REQUEST FOR PROPOSAL(RfP)

Room To Read India Trust invites proposals from reputed IRDAI Registered Insurance Companies / Brokers / Agents for providing the Group Medical Coverage (GMC) Insurance Policy for employees of Room to Read India Trust.

About Room To Read

Room to Read India was established in 2003 and presently has programs in twelve states – Andhra Pradesh, Bihar, Chhattisgarh, Delhi NCR, Jharkhand, Karnataka, Madhya Pradesh, Maharashtra, Rajasthan, Telangana, Uttarakhand, and Uttar Pradesh.

Room to Read is a global organization transforming the lives of millions of children in low-income communities by focusing on literacy and gender equality in education. Founded in 2000 on the belief that World Change Starts with Educated Children®, our innovative model focuses on deep, systemic transformation within schools during two time periods that are most critical in a child’s schooling: early primary school for literacy acquisition and secondary school for girls’ education.

We work in collaboration with local communities, partner organizations, and governments to develop literacy skills and a habit of reading among primary school children and ensure girls can complete secondary school with the skills necessary to negotiate key life decisions.

By focusing on the quality of education provided within the communities and ensuring these outcomes are measured, we have created a model that can be replicated, localized, and sustained by governments. With its global headquarters in San Francisco, Room to Read has benefited 32 million children across 21 low-income countries.

Objective

To get Comprehensive Group Medical Insurance coverage and manage high levels of service in the most cost-effective manner for Room to Read India Trust Employees and their dependents.

Room To Read India Trust invites proposals for the same from the IRDAI registered insurance companies having the flexibility to respond to Room To Read India Trust current and changing needs.

1.     Important Dates:

RFP Issue Date	2 Feb 2023
Last Date for Query Submission	10 Feb 2023
Last Date for Proposal Submission	15 Feb 2023

2.     Data Sheet[1]

SUM INSURED	5,00,000/family
Total Employee	200
Total Lives	627
Age Limit	0-80

3.     Instruction to Bidders:

• Read the ToR and enclosed documents thoroughly before applying.
• Any benefits offered over & above shall be mentioned in the email body.
• Any incomplete application or process deviation, the proposals will automatically be rejected.
• Strict compliance with the requirements of the invitation and any supplementary instructions which may accompany the invitation is required to be adhered to.
• Proposal received after the prescribed deadline will not be considered.
• Proposals received which will not be as per desired format (Technical and Financial) laid down in this RfP will not be considered
• The bidder should send the quotation only to the below-mentioned email address.
• Room To Read India Trust shall not be held responsible for delivery of quotation to the wrong email address and for any other delay.
• Room To Read India Trust reserves the right to modify whole or in part or to terminate this RfP or reject any or all proposals at any stage without assigning any reason
• The rates quoted by the bidder shall be fixed, all duties, taxes and other levies payable must be included in the financial proposals. 
• The bidder should have a minimum Claim Settlement Ratio of 80% and above, during last 3 financial Years.
• The value of the proposal must be quoted in Indian Rupees. (INR) 

4.     Indicative Terms of Reference (ToR)

• The policy should provide the comprehensive group medical insurance coverage. The proposal must comply with the following terms and conditions broadly.

Mandatory Benefits:

1. Mid-Term Inclusions / Separation of employees and their family members (Parents, Spouse and Children’s) during the term of policy
2. The premium payment with respect to fresh enrolments during the term of policy would be paid on pro-rata basis.

• The proposal will have to extend the group medical insurance cover without any medical examination/ medical test of the employees of Room To Read India Trust India at any time prior or during the tenure of policy.
• Policy should cover Family Structure: Self , Spouse, 3 Dependent Children for married Employees only & Dependent Parents upto 80 years covered for Unmarried Employees
• Only Female employees have an option to cover either Parents or Parents -in laws. However only one set of parents are allowed to be covered (Cross combination of parents (e.g.:- Father and Mother in law is not allowed).
• Pre-existing diseases are covered for existing members and new joinees
• First & Second year exclusion condition for specific diseases is waived off for all Insured Members
• 30 Days Wait Period condition is waived off for existing members and new joinees
• Maximum Limit for Maternity claims is Rs. 75,000 for Normal and Rs. 75,000 for LSCS .
• Maternity Expenses Benefit is available for Employees or Spouse only if covered in insured members data received from policyholder.
• Maternity claim is payable for first two Living children only.
• 9 month waiting period in respect of maternity claims waived off for all Insured Members.
• Pre & Post Natal are Covered under the policy upto Rs 10000 over and above Maternity Limit ( Pre-post Natal bill covered ( From the date of conceive till up to 60 days for postdischarge of delivery Both on OPD and IPD basis). Additional Natal can be covered in OPD if Pre/post-natal limit exhasted.
• New Born Baby covered from day one within family floater Sum Insured applicable to the Employee.
• Ambulance charges up to Rs. 2,500/- per claim.
• Claim for lasik treatment - if power of eye is above +/- 7.5d, is payable.
• Modern treatments, psychiatric treatments and Bariatric treatments (weight loss) covered under the policy as per terms and conditions upto 50% of the Sum Insured
• E-Consultation General Physician
• Room Rent - Single AC room for Normal & No Limit for ICU/ITU/HDU/ICCU (inclusive of nursing charges). If insured is admitted in a higher category, then insured will bear difference of all medical expenses as in final hospital bill in same proportion.
• Annual Health Check-up once in a year without any cost as per test list mentioned in Annex-A.
• CONGENITAL EXTERNAL DISEASE-Covered for Life Threatening Conditions, non-cosmetic only
• OPD Coverage of Rs.15,000/- per family in a year.
• OPD Buffer: Overall CF Limit of 2 lacs
• All services would be Cashless for beneficiaries for all services covered in the proposal.
• Pre-Hospitalizations and Post Hospitalization for 30 days & 60 days respectively are covered
• Day Care Treatment Cover (as per Annexure I of Group Care 360 T&C – List of day care surgeries
• No Capping for Any Diseases and No Co-pay applicable
• Corporate Buffer: Overall CF Limit:15,00,000.  Per Employee Limit: Rs.1 lacs. Up to family sum insured without any disease’s restriction.
• 50% co-payment applicable for cyber knife treatment, stem cell transplantation and Robotic Surgery Cochlear implant treatment is restricted to 50% of the sum insured.
• All Vaccination covered including covid vaccination
• In case of death, 24 hours of hospitalization is not required with no-claim deduction
• Well- baby care or well mother expenses must be covered
• Organ Donor (Only harvesting cost, shall be covered for Donor) expenses covered
• Domiciliary treatment covered as per our standard gmc policy t &C
• Ayush treatment Covered upto 25% of family Sum Insured
• The tenure of policy will be for one year from the date of issuance i.e. the date on which the cover starts.
• There should be a dedicated helpline (24 X 7) of the bidder available and the contact details should be furnished at the start of the insurance cover.
• The proposal shall be valid for a period of minimum 45 days from the due date of submission of proposal.
• The premium quoted must be in INR only
• The successful bidder will not disclose any information provided by Room To Read India Trust or obtained by it during the course of the policy without the prior written consent of Room To Read India Trust.
• The bidder may engage / participate in  the bidding process through their authorized broking agencies.
• No proposal can be modified or withdrawn by the bidder, subsequent to the closing date and time for submission of proposals.
• The bidder should be registered as Indian Insurer in accordance with the Insurance Act, approved by IRDA (Insurance Regulatory Development Authority) as Mediclaim Insurer and must have a license to carry out Mediclaim insurance business in India.
• The bidder must not be blacklisted/barred/ disqualified by any regulatory/statutory body/govt organization in past   years.
• The bidder should have Minimum Claim Settlement Ratio of 80% and above, during last 3 financial Years.
• The bidder must be in the line of business of providing Group Medical Coverage for last five (5) years.
• The Insurers should have PAN India coverage of minimum 5500+ network hospitals.
• The Third-Party Administrator (TPA) desk is preferred to be In-house.
• The bidder must be able to provide services 24x7x365.

5.     Other Terms and Conditions

• The tenure of policy will be for one year from the date of issuance i.e. the date on which the cover starts.
• There should be a dedicated helpline (24 X 7) of the bidder available and the contact details should be furnished at the start of the insurance cover.
• The proposal shall be valid for a period of minimum 45 days from the due date of submission of proposal.
• The premium quoted must be in INR only
• The successful bidder will not disclose any information provided by Room To Read India Trust or obtained by it during the course of the policy without the prior written consent of Room To Read India Trust.
• The bidder may engage / participate in  the bidding process through their authorized broking agencies.
• No proposal can be modified or withdrawn by the bidder, subsequent to the closing date and time for submission of proposals.

6.     Selection Criteria

• The bidder should be registered as Indian Insurer in accordance with the Insurance Act, approved by IRDA (Insurance Regulatory Development Authority) as Mediclaim Insurer and must have a license to carry out Mediclaim insurance business in India.
• The bidder must not be blacklisted/barred/ disqualified by any regulatory/statutory body/govt organization in past   years.
• The bidder should have Minimum Claim Settlement Ratio of 80% and above, during last 3 financial Years.
• The bidder must be in the line of business of providing Group Medical Coverage for last five (5) years.
• The Insurers should have PAN India coverage of minimum 5500+ network hospitals.
• The Third-Party Administrator (TPA) desk is preferred to be In-house.
• The bidder must be able to provide services 24x7x365.

7.     How to Apply

1.     Online Proposals – Through E mails

Two Proposals are invited i.e., “Technical Proposal” and “Financial Proposal” must be prepared by the Bidders which shall comprise of the following:

• Bidders need to Submit TECHNICAL & FINANCIAL PROPOSALS in SEPARATE EMAILS
  • Subject for submission of Technical Proposal – TECHNICAL PROPOSAL: GMC-2023
  • Subject for submission of Financial Proposal– FINANCIAL PROPOSAL: GMC-2023
  • Proposals to be submitted over Procurement.India@roomtoread.org (without copying anyone from RtR and neither the below mentioned email ID)
  • Last Date for the submission is…………

A) Email 1- Technical Proposal: Group medical coverage [GMC] must include.

• Bidder’s company profile 
• IRDAI registration certificate

B) Email 2- Financial Proposal: Group medical coverage [GMC] must include

• Financial Proposal must be duly filled quotation as per the attached format [Annex-A] only.
• Kindly attach GST, PAN Card, etc as applicable
• All pages of the proposals are preferred with stamp and signature.

2.     Offline Proposals – Hard Copy

Two Proposals are invited i.e., “Technical Proposal” and “Financial Proposal” must be prepared by the Bidders which shall comprise the following and must be submitted at the following address:

Kind Att: Procurement Department,

Room to Read India Trust

Office No. 201E(b), 2^nd floor, D-21 Corporate Park,

Dwarka Sec-21, New Delhi 110075

Nr. Sec-8 metro station

A) Envelope 1- Technical Proposal: GMC-2023 must include

• Bidder’s company profile 
• IRDAI registration certificate

B) Envelope 2- Financial Proposal: GMC-2023  must include

• Financial Proposal must be duly filled as per the attached format [Annex-A] only.
• Kindly attach GST, PAN Card, etc as applicable
• All pages of the proposals are preferred with stamp and signature.

Proposal received after the prescribed deadline will not be considered.

• For the Selected bidder it will be mandatory to sign and abide by Room to Read’s Child Protection Policy and Child Protection of Code of Conduct policy.
• Only Shortlisted agency will be contacted
• Any incomplete application or process deviation, the proposals will automatically be rejected

For any queries, please write at  Vivek.shrawat@roomtoread.org

Enclosures

1.     Current policy copy GMC (for reference purposes ONLY)
2.     Group Care 360 T & C (for reference purposes ONLY)
3.     Latest Claim Ratio
4.     Template for Financial Proposal – Annex A
5.     T&Cs for Bidders - Annex B

To download the RFP documents, click here

To download the Lives Data GMC, click here

---

[1] employees and their dependents data shall be shared with selected bidder separately