MINUTES OF THE PRE-BID MEETING FOR THE APPOINTMENT OF IMPLEMENTATION SUPPORT AGENCY (ISA) in respect of Central Government Employees & Pensioners Health Insurance Scheme (CGEPHIS) .

MINUTES OF THE PRE-BID MEETING FOR THE APPOINTMENT OF IMPLEMENTATION SUPPORT AGENCY (ISA) in respect of Central Government Employees & Pensioners Health Insurance Scheme (CGEPHIS) held at 3.00 PM on 18th March, in Conference Hall, NIHFW, Munirka, New Delhi.





The meeting was chaired by Dr. S.P. Goswamy, National Consultant (Health Insurance), Ministry of Health & Family Welfare.



List of participants is enclosed as Annexure



Deputy Secretary, MOHFW welcomed all the participants to the pre-bid meeting and spelled out the objectives of the scheme. Dr. S P GOSWAMY, National Consultant (Health Insurance), gave an outline of the Central Government Employees & Pensioners Health Insurance Scheme (CGEPHIS) and the role to be played by the Insurers. DR S K Sinha, Sr. Technical Director, NIC, elaborated on the specifications of the Smart Card and related software required under the scheme. There were queries from the bidders, most of them pertaining to similar issues. They were answered by the Officers present in the meeting.





The issues raised during the meeting and the answers to the queries as furnished by the Govt. side, are listed below.

1. Are Qualifying criteria specified in the RFP relaxable?





Ans: No. The Qualifying criteria specified are mandatory and not relaxable. Any bidder not fulfilling any of the eligibility conditions will stand disqualified and his technical bid will not be evaluated further.





2. Are TPAs eligible to participate in the tender?





Ans: No. Only General Insurance Companies which satisfy the conditions specified in qualifying criteria are eligible to participate in the tender.





3. In the technical proposal, can an Insurance Company include the number of lives and claims servicing done by its subsidiary TPA?





Ans: Yes, but strictly relating to respective company only.





4. Is ICD coding required?





Ans: Yes. It is integrated in the IT platform. Training for ICD coding will be conducted.





5. If one Insurance Company gets the contract, can they share the business with other companies?





Ans: No. The contract cannot be transferred. Whichever bidder gets the contract will be under an obligation to provide the services.





6. When will the Corporate floater be triggered or restricted to critical diseases





Ans: Once the sum insured is exhausted the corporate floater becomes available to the beneficiary without limit. It is not restricted to critical illness.





7. What is per family limit for corporate floater? And how would the same is triggered?



Ans: There is no limit for family. Once the sum insured is exhausted, the corporate floater/buffer will be triggered.





8. Package rates for maternity- does it include pediatric charges? Is there any sub-limit amount to be affixed under Maternity Cover?





Ans: No. There is no sub limit under above section. Both will be dealt with as per packages defined in under CGHS packages.





9. The percentage loading on the basis of claims ratio would be applicable on the next year renewal. In case renewal is not done with same company, the benefit would not be passed on?





Ans: As a part of the contract the insurer will have to bear the loss in the last year of the policy with it. The new insurer will be provided the business at the new tender rate.

10. Rates would be differential on the basis the category of wards; details would be required on the number of employees in each category.





Ans: Number of beneficiaries category wise is not available as who would be opting for the policy is not available as yet.





11. In case of non availability of beds in a certain category of ward will they be eligible to be upgraded or downgraded to the next category and how would the claims be paid.





Ans: No option of up gradation of category can be allowed. The patient is to be accommodated in higher class by the hospital temporarily in case of emergency and to be shifted to the entitled class as soon as possible. Hospital will not be entitled for the difference.





12. The CGHS rates are likely to be revised in near future- how soon would the same be revised (post commencement of the policy period) and how often will the same be revised.





Ans: It is very well mentioned in the RFP the possibility of revision of CGHS rates to the extent of 10% - 15%. The prospective bidders should keep it in their mind while quoting the premium rates. No Reduction/ Enhancement is applicable during the policy period.



13. Clarification on the usage of biometric cards – will be used on the pos machines in the empanelled hospitals.

Ans: The cards would be used to identify the beneficiary and the rest cashless approval will have to be done as per procedure of pre authorization. There will be only one smart card issued for the entire family which will contain photograph of each insured member of the family. At present there is no intention to issue bio-metric cards however the same smart card specification has enough room for up gradation.





14. As per tender enquiry the OPD- consultation and OPD - diagnostic test charges would be included as additional benefits. What are the limits for the same? As per another clause OPD charges shall not be a part of day care. Clarity required on the same.

Ans: The tender has suggested that the empanelled hospitals should provide OPD consultation as free facilities and charge the diagnostic test as per CGHS rates for CGEPHIS beneficiaries visiting the hospital for consultation. This does not mean that these expenses are covered in policy.



15. Other standard exclusions have not been mentioned: - eg AIDS, HIV, human, t-cell lymphotropic virus type iii (htlv –iii) or lymphadinopathy associated virus (lav) or the mutant’s derivative or variations deficiency syndrome or any syndrome or condition of a similar kind.





Ans: These have to be covered. The exclusions not mentioning the above means these are covered under the policy.





16. For reimbursements -account transfer can be done only for beneficiaries providing Bank account details. What about those who do not provide the same, cheques would have to be dispatched. If provision for reimbursement is not there in this policy, how would the pensioners who would be in remote areas get the facility as it would be difficult to have the NABH qualified hospitals in those areas.

Ans: The reimbursement to the beneficiaries shall be done in case of domiciliary hospitalization and pre and post hospitalization. The policy works only for the NABH hospitals as empanelled hospitals. So if there is no hospital in an area then the beneficiary will have to approach the empanelled hospital only. We need to ensure that the bank details with ECS number are captured at the time of enrollment and without these details we should not accept the form. Exceptions shall be there those not having such facilities. In that case, payment to be sent by crossed cheques only.





17. There would be individual photo cards to be put on smart card. If there are 7 members its feasibility has to be seen. A group photo would have been better.





Ans: One Card to be issued for a family having individual photo only.



18. The RFP suggests that the pensioner would be paying his first year contribution cheque along with the enrollment form – what is the contribution amount.





Ans: This will be decided by the Central Government at later stage; however, the Central Government will pay a premium for One Lakh assured family as an advance premium. This will be reconciled as per the procedure defined in RFP.



19. What is the age limit for the beneficiaries and the dependent parents to be covered in the policy?





Ans: There is no age limit for employees and pensioners. The age of dependents is very well defined in the RFP.





20. Service tax would be part of packages or it would be paid extra by hospitals.





Ans: The rates to be allowed under this scheme would be the CGHS rates. However, service tax is not levied on hospital services.

21. What is required by the provision of clause xii on Page no. 19, regarding Tax payable by Hospital?





Ans. The Insurer will have to comply with the orders of the CBDT regarding the tax liability of the Hospital and deduct the same as TDS while making the payment to hospital.





22. Whether on deletion of additional members during the currency of policy any refund is applicable?





Ans: Inclusion of addition and deletion of members are defined in RFP. This will be on the basis of refund of premium on prorata basis.

23. As per tender separate guidelines for Ayurveda / Unani would be confirmed to us. When it would take place and in which form?





Ans. The tender requires Insurer to cover such treatment and only in accredited hospitals. The guidelines for such hospitals are being framed.

24. For NABH accreditation there are 9 stages. As per tender all hospitals empanelled under CGHS would be eligible if they apply. Would suggest that they should be eligible after 3rd/4th stage.





Ans. For the hospitals which are not NABH accredited the same can become part of the scheme if they obtain the entry level certification from NABH. Also the CGHS empanelled hospitals can become part of scheme provided they obtain entry level certification within two months of empanelment.





25. How the premium remittance by the beneficiary will take place for the additional member?





Ans. The premium for the additional member in case of employees would be paid by the employee through cheque in favour of the Insurer.

26. Government may provide the list of pension paying offices on pan India basis and list of departments and their offices on state wise basis.

Ans. It would be provided in due course after signing of agreement.





27. Whether there would be any refund of the initial amount of premium paid by Government, in case the enrollment does not reach 1 lakh figure.





Ans. The premium paid to the Insurer would be as assured premium and there would be no refund on account of enrollment less than 1 lakh.





28. The qualification criteria were also questioned by one insurance company as the PSU’s do not have any MBBS doctors on their rolls.





Ans. It is clarified that the scheme is a health insurance scheme for the GOI employees and pensioners and thus the Doctors on the rolls of the Insurance Company would only help in administering the scheme. Further, it was also stated that the criteria have been laid down as per requirement of the scheme.





ANNEXURE





PRE-BID MEETING FOR THE APPOINTMENT OF IMPLEMENTATION SUPPORT AGENCY (ISA) in respect of CGEPHIS held at 3.00 PM on 18th March, in Conference Hall, NIHFW, Munirka, New Delhi.

LIST OF PARTICIPANTS





Officers Present:







1. Shri V P Singh, Deputy Secretary, MOHFW, Chairman.



2. Dr. S P Goswamy, national consultant, (HI), MOHFW.



3. Dr. S K Sinha, Sr. Technical Director, NIC.



4. Shri V. Ringe, Technical Director, NIC



5. Shri Jai Prakash, Under Secretary, MOHFW



6. Shri Sarvjit Singh, Section Officer, CGHS(P)



Bidders Present:

Name Organisation

1. Mr. Mayank Misra ICICI Lombard General Insurance Company Ltd



2. Mr. Deepak Khanna ICICI Lombard General Insurance Company Ltd.



3. Ms. Ritu Arora ICICI Lombard General Insurance Company Ltd



4. Ms. M.jena National Insurance Company Ltd.



5. Ms. Radhika Saberwal National Insurance Company Ltd.



6. Mr. Rohit Khandelwal National Insurance Company Ltd.



7. Mr. N.Banchur National Insurance Company Ltd.



8. Mr. Rishi Kapoor Max Bupa Health Insurance Ltd.



9. Mr.Bipul Chatterjee Max Bupa Health Insurance Ltd.



10. Dr. Shubnum Singh Max Healthcare Institute Ltd.



11. Mr. Saurabh Mehrotra HDFC ERGO General Insurance Co. ltd.



12. Mr. Ajay K. Singh Cholamandalam MS General Insurance Company Ltd.



13. Mr. Chandrakanta Mishra Cholamandalam MS General Insurance Company Ltd.



14. Mr. Kishore Kumar Cholamandalam MS General Insurance Company Ltd.



15. Mr. Inderjit Chakraborty Cholamandalam MS General Insurance Company Ltd.



16. Mr. Deepak Bhaalerao Oriental Insurance Company Ltd.



17. Mr. Virander Oriental Insurance Company Ltd.



18. Dr. R.K. Kaushik New India Assurance Co.Ltd



19. Mr. K.K.Rao United India Insurance Co.Ltd.



20. Mr. Tajider Mukherjee United India Insurance Co.Ltd.



21. Mr. P.C.Tripathy Star Health & Allied Insurance Co.Ltd.



22. Mr. Baljinder Pal Singh Gemalto



23. Mr. Naveen Yadav Gemalto





SOURCE;MINISTRY OF HEALTH AND FAMILY WELFARE