91��Ƭ��

INDIAN INSTITUTE OF MANAGEMENT CALCUTTA

Notice Inviting Tender
for
Group Mediclaim & Personal Accident Insurance Policy

Tender Notice No.NIT/91��Ƭ��C/Mediclaim/28/2015-16 dated 12th August, 2015

91��Ƭ�� invites sealed quotations from IRDA (Insurance Regulatory and Development Authority) accredited Insurance companies for Group Mediclaim & Personal Accident Insurance Policy for a period of one year w.e.f. 10th September, 2015 to 9th September, 2016 (Mid night) for the existing employees & their dependents, post 31st March 2007 retired employees & their respective spouses and spouses of deceased employees. Interested companies may submit sealed Tender as per the attached format.

Tenders are to be submitted in three envelopes. First envelope super-scribing ‘Technical Bid’ should contain the terms & conditions of the tender duly signed and sealed in all pages and the eligibility criteria with supporting documents. Second envelope super-scribing ‘Financial Bid’ should contain financial bid in the prescribed format in Annexure-III duly filled-in, signed and sealed. The two envelopes are to be put in a bigger envelope (3rd envelope) super-scribing as “Group Mediclaim & Personal Accident Insurance Policy for 91��Ƭ��”.

Important dates & time:

The bids/offers received after the due date and time mentioned above will not be entertained under any circumstances. Incomplete and unsigned bids or the bids not in prescribed format will be rejected without assigning any reason thereof. The bids/offers should be completed in all respects and submitted to:-

The Senior Administrative Officer (Purchase)
91��Ƭ��
Joka, Diamond Harbour Road
Kolkata – 700 104
Telephone: 033-2467-8300-05 Extn. 202
Email: purchasesection@iimcal.ac.in

A. General Terms and Conditions:

1. Procedure for submission: The sealed envelope super scribed as “Tender for Group Mediclaim & Personal Accident Insurance Policy” should be dropped in the tender box placed in the office of the Senior Administrative Officer (Purchase), Ground Floor, Administrative Building East Side, within the due date and time. Those who send the Bid documents by post, have to ensure that the documents reach before the prescribed time and date. The Institute will not take any responsibility under any circumstances for courier/postal delays.
2. One authorized representative of the bidder can be present while opening the Bid
3. The Insurance Company/Agency should have been registered with IRDA
4. The Insurance Company should have adequate experience for providing such Group Mediclaim Insurance to Government/Semi-Government/Govt. of India Undertaking/ Autonomous Body during the preceding ten years. A list of clients in proof of the above along with the certificate of satisfactory performance issued by the competent authority of such establishments and from such clients may be invariably furnished along with the technical bid.
5. The Committee of the Institute constituted for the purpose shall assess the ability of the Insurance agencies to render the requisite services based on the company profile, rating and on such other criteria as it may fix and the Financial Bids of only those firms qualifying the technical evaluation will be considered.
6. The bidder should sign on each page of the Bid documents
7. Bids which are late/vague/conditional/incomplete/not confirming to the laid down procedure in any respect will be rejected.
8. Bids sent by fax & e-mail will not be considered.
9. The Insurance Policy should have provisions for new entrants in service to get coverage.
10. The successful Company shall at its own cost comply with the provision of orders and notifications issued by IRDA and Government from time to time.
11. In case of failure in settlement of clams within the time frame, the penalty will be enforced as per Institute norms.
12. The period of contract will be for one year on agreed terms and conditions, which is liable to be terminated with one months’ notice, if any lapse or unsatisfactory performance of the Company/Firm/Agency is noticed.
13. Each tenderer/Insurer, will be required to confirm and declare in the tender submitted that no agent, middleman or any intermediary (except TPA) has been, or will be engaged to provide any services, or any other items of work related to the award and performance of this contract.They will have to further declare that no agency commission or any payment, which may be construed as an agency commission, has been, or will be paid and that tender price will not include any such amount.
14. The Courts of Calcutta alone will have the jurisdiction to try any matter, dispute or reference between the bidders and the Institute arising out of this service. It is specifically agreed that no court outside and other than Court in Kolkata shall have jurisdiction in the matter.
15. 91��Ƭ�� reserves the right to modify/change/delete/add any further terms and conditions prior to issue of agreement.
16. Arbitration- All dispute and differences which may arise between the 91��Ƭ�� and the Insurance Company shall be referred to the Director, 91��Ƭ�� whose decision shall be binding on all concerned.
17. 91��Ƭ��C reserves the right to accept or reject any or all proposals without assigning any reason. No tenderer shall have any cause of action or claim against 91��Ƭ��C for rejection of his proposal.
18. Canvassing in any form in connection with the tender is strictly prohibited and the tenders submitted by the bidders who resort to canvassing are liable to be rejected.
19. A Letter of Acceptance along with the cheque of insurance premium shall be issued to the successful bidder and the same shall be treated as unconditional binding document on the part of the insurer till a formal insurance policy is received by 91��Ƭ��C.
20. All tenderers are hereby cautioned that conditional offers with deviations from the conditions and other requirements stipulated in these documents are likely to be rejected as non-responsive and will not be considered in tender evaluation and award of contract
21. The selected insurance company needs to send an Invoice to facilitate issuance of work order along with approved premium amount in cheque.
22. Identified Claim Ratio (ICR) as on 30th June, 2015 is 68.69%.

B. Terms & Conditions to be included in the Mediclaim Insurance Policy:-

1. Capping – Capping limit for diseases should be mentioned in terms of percentage of sum insured. Diseases under capping are to be very clearly mentioned in the quotation. However, waiver of capping is desirable by the management of 91��Ƭ��C without any extra cost of premium. There will be capping on claims as detailed under:
   1. Cataract (Eye related) claims limited to 12% of Family Floater sum insured
   2. Hysterectomy claims limited to 22% of Family Floater sum insured
   3. Gall Bladder Stone operation claims limited to 22% of Family Floater sum insured
   4. Appendicitis claims limited to 17% of Family Floater sum insured
   5. Surgeries: There is no such capping on all major & minor surgeries.
2. TPA– Selection of TPA is in the discretion of 91��Ƭ��C Management. However, the insurance agency may give the references / recommendations for at least three TPAs, who are dependable for better services. But at the same time the TPA should be controlled by the insurer for better services.
3. Surgeries – All Major & Minor surgeries will be out of any capping limit.
4. Network Hospitals / Nursing Homes – Renowned & Major Hospitals / Nursing homes should be in the NWH / PPN Hospital list, which is to be attached with the quotation. However, the inclusion of Hospitals/Nursing Homes should be in the discretion of 91��Ƭ��C Management as per the requirement.
5. All pre-existing diseases are to be covered under the policy.
6. Coverage of benefits should be from very first day of the inception of the policy.
7. Claim submission after discharge from Hospitals/Nursing Homes- Submission of claims should be allowed up-to 30 days from the date of discharge from the Hospital / Nursing Homes.
8. Pre & Post Hospitalization benefits – Coverage for reimbursement is 30 days for pre- hospitalization and post hospitalization is 60 days.
9. Claim settlement on discharge - Settlement of claims on discharge should be done on priority without any delay. Responsibility against such settlement by the TPA should be borne by the Insurer.
10. Claim submission after post-hospitalization- Should be up-to 30 days from the date of treatment.
11. Return of original documents -In some cases after the claims are submitted along with the original documents for reimbursement, where the patient is in need of getting back the original documents after the verifications are over by the TPAs, should be returned on furnishing a request towards the same by the concerned employee.
12. Intimation of hospitalization- On admission of a patient in a network-hospital, intimation is required to be given within 24 hours, with reasonable flexibility in certain circumstances.
13. Inclusion/Exclusion – Provision for inclusion / exclusion of members should be made on pro-rata basis. In this regard, the break-up figure of individual exclusion is to be specified by the insurance service provider.
14. Inclusion of rare & uncommon diseases - Certain diseases which are not covered in the common list of disease may be covered in the policy documents.
15. Coverage of the policy should take place from the very first day of inception.
16. Ambulance services – 1% of the sum insured or Rs.1000/- whichever is less shall be reimbursable
17. Room rent - Room rent will be 1% of the Sum Insured for normal and 2% for ICCU/ITU

C. Special Terms and Conditions:

1. There should be a dedicated helpline (24x7) from the TPA of Insurance Company available and the contact details should be furnished after the finalisation of the Policy.
2. If there is any reimbursement to the employees by the TPA/Insurance Company the same should be paid within 15 days to 91��Ƭ��C on receipt of bills.
3. The response time by the TPA at the time of admission should be maximum of six hours
4. Reports including the claims of individuals and the details of settlement are to be furnished to the Institute on monthly basis.

D. Award of Contract:
91��Ƭ��C will award, the Contract to the lowest tenderer, whose tender has been determined to be substantially responsive, technically &financially suitable, complete and in accordance with the tender documents.

E. Notification of Award:
91��Ƭ��C will notify the successful tenderer by writing letter, that his tender has been accepted for final offer. This letter hereinafter and in the Conditions of Contract called 'the Letter of Acceptance. The "Letter of Acceptance" will be sent in duplicate to the successful tenderer, who will return one copy to the 91��Ƭ��C duly acknowledged and signed by the authorized signatory, immediately on receipt of the same by him. 91��Ƭ��C will not entertain any correspondence from the unsuccessful tenderers. The “Letter of Acceptance” will constitute a part of the contract. Upon "Letter of Acceptance" being signed and returned by the successful tenderer, work order will be issued to the successful tenderer.

F. Signing of Agreement:
Immediately on receipt of work order, the successful tenderer will be required to execute the Contract Agreement. The performance guarantee should be submitted immediately after issue of Letter of Acceptance but not later than the agreement is signed between the parties. 91��Ƭ��C will send one copy of the Agreement to the Insurer duly signed by them and the Insurer through their authorized signatories.

G. Compliance with the Law:
The INSURER at its sole risk and expense, at all times during the term thereof promptly comply with all such requirements. The INSURER shall comply with all applicable statutes, ordinances, rules and regulations of Central, State Governments, and all applicable rules and also regulations of the IRDA.

H. Indemnity against all actions of Insurer:
The Insurer shall hold and save harmless and indemnify the 91��Ƭ��C, from and against all actions, suits, proceedings, loss, costs, damages, charges, claims and demands of every nature and description brought or recovered against the 91��Ƭ��C, by reason of any act or omissions of the Insurer, his agent or his employees, in the execution of the Insurance or in the guarding of the same. All sums payable by way of compensation under any of these conditions, shall be considered as reasonable compensation payable to the Employer, without reference to the actual loss or damage sustained, and whether or not any damage shall have been sustained.

I. General responsibility of the Insurer:
The Insurer shall comply with the provisions of the insurance and with due care and diligence execute and maintain the insurance Plans and documents whether of temporary or permanent nature required for such execution and maintenance in so far as necessary for providing these, as is specified or as is reasonably inferred from the Contract. The Insurer shall take full responsibility for the adequacy, stability of the insurance plans.

J. Breach of Contract:
If any breach is committed by the Insurer in delivery of the services stipulated herein or in the due performance or observance of the provisions of this Agreement, 91��Ƭ��C shall be at liberty to terminate thereafter this agreement by giving the INSURER thirty days notice in writing and upon the expiry of the period of such notice, this agreement shall stand terminated.

Senior Administrative Officer (Purchase)
91��Ƭ��

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