RFP for inviting proposals from IRDAI Registered Insurance Companies / Firms for providing the Group Medical Coverage (GMC) Insurance Policy for Employees of Room to Read India Trust

Room To Read India Trust nonprofit organization that works in collaboration with local communities, partner organizations and governments to develop  literary skills and a habit of reading among primary school children, and to support girls to complete secondary school with relevant life skills to succeed in  school and beyond.  

 

Dear Bidder,  

 

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

 

Objective 

 

To get a Comprehensive Group Medical Insurance for Room to Read’s Employees and their dependents; required to be managed at high levels of  service in the most cost-effective manner. 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’s current and changing needs. 

1. Important Dates: 

2. Data Sheet

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 Vendor should send the quotation only to the above-mentioned email address only.
• Room To Read India Trust shall not be held responsible for delivery of quotation to the wrong email address and for any 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 o All duties, taxes and other levies payable shall be included in the financial proposals.
• The rates quoted by the vendor shall be fixed for this event and the PO/Contract will be issued by Room to Read India Trust and shall not be subject to adjustment on any account.
• The bidder should have Minimum Claim Settlement Ratio of 80%and above, during last 3 financial Years. (2019-20, 2020-21 & 2021-22). o The value of contract should be quoted in Indian Rupees. (INR)

Indicative Terms of Reference (ToR)

• The policy should provide the comprehensive group medical insurance coverage. The proposal should 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, upto 2 Children and Parent for employees.
• Ambulance charges up to Rs. 2,500/- per claim.
• 2% of Sum Insured for Normal & 4% of Sum Insured 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.
• Internal Congenital disease is covered, and external congenital disease is covered in life threatening situation.
• OPD Coverage of Rs.15,000/- per family in a year.
• OPD Buffer: Overall CF Limit of 2 lacs 
• Waiver of 30 Days waiting period o Waiver of 1st Year’s exclusions, 2nd, 3rd & 4th Year Exclusions
• Waiver of pre-existing diseases exclusion.
• 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
• Maternity benefits Rs.75,000 for Normal or Caesarean section, 9 months waiting period waived off (for First 2 children) 
• Pre & Post Natal are Covered under the policy upto Rs 10,000/- for first two children over and above Maternity Limit ( Pre-post Natal bill covered ( From the date of conceive till up to 60 days for post discharge of delivery Both on OPD and IPD basis). Additional Natal can be covered in OPD if Pre/post-natal limit exhausted.
• Newborn baby cover from day one within family sum insured o Day Care Treatment Cover as per standard policy wordings
• 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.
• MONOCLONAL injection- covered up to the actual limit
• Oral Chemotherapy- covered up to 50% of the sum Insured
• In case of death, 24 hours of hospitalization is not required with no-claim deduction o Well- baby care is covered
• Intra Vitreal Injections- covered up to 50% of the sum Insured.
• Room Rent: Single AC for normal room (proportionate charges waive off) & for ICU on actuals

Selection Criteria 

• The bidder should be registered 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 as on 31st March 2022. o The bidder should have Minimum Claim Settlement Ratio of 80%and above, during last 3 financial Years. (2019-20, 2020-21 & 2021-22). o The bidder must be in the line of business of providing Group Medical insurances for at least five (5) years as on 31st March 2022. o 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. 

How to Apply 

1. Online Proposals – Through E mails 

under Two Proposal System are invited i.e., “Technical Proposal” and “Financial Proposal” is to be prepared by the Bidders which shall  comprise the following: 

• Bidders need to Submit TECHNICAL & FINANCIAL PROPOSALS in SEPARATE EMAILS  

o Subject for submission of Technical Proposal – TECHNICAL PROPOSAL: Group medical coverage [GMC]  

o Subject for submission of Financial Proposal– FINANCIAL PROPOSAL: Group medical coverage [GMC]  

• 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 2nd Sep 2022 

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

• Kindly submit Bidder’s company profile  

• Attach IRDAI registration certificate  

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

• 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 signatures.  

2. Offline Proposals – Hard Copy 

Shall be submitted under Two Proposal System i.e., “Technical Proposal” and “Financial Proposal” is to be prepared by the Bidders which  shall comprise the following and shall be submitted at the following address:  

Kind Att: Procurement Department, 

Room to Read India Trust 

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

Dwarka Sec-21, New Delhi 110075 

Nr. Sec-8 metro station 

A) Envelope 1- Technical Proposal: Group medical coverage [GMC]  

• Kindly submit Bidder’s company profile  

• Attach IRDAI registration certificate  

B) Envelope 2- Financial Proposal: Group medical coverage [GMC] 

• 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 signatures.  

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.  

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

Enclosures 

1. Current policy copy GMC (for reference purposes ONLY) 

2. Latest Claim Ratio 

3. Template for Financial Proposal – Annex A 

4. T&Cs for Bidders - Annex B

 

To download the full RFP, click here

Click here to download relevant documents - Medical Insurance(MS)

 

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