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
Page 2 of 80
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.
Providing Support Services for Implementation of Mukhyamantri Amrutum ‘MA’ & MA Vatsalya & AB-NHPM Yojana
Page 3 of 80
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
Providing Support Services for Implementation of Mukhyamantri Amrutum ‘MA’ & MA Vatsalya & AB-NHPM Yojana
Page 4 of 80
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.
Providing Support Services for Implementation of Mukhyamantri Amrutum ‘MA’ & MA Vatsalya & AB-NHPM Yojana
Page 5 of 80
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.
Providing Support Services for Implementation of Mukhyamantri Amrutum ‘MA’ & MA Vatsalya & AB-NHPM Yojana
Page 6 of 80
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
Providing Support Services for Implementation of Mukhyamantri Amrutum ‘MA’ & MA Vatsalya & AB-NHPM Yojana
Page 7 of 80
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
Providing Support Services for Implementation of Mukhyamantri Amrutum ‘MA’ & MA Vatsalya & AB-NHPM Yojana
Page 8 of 80
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.
Providing Support Services for Implementation of Mukhyamantri Amrutum ‘MA’ & MA Vatsalya & AB-NHPM Yojana
Page 9 of 80
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.
Providing Support Services for Implementation of Mukhyamantri Amrutum ‘MA’ & MA Vatsalya & AB-NHPM Yojana
Page 10 of 80
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:
Providing Support Services for Implementation of Mukhyamantri Amrutum ‘MA’ & MA Vatsalya & AB-NHPM Yojana
Page 11 of 80
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.
Providing Support Services for Implementation of Mukhyamantri Amrutum ‘MA’ & MA Vatsalya & AB-NHPM Yojana
Page 12 of 80
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:
Providing Support Services for Implementation of Mukhyamantri Amrutum ‘MA’ & MA Vatsalya & AB-NHPM Yojana
Page 13 of 80
(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
Providing Support Services for Implementation of Mukhyamantri Amrutum ‘MA’ & MA Vatsalya & AB-NHPM Yojana
Page 14 of 80
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
Providing Support Services for Implementation of Mukhyamantri Amrutum ‘MA’ & MA Vatsalya & AB-NHPM Yojana
Page 15 of 80
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:
Providing Support Services for Implementation of Mukhyamantri Amrutum ‘MA’ & MA Vatsalya & AB-NHPM Yojana
Page 16 of 80
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
Providing Support Services for Implementation of Mukhyamantri Amrutum ‘MA’ & MA Vatsalya & AB-NHPM Yojana
Page 17 of 80
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.
Providing Support Services for Implementation of Mukhyamantri Amrutum ‘MA’ & MA Vatsalya & AB-NHPM Yojana
Page 18 of 80
(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
Providing Support Services for Implementation of Mukhyamantri Amrutum ‘MA’ & MA Vatsalya & AB-NHPM Yojana
Page 19 of 80
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
Providing Support Services for Implementation of Mukhyamantri Amrutum ‘MA’ & MA Vatsalya & AB-NHPM Yojana
Page 20 of 80
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
Providing Support Services for Implementation of Mukhyamantri Amrutum ‘MA’ & MA Vatsalya & AB-NHPM Yojana
Page 21 of 80
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:
Providing Support Services for Implementation of Mukhyamantri Amrutum ‘MA’ & MA Vatsalya & AB-NHPM Yojana
Page 22 of 80
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.
Providing Support Services for Implementation of Mukhyamantri Amrutum ‘MA’ & MA Vatsalya & AB-NHPM Yojana
Page 23 of 80
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.
Providing Support Services for Implementation of Mukhyamantri Amrutum ‘MA’ & MA Vatsalya & AB-NHPM Yojana
Page 24 of 80
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,
Providing Support Services for Implementation of Mukhyamantri Amrutum ‘MA’ & MA Vatsalya & AB-NHPM Yojana
Page 25 of 80
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.
Providing Support Services for Implementation of Mukhyamantri Amrutum ‘MA’ & MA Vatsalya & AB-NHPM Yojana
Page 26 of 80
(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
Providing Support Services for Implementation of Mukhyamantri Amrutum ‘MA’ & MA Vatsalya & AB-NHPM Yojana
Page 27 of 80
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
Providing Support Services for Implementation of Mukhyamantri Amrutum ‘MA’ & MA Vatsalya & AB-NHPM Yojana
Page 28 of 80
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
Providing Support Services for Implementation of Mukhyamantri Amrutum ‘MA’ & MA Vatsalya & AB-NHPM Yojana
Page 29 of 80
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:
Providing Support Services for Implementation of Mukhyamantri Amrutum ‘MA’ & MA Vatsalya & AB-NHPM Yojana
Page 30 of 80
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.
Providing Support Services for Implementation of Mukhyamantri Amrutum ‘MA’ & MA Vatsalya & AB-NHPM Yojana
Page 31 of 80
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
Providing Support Services for Implementation of Mukhyamantri Amrutum ‘MA’ & MA Vatsalya & AB-NHPM Yojana
Page 32 of 80
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
Providing Support Services for Implementation of Mukhyamantri Amrutum ‘MA’ & MA Vatsalya & AB-NHPM Yojana
Page 33 of 80
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:
Providing Support Services for Implementation of Mukhyamantri Amrutum ‘MA’ & MA Vatsalya & AB-NHPM Yojana
Page 34 of 80
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.
Providing Support Services for Implementation of Mukhyamantri Amrutum ‘MA’ & MA Vatsalya & AB-NHPM Yojana
Page 35 of 80
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/
Providing Support Services for Implementation of Mukhyamantri Amrutum ‘MA’ & MA Vatsalya & AB-NHPM Yojana
Page 36 of 80
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.
Providing Support Services for Implementation of Mukhyamantri Amrutum ‘MA’ & MA Vatsalya & AB-NHPM Yojana
Page 37 of 80
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.
Providing Support Services for Implementation of Mukhyamantri Amrutum ‘MA’ & MA Vatsalya & AB-NHPM Yojana
Page 38 of 80
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
Providing Support Services for Implementation of Mukhyamantri Amrutum ‘MA’ & MA Vatsalya & AB-NHPM Yojana
Page 39 of 80
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
Providing Support Services for Implementation of Mukhyamantri Amrutum ‘MA’ & MA Vatsalya & AB-NHPM Yojana
Page 40 of 80
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
Providing Support Services for Implementation of Mukhyamantri Amrutum ‘MA’ & MA Vatsalya & AB-NHPM Yojana
Page 41 of 80
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
Providing Support Services for Implementation of Mukhyamantri Amrutum ‘MA’ & MA Vatsalya & AB-NHPM Yojana
Page 42 of 80
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
Providing Support Services for Implementation of Mukhyamantri Amrutum ‘MA’ & MA Vatsalya & AB-NHPM Yojana
Page 43 of 80
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
Providing Support Services for Implementation of Mukhyamantri Amrutum ‘MA’ & MA Vatsalya & AB-NHPM Yojana
Page 44 of 80
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.
Providing Support Services for Implementation of Mukhyamantri Amrutum ‘MA’ & MA Vatsalya & AB-NHPM Yojana
Page 45 of 80
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
Providing Support Services for Implementation of Mukhyamantri Amrutum ‘MA’ & MA Vatsalya & AB-NHPM Yojana
Page 46 of 80
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
Providing Support Services for Implementation of Mukhyamantri Amrutum ‘MA’ & MA Vatsalya & AB-NHPM Yojana
Page 47 of 80
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.
Providing Support Services for Implementation of Mukhyamantri Amrutum ‘MA’ & MA Vatsalya & AB-NHPM Yojana
Page 48 of 80
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
Providing Support Services for Implementation of Mukhyamantri Amrutum ‘MA’ & MA Vatsalya & AB-NHPM Yojana
Page 49 of 80
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
Providing Support Services for Implementation of Mukhyamantri Amrutum ‘MA’ & MA Vatsalya & AB-NHPM Yojana
Page 50 of 80
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
Providing Support Services for Implementation of Mukhyamantri Amrutum ‘MA’ & MA Vatsalya & AB-NHPM Yojana
Page 51 of 80
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.
Providing Support Services for Implementation of Mukhyamantri Amrutum ‘MA’ & MA Vatsalya & AB-NHPM Yojana
Page 52 of 80
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
Providing Support Services for Implementation of Mukhyamantri Amrutum ‘MA’ & MA Vatsalya & AB-NHPM Yojana
Page 53 of 80
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:
Providing Support Services for Implementation of Mukhyamantri Amrutum ‘MA’ & MA Vatsalya & AB-NHPM Yojana
Page 54 of 80
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.
Providing Support Services for Implementation of Mukhyamantri Amrutum ‘MA’ & MA Vatsalya & AB-NHPM Yojana
Page 55 of 80
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.
Providing Support Services for Implementation of Mukhyamantri Amrutum ‘MA’ & MA Vatsalya & AB-NHPM Yojana
Page 56 of 80
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%
Providing Support Services for Implementation of Mukhyamantri Amrutum ‘MA’ & MA Vatsalya & AB-NHPM Yojana
Page 57 of 80
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
Providing Support Services for Implementation of Mukhyamantri Amrutum ‘MA’ & MA Vatsalya & AB-NHPM Yojana
Page 58 of 80
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.
Providing Support Services for Implementation of Mukhyamantri Amrutum ‘MA’ & MA Vatsalya & AB-NHPM Yojana
Page 59 of 80
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:
Providing Support Services for Implementation of Mukhyamantri Amrutum ‘MA’ & MA Vatsalya & AB-NHPM Yojana
Page 60 of 80
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).
Providing Support Services for Implementation of Mukhyamantri Amrutum ‘MA’ & MA Vatsalya & AB-NHPM Yojana
Page 61 of 80
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.
Providing Support Services for Implementation of Mukhyamantri Amrutum ‘MA’ & MA Vatsalya & AB-NHPM Yojana
Page 62 of 80
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)
Providing Support Services for Implementation of Mukhyamantri Amrutum ‘MA’ & MA Vatsalya & AB-NHPM Yojana
Page 63 of 80
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 :
Providing Support Services for Implementation of Mukhyamantri Amrutum ‘MA’ & MA Vatsalya & AB-NHPM Yojana
Page 64 of 80
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)
Providing Support Services for Implementation of Mukhyamantri Amrutum ‘MA’ & MA Vatsalya & AB-NHPM Yojana
Page 65 of 80
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.
Providing Support Services for Implementation of Mukhyamantri Amrutum ‘MA’ & MA Vatsalya & AB-NHPM Yojana
Page 66 of 80
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.
Providing Support Services for Implementation of Mukhyamantri Amrutum ‘MA’ & MA Vatsalya & AB-NHPM Yojana
Page 67 of 80
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
Providing Support Services for Implementation of Mukhyamantri Amrutum ‘MA’ & MA Vatsalya & AB-NHPM Yojana
Page 68 of 80
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.
Providing Support Services for Implementation of Mukhyamantri Amrutum ‘MA’ & MA Vatsalya & AB-NHPM Yojana
Page 69 of 80
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
Providing Support Services for Implementation of Mukhyamantri Amrutum ‘MA’ & MA Vatsalya & AB-NHPM Yojana
Page 70 of 80
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
Providing Support Services for Implementation of Mukhyamantri Amrutum ‘MA’ & MA Vatsalya & AB-NHPM Yojana
Page 71 of 80
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.
Providing Support Services for Implementation of Mukhyamantri Amrutum ‘MA’ & MA Vatsalya & AB-NHPM Yojana
Page 72 of 80
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.
Providing Support Services for Implementation of Mukhyamantri Amrutum ‘MA’ & MA Vatsalya & AB-NHPM Yojana
Page 73 of 80
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
Providing Support Services for Implementation of Mukhyamantri Amrutum ‘MA’ & MA Vatsalya & AB-NHPM Yojana
Page 74 of 80
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
Providing Support Services for Implementation of Mukhyamantri Amrutum ‘MA’ & MA Vatsalya & AB-NHPM Yojana
Page 75 of 80
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.
Providing Support Services for Implementation of Mukhyamantri Amrutum ‘MA’ & MA Vatsalya & AB-NHPM Yojana
Page 76 of 80
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]
Providing Support Services for Implementation of Mukhyamantri Amrutum ‘MA’ & MA Vatsalya & AB-NHPM Yojana
Page 77 of 80
(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.
Providing Support Services for Implementation of Mukhyamantri Amrutum ‘MA’ & MA Vatsalya & AB-NHPM Yojana
Page 78 of 80
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
Providing Support Services for Implementation of Mukhyamantri Amrutum ‘MA’ & MA Vatsalya & AB-NHPM Yojana
Page 79 of 80
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.
Providing Support Services for Implementation of Mukhyamantri Amrutum ‘MA’ & MA Vatsalya & AB-NHPM Yojana
Page 80 of 80
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.