell, Commissionerate of

Health & Family Welfare, MS, ME, Gandhinagar, Gujarat State,

India.

(b) "Applicable Law" means the laws and any other instruments having

the force of law in India, as they may be issued and in force from

time to time;

(c) "Agreement" means the Agreement signed by the Parties, to which

these General Conditions of Agreement are attached, together with

all the documents listed in letter of award;

(d) "Effective Date" means the date on which this Agreement comes into

force and effect pursuant to Clause in General Condition.

(e) "GC" mean these General Conditions of Agreement.

(f) "Government" means the Government of India or Government of

Gujarat as applicable in the specific instance.

(g) "Local Currency" means Indian Rupees;

(h) "Personnel" means persons engaged by the Service Agency for

providing specific services or any part thereof; "Foreign Personnel"

means such persons who at the time of being so hired had their

domicile outside India; "Local Personnel" means such persons who

at the time of being so hired had their domicile inside India; and

"Key Personnel" means the personnel referred to in the Clause 4.2

of this document.

(j) "Party" means the State Nodal Cell or the Service Agency, as the case

may be, and Parties means both of them;

(k) "Services" means the work to be performed by the service Agency

pursuant to this Contract for the purposes of the Scheme, as

described in this document under Clause 9 hereto.

(l) "Sub Agency" means any entity to which the Service Agency

subcontracts any part of the Services.

(m) "Third Party" means any person or entity other than the State Nodal

Cell, and the Service Agency.

(n) "Contract Sums" means gross amounts of the Service Agency's

original proposal in Indian Rupees with tax, duties, fees and other

imposition as provided for in the General Conditions inclusive of all

cost, all types of investigation works if any.

(o) "Approved / approval" means the approval in writing.

(p) “PHI-Protected Health Information” means all types of health related

information given by beneficiaries in this project.

(q) "Agency" means Implementing Support Agency (ISA)

(r) "AB-NHPM" refers to Ayushman Bharat-National Health Protection

Mission managed and administered by the Ministry of Health and

Family Welfare, Government of India with the objective of reducing


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out of pocket healthcare expenses and improving access of validated

Beneficiary Family Units to quality inpatient care and day care

surgeries (as applicable) for treatment of diseases and medical

conditions through a network of Empanelled Health Care Providers.

(s) "NHPM Beneficiary Database" refers to all NHPM Beneficiary Family

Units, as defined in Category under the deprivation criteria of D1,

D2, D3, D4, D5 and D7, Automatically Included category (viz as

Households without shelter, Destitute-living on alms, Manual

Scavenger Families, Primitive Tribal Groups and Legally released

Bonded Labour) and 11 defined occupational un-organised workers

(in Urban Sector) of the Socio-Economic Caste Census (SECC) 2011

database of the State / UT along with the existing RSBY Beneficiary

Families not figuring in the SECC Database of the Socio-Economic

Caste Census (SECC) database as on 13.07.2018.

(t) "State Health Agency" (SHA) refers to the agency/ body set up by the

Department of Health and Family Welfare, Government of Gujarat

for the purpose of coordinating and implementing the Pradhan

Mantri Rashtriya Swasthya Suraksha Mission in the State of

Gujarat.

1.2. Relations between the Parties:

“Nothing contained herein shall be construed as establishing a

relation of master and servant or of agent and principal as between

the State Nodal Cell and the Service Agency. The Service Agency,

subject to this contract, has complete charge of Personnel performing

the Services and shall be fully responsible for the services performed

by them or on their behalf hereunder”.

1.3. Law Governing the Contract:

This Agreement, its meaning and interpretation and the relation

between the Parties shall be governed by the Applicable Laws in India.

1.4. Language:

This Agreement has been executed in the language English, which

shall be the binding and controlling language for all matters relating

to the meaning or interpretation of this contract.

1.5. Headings


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The headings shall not limit, alter or affect the meaning of this

Agreement.

1.6. Notices:

1.6.1. Any notice, request or consent required or permitted to be given

or made pursuant to this Agreement shall be in writing. Any

such notice, request or consent shall be deemed to have been

given or made when delivered in person to an authorised

representative of the party to whom the communication is

addressed, or when sent by registered mail, telex, telegram or

facsimile to such Party at the address given in the proposal

document for issue of proposal document.

1.6.2. Notice will be deemed to be effective as follows:

(a) in the case of personal delivery or registered mail, on

delivery;

(b) in the case of telexes, 24 hours following confirmed

transmission;

(c) in the case of telegrams, 24 hours following confirmed

transmission; and

(d) in the case of facsimiles, 24 hours following confirmed

transmission.

1.6.3. A Party may change its address for notice hereunder by giving

the other Party notice of such change pursuant to the

provisions listed in General Condition.

1.7. Location:

The Services shall be performed at such locations are specified in

clause 9.4 hereto and, where the location of a particular task is not

so specified, at such locations, as the State Nodal Cell may approve.

1.8. Authorized Representatives:

Any action required or permitted to be taken, and any document

required or permitted to be executed, under this Agreement by the

State Nodal Cell or the Service Agency may be taken or executed by

the authorized representative specified in the bid document.

1.9. Taxes and Duties:


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The Service Agency and their personnel (domestic personnel and

foreign personnel) shall pay the taxes, custom duties, fees, levies and

other impositions levied under the existing, amended or enacted laws

during life of this Contract and the State Nodal Cell shall perform such

duties in regard to the deduction of such tax as may be lawfully

imposed.

2. Commencement, Completion, Modification & Termination of

Agreement:

2.1. Termination of Contract for Failure to Become Effective if this

Agreement has not become effective within three months or such other

time period as the party may agree in writing after date of the

Agreement signed by the Parties, either Party may, by not less than

four (4) weeks' written notice to the other Party, declare this Agreement

to be null and void, and in the event of such declaration by either

Party, neither Party shall have any claim against the other Party with

respect hereto.

2.2. Commencement of Services:

The Service Agency shall begin carrying out the Services within 15

days of signing this Agreement or such other time period as the party

may agree in writing.

2.3. Expiration of Contract:

Unless terminated earlier pursuant to Clause 2.8 hereof, this

Agreement shall expire when services have been completed and

confirmed by the State Nodal Cell by issuing completion certificate at

the end of period of contract or such other time period as the parties

may agree in writing.

If the Mukhyamantri Amrutam (MA) Yojana & MA Vatsalya (hereinafter

referred to as the Scheme) is terminated before the scheduled period,

the Agreement may be foreclosed. The Agreement may also be

extended if so desired by the Parties. In case of extension and

foreclosure, pro-rata addition or deduction shall be entertained based

on percentage quoted for the supervision part of the whole assignment.

At the discretion of State Nodal Cell without assigning any reasons of

whatsoever, the assignment may foreclose at any stage. In case of


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foreclosure, percentage payment due up to the completed stage will be

made as indicated in the Financial Proposal. In case assignment

forecloses in the middle of any indicated stage in financial proposal,

pro-rata payment shall be made for the completed services as agreed

mutually. The Service Agency agrees and acknowledges that it does

not reserve any right to claim compensation of whatsoever nature for

foreclosure of contract by State Nodal Cell.

2.4. Entire Agreements:

This Agreement contains all covenants, stipulations and provisions

agreed by the Parties. No agent or representative of either Party has

authority to make, and the Parties shall not be bound by or be liable

for, any statement, representation, promise or agreement not set forth

herein.

2.5. Modification:

Modification of the terms and conditions of this Contract, including

any modification of the scope of the Services, may only be made by

written agreement between the Parties. Pursuant to Clause 7.2 hereof,

however, each Party shall give due consideration to any proposals for

modification made by the other Party.

2.6. Force Majeure:

2.6.1. Definition:

(a) For the purposes of this Agreement, "Force Majeure" means

an event which is beyond the reasonable control of a Party,

and which makes a Party's performance of its obligations

hereunder impossible or so impractical as reasonably to be

considered impossible in the circumstances, and includes,

but is not limited to, war, riots, civil disorder, earthquake,

fire explosion, storm, flood or other adverse weather

conditions, strikes, lockouts or other industrial action

(except where such strikes, lockouts or other industrial

action are within the power of the Party invoking Force

Majeure to prevent), confiscation or any other action by

government agencies.


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(b) Force Majeure shall not include (i) any event which is caused

by the negligence or intentional action of a Party or such

Party's or agents or employees, nor (ii) any event which a

diligent Party could reasonably have been expected to both

(A) take into account at the time of the conclusion of this

Contract and (B) avoid or overcome in the carrying out of its

obligations hereunder.

(c) Force Majeure shall not include insufficiency of funds or

failure to make any payment required hereunder.

2.6.2. No Breach of Contract:

The failure of a Party to fulfill any of its obligations hereunder

shall not be considered to be a breach of, or default under, this

Agreement insofar as such inability arises from any event of

Force Majeure, provided that the Party affected by such an

event has taken all reasonable precautions, due care and

reasonable alternative measures, all with the objective of

carrying out the terms and conditions of this Agreement.

2.6.3. Measures to be taken:

(a) A Party affected by an event of Force Majeure shall take all

reasonable measures to remove such Party's inability to

fulfill its obligations hereunder with a minimum of delay.

(b) A Party affected by an event of Force Majeure shall notify

the other Party of such event as soon as possible, and in any

event not later than fourteen (14) days following the

occurrence of such event, providing evidence of the nature

and cause of such event, and shall similarly give notice of

the restoration of normal conditions as soon as possible.

(c) The Parties shall take all reasonable measures to minimize

the consequences of any event of Force Majeure.

2.6.4. Extension of Time:

Any period within which a Party shall, pursuant to this

Agreement, complete any action or task, shall be extended for


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a period equal to the time during which such Party was unable

to perform such action as a result of Force Majeure.

2.6.5. Payments:

During the period of their inability to perform the Services as a

result of an event of Force Majeure, the Service Agency shall

not be entitled to be reimbursed for any additional costs.

2.6.6. Consultation:

Not later than thirty (30) days after the Agency, as the result of

an event of Force Majeure, have become unable to perform a

material portion of the Services, the Parties shall consult with

each other with a view to agreeing on appropriate measures to

be taken in the circumstances.

2.7. Suspension:

The State Nodal Cell may, with written notice of suspension to the

service Agency, suspend all payments to the Service Agency

hereunder if the Service Agency fails to perform any of their

obligations under this Agreement, including the carrying out of the

Services, provided that such notice of suspension (i) shall specify the

nature of the failure, and (ii) shall request the Service Agency to

remedy such failure within a period not exceeding fifteen (15) days

after receipt by the Service Agency of such notice of suspension.

2.8. Termination:

2.8.1. By the State Nodal Cell:

The State Nodal Cell may, by not less than thirty (30) days written

notice of termination to the Agency for the occurrence of any of

the events specified hereunder of this Clause 2.8.1 terminate this

Agreement.

(a) If the Service Agency fails to remedy a failure in the performance

of their obligations hereunder, as specified in a notice of

suspension pursuant to Clause 2.8 hereinabove, within thirty

(30) days of receipt of such notice of suspension or within such


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further period as the State Nodal Cell may have subsequently

approved in writing:

(b) If the Service Agency becomes insolvent or bankrupt or enter

into any agreements with their creditors for relief of debt or take

advantage of any law for the benefit of debtors or go into

liquidation or receivership whether compulsory or voluntary;

(c) If the Service Agency fails to comply with any final decision

reached as a result of arbitration proceedings pursuant to

Clause 8 hereof;

(d) If the Service Agency submits to the State Nodal Cell a statement

which has material effect on the rights, obligations or interests

of the State Nodal Cell and which the Agency know to be false.

(e) If, as a result of Force Majeure, the Service Agency are unable

to perform a material portion of the Services for a period of not

less than sixty (60) days; or

(f) If the State Nodal Cell, in its sole discretion and for any reason

whatsoever, decides to terminate this Agreement.

(g) If the Service Agency, in the judgment of the State Nodal Cell

has engaged in corrupt or fraudulent practices in competing for

or in executing the Agreement.

(h) If the Service Agency is found to have appointed a sub-agency

to perform all or any part of his Service.

(i) If by the assessment of the State Nodal Cell, the Service Agency

is found to be deficient in the delivery of service of any

component specified in the clause 10, partly or wholly.

For the purpose of this clause:

"Corrupt practice" means the offering, giving, receiving or

soliciting of anything of value to influence the action of a public

official in the selection process or in Agreement execution.

"Fraudulent practice" means a misrepresentation of facts in

order to influence a selection process or the execution of


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Agreement to the detriment of the State Nodal Cell and includes

collusive practice among Agency (prior to or after submission of

proposals) designed to establish prices at artificial non-

competitive levels and to deprive the State Nodal Cell of the

benefits of free and open competition.

In case the Agreement is terminated, the balance amount of

advance fee if, any, paid earlier shall be paid back by the Service

Agency to the State Nodal Cell within thirty days of the

termination letter, failing which the same shall be recovered by

en-cashing the existing Bank Guarantee submitted by Service

Agency.

2.8.2. By the Service Agency:

The Service Agency may, by not less than thirty (30) days' written

notice to the State Nodal Cell, such notice to be given after the

occurrence of any of the events specified hereunder of this Clause

2.8.2, terminate this Agreement;

(a) If the State Nodal Cell fails to pay the money due to the

Service Agency pursuant to this Agreement and not subject

to dispute pursuant to Clause 8 hereof within forty-five (45)

days after receiving written notice from the Service Agency

that such payment is overdue;

(b) If the State Nodal Cell is in material breach of its obligations

pursuant to this Agreement and has not remedied the same

within forty-five (45) days (or such longer period as the

Service Agency may have subsequently approved in writing)

following the receipt by the State Nodal Cell of the Service

Agency notice specifying such breach;

(c) If, as the result of Force Majeure, the Service Agency are

unable to perform a material portion of the Services for a

period of not less than sixty (60) days; or

(d) If the State Nodal Cell fails to comply with any final decision

reached as a result of arbitration pursuant to Clause 8

hereof.

2.8.3. Cessation of Rights and Obligations:


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Upon termination of this Agreement pursuant to Clause 2.1 or

2.8 hereof, or upon expiration of this Agreement pursuant to

Clause 2.3 hereof, all rights and obligations of the Parties

hereunder shall cease, except;

i) such rights and obligations as may have accrued on the date

of termination or expiration;

ii) the obligation of confidentiality set forth in Clause General

Condition 3.3 hereof;

iii) any right which a Party may have under the Applicable Law.

2.8.4. Cessation of Services:

Upon termination of this Agreement by notice of either Party to

the other pursuant to Clauses 2.8.1 or 2.8.2 hereof, the Service

Agency shall, immediately upon dispatch or receipt of such

notice, take all necessary steps to bring the Services to a close in

a prompt and orderly manner and shall make every reasonable

effort to keep expenditures for this purpose to a minimum. With

respect to documents prepared by the Service Agency and

equipment and materials furnished by the State Nodal Cell, the

Agency shall proceed as provided by Clause 3.9 and 3.10 hereof.

2.8.5. Payment upon Termination:

Upon termination of this Agreement pursuant to Clauses 2.8.1

or 2.8.2 hereof, the State Nodal Cell shall make the payments to

the Service Agency provided after offsetting against these

payments any amount that may be due from the Service Agency:

i) Service charges pursuant to Clause 6 hereof for Services

satisfactorily performed prior to the effective date of

termination;

ii) except in the case of termination pursuant to paragraphs (a)

through (g) of Clause 2.8.1 hereof, reimbursement of any

reasonable cost incident to the prompt and orderly

termination of the Agreement.


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2.8.6. Disputes about Events of Termination:

If either Party disputes whether an event specified in paragraphs

(a) through (g) of Clause 2.8.1 or in Clause 2.8.2 hereof has

occurred, such Party may, within forty-five (45) days after receipt

of notice of termination from the other Party, refer the matter to

arbitration pursuant to Clause General Condition 12 hereof, and

this Agreement shall not be terminated on account of such event

except in accordance with the terms of any resulting arbitral

award.

3. Obligations of the Service Agency:

3.1. General:

3.1.1. Standard of Performance:

The Service Agency shall perform the Services and carry out their

obligations hereunder with all due diligence, efficiency and

economy, in accordance with generally accepted professional

techniques and practices, and shall observe sound management

practices, and employ appropriate advanced technology and safe

and effective equipment, machinery, materials and methods. The

Service Agency shall always act, in respect of any matter relating

to this Agreement or to the Services, as faithful advisers to the

State Nodal Cell, and shall at all times support and safeguard

the State Nodal Cell's legitimate interest in any dealings with

Third Parties.

3.1.2. Law Governing Services:

The Service Agency shall perform the Services in accordance with

the Applicable Law and shall take all practicable steps to ensure

that any Personnel and agents of the Agency comply with the

Applicable Law. The State Nodal Cell shall advise the Service

Agency in writing of relevant local customs and the Service

Agency shall, after such notifications respect such customs.

3.2. Conflict of Interests:

3.2.1. Service Agency not to Benefit from Commissions, Discounts etc.


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The service charges of the Service Agency pursuant to Clause 6

hereof shall constitute the Service Agency' sole remuneration in

connection with this Contract or the Services and, the Service

Agency shall not accept for their own benefit any trade

commission, discount or similar payment in connection with

activities pursuant to this Agreement or to the Services or in the

discharge of their obligations hereunder, and the Service Agency

shall use their best efforts to ensure that their Personnel or their

agents, similarly shall not receive any such additional

remuneration.

3.2.2. Procurement Rules of the State Nodal Cell:

If the Service Agency as part of the Services, have the

responsibility of advising the State Nodal Cell on the

procurement of goods, works or services, the Service Agency

shall comply with any applicable procurement guidelines of the

State Government/ State Nodal Cell and shall at all times

exercise such responsibility in the best interest of the State Nodal

Cell. Any discounts or commissions obtained by the Service

Agency in the exercise of such procurement responsibility shall

be for the account of the State Nodal Cell.

3.2.3. Prohibition of Conflicting Activities:

Neither the Service Agency nor the Personnel appointed by

Service Agency shall engage, either directly or indirectly, in any

of the following activities:

(a) during the term of this Contract, any business or

professional activities in India which would conflict with the

activities assigned to them under this Contract; or

(b) after the termination of this Contract, such other activities

objectionable to State Nodal Cell.

3.3. Confidentiality:

Each party shall maintain in confidence all information they have

been identified as ‘Confidential’ and disclosed to the other party

including but not limited to information related to the other party’s

trade secrets, know-how/technical data, research, products,


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software services, development, inventions, processes, techniques,

strategies, internal procedures, employees and business

opportunities, beneficiaries either present or prospective and PHI

(‘Confidential Information’). Further each party shall not divulge to a

third party any Confidential Information obtained by it in the course

of its execution of its work or use such information for any purpose

whatsoever save as may be strictly necessary for the performance of

the obligation under this Agreement.

State Nodal Agency shall execute Separate Non-Disclosure

Agreement (NDA) with Service Agency so as to comply privacy &

confidentiality.

In any case System must comply with Reasonable Security Practices

for PHI as specified in Section 43A of Indian I.T. Act, 2000 so as to

avoid legal liabilities in the cases confidentiality violation resulting

in I.T. Act, 2000 compensation claims against service agency.

Special Techno-Legal Audit and Cyber Law Compliance Audit Report

shall be submitted by a service agency to the SNC so as to comply

with aforesaid provisions of due diligence as per Indian I.T. Act,

2000.

3.4. Liability of the Service Agency:

Limitation of the Service Agency’s Liability towards the State Nodal

Cell:

(a) Except in case of gross negligence or willful misconduct on the

part of the Service Agency or on the part of any person or firm

acting on behalf of the Service Agency in carrying out the

Services, the Service Agency, with respect to damage caused by

the Service Agency to the State Nodal Cell's property, shall be

liable to the State Nodal Cell.

(i) for any indirect or consequential loss or damage; and

(ii) for any direct loss or damage that does not exceeds (A) the

total payments for Professional Fees or (B) the proceeds the

Service Agency may be entitled to receive from any

insurance maintained by the Service Agency to cover such

a liability, whichever of (A) or (B) is higher.


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(b) This limitation of liability shall not affect the Service Agency'

liability, if any, for damage to Third Parties caused by the

Service Agency or any person or firm acting on behalf of the

Service Agency in carrying out the Services.

3.5. Insurance to be taken out by the Implementing Support Agency (ISA):

The Service Agency (i) shall take out and maintain, at their own cost

but on terms and conditions approved by the State Nodal Cell,

insurance against the risks, and for the coverage, as mentioned below,

and (ii) at the State Nodal Cell's request, shall provide evidence to the

State Nodal Cell showing that such insurance has been paid.

The risks and the coverage shall be as follows:

(a) Third Party Motor Vehicle Liability Insurance as required under

existent Motor Vehicles Act in respect of motor vehicles operated in

India by the Service Agency or their Personnel for the period of

Consultancy.

(b) Third Party Liability Insurance with a minimum coverage for Rs. 10.00

lakhs for the period of consultancy.

(c) State Nodal Cell's Liability and Workers' Compensation Insurance in

respect of the Personnel of the Agency, in accordance with the relevant

provisions of the Applicable Law, as well as, with respect to such

Personnel, any such life, health, accident, travel or other insurance as

may be appropriate; and

(d) Insurance against loss of or damage to:

(i) the Service Agency' property used in the performance of the

Services,

(ii) any documents prepared by the Service Agency in the

performance of the Services.

3.6. Accounting, Inspection and Auditing:

The Service Agency shall follow standard accounting practices for

maintaining their accounts and shall permit the nominated or


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authorised representatives of State Nodal Cell to inspect the Service

Agency's account and records related to the performance of the

Service Agency, if so required by the State Nodal Cell.

3.7. Service Agency's Actions requiring State Nodal Cell's prior Approval:

The Service Agency shall obtain the State Nodal Cell's prior approval

in writing before taking any of the following actions:

(a) Any action which is likely to affect the interests of the State

Nodal Cell.

(b) any other action objectionable to the State Nodal Cell.

3.8. Reporting Obligations:

The Service Agency shall submit to the State Nodal Cell the reports

and documents required to be submitted intimated to him in writing

by the State Nodal Cell, in the numbers and within the time periods

set forth.

3.9. Documents Prepared by the Service Agency to be the Property of State

Nodal Cell:

All plans, drawings, specifications, designs, reports and other

documents prepared by the Service Agency in performing the Services

shall become and remain the property of the State Nodal Cell, and

the Service Agency shall, not later than upon termination or

expiration of this Contract, deliver all such documents to the State

Nodal Cell, together with a detailed inventory thereof. The Service

Agency may retain a copy of such documents. The Service Agency

shall not use these documents for purposes unrelated to this

Contract without the prior written approval of the State Nodal Cell.

3.10. Equipment and Materials Furnished by the State Nodal Cell:

Equipment and materials made available to the Service Agency by the

State Nodal Cell, or purchased by the Service Agency with funds

provided by the State Nodal Cell, shall be the property of the State

Nodal Cell and shall be marked accordingly. Upon termination or

expiration of this Contract, the Service Agency shall make available

to the State Nodal Cell an inventory of such equipment and materials

and shall dispose of such equipment and materials in accordance


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with the State Nodal Cell's instructions. While in possession of such

equipment and materials, the Service Agency, unless otherwise

instructed by the State Nodal Cell in writing, shall insure them in an

amount equal to their full replacement value.

3.11 Intellectual Property Rights:

a. The Service Agency shall indemnify State Nodal Cell against all third-

party claims of infringement of IP rights, copyright, patent, trademark

or industrial design rights arising from use of the Goods or any part

thereof in India. In the event of any claim asserted by a third party of

infringement of IP rights, copyright, patent, trademark or industrial

design rights arising from the use of the Goods/Services or any part

thereof in India, the Service Agency shall act expeditiously to

extinguish such claim. If the Service Agency fails to comply and State

Nodal Cell is required to pay compensation to a third party resulting

from such infringement, the Service Agency shall be responsible for

the compensation including all expenses, court costs and lawyer fees.

State Nodal Cell will give notice to the service agency of such claim,

if it is made, without delay.

b. Application Software being used by Service Agency for providing the

services shall be fully owned by the Service Agency. All the data

generated during the services will be owned by State Nodal Cell as

per the stated policy of government of Gujarat. Service Agency has

to establish piracy prevention policy and submit the same to the State

Nodal Cell.

c. The software licenses supplied by Service Agency shall be genuine,

perpetual, full use and should provide patches, fixes, security

updates directly from the Original Equipment Manufacturer (OEM)

at no additional cost to the State Nodal Cell during the entire period

of contract.

3.12. Appointment of Sub-Agency:

The bidder may subcontract certain activities related to scope of work

of the bidder under this Project. The activities proposed to be

subcontracted by the Bidder shall be indicated in the Technical

Proposal, with sufficient justification. It is clarified that Bidder shall

be the sole responsible party for all activities in the scope of work of


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the project – sub-contracted or otherwise, and will be held liable by

State Nodal Cell for all aspects of the project.

The Back-up and Disaster Recovery services shall be outsourced with

the prior approval of State Nodal Cell.

4. Agency' Personnel:

4.1. General:

The Service Agency shall engage and provide services of required

qualified and experienced Personnel.

4.2. Description of Personnel:

(a) The titles, job descriptions, minimum qualification and estimated

periods of engagement in the carrying out of the Services of each

of the Agency' Key Personnel, are to be submitted in the Technical

proposal. The actual list of personnel marked for deployment has

to be submitted to the State Nodal Cell and got approved before

the commencement of Service.

(b) If required to comply with the provisions of Clause 3.1.1 of this

Agreement, adjustments with respect to the estimated periods of

engagement of Key Personnel may be made by the Agency by

written notice to the State Nodal Cell, provided that such

adjustments shall not alter the originally estimated period of

engagement of any individual by more than 10% or one week,

whichever is larger. Any other such adjustments shall only be

made with the State Nodal Cell's written approval.

(c) “Key Personnel” are those who will be individually in-charge of Pre-

Authorization, Claims Processing, Network Hospital Management

and Medical Audit, IEC and Health Camp Management, and MIS.

Key Personnel should have the following minimum qualifications:


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Key Personnel Minimum Qualification

Pre-Authorization - Master of Surgery Degree in General

Surgery or other relevant specialties

Claims Processing - Master of Surgery Degree in General

Surgery or other relevant specialties

Network Hospital

Management and

Medical Audit

- Post Graduate Qualification in Medicine

(M.D. or M.S.)

IEC and Health Camp

Management

- Master Degree in Communication /Social

Work.

- Experience in working with development

sector and designing mass media

campaign and advocacy

MIS - Degree from a recognized University of

India with experience in handling MIS for

similar type of schemes / policies.

4.3. Approval of Personnel:

The Key Personnel, which the Service Agency proposes to engage

in carrying out the Services, are to be approved by the State Nodal

Cell. The Service Agency shall submit a copy of their Bio data to

the State Nodal Cell for review and approval. If the State Nodal Cell

does not object in writing (stating the reasons for the objection)

within twenty-one (21) calendar days from the date of receipt of

such biographical data such Key Personnel shall be deemed to

have been approved by the State Nodal Cell.

4.4. Working Hours, Overtime, Leave, etc.:

The Service Agency' Service Charges shall be deemed to cover all

the expenditure incurred in leaves, overtime pays, home travel etc.

Any taking of leave by Personnel on account of unforeseen

circumstances shall be with prior approval of the State Nodal Cell

and the Service Agency shall ensure that absence for leave

purposes will not delay the progress and adequate supervision of

the Services. Further, no fee shall be payable to the Service Agency

for such leave periods and suitable deductions from the bills shall

be made on this account.


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4.5. Removal and/or Replacement of Personnel:

(a) Except as the State Nodal Cell may otherwise agree, no

changes shall be made in the Key Personnel. If, for any

reason beyond the reasonable control of the Service Agency,

it becomes necessary to replace any of the Personnel, the

Service Agency shall forthwith provide as a replacement a

person of equivalent or better qualifications. The upper limit

of substitution on account of various reasons including on

health ground should normally not exceed 25% of the total

key personnel as approved as per clause 4.3.

(b) If the State Nodal Cell (i) finds that any of the Personnel has

committed serious misconduct or has been charged with

having committed a criminal action, or (ii) has reasonable

cause to be dissatisfied with the performance of any of the

Personnel, then the Agency shall, at the State Nodal Cell's

written request specifying the grounds therefore, forthwith

provide as a replacement a person with qualifications and

experience acceptable to the State Nodal Cell.

(c) In case of any of the Personnel provided as a replacement

under Clauses (a) and (b) above, the Agency shall bear all

additional travel and other costs, or any costs arising out of

or incidental to any such removal and/or replacement.

4.6 Head Office and Regional Office:

The Service Agency shall establish the Head Office with adequate

staff and infrastructure at Gandhinagar, as close to the

Commissionerate of Health office as possible, which shall form

the official address for all communication and transaction with

regard to the performance of the services of the Service Agency.

The Service Agency shall ensure that at all times during the

performance of the Services a Project Manager, acceptable to the

State Nodal Cell, shall take charge of the performance of such

Services.

The Agency shall also establish a Regional Office at the Regional

Headquarters with adequate staff and infrastructure which shall

form the one point contact for the State Nodal Cell and Service


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Agency Head Office to coordinate with Regional and District

Administration and assist with performance of the Services at the

local level. The Regional Office shall also coordinate with District

Coordinators to be appointed by the Agency, as mentioned later

in clause 9.10.

4.7 Non-Disclosure Agreement:

Every person appointed by service agency shall sign separate Non-

Disclosure Agreement with Service agency so as to comply with

reasonable security requirements as per provisions of Information

Technology Act, 2000.

5. Obligations of the State Nodal Cell:

5.1. Assistance and Exemptions:

The State Nodal Cell shall use its best efforts to ensure that the

Government shall:

(a) provide the Agency, and Personnel with documents as shall

be necessary to enable the Agency, or Personnel to perform

the Services;

(b) issue to officials, agents and representatives of the

Government all such instructions as may be necessary or

appropriate for the prompt and effective implementation of

the Services;

(c) provide to the Agency, and Personnel any such other

assistance as may be required time to time.

5.2. Access to all facilities:

The State Nodal Cell will facilitate access free of charge, to all

facilities owned by State of Gujarat, in respect of which access is

required for the performance of the Services.

5.3 Services, Facilities and Property of the State Nodal Cell:

Though not obligatory, the State Nodal Cell shall provide all possible

assistance, within his own constraints, to the Service Agency to set


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up the establishment in the place of providing service covered under

this Agreement in the section “Scope of Work”.

5.4 Counterpart Personnel:

No counterpart personal will be made available to the Service

Agency by the State Nodal Cell.

6. Payments to the Agency:

6.1. Service Charges:

a) The State Nodal Cell will pay the Service Charges to the

Implementation Support Agency directly in 4 (four) equal quarterly

installments of the total service charge.

b) for Additional Services if any ordered by the State Nodal Cell in

writing at rates and prices as agreed mutually.

6.2. Currencies of Payment:

All payments by the State Nodal Cell under this Agreement will

be made only in Indian Rupees.

6.3. Mode of Billing and Payment:

Billing and payments in respect of the Services shall be made as

follows:-

(a) As soon as practicable and not later than fifteen (15 days) after

the end of each quarter during the period of the Services, the

Agency shall submit to the State Nodal Cell, the claim for amount

as specified in clause 6.1.b of this document, and in duplicate,

itemized report of services provided during the period.

(b) The State Nodal Cell after confirming the veracity of the report

submitted, and that the quality of the services provided by the

Agency has been satisfactory, will make the payment to the

Agency, not later than 21 (twenty one) working days from the date

of submission of the claim.

6.4. Penalty for not executing the work or for delay in execution:


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a. If the State Nodal Cell realises directly, or through an agency

(third party) appointed by the State Nodal Cell for the purpose of

evaluating the service, that the Service Agency has not completed

all or any or any part of its work described in Scope of work

clause 10, during the contract period; the payment to the Service

Agency shall be restricted to the amount proportionate to the

quantum of work performed under that component. In addition

the Service Agency shall be liable to pay a penalty equivalent to

maximum of 20% (twenty percent) of the Service charges for that

component.

b. In case of delay of execution of work, the Agency shall be liable

to pay a penalty as described in Schedule 1 (“Penalty for delay in

Execution of Work”) of this document.

6.5. Performance Security:

a. The Agency shall, for due and punctual performance of its

obligations relating to the Scheme, deliver to the State Nodal

Cell, on the same day with the execution of this Agreement, a

bank guarantee from a Nationalised bank acceptable to the

State Nodal Cell, in the form as set forth in Appendix J,

("Performance Security”) for a sum equivalent to 10% of the

total Service Charges agreed to be paid to the Agency by the

State Nodal Cell.

b. The Performance Security shall be kept valid for the contract

period and one month thereafter.

7. Fairness and Good Faith:

7.1. Good Faith:

The Parties undertake to act in good faith with respect to each

other's right under this Agreement and to adopt all reasonable

measures to ensure the realization of the objectives of this

Agreement.


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7.2. Operation of the Agreement:

The Parties recognize that it is impractical in this Agreement to

provide for every contingency which may arise during the life of

the Agreement, and the Parties hereby agree that it is their

intention that this Agreement shall operate fairly as between

them, and without detriment to the interest of either of them, and

that, if during the term of this Agreement either Party believes

that this Agreement is operating unfairly, the Parties will use

their best efforts to agree on such action as may be necessary to

remove the cause or causes of such unfairness, but no failure to

agree on any action pursuant to this Clause shall give rise to a

dispute subject to arbitration in accordance with Clause 12

hereof.

8. Settlement of Disputes:

8.1. Amicable Settlement:

The Parties shall use their best efforts to settle amicably all

disputes arising out of or in connection with this Agreement or

the interpretation thereof.

8.2. Dispute Settlement:

Disputes shall be settled by arbitration in accordance with the

following provisions:

The parties shall seek to resolve in good faith any dispute or

difference arising between them in respect of any matter

connected with this Agreement. If the parties cannot resolve any

such dispute then disputes shall be referred to the award of two

arbitrators (one to be nominated by the "Agency" and one by

"State Nodal Cell" or in case of said arbitrators not agreeing, then

to the award of an Umpire to be appointed by the said arbitrators)

in writing before proceeding on the reference. The decision of the

arbitrators or in the event of their not agreeing, of the Umpire

appointed by them shall be final and binding on all parties to the

Agreement and the provision of the Arbitration and Conciliation

Act, 1996 and the rules hereunder and any statutory modification

thereof shall be deemed to apply to such reference and deemed

to be incorporated in the Agreement. The joint Arbitrators/


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Umpire may from time to time with the consent of parties enlarge

the time for making and publishing the award. The joint

Arbitrators/ Umpire will be bound to give claim-wise detailed and

speaking award and it should be supported by reasoning.

Only questions and disputes as were raised during the execution

of the work till its completion and not thereafter shall be referred

to arbitration. However, this would not apply to the questions and

disputes relating to liabilities of the parties after completion of the

work.

While invoking arbitration, the Agency shall give a list of disputes

with amounts in respect of each dispute along with the notice for

appointment of Arbitrator.

The proceedings of arbitration shall be conducted in the English

language and the arbitration shall be held in Gandhinagar,

Gujarat, India.

If the Agency does not make any demand for appointment of

Arbitrator in respect of any claims in writing as aforesaid within

120 days of receiving the intimation from the State Nodal Cell

that final bill is ready for payment, the claim of Agency shall be

deemed to have been waived and absolutely barred and the State

Nodal Cell shall be discharged and absolved of all liabilities under

the Agreement.

8.3. Arbitrator’s fee:

If any fees are payable to the Arbitrator these shall be paid equally

by both parties.

8.4 Arbitration clause shall be only applicable in case of dispute is

arising out of contract. The said clause shall not be applicable in

the case of cyber-crimes and any other type of

confidentiality/security breach carried out by either Service

Agency itself or its employees. Both the parties agree the

jurisdiction of Adjudicating Authority, Gujarat state and Cyber

Appellate Tribunal, New Delhi under Information Technology Act,

2000 (including any amendments therein) shall be final in case of

any cyber contraventions, security and confidentiality breaches.


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9. OVERVIEW OF THE SCHEME:

9.1 The name of the scheme is “MUKHYAMANTRI AMRUTAM (MA)

& MA VATSALYA YOJANA”

9.2 Background:

A large number of households are pushed into poverty as a result

of high levels of household spending on healthcare. The Below

Poverty Line (BPL) population and Lower Income Group of

Families is especially vulnerable to catastrophic health risks. To

address this key vulnerability faced by these group of population

in the state, the Government of Gujarat has launched a medical

care scheme called MUKHYAMANTRI AMRUTAM (MA) YOJANA

(for BPL population) and MA VATSALYA YOJANA (for families

having and annual income of Rs.3 lacs or below per annum, fix

pay State Government employees, State government registered

press reporters and Accredited Social Health Activists (ASHAs)) –

providing cashless treatment and coverage of catastrophic

medical care to the scheme beneficiaries of the entire State of

Gujarat.

At the State level “State Nodal Cell (SNC)”, has been set up by the

State Government for the implementation of the Scheme. The

State Nodal Cell implements, administers, and supervises the

scheme Mukhyamantri Amrutam (MA) and MA Vatsalya Yojana

for providing medical care to the beneficiaries.

The Implementation Support Agency will assist the State Nodal

Cell in developing empanelment criteria for networking with the

Government/Private/Grant-in-Aid/Trust hospitals having Super

specialty services, and in fixing of treatment protocol and costs,

treatment authorization, so that the cost of administering the

scheme is kept at the lowest, while making full use of the

resources available in the Government / Private/ Grant-in-Aid/

Trust hospital systems. ISA will sign MoU with the

Private/Government/Trust/Grant-in-Aid hospitals fulfilling

minimum qualifications in terms of availability of inpatient

medical beds, laboratory, equipment’s, operation theatres etc.

and a track record in the treatment of the diseases can be

enlisted for providing treatment to the beneficiaries under the

scheme.


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9.3 Objective :

To improve access of BPL and Lower Income Group families or

families as decided by the State government from time to time

to quality medical and surgical care for treatment of identified

diseases involving hospitalization, surgeries and therapies

through an empaneled network of health care providers.

9.4 Beneficiaries:

The service agency shall cater services to three categories of

beneficiaries;

First- MA Vatsalya beneficiaries; Those families who are not

enlisted under SECC data base, having MA Vatsalya card and

are eligible for a benefit of Rs.3 lakh per family of five members

per year on a family floater basis. This beneficiary category

mainly includes families belonging to Lower Income Group (LIG)

(family having an income of Rs.3 lakh or below per annum),

Press Reporters (As per State Information Department), ASHAs

(as per Health and Family Welfare Department Gujarat), Fix pay

State Government Employees belonging to Class 3 (three) & 4

(four) category, Senior citizens (Having an income of Rs.6 lakh

or below per annum) and any other families as decided by the

State government. According to a recent enumeration, there are

approximately 40 lakh such families (LIG families as per SECC-

2011 data base excluding families belonging to BPL category as

per 2003 senses) in Gujarat. Out of this approximately 39 lakh

families are registered and the Database and photograph of these

families are available in the form of bar coded plastic card issued

by the Commissionerate of Health & Family Welfare Department,

Gandhinagar. However numbers of bar coded plastic card

holders are subject to increase or decrease.

Second- MA beneficiaries; Those families who are not enlisted

under SECC data base, having MA card and are eligible for a

benefit of Rs.3 lakh per family of five members per year on a

family floater basis. This beneficiary category includes families

belonging to Below Poverty Line (BPL) (as per the list provided by

the Urban & Rural Development Department). There are 38 lakh

BPL families existing in the State and out of this 22 lakh


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families are registered under MA Yojana. The Database and

photograph of these families are available in the form of bar coded

plastic card issued by the H&FW Department, Gandhinagar.

However, numbers of bar coded plastic card holders are subject

to increase or decrease because enrollment under MA Yojana is a

continuous process throughout the year and there is no fix time

period for beneficiary’s enrollments.

Third- AB-NHPM beneficiaries; Those families who are enlisted

under SECC data base, having MA/MA Vatsalya card and are

eligible for a benefit of Rs.5 lakh per family per year on a family

floater basis. According to a recent enumeration, there are 44.85

lakh such families (as per Government of India) and all are

entitled for scheme benefits. The beneficiary’s name, mobile

number, Aadhar number in the form of e-card will be issued by

the Health & Family Welfare Department, Gandhinagar.

However numbers of e-card card holders are subject to increase

or decrease.

District wise category wise cards issued to aforementioned

category of families are given below:

Sr.

No District Name

Families

Having "MA" cards

Having "MA" Vatsalya cards

1 Ahmedabad 1,51,567 2,56,715

2 Amreli 59,071 1,05,180

3 Anand 68,741 81,643

4 Aravalli 51,756 84,192

5 Banaskantha 1,39,391 1,93,474

6 Bharuch 85,136 70,590

7 Bhavnagar 63,626 1,34,800

8 Botad 19,467 62,553

9 Chhotaudepur 68,603 43,751

10 Dahod 1,22,061 17,451

11 Dangs 28,497 2,551

12 Devbhoomi Dwarka 22,536 40,138

13 Gandhinagar 38,958 77,775

14 Gir Somnath 36,931 95,063

15 Jamnagar 45,898 74,537


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16 Junagadh 45,810 1,22,495

17 Kheda 1,05,752 91,007

18 Kutch 60,159 70,340

19 Mahisagar 67,588 26,100

20 Mehsana 92,572 1,40,204

21 Morbi 30,857 32,122

22 Narmada 66,239 12,685

23 Navsari 44,637 72,656

24 Panchmahal 87,935 33,929

25 Patan 75,734 81,781

26 Porbandar 23,525 39,846

27 Rajkot 98,270 2,34,153

28 Sabarkantha 62,564 78,771

29 Surat 89,564 1,97,029

30 Surendranagar 82,739 85,594

31 Tapi 64,384 28,332

32 Vadodara 85,174 1,51,988

33 Valsad 78,548 44,505

Total 22,64,290 28,83,950

9.5 Unit of Enrolment:

A family would comprise the Head of the family, spouse, and up

to three dependents. The dependents would include such

members as listed as part of the family in the beneficiary

database. Head of the household will need to identify three

members (In cases where spouse is not in the beneficiaries list,

four members can be identified) who will be enrolled in the

scheme. If the spouse is part of the identified beneficiary family

list then it would be mandatory to enroll the spouse. However,

there will not be any limit for family members under AB-NHPM.

9.6 Sum Insured on Floater Basis:

The MA and MA Vatsalya scheme provides coverage for meeting

expenses of hospitalization and surgical procedures of

beneficiary members up to Rs.3.0 lakh per family of five

members per year subject to limits, in any of the network

hospitals. The benefit on family is on family floater basis i.e.

the total reimbursement of Rs.3.0 lakh can be availed


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individually or collectively by members of the family. However,

AB-NHPM beneficiaries shall be eligible for a benefit of Rs.5

lakh per family per year on a family floater basis. Claims under

AB-NHPM up to Rs.50,000 will be settled by the Insurance

Company. If the said claim amount is more than Rs.50,000 then

the left out claim amount within the limit of Rs.5.0 lakh per

family per annum will be settled by the SNC from MA Yojana.

9.7 Benefits:

1. Under MA and MA Vatsalya Yojana only the medical

procedures and other services as part of the

disease/treatment packages are provided on a complete

cashless basis. Enrolled beneficiary goes to the network

hospital with the bar coded plastic card and come out

without making any payment to the hospital for all

procedures which are covered under the scheme.

1) Cardiovascular Surgeries

2) Neurosurgeries

3) Burns

4) Poly Trauma

5) Malignancies (Cancer)

6) Renal (kidney)

7) Neo-natal diseases

In addition, there are no exclusions of pre-existing

conditions. Pre-existing diseases are covered from day one

which means that any illnesses existing prior to the

inception of the scheme are also covered.

Provision for transport allowance (Rs.300/- per visit) but

subject to an annual ceiling of Rs.4500/- is a part of the

total coverage of Rs.3, 00,000/- per family.

2. Under AB-NHPM

The AB-NHPM beneficiaries will get treatment free of cost for all such ailments covered under the Scheme within the

limits/ sub-limits and sum insured. The Empanel Health Care Provider will be reimbursed as per the package cost

specified in AB-NHPM Document. The Insurer shall undertake empanelment of all such hospitals providing primary, secondary and tertiary care services and

satisfying empanelment criteria’s of AB-NHPM. Here


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Insurance Company will perform beneficiaries Identification process and will ascertain availability of

sufficient balance at the time of hospitalization. Insurance Company will train Ayushman Mitras at each hospital on

the use of the Hospital IT infrastructure for making Claims electronically and providing Cashless Access Services at empanelled hospitals under AB-NHPM.

9.8 Eligible Health Services Providers:

All the public, private, trust and grant-in-aid hospitals which

provides hospitalization and/or daycare services would be eligible

for empanelment/inclusion under MA, MA Vatsalya and AB-

NHPM scheme, subject to such requirements for empanelment as

agreed between the State Nodal Cell, Implementation Support

Agency (ISA) and Insurance Company.

9.9 Empanelment of Hospitals:

Agreement with network Hospital: The ISA shall sign MoU with

all the hospitals to be empaneled under MA Yojana. Institutions

meeting the empanelment criteria set forth by the State Nodal

Cell and having undergone satisfactory inspection by the

Empanelment and Disciplinary Committee shall extend

healthcare to the beneficiary under the scheme. For non-

compliance, necessary clauses are to be made in the hospital

MoU.

9.10 Implementation procedure:

The entire scheme is intended to be implemented as cashless

hospitalization arranged by the Implementation Support Agency.

A) Package Rates:

The package rates includes; consultations, medicine, diagnostics,

food, hospital charges, etc. as indicated in the treatment package

and as decided by the State Nodal Cell from time to time.

B) Health Camps:

Health Camps are to be conducted by the network hospitals in


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various Taluka Head Quarters/ Gram Panchayats/

Municipalities/ Municipal Corporations as and when required.

The Implementation Support Agency should assist conducting

such medical camps with the support of the Network Hospitals at

the place and time suggested by the District/ Municipal

Corporation Authorities and the State Nodal Cell. Network

Hospitals shall provide necessary screening equipment and the

required specialists and other para-medical staff. They should

also work in close liaison with RDD/CDHO/MOH/CDMO and in

consultation with District Collector and District Development

Officer (DDO).

C) Procedure to be followed for availing treatment at Network

Hospitals

Step 1

Beneficiaries approaches the nearby Sub District

Hospitals/District Hospital/Medical College &

Hospital/Network Hospital. Arogya mitra would facilitate the

beneficiary. If the beneficiary visits any Government hospital

other than the Network Hospital, the doctors will give

him/her a referral card for the Network Hospital after

preliminary diagnosis. The Beneficiary may also attend the

Health Camps being conducted by the network hospitals and

can get the referral card based on the diagnosis.

Step 2

The Arogya mitra engaged by the Implementation Support

Agency at MA empaneled hospital and Ayushman Mitra at

AB-NHPM empaneled hospital will examine the referral card

and MA/ MA Vatsalya card/ Aadhar card/E-card or any

photo identity card (for AB-NHPM benefits) and

facilitates the beneficiary to undergo preliminary diagnosis

and basic tests.

Step 3

The Network Hospital, based on the diagnosis, admits the patient

and sends preauthorization request to the Insurance Company.

Step 4

Doctors/Specialists of the Insurance Company will examine the preauthorization request and will approve preauthorization within


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12 hours on receiving the preauthorization request for all normal

cases with claim amount less than Rs.50,000 and within 1 (one)

hours for emergencies. In case, if claim amount is more than Rs.50,000, then Insurance Company will forward the claim to the

Implementation Support Agency for Preauthorization. The decision of ISA shall be final in such cases.

Step 5

Doctors/Specialists of the Implementation Support Agency will

examine the preauthorization request and will approve

preauthorization within 12 hours on receiving the

preauthorization request from the network hospitals. In case of

claims forwarded by the Insurance Company the approval time for

the ISA shall be of 6 hours if all conditions are satisfied.

Step 6

The Network Hospital extends cashless treatment and surgery to

the beneficiary subject to the limits prescribed under the scheme.

Step 7

Network Hospital after discharge will forwards the original bill,

discharge summary with signature of the patient and other

relevant documents first to the Insurance Company (In case of AB-

NHPM claim up to Rs.50,000) and to the Implementation Support

Agency (In case of MA and MA Vatsalya beneficiaries) for

processing and settlement of claim within one week (7 days) from

the date of discharge of the patient. For all AB-NHPM claims above

Rs.50000 or if the family exhausts sum insured of Rs.50,000,

Insurance Company will forward the claim files to the ISA for

processing the amount/difference amount (as per the case) to the

respective Hospital.

Step 8

Implementation Support Agency will scrutinize the bill and

forwards the payment request to the State Nodal Cell (SNC)

within fifteen days (15 days) of its receipt from the Insurance

Company/Network Hospital.

Step 9

The State Nodal Cell (SNC) after verification of the bills in lieu of

the services provided will directly make the payment by way of

electronic transfer to the Network Hospital(s) within 30-days of

receiving the bills from the Implementation Support Agency.


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D) MIS/ IT Platform:

The Implementation Support Agency and all network providers

will use the IT platform developed by the State Nodal Cell to

conduct all transactions related to the Mukhyamantri Amrutam

(MA), MA Vatsalya and Ayushman Bharat- National Health

Protection Mission (AB-NHPM). Transactions including planning

and schedules of medical camps, E-preauthorization, processing

of claims and claims settlement among others will be conducted

on the Mukhyamantri Amrutam (MA) Yojana’s web portal. All data

related to scheme will be a proprietary right of the State Nodal Cell.

E) District Level Co-ordination:

District level offices with necessary infrastructure; including

manpower, table, computer and broadband connectivity etc., will

be provided by the Implementation Support Agency. The

Implementation Support Agency needs to have district level

monitoring staff with district coordinators (in charge of a group of

talukas within the district). They should ensure that camps are

held as per schedule, arrange for canvassing for the camp,

mobilize patients and follow up of beneficiaries. The role of Arogya

Mitras and District coordinators are detailed below. The ISA is

responsible for identifying, engaging, training and positioning the

Arogya Mitras, District and Regional Coordinators.

9.11 Online MIS and 24 Hour E-Preauthorisation:

The Implementation Support Agency should provide adequate

manpower, so as to ensure free flow of daily MIS and ensure

that progress of scheme is reported to State Nodal Cell in the

desired format on a real-time basis. The agency should facilitate

proper networking for quick and error-free processing of pre-

authorizations on MA portal. The upgradation and maintenance

cost of the software, hardware, connectivity and data center will

be borne by the State Nodal Cell. The preauthorization has to

be done round- the-clock i.e., by a team of doctors at the

Implementation Support Agency. The ISA will conduct all

transactions including e-Preauthorization on the MA Web

Platform. The ISA will be responsible for all preauthorization

requests and to complete it within 24 hours on receipt of the


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request. The preauthorization team shall have qualified

specialists, headed by ‘Key Personnel’ as specified in clause

4.2.

In case of repudiation of the claim not covered under the policy,

ISA will mention the reasons for repudiation in writing and

online to the network hospital and Insurance Company (in Case

of AB-NHPM).

9.12 Medical Auditors:

The scheme will have two separate audit mechanisms:

Internal audit: to be carried out by the Implementation Support

Agency. The Agency will create an internal audit function to ensure

claims are paid within the prescribed benefit package and also

ensuring the quality of service being delivered. The audit team will

consist of qualified specialist doctors, one audit district level

coordinator in all the thirty three districts, and two coordinators at

the State level headed by ‘Key Personnel’ as specified in clause 4.2.

At least 25 percent of the cases i.e., those admitted in the hospital

and receiving treatment, and audit of all network providers at least

once in a year needs to be conducted.

External audit: to be conducted by the State Nodal Cell. The audit

could include concurrent audits of pre-authorization, claims

management and administration, and network management among

others. The State Nodal Cell will also carry out surprise audits at a

regular frequency and the Agency is required to provide the

necessary assistance.

9.13 Publicity:

Publicity will be an integral component in driving the vision of the

programme to the masses. The Implementation Support Agency on its

part shall ensure that proper publicity is given to the scheme. Hence,

the “Key Personnel” in-charge of such activities, as mentioned in

clause 4.2, will be of great importance. The ISA would assist in

developing the publicity materials including brochures, banners,

display boards, etc. to be supplied by the State Nodal Cell and

displayed in public places. The Service Agency should effectively use

services of Arogya Mitras, district coordinators and the regional


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coordinators for this purpose. The ISA would also provide continuous

feedback to the State Nodal Cell on the methodology and

effectiveness of IEC activities.

9.14 Arogya Mitra – roles and responsibilities:

AROGYA MITRA (Friend of Health) will acts as facilitator for the

patients. In fact they form the face of this scheme. The

Implementation Support Agency (ISA) is the nodal agency that

selects the Health Coordinators (Arogya Mitras). The following

qualifications are to be ensured while engaging Arogya Mitras by the

ISA.

1. Graduate degree from a recognised university

2. Good communication skills

3. Prefers to move around the villages

4. Functional knowledge of computers

5. Proficient in Gujarati Language

The ISA will offer a suitable compensation package to Arogya

Mitras to ensure availability and retention of best talent. The

Arogya Mitras wages should not be less than the minimum wages

as decided by the State government from time to time. The

consolidated service charges for the Arogya Mitras should

including incidental expenses like traveling and all statutory

benefits like Provident Fund (PM) etc. The ISA will Provide Mobile

handsets and pay monthly service charges for CUG connections to

Arogya Mitras and District Coordinators. The work of the Arogya

Mitras will be monitored on a daily basis by the district

coordinators of the ISA.

The number of Arogya Mitras to be positioned in various Sub

District Hospital / District Hospital / Medical College & Hospital

/ Hospitals will vary in keeping with the requirements of each

local area. However, in the first instance about 210 Arogya Mitras

will be positioned. State Nodal Cell will decide the number and

place of posting of Arogya Mitras.

The State Nodal Cell may seek to increase or decrease the number

of Arogya Mitras and the service charges payable to ISA will be

adjusted on pro-rata basis.


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Training of Arogya Mitras:

Prior to placing Arogya Mitras in Network Hospitals, the ISA is

required to provide a two day training on their roles and

responsibilities as detailed below. The ISA is also required to

provide refresher training once in every 6 months incorporating

the experiences and gaps identified.

A. Role of Arogya Mitras in Government Hospitals:

Arogya Mitras should also ensure proper flow of MIS and reports to

the State Nodal Cell on day-to-day basis about the progress of the

scheme in the assigned area.

a. In Government Hospital:

Publicity and awareness.

Maintain helpdesk at hospital.

Receive the beneficiary.

Verify the Beneficiary criteria. (Eligibility Criteria)

Facilitate consultation with Doctor.

To counsel the patients who may require any one of the listed

surgeries.

To facilitate either to a Government Hospital for further tests

or to a Network Hospital depending upon the advice of the

doctor.

If required to be referred, fill up the referral card.

Guide the patient to the next center.

To guide the patient to Network Hospital.

Follow-up the referred cases.

In effect to act as, a guide and friend for the prospective

beneficiaries under the ‘MA’ Yojana.

b) Outside the Hospital:

To send daily MIS of the patients

To spread the awareness of the scheme in the villages.

To spread the awareness about the scheduled health camps by

network hospitals in the villages.

To coordinate with network hospitals and help conduct health

camps.

Mobilize the patients for health camps


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Follow up the patients identified in the health camp to report

to network hospital.

Coordinate with local PR Bodies, ANMs, and Women Health

Volunteers for effective implementation of the scheme.

Move around the villages and encourage patients to come to

avail the benefits of the scheme.

Educate villagers about the scheme and distribute brochures

and other material.

Keep in touch with the District Coordinator

Follow up the Beneficiaries before and after Surgery/Therapy.

B. Role of Arogya Mitras in the Network Hospitals:

Maintain Help Desk at Reception of the Hospital.

Receive the patient referred from (PHC/CHC or Network)

Verify the bar coded plastic card and the documents of the

patients.

Obtain digital photograph of the patient.

Facilitate the Patient for consultation and admission.

Liaison with Hospital Arogya Mitra (Hospital Coordinator)

/administration of the hospital.

Counsel the patient regarding treatment/surgery/therapy.

Facilitate early evaluation and posting for surgery/therapy.

Facilitate hospital send proper pre-authorization.

Follow-up preauthorization procedure and facilitate approval.

Follow-up recovery of patient.

Facilitate payment of transport charges as per the guidelines.

Facilitate cashless transaction at hospital.

Facilitate discharge of the patient.

Obtain feedback from the patient.

Counsel the patient regarding follow-up.

Coordinate with ANM/FHW/MPW/Government Hospitals/

Taluka Arogya Mitras for follow up of beneficiary.

Follow-up the patient referred by the hospital during the

camps.

Coordinate with the ISA and Medical officers for any

clarifications.

Send death reports

Send daily MIS.

Facilitate Network Hospital in conducting Health Camps as

scheduled


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9.15 Payment for Arogya Mitras:

Arogya Mitras will be paid the due service charges through

cheque or electronic credit by 5th of every month to their

respective bank account by the ISA.

9.16 Empanelled health facilities:

List of existing empanelled health facilities in the State will be

provided later.

9.17 Package rates:

State Nodal Cell will negotiate the rates of various medical /

surgical interventions / procedures under the scheme with the

hospitals in consultation with the Implementation Support

Agency and those hospitals who agree to accept the package rates

shall be empanelled. These package rates will include bed

charges (general ward), Nursing and boarding charges, Surgeons,

Anesthetists, Medical Practitioner, Consultants fees, Anesthesia,

Blood, Oxygen, O.T. Charges, Cost of Surgical Appliances,

Medicines and Drugs, Cost of Prosthetic Devices, implants, X-Ray

and Diagnostic Tests, food to patient etc. Expenses incurred for

diagnostic test and medicines up to 10 days of the discharge from

the hospital for the same ailment / surgery and transport

expenses will also be the part of package.

The package should cover the entire cost of patient from date of

reporting to his discharge from hospital, making the transaction

truly cashless to the patient. The claims will be settled by the State

Nodal Cell directly to the network service provider within 30-days of

its receipt from the implementation support agency.

9.18 Capacity Building:

The ISA will arrange workshops/training sessions for the

capacity building of Staff within the State Nodal Cell, their

representatives and other stakeholders as follows:

a. One training programme per quarter on Health Insurance

Administration and claims processing, for approx 15-20


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professional staff.

b. Training programme including refresher trainings for

Hospital Network Providers.

c. Training for Arogya Mitras based on the functions as listed

in clause 9.14.

9.19 Advocacy, Patient facilitation and Support Services:

The implementation support agency is required to present a

detailed plan on:

a) Mechanism for awareness generation among the beneficiaries,

particularly in the rural areas and more specifically among

the vulnerable sections of the community such as women &

children, Schedule Caste and Schedule Tribe population.

b) Engagement of services, training and deployment of Arogya

Mitras at each of the Taluka (Sub District) Hospitals/District

Hospitals/ Medical College & Hospitals and Network

Hospitals to facilitate the access to care for the scheme

beneficiaries.

10. Scope of Work:

10.1 Servicing of the Claims:

a. To review and update empanelment criteria for hospitals. The

service agency shall assist the State Nodal Cell in identifying and

networking with Providers within the State. (The ISA will enter

into MoU with the Network Providers)

b. To provide input on various formats used for cashless

transactions, discharge summary, billing pattern and other

reports prepared by the State Nodal Cell.

c. To arrange cashless treatment of the beneficiaries in the Network

hospitals under the defined benefit package.


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d. To provide adequate manpower, so as to ensure free flow of daily

MIS and ensure that progress of scheme is reported to State Nodal

Cell in the desired format on a real-time basis. The agency should

facilitate proper networking for quick and error-free processing of

pre-authorizations. This will be done through the dedicated

website of the State Nodal Cell.

e. To standardize various formats used for cashless transactions,

discharge summary, billing pattern and other reports in

consultation with the State Nodal Cell.

f. The Implementation Support Agency and all network providers

will use the IT platform developed by the State Nodal Cell to

conduct all transactions related to the Mukhyamantri Amrutam

(MA) & MA Vatsalya Yojana.

10.2 Pre-authorization and Claim Settlement:

10.2.1 The Implementation Support Agency shall process all the

claims related to the Scheme. The pre-authorization

processing personnel shall be qualified specialist Doctors,

headed by ‘Key Personnel’ as specified in clause 4.2. The

claims processing by implementation support agency

includes:

a. Pre-authorization of requests and approve preauthorization if

all the conditions are fulfilled, within 24-hours of receiving the

preauthorization request from the network provider.

b. Ensuring that Network Hospital extends cashless treatment

and surgery to the beneficiary

c. Scrutinize the bills from Insurance Company/network

hospitals (i.e., ensuring charges are as per the package

rates) and give approval for the sanction of the bill and

forward it to the State Nodal Cell for payment within 15 days

of the receipt of the bills from the Insurance

Company/Network Hospitals.

10.2.2 The State Nodal Cell will settle the claims of the hospitals

within 30 days of receipt of the approved bills along with


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the discharge summary and satisfaction letter of the

patient. The claims amount will be paid directly to the

provider by the State Nodal Cell i.e., the payment will not

be routed through the Implementation Support Agency. The

claim settlement progress will be audited both by an

internal and external audit team set-up by the State Nodal

Cell.

10.2.3 The Agency should not under any circumstances carry

out activities relating to insurance underwriting since the

proposed scheme is a prefunded scheme by the

Government of Gujarat.

10.2.4 The Agency is not required to carry any insurance risk,

since this is a pre-funded health scheme promoted by the

Government of Gujarat. Hence, all incurred health

expenditure under the scheme will be paid by the State

Nodal Cell set-up exclusively by the Government of Gujarat

for administering the scheme.

10.2.5 To set up field level monitoring staff as follows;

a. District coordinators (1 per district) for monitoring and

supervision of Arogya Mitras, and organizing Health

Camps.

b. District level internal auditors (a team of specialists with

relevant specializations) for conducting concurrent audits

of services delivered by Network Hospitals (At least 25% of

the patients undergoing treatment or treated are to be

covered under audit).

c. District level auditors (a team of specialists with relevant

specializations) for auditing quality of service provided to

the beneficiaries.

d. District level auditors to audit at least once a year, the

medical facilities available in the Network Hospitals.

10.3 Advocacy, Patient Facilitation and Support Services:


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10.3.1 To select, train and deploy adequate number of Arogya

Mitra personnel as sought for by the State Nodal Cell. The

Government of Gujarat / State Nodal Cell (SNC) is under

no obligation whatsoever in respect of their service claims.

10.3.2 To ensure, support and monitor that,

a) Each of the Network Hospitals organizes Health Camps as

assigned by the State Nodal Cell / District Health

Authorities.

b) All Taluka Head Quarters/ Gram Panchayats/

municipalities are covered in the health camp programme.

10.3.3 To ensure that proper publicity is given to the scheme.

The publicity includes interactive awareness creation

meeting in the villages, display of materials including

brochures, banners and display boards supplied by the

State Nodal Cell have to be displayed in public places, etc.

10.3.4 The ISA will Provide Mobile handsets and pay monthly

service charges for CUG connections to Arogya Mitras,

District Coordinator and Regional Coordinators.

To maintain quality and continuity of services the preference shall be

given to staff who has worked previously under MA Yojana.

IT IS HEREBY FURTHER AGREED THAT

The following arrangement for accounting, financing and audit are made by

the second party:-

a) The second party shall maintain a separate account and keep a true and

accurate record of the funds received from the first party. Such records

and the accounts will be made available for the inspection by the

designated representative of the first party.

b) The second party shall furnish true and correct accounts every year to

the State Nodal Cell and as and when requisitioned by the State Nodal

Cell.


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c) The second party shall furnish the Utilization Certificate to the first party

once in a quarter before claiming the next installment.

d) The second party shall furnish by 10th day of every month to the first

party, the statement of expenditure pertaining to the previous month

along with all the supporting documents.

e) Auditing of the accounts maintained by the second party shall be

conducted strictly in accordance with the guidelines given in the

Operation Manual. The audited accounts along with a copy of the audit

report shall be furnished to the first party every year.

f) It is hereby further agreed that the second party shall submit to the State

Nodal Cell all reports and documents relating to the progress of the

project, the accounts, audit, procurement, disbursement and annual

work plan at such intervals as required by the first party.

g) The Second party shall facilitate inspection by the First party or its

representatives; of the works, activities and documents related to the

Scheme when so desired by the First party.

IT IS HEREBY FURTHER AGREED THAT:

a) The first party will specify from time to time detailed norms for

maintenance of records and accounts for the expenditure, disbursement

and repayment under the scheme and shall have the power to modify,

amend or withdraw such norms as and when it deems it necessary;

b) That if at any time, any dispute, doubt or question shall arise between

the second party and the first party or any person claiming under them,

touching or arising out of or in respect of this deed or the subject matter

thereof, the same shall be resolved as specified in Clause 8 of this

document.


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AGREEMENT Schedule 1

Penalty for delay in execution of work

The Agency shall perform the assignment in the time frame as specified

under this clause. The Agency shall be liable to pay Penalty as shown below

for delay of execution of work.

SI

No.

Activity Time frame

from the

date of

Signing of

Agreement

Penalty for one

month of delay

in execution

in % of

component

charges

Servicing Claims

a. To arrange cashless treatment of

beneficiaries in the Network hospitals

under the defined benefit package.

3

months

6%

b. To provide adequate manpower, so as

to ensure free flow of daily MIS and

ensure that progress of scheme is

reported to State Nodal Cell in the

desired format on a real-time basis.

3

months

6%

c. Processing of preauthorization requests

related to the scheme. Scrutiny and

approval of preauthorization requests if

all the conditions are fulfilled, within 24-

hours of receiving the preauthorization

request from the network provider

System to

be ready in

4 months

(Continuin

g activity)

5%

d. Scrutinize claims from network

hospitals (i.e., ensuring charges are

as per the package rates) and give

approval for the sanction of the bill and

forward it to the State Nodal Cell for

payment within 15 working days of the

receipt of the bills from the Network

Hospitals.

System to

be ready in

4 months

(Continuin

g activity)

5%

e. District coordinators (1 per district) for

monitoring and supervision of Arogya

Mitras, and organization of the Health

Camps

1

month

20%


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f. District level internal auditors (a team

of specialists with relevant

specialisations) for conducting

concurrent audits of services delivered

by Network Hospitals

3

months

3%

g. District level auditors (a team of

specialists with relevant

specialisations) for auditing quality of

service provided to the beneficiaries

3

months

6%

h. District level auditors to audit at least

once a year, the medical facilities

available in the Network Hospitals.

10

months

2%

Advocacy, Patient Facilitation and Support Services

A To select, train and deploy required

number of Arogya Mitra personnel

3 months 6%

B To ensure each of the Network Hospital

organize Health Camps as per schedule

specified by State Nodal Cell.

4 months

onwards

Proportionate to

% of non-

performance

C To ensure proper publicity 3 months

onwards

Proportionate to

% of non-

performance

D One training programme per quarter on

Health Insurance Administration and

claims processing, for approx 15-20

professional staff.

3 months

onwards

Proportionate to

% of non-

performance

E Training programme including refresher

trainings for Hospital Network Providers

one in a month.

3 months

onwards

Proportionate to

% of non-

performance

F Claim Process related

1. Error in claims and Pre-

authorization;

Wrong package approval or

mismatch in actual approved

procedure and submitted physical

claim file.

From the

1st day of

work order

Equal to the

amount of claim

package

approved

Submission of Claim file with to

SNC with following errors;

1) missing; first consultation letter,

pre and post investigation

reports, OT note, charts

Hospital bill, patients discharge


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summary, patients satisfactory

letter, incomplete transportation

letter, claim documents with

missing signatures of patient,

specialist, HAM, patients

photograph, and all software

generated claim documents and

procedure wise documents as

decided by the SNC from time to

time.

From the

1st day of

work order

5% claim

amount of the

submitted claim

file with error.

2) Delay in pre-authorization

without any reason beyond 24

hrs.

5% claim

amount of the

submitted claim

file with error.

3) Delay in submission of physical

claim file beyond 15 days to

SNC.

5% claim

amount of the

submitted claim

file with error.

4) Claim file with mismatch in

claim amount then the actuals

as per the scheme guidelines.

Equal to the

amount of

mismatch claim

Amount.

5) Twice submission of same claim

files or claim related to

complication arisen from the

previous approved claims.

Equal to the

amount of said

claim approved

and released to

the hospital.

6) Claim approved not as per

scheme guidelines.

Equal to the

amount of said

claim approved

and released to

the hospital.


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Appendix B

Scope of Work of the ISA

I. Servicing of the Claims:

1. To review and update empanelment criteria for hospitals. The service

agency shall assist the State Nodal Cell in identifying and networking

with Providers within the State. (The ISA will enter into MoU with the

Network Providers)

2. To provide input on various formats used for cashless transactions,

discharge summary, billing pattern and other reports prepared by the

State Nodal Cell.

3. To arrange cashless treatment of beneficiaries in Network hospitals

under the defined benefit package.

4. To provide adequate manpower, so as to ensure free flow of daily MIS

and ensure that progress of scheme is reported to State Nodal Cell in

the desired format on a real-time basis. The agency should facilitate

proper networking for quick and error-free processing of pre-

authorizations. This will be done through the dedicated website of the

State Nodal Cell.

5. To standardize various formats used for cashless transactions,

discharge summary, billing pattern and other reports in consultation

with the State Nodal Cell.

6. The Implementation Support Agency and all network providers will use

the IT platform developed by the State Nodal Cell to conduct all

transactions related to the Mukhyamantri Amrutam (MA) & MA Vatsalya

Yojana. However, till the time State Nodal Cell develops its own IT solution,

the ISA may make use of its in-house software if available, subject to

meeting the requirements of the processes.

II. Claim settlement:

1. The Implementation Support Agency shall process all the claims related

to the Scheme. The pre-authorization processing personnel shall be

qualified specialist Doctors. The claims processing by implementation

support agency includes:


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a) Pre-authorization of requests and approve preauthorization if all the

conditions are fulfilled, within 24-hours of receiving the

preauthorization request from the network provider.

b) ensuring that Network Hospital extends cashless treatment and

surgery to the beneficiary

c) Scrutinize the bills from network hospitals (i.e., ensuring

charges are as per the package rates) and give approval for the

sanction of the bill and forward it to the State Nodal Cell for payment

within 15 days of the receipt of the bills from the Network Hospitals.

2. The State Nodal Cell will settle the claims of the hospitals within 30

days of receipt of the approved bills along with the discharge

summary and satisfaction letter of the patient. The claims amount

will be paid directly to the provider by the State Nodal Cell i.e., the

payment will not be routed through the Implementation Support

Agency. The claim settlement progress will be audited both by an

internal and external audit team set-up by the State Nodal Cell.

3. The Agency should not under any circumstances carry out activities

relating to insurance underwriting since the proposed scheme is a

prefunded scheme by Government of Gujarat.

4. The Agency is not required to carry any insurance risk, since this is a

pre-funded health scheme promoted by the Gujarat Government.

Hence, all incurred health expenditure under the scheme will be paid

by the State Nodal Cell set-up exclusively by the Government of Gujarat

for administering the scheme.

5. To set up field level monitoring staff as follows;

a) District co-ordinators (1 per district) for monitoring and supervision

of Arogya Mitras and organisation of the Health Camps.

b) District level internal auditors (a team of specialists with relevant

specialisations) for conducting concurrent audits of services

delivered by Network Hospitals (At least 25% of the patients

undergoing treatment or treated are to be covered under audit).


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c) District level auditors (a team of specialists with relevant

specialisations) for auditing quality of service provided to the

beneficiaries.

d) District level auditors to audit at least once a year, the medical

facilities available in the Network Hospitals.

III. Advocacy, Patient Facilitation and Support Services:

1. To select, train and deploy adequate number of Arogya Mitra personnel

as sought for by the State Nodal Cell. The Government of Gujarat /

State Nodal Cell (SNC) is under no obligation whatsoever in respect of

their service claims.

2. To ensure, support and monitor that:

a. Each of the Network Hospitals organizes Health Camps as per

schedule given by the State Nodal Cell/ District Health

Authorities.

b. All Taluka Head Quarters/ Gram Panchayats/

municipalities/Municipal Corporations are covered in the health

camp programme.

3. To ensure that proper publicity is given to the scheme: The publicity

includes interactive awareness creation meeting in the villages, display

of materials including brochures, banners, and display boards supplied

by the State Nodal Cell, have to be displayed in public places, etc.

IV. Capacity Building:

The ISA will arrange workshops/training sessions for the capacity

building of Staff within the State Nodal Cell, their representatives and

other stakeholders as follows:

a) One training programme per quarter on MA Yojana, Health

Insurance Administration and claims processing, for approx.

15-20 professional staff.

b) Training programme including refresher trainings for Hospital

Network Providers at least on quarterly basis or as and when

required.


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Appendix C

Covering Letter

(On the Letter-head of the Bidders)

Date:

To

The Project Director,

The State Nodal Cell (SNC),

Commissionerate of Health, Block No-5,

Dr. Jivraj Mehta Bhavan,

Gandhinagar, Gujarat,

India

Sub: Providing Support Services for Implementation of Mukhyamantri

Amrutam (MA) & MA Vatsalya Yojana

Sir/Madam,

Being duly authorized to represent and act on behalf of

…………………….. (hereinafter referred to as “the Bidder”), and having

reviewed and fully understood all of the Proposal requirements and

information provided and collected, the undersigned hereby submits the

Proposal on behalf of (Name of Bidder) for the Project, with the details as

per the requirements of the RFP, for your evaluation.

We confirm that our Proposal is valid for a period of six calendar months

from (insert Proposal Due Date).

Yours faithfully,

For and on behalf of (Name of Bidder)

Duly signed by the Authorised Signatory of the Bidder

(Name, Title and Address of the Authorised Signatory)


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Appendix D

Details of Bidder

(On the Letter Head of the Bidder)

1. (a) Name of Bidder

(b) Address of the office(s)

(c) Date of incorporation and/or commencement of business

2. Brief description of the Bidder's main lines of business.

3. Details of individual(s) who will serve as the point of contact /

communication for State Nodal Cell with the Bidder:

(a) Name :

(b) Designation :

(c) Company/Firm :

(d) Address :

(e) Telephone number :

(f) E-mail address :

(g) Fax number :

(h) Mobile number :

4. Name, Designation, Address and Phone Numbers of Authorised

Signatory of the Bidder

(a) Name :

(b) Designation :

(c) Company/Firm :

(d) Address :

(e) Telephone number :

(f) E-mail address :

(g) Fax number :

(h) Mobile number :


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Appendix E

Format for Anti-Collusion Certificate

Anti-Collusion Certificate

I/ We undertake that, in competing for (and, if the award is made to us, in

executing) the above contract, I / we will strictly observe the laws against

fraud and corruption in force in India namely “Prevention of Corruption Act

1988”.

I / We hereby certify and confirm that in the preparation and submission of

our Proposal, I / we have not acted in concert or in collusion with any other

Bidder or other person(s) and also not done any act, deed or thing which is or

could be regarded as anti-competitive.

I / We further confirm that we have not proposed nor will proposal any illegal

gratification in cash or kind to any person or agency in connection with the

instant Proposal.

Dated this ..........................Day of ......................, 2012

....................................................

(Name of the Bidder)

....................................................

(Signature of the Bidder / Authorised Person)

....................................................

(Name of the Authorised Person)


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Appendix F

Proof of Eligibility

Qualification Criteria:

The Implementation Support Agency (ISA) should have been incorporated at

least 5 (five) years before as of the tender notification date. It should have

full-fledged establishment with relevant experience in handling Medical

Claims for a minimum period of 5 years.

The ISA should furnish the following

Sl. No.

Qualification Criteria Supporting document

1 Company should have been incorporated at least 5 (five) years

prior to 31/03/2018

Copy of the Registration certificate and Audited Balance sheet of the

preceding 5 (five) financial years issued by the Chartered Accountant.

2 Having Annual Turnover of Rs. 50.00

crore in each of the previous three (3)

financial years(2015-16, 2016-17 &

2017-18)

Last three (3) years- audited Balance Sheet and Profit and Loss Statement

with Auditors Report

3 Experience in handling health claims- should have processed at

least 2,00,000 claims during the financial year 2017-18

Certified by Chartered Accountant/ any other proof showing the

experience

4 Claims management capacity of medical claims:

Proof of experience issued by the relevant authority/Chartered

Accountant. Submit Appointment letter

In the year 2017-18 not less than

Rs.200 Crores worth of claims

Company should have minimum

10 full time doctors on payroll

with minimum MBBS qualification in the last financial year 2017-18.

5 Should be an income tax assesse Income tax returns filed for the

preceding 1 (one) financial years (2016-17)

6 Should not have been black listed by any State government/ Central Government or their agencies

Undertaking to the effect

7 PF, ESIC, GST complaint

Copies of registration and self-

declaration that no dues are pending.


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Note: Bidders shall need to fulfill all the above mentioned qualification

criteria in order to qualify for the evaluation of the Technical Proposal.

Instructions:

The Bidder should provide the details mentioned above based on its own

technical capability. Technical capability of the Bidder's parent company or its

subsidiary or any associate company will not be considered for assessment of

the qualification parameters of the Bidder.

The Bidder should not have been blacklisted by Gujarat State/ Central

Government or any of its agencies. If it is found that the Bidder has not

disclosed above information during the Bid stage and such information has

been found after the award of the contract, the State Nodal Cell will impose a

penalty of 10% of the total cost of the worker order issued under

Mukhyamantri Amrutam (MA) & MA Vatsalya Yojana besides forfeiting the

Performance Security. Such Bidder will also be blacklisted for all further award

of contracts by the Health and Family Welfare Department, Gujarat.


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Appendix G

Technical Proposal

The evaluation of Technical Proposal will be done as follows:

Component Weight age pts

Annexure-1 Statement of Strategy for implementation

including Activity Chart

10

Annexure-2 Experience in handling hospitalization

claims of minimum families during the

Financial year 2017-18.

a) Up to 25 lakh families- 5

b) Above 25 lakh families- 10

10

Annexure-3 Experience of handling state/central govt.

health assurance schemes in last Financial

year i.e. FY 2017-18

a) One Scheme - 15 points

b) More than one scheme - 20 points

20

Annexure-4 Experiencing in managing hospitalization

claims by Volume in last Financial year

2017-18

a) up to 2,00,000 claims - 10 points

b) 200,001- 3,00,000 claims - 15 points

c) more than 3,00,000 claims - 20 points

20

Annexure-5 Technical and Management skills- MBBS &

Above Doctors on payroll

a) Up to 10 Doctors - 5 points

b) more than 10 doctors - 10 points

10

Annexure-6 Claims Management capacity of medical

claims: Total Claims Management Capacity

during the year 2017-18.

a) Up to Rs. 200 crores - 5 pts

b) Rs. 201 crores to Rs. 300 Crores - 10 pts

c) Rs. 300 crores and above - 20 pts.

20

Annexure-7 Power Point presentation to demonstrate

Bidder’s capability in relation to the main

deliverables within the timeframes

identified.

10

Total 100

Annexure-8 Self-declaration certificate regarding details

of terminations and litigations against the

Bidder

A self-

declaration

certificate


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Note:

The bidders are required to submit a self-declaration certificate regarding

details of terminations and litigations against the Bidder- As Annexure-8

The shortlisted Bidder shall be required to make a presentation of not more

than 20 minutes to demonstrate their capability to meet the deliverables.

Bidders scoring at least 70 points in the Technical Proposal shall be

declared as Technically Qualified Bidders. Financial Proposal of only the

Technically Qualified Bidders shall be opened for further evaluation.


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SCORING OF TECHNICAL PROPOSAL WILL BE AS DETAILED BELOW

Annexure 1

Statement of strategy for implementation of

a. Cashless transaction

b. Pre-authorization (24x7)

c. Claims management

d. Publicity

e. Quality assurance

f. Controlling fraud

g. Medical and Health facility audits

h. Handling 24x7 state or national level toll free call center

Activity Chart

Sr.

No.

Activity

Number of

days required to

complete the

activity from

the award date

Remarks

1 Identifying the Project Officer

2 Setting up of Project Office with

Infrastructure

3 Appointment of Medical Officers

4 Establishment of other staff

5 Preparatory meeting with hospitals

6 Inspection of hospitals vis-à-vis

scheme requirements, identification of

District Coordinators and District Level

auditors

7 Issue of CUG connections to District

Coordinators & Arogya Mitras

8 Distribution of publicity Material

9 Engaging services of Arogya Mitras at

Network Hospitals

10 Training of Arogya Mitras, distribution of

Aprons and CUG mobiles.

11 Training of Doctors

12 Training of other staff

13 IT enabling

14 Establishment of 24 Hrs. Call Center

15 Establishment of other infrastructure


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16 Establishment of infrastructure in the

districts

17 Preparatory meetings and trainings at

district level for inaugural of mega

camps.

Annexure-2

Experience in handling hospitalization claims of families during the year

2017-18.

Year Name of the

Scheme/ Contract

No. of

Claims

Processed

Amount of Claims

processed for

the period

Annexure-3

Experience of handling state/central govt. health assurance schemes in last

Financial year i.e. FY 2017-18

Name of the

Scheme /

Contract

No. of

Months/

Years

Scheme is

handled

No. of

Beneficiaries

Per Capita

Benefit

Amount of

claims

reported for

the period

Annexure-4

Experiencing in managing hospitalization claims by Volume in last financial

year 2017-18

Name of the

Scheme /

Contract/

Policies

No. of

Families

No. of

Beneficiaries

Per Capita

Benefit

Amount of

claims

Processed for

the period


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Annexure- 5

Curriculum Vitae of Technical and Management Personnel- key personnel’s

and MBBS & above Doctors on payroll.

Name of

the person

Area of Operation Skill sets Experience

and

qualification

Annexure-6

Total Claims Management Capacity during the year 2017-18.

Annexure 7

Power Point presentation to demonstrate Bidder’s capability in relation to the

main deliverables within the timeframes identified.

Annexure 8

Self-declaration certificate with details of terminations and litigations

against the Bidder.


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Appendix H

Financial Proposal for the Project

(On the Letter head of Bidder)

Through Online submission only

Date:

The Project Director,

The State Nodal Cell (SNC),

Commissionerate of Health, Block No-5,

Dr. Jivraj Mehta Bhavan,

Gandhinagar, Gujarat,

India

Sub: Providing Support Services for Implementation of Mukhyamantri

Amrutam (MA) & MA Vatsalya Yojana

Sir/Madam,

Having gone through this RFP document and having fully

understood the Scope of Work for the Providing Support Services for

Implementation of Mukhyamantri Amrutam (MA) & MA Vatsalya Yojana as

set out by The State Nodal Cell in the RFP document, I/ we are pleased to

inform that I / we would charge the following rates for providing various

support services as specified in Appendix B of RFP document.


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Item Total

value In

Rs. (for 3

years)

1. Servicing Claims Item-wise

I Assist SNC in Identifying Network Hospitals.

II. Preauthorization and Claims Settlement

a) Review and preparation of various formats used for

cashless transactions, discharge summary, billing pattern

and other reports in consultation with the SNC.

b) Facilitation of proper networking for quick and error-free

processing of pre-authorizations

c) Processing of preauthorization requests related to the

scheme. Scrutiny and approval of preauthorization requests

if all the conditions are fulfilled, within 24-hours of receiving

the preauthorization request from the network provider

(minimum 7 specialists and 3 MBBS for pre authorization,

and 7 specialists and 3 MBBS for claim processing).

d) To arrange cashless treatment of beneficiaries in the

Network hospitals under the defined benefit package.

e) Scrutinize the bills from network hospitals (i.e.,

ensuring charges are as per the package rates) and

give approval for the sanction of the bill and forward it to

the State Nodal Cell for payment within 15 days of the receipt

of the bills from the Network Hospitals (minimum 100

supporting administrative staff).

f) To provide adequate manpower, so as to ensure free flow

of daily MIS and ensure that progress of scheme is

reported to State Nodal Cell in the desired format on a

real-time basis.

Audit Number

of units

Rates per

unit/item

in Rs. (fig)

g) District co-coordinators (1 per

district) for monitoring and

supervision of Arogya Mitras,

and organization of the Health

Camps in 33 districts.

33


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h) Regional Coordinator (1 per

region) for monitoring and

supervision of District

Coordinator, Arogya Mitras, and

organization of the Health

Camps in districts.

6

i) District Grievance Coordinator (1

per district) for receiving and

resolving complains and

grievance arising under the

scheme in coordination with the

district grievance redressal

committee.

33

j) District level internal auditors

team (a team of specialists with

relevant specializations) for

conducting concurrent audits of

services delivered by Network

Hospitals.

33

k) District level auditors (a team of

specialists with relevant

specializations) for auditing

quality of service provided to the

beneficiaries.

33

l) District level auditors to audit at

least once a year, the medical

facilities available in the Network

Hospitals.

33

Sub Total

2. Advocacy, patient facilitation and support services (Item wise)

a. To select, train and deploy 210

number of AROGYA MITRA.

210

b. Provide Mobile handsets and pay

monthly service charges for CUG

connections to Arogya Mitras and

District Coordinators

240

c. To ensure proper publicity in every

district

33

d. One training programme per quarter

on Health Insurance Administration

9


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and claims processing, for approx 15-

20 professional staff.

e. Training programme including

refresher trainings for Hospital

Network Providers once in each

quarter.

9

f. 24x7 Call Center services

management including call center

set-up cost.

(Note- State has 18002331022 as

toll free number. The monthly land

line bill will be reimbursed by State

on actual basis):

a) Salary of 12 executive staff

managing the call center.

12

b) Salary of 2 (two) assistant

Manager.

2

g. To ensure, support and monitor that each of the Network

Hospitals organizes Health Camps assigned by the State

Nodal Cell / District Health Authorities.

Sub total

Total (1+2) service Charge

(The bid excludes the taxes to be paid)

I / we have reviewed all the terms and conditions of the Request for

Proposal including the Draft Agreement and would undertake to abide by all

the terms and conditions contained therein. I / we hereby declare that there

are, and shall be, no deviations from the stated terms in the RFP Document.

I undertake that the above rates will remain valid and that there will be no

ground to consider any changes during the term of this Agreement

Yours faithfully,

For and on behalf of (Name of Bidder), Duly signed by the Authorised

Signatory of the Bidder, (Name, Title and Address of the Authorised

Signatory),Signature of the Issuing Authority / THE State Nodal Cell

Representative

DECLARATION BY THE BIDDER

I, __________ Designated as ______ At_______ of ________ Implementation

Support Agency hereby declare that I have read the contents of the RFP

document and here by submit the Bid in the desired format with respective

annexures duly signed by me.


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Appendix I

Power of Attorney for signing of Bid

Know all men by these presents, We, ________________________ (name of the

firm and address of the registered office) do hereby irrevocably constitute,

nominate, appoint and authorize Mr. / Ms (Name), son/daughter/wife of

________________________ and presently residing at ________________________,

who is presently employed with us and holding the position of

________________________], as our true and lawful attorney (hereinafter

referred to as the “Attorney”) to do in our name and on our behalf, all such

acts, deeds and things as are necessary or required in connection with or

incidental to submission of our bid for ________(Name of Project) proposed or

being developed by the State Nodal Cell (SNC) (the “State Nodal Cell”)

including but not limited to signing and submission of all applications, bids

and other documents and writings, participate in bidders' and other

conferences and providing information / responses to the State Nodal Cell,

representing us in all matters before the State Nodal Cell, signing and

execution of all contracts including the Agreement and undertakings

consequent to acceptance of our bid, and generally dealing with the State

Nodal Cell in all matters in connection with or relating to or arising out of our

bid for the said Project and/or upon award thereof to us and/or till the

entering into of the Agreement with the State Nodal Cell.

AND we hereby agree to ratify and confirm and do hereby ratify and

confirm all acts, deeds and things lawfully done or caused to be done by our

said Attorney pursuant to and in exercise of the powers conferred by this

Power of Attorney and that all acts, deeds and things done by our said

Attorney in exercise of the powers hereby conferred shall and shall always be

deemed to have been done by us.

IN WITNESS WHEREOF WE, ________________________, THE ABOVE NAMED

PRINCIPAL HAVE EXECUTED THIS POWER OF ATTORNEY ON THIS

__________ DAY OF __________, 2018.

For________________________

(Signature)

(Name, Title and Address) Witnesses:

Accepted [Notarized]


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(Signature)

(Name, Title and Address of the Attorney)

Notes:

The mode of execution of the Power of Attorney should be in accordance with

the procedure, if any, laid down by the applicable law and the charter

documents of the executants(s) and when it is so required, the same should be

under common seal affixed in accordance with the required procedure.

Also, wherever required, the Bidder should submit for verification the extract of

the charter documents and documents such as a resolution/power of attorney

in favour of the person executing this Power of Attorney for the delegation of

power hereunder on behalf of the Bidder.


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Appendix J

PERFORMANCE SECURITY

(PROFORMA OF BANK GUARANTEE)1

THIS DEED OF GUARANTEE executed on this the ____day of ______at

________________ by ___________________________ (Name of the Bank) having its

Head/Registered office at ________________________________________

hereinafter referred to as “the Guarantor” which expression shall unless it be

repugnant to the subject or context thereof include successors and assigns;

In favour of

State Nodal Cell (SNC), (herein after referred to as the State Nodal Cell) and

having its office at Gandhinagar, which expression shall, unless repugnant to

the context or meaning thereof include its administrators, successors or

assigns.

WHEREAS

By the Agreement (“the Agreement”) dated ------- entered into between the

State Nodal Cell and the Agency........................ (herein after referred to as

the Agency) the Agency has agreed to provide service as per the Agreement

for the Mukhyamantri Amrutam (MA) & MA Vatsalya Yojana (hereinafter

referred to as “the Scheme”).

A. In terms of the said Agreement, the Agency is required to furnish to the

State Nodal Cell, an unconditional and irrevocable bank guarantee for an

amount of Rs. ........ [Rupees ............. only] as security for due and punctual

performance/discharge of its obligations under the Agreement, relating to

the execution of the Scheme.

B. At the request of the Agency, the Guarantor has agreed to provide bank

guarantee, being these presents guaranteeing the due and punctual

performance/discharge by the Agency of its obligations relating to the

Project.

1 To be issued by a Nationalised Bank in India


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NOW THEREFORE THIS DEED WITNESSETH AS FOLLOWS:

1. The Guarantor hereby irrevocably guarantees the due and punctual

performance by the Agency of all its obligations relating to the Scheme

and in connection with execution of the Scheme as envisaged in the

Agreement.

2. The Guarantor shall, without demur, pay to the State Nodal Cell sums

not exceeding in aggregate Rs. ....... [Rupees .............. only], within 15

days of receipt of a written demand therefore from the State Nodal Cell

stating that the Agency has failed to meet its obligations under the

Agreement. The Guarantor shall not go into the veracity of any breach

or failure on the part of the Agency or validity of demand so made by

the State Nodal Cell and shall pay the amount specified in the demand

notwithstanding any direction to the contrary given or any dispute

whatsoever raised by the Agency or any other Person. The Guarantor’s

obligations hereunder shall subsist until all such demands are duly met

and discharged in accordance with the provisions hereof.

3. In order to give effect to this Guarantee, the State Nodal Cell shall be

entitled to treat the Guarantor as the principal debtor. The obligations

of the Guarantor shall not be affected by any variations in the terms

and conditions of the Agreement or other documents or by the extension

of time for performance granted to the Agency or postponement/non

exercise/ delayed exercise of any of its rights by the State Nodal Cell or

any indulgence shown by the State Nodal Cell to the Agency and the

Guarantor shall not be relieved from its obligations under this

Guarantee on account of any such variation, extension, postponement,

non-exercise, delayed exercise of any of its rights by the State Nodal

Cell or any indulgence shown by the State Nodal Cell, provided nothing

contained herein shall enlarge the Guarantor’s obligation hereunder.

4. This Guarantee shall be irrevocable and shall remain in full force and

effect for the contract period and one month thereafter, unless

discharged/released earlier by the State Nodal Cell in accordance with

the provisions of the Agreement. The Guarantor’s liability in aggregate

be limited to a sum of Rs. ............. (Rupees ................. Only).

5. This Guarantee shall not be affected by any change in the constitution

or winding up of the Agency/the Guarantor or any absorption, merger

or amalgamation of the Agency/the Guarantor with any other person.


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The Guarantor has power to issue this guarantee and discharge the

obligations contemplated herein, and the undersigned is duly authorised

to execute this Guarantee pursuant to the power granted under

______________.

IN WITNESS WHEREOF THE GUARANTOR HAS SET ITS HANDS HEREUNTO

ON THE DAY, MONTH AND YEAR FIRST HEREINABOVE WRITTEN.

SIGNED AND DELIVERED

by___________________________________Bank by the

hand of Shri_____________________________

its_________________and authorised official.