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ENERGY EFFICIENCY SERVICES LIMITED (A JV of PSUs under the Ministry of Power) REQUEST FOR PROPOSAL FOR Hiring of General Insurance Companies (Licensed and Registered with IRDA) dealing with Health Insurance for implementation of EESL's MEDICAL POLICY on PAN India basis (Last date for submission of Proposal: 27.05.2023 up to 1100 Hrs. IST) Registered & Corporate Office CCI Building, 4th Floor, Core – V, SCOPE Complex, Lodhi Road, New Delhi – 110003 (This document is meant for exclusive purpose of bidding against this specification only and shall not be transferred, reproduced or otherwise used for purpose other than that for which it is specifically issued) Hiring of General Insurance Companies (Licensed and Registered with IRDA) dealing with Health Insurance for implementation of EESL's MEDICAL POLICY on PAN India basis NIT NO.: EESL/06/2023-24/HR/IPD/OTE/232405003, dated 05.05.2023 1. Introduction 1.1 Energy Efficiency Services Limited (hereinafter referred to as ‘EESL’ or ‘Company’ or ‘Owner’ or ‘Employer’) is a Joint Venture of Power Grid Corporation of India Limited (PGCIL), NTPC Limited (NTPC), Power Finance Corporation Limited (PFC) and Rural Electrification Corporation Limited (REC) to facilitate implementation of energy efficiency projects. EESL is working as an ESCO, as Consultancy Organization for CDM, Energy Efficiency, etc.; as a Resource Center for capacity building of SDAs, Utilities, financial institutions, etc. EESL is also leading the market-related actions of the NMEEE. It is first such company exclusively for implementation of energy efficiency in South Asia and amongst a very few such instances in the world. 2. About subject assignment The subject assignment is to Hire an Agency in this RfP the word (Consultant and Agency are used interchangeably) for IPD Medical Policy for EESL and its Group Companies. Proposals are hereby invited from the firms to carry out the responsibilities and obligations of the Consultant as per the subject RfP. In case your firm is interested to be considered for the above assignment, you may submit your bid/proposal to the Company. The terms and conditions with regard to the submission of bid/proposal, scope of work, evaluation/selection process and execution of assignment by the successful Bidders/Consultant are detailed herein after. 3. Scope of Work & Timeline EESL is looking for IPD Health Insurance Medi-claim Policy (Family Floater) for Regular Employees with the following benefits/conditions: 1. The Bidder must be capable of rendering Health/ Medical services anywhere in India. 2. The bidder should be on IRDA approved Insurance Company or IRDA approved on behalf of the Insurance Company and negotiation (if required) shall be done with L1 bidder directly. 3. THIRD PARTY ADMINISTRATIOR ASSISTANCE: Third Party Administrator means a Third-Party Administrator who holds a valid License from Insurance Regulatory and Development Authority to act as a THIRD-PARTY ADMINISTRATOR and is engaged by the Company for the provision of health services as specified in the agreement between the Company and Third-Party Administrator. IRDAI approved TPA Services Involved (if any) and Name and contact details to be submitted. The authorized representative of the corporation will participate in the screening process of TPA. List of Network of Authorized hospitals to be provided 4. NETWORK PROVIDER: Network Provider means hospitals or health care providers enlisted by an insurer or by a Third-Party Administrator and insurer together to provide medical services to an insured on payment by a cashless facility. The list of network hospitals is maintained by and available with the THIRD-PARTY ADMINISTRATOR and the same is subject to amendment from time to time. 5. Claim Settlement: In case of an empanelled hospital hospitals treatment should be done purely on cash basis. No charge/fee/payment shall be borne by the employee or their dependent insured members on hospitalization and the claim settlement should be done between the insurance provider and the hospital. 6. In case of non empanelled hospitals: the claim would be expected to be submitted to the insurance company directly by the employee within 60 days from the date of discharge from the hospital. Such claims should be settled within 30 days of submission and payment will be made directly to the insured. 7. In case of delayed payment, interest shall be payable as per IRDA rules and regulations. 8. Quarterly claim review meeting shall be held with insurance company, wherein, their senior level executives shall be present. 9. The Insurance cover shall commence from the date the Insurance Policy comes into force. 10. The Policy shall cover all pre-existing diseases on the date of commencement of the Insurance Policy. Accordingly, there shall be no gestation period for extending coverage for treatment of any disease, whatsoever. 11. Provisions for Day Care Procedures shall exist and the diseases covered is enclosed. 12. The list of exclusions, if any, shall be minimal and clearly specified. Merely mentioning ‘Standard Exclusions’ shall not suffice. However, HIV/AIDS, other Disease-wise capping, Critical/ Major illness etc. should be considered as per the Govt. guidelines. Also, any new day care procedure that has been pre-approved by TPA shall be considered. 13. New born Baby shall be covered from the date of birth itself. 14. Pre-Hospitalisation 30 days and Post Hospitalization 60 days to be covered under the policy. 15. The Insurer’s TPAs shall have 24 X 7 helpline numbers in addition to the helpdesks preferably located in all Principal cities. The TPAs shall also have Mobile application and web based application providing details of eligibility, claims status, |