Life Insurance Corporation of India

1 Life Insurance Corporation of India Tender Document for Empanelment of TPAs for providing services for LIC s Health Insurance Policies Health Insurance Division, 4-1-898, Oasis Plaza Tilak Road, Abids, Hyderabad 500 001.

2 TABLE OF CONTENTS Page Contents No. ACTIVITY SCHEDULE: 3 SECTION:1 1.1: INTRODUCTION 4 1.2: GEOGRAPHICAL SPREAD OF LIC 4 1.3: OBJECTIVE 4 1.4: DISCLAIMER 4 SECTION: 2 2.1: BASIC ELIGIBILITY CRITERIA FOR BIDDERS 4 2.2: CRITERIA FOR EVALUATION OF TPAs AT TECHNICAL BID STAGE 5 SECTION: 3 3.1: BID TERMS AND CONDITIONS 5 3.2: EARNEST MONEY DEPOSIT (EMD) 6 3.3: BIDDING PROCESS 6 3.4: TERMS OF PAYMENT 7 SECTION: 4 GENERAL TERMS AND CONDITIONS 4.1: ASSIGNMENT 7 4.2: DISPUTE 7 4.3 PRE-BID MEETING 7 4.4: RIGHTS RESERVED BY THE CORPORATION 7 4.5: EVALUATION CRITERIA 8 4.6: CONFIDENTIALITY 8 LIST OF ATTACHMENTS: 1. Annexure I - Basic Eligibility Criteria 2. Annexure II - Criteria for Evaluation of TPAs 3. Annexure III - List of Regions 4. Annexure IV - Role of TPA 5. Annexure V - Format for Technical Bid 6. Annexure VI - Format for Financial Bid

3 ACTIVITY SCHEDULE Name of Project RFP for Empanelment of TPAs for providing services for LIC s Health Insurance Policies 1 RFP/Bid Date 12.02.2015 2 Address for Receipt / submission of Bid The Executive Director(HI), L I C of India, Health Insurance Division, 4-1-897, Oasis Plaza, Tilak Road, Abids, Hyderabad 500 001. 3 BID SUBMISSION The bids are to be submitted in two parts. One sealed envelope super scribed as TECHNICAL BID giving details in the format as per Annexure V and second envelope super scribed as FINANCIAL BID in the format as per Annexure VI. The two sealed envelopes as above will be placed in another sealed cover super scribed as bid for TPA services 4 Date of Calling for Expression of Interest 5 Last Date to receive the Expression of Interest and to issue the Bid Forms 12.02.2015 21.02.2015 6 Pre-Bid Meeting 03.03.2015, 11.00 a.m. 7 Last date & time of Submission of Bid papers by the TPA 8 Technical Bid OPENING DATE,TIME & VENUE 13.03.2015, 4.00 p.m. 13.03.2015, 4.15 p.m. at Health Insurance Division, L I C of India, 4-1-897, Oasis Plaza, Tilak Road, Abids, Hyderabad. 9 Financial Bid OPENING 23.03.2015 10 Contact Details Email ID co_hitpa@licindia.com 11 Official Website www.licindia.com 12 EMD/Bid Security Rs.50000/- If there is any change in any of the above dates, bidders will be informed by mail. 4

SECTION: 1 1.1: INTRODUCTION: Health Insurance Division is a wing of Life Insurance Corporation of India started in 2007 with head quarters at Hyderabad handling the health insurance business throughout the country. 1.2: GEOGRAPHICAL SPREAD OF LIC: Corporate Office: Mumbai Zonal Offices: 8 (Bhopal, Kolkata, Chennai, Hyderabad, Kanpur, Delhi, Mumbai and Patna) Divisional Offices: 112 Branch Offices: 2048 Satellite Offices: 1346 Mini offices: 1242 1.3: OBJECTIVE: LIC s Health Insurance Division, Hyderabad intends to issue this Bid Document, hereinafter called Request for Proposal or RFP to the bidders to participate in the selection of TPAs process for facilitating tender services (two bid system), in order to establish more transparency in the Selection process. The Selection process will be Region wise. (Please see the Annexure III) The TPAs to submit the Financial Bids Region wise. First Technical Bids will be opened and evaluated. For those TPAs, who have been selected in Technical evaluation, their financial bids will be opened and L1 of the respective Regions will be selected. 1.4: DISCLAIMER: This RFP document is an invitation by LIC to the applicants who are qualified to submit the Bids. The purpose of this RFP document is to provide Bidder with information to assist the formulation of their proposals. LIC may in its absolute discretion, but without being under any obligation to do so, update or amend the RFP document. SECTION-2: 2.1: BASIC ELIGIBILITY CRITERIA FOR BIDDERS 1. The Bidder should have a valid and In-force Licence issued by IRDA as on date of Opening of Financial Bids. The LIC HI Division should receive the scanned copy of the Valid and In-force Licence issued by IRDA on or before 21.03.2015. 2. The Bidder should have a minimum 5 years of experience. 3. The Bidder should have tie up with a network minimum 1000 hospitals in the Region applied for except East Region. For East Region, they should have tie up with a network minimum of 250 hospitals. 4. The bidder should have their own Web-site and Toll Free/Call Centre facilities

2.2: Criteria for evaluation of TPAs at Technical Bid Stage to Rank R1, R2..etc. (please see the Annexure II) 3.1 BID TERMS AND CONDITIONS: 5 i. The Bidder shall bear all costs associated with the preparation and submission of its bid and the Corporation, will in no way be held responsible or liable for these costs, regardless of the conduct or outcome of the selection process. It is also clarified that no binding relationship will exist between any of the Respondents and Life Insurance Corporation of India until execution of a contractual agreement. ii. The Bidder is expected to examine all instructions, statements, forms, terms, conditions and specifications in the bid document. Failure to furnish all information required by the bid document will be at the Bidder s risk and may result in rejection of bid. iii. Kindly note that the bids which are not duly signed will not be entertained under any circumstances. Any corrections and alterations in the entries of tender papers shall be signed in full by the bidder with date. iv. The bidder should submit all the requirements as called for in the form of Hardcopies (bidder s documents, annexure, certificates etc.) - duly signed and stamped with company seal. v. The bidders who do not conform either to the Minimum eligibility criteria or Technical Evaluation will not be considered for empanelment. However, the EMD of such bidders will be returned in due course. vi. Any notice by one party to the other pursuant to the Contract shall be sent by fax/email and confirmed in writing to the address specified for that purpose in the Contract. All communications shall be addressed to Executive Director (HI) L I C of India, Health Insurance Division 4-1-898, Oasis Plaza, Tilak Road, Abids Hyderabad 500 001 (Telangana State) vii. Bids without proper authorization from the Principal (in case the bidder is not the Principal) shall be treated as rejected. viii. The bids received after 4.00 p.m. on 13.03.2015 will not be accepted. However, LIC reserves the right to extend the last date and time for the same at its own discretion. ix. Canvassing in any form in connection with bids is prohibited and bids submitted by bidders who resort to canvassing are liable to be rejected. x. The Bidder should not send any communication either in hard-copy/fax/e-mail after submission of the Bid, unless any clarification is sought for. If this clause is violated, the Bid will be rejected. xi. To Assist in Technical Evaluation, LIC reserves the right to call for any clarification from any/all bidder/s during the evaluation of the bids. Such clarifications should be submitted only in writing. No other correspondence on bids will be entertained. xii. This empanelment shall be valid for three years from the date of entering into SLA xiii. However, the Corporation may, at its discretion extend the validity period of this empanelment on the same terms and conditions stated in the bid document.

6 xiv. However, the Corporation may, at its discretion, terminate the contract at any time by giving one month notice. xv. If it is found that the Bidder had made a statement which is factually incorrect or if the bidder does not fulfill any of his contractual obligations, LIC may terminate the contract with the Bidder xvi. The Corporation has the right to cancel the RFP process at any time without assigning any reason, prior to finalization of this tender, without thereby incurring any liability to the affected Bidder/Bidders. xvii. Decision of ED (HI) in all matters with regard to this tender will be final and binding on all Bidders participating in this Bid. xviii. LIC reserves its right to carry out a technical inspection and performance evaluation (bench-marking) of the system offered by the short-listed bidders. xix. All bids and supporting documents should be submitted in English. 3.2: EARNEST MONEY DEPOSIT (EMD): a) Earnest Money Deposit (EMD) of Rs.50000/- (Rs. Fifty Thousand Only) should accompany the Technical bid document *Annexure V) b) The EMD shall be paid in the form of a Demand Draft from a Nationalized Bank/Scheduled Commercial Bank in favour of LIC of India, payable at Hyderabad. Any bid not accompanied by requisite EMD shall be deemed invalid and rejected. c) No Interest will be paid on EMD. d) The EMD will be returned to the unsuccessful bidders after the evaluation of the Technical bid/financial Bid. e) The EMD will be retained as security deposit for the successful Bidder. f) The EMD will be forfeited if the bidder withdraws his bid at any time after submission of the bid but before the issue of empanelment Order. 3.3: BIDDING PROCESS: There shall be a two stage bidding process: a) Technical bids submitted by the Bidders shall be evaluated first. (Please see the Annexure V for Technical bid format) b) For those TPAs who are qualified through technical bids, and having a valid and In-force Licence issued by IRDA, (The LIC HI Division should receive the scanned copy of the Valid and In-force Licence issued by IRDA on or before 21.03.2015) their financial bids will be opened region wise and ranks L1, L2 etc. (Please see the Annexure VI for financial bid format. The rates are to be quoted in the format of Financial Bid only) The rates should be written both in figures and words. In case of any mismatch, the rates noted in words shall hold precedence. c) L1 of the respective regions will be selected and shall be declared as empanelled TPA for that particular Region.

7 The tender not submitted in the prescribed format/s and/or incomplete may be liable for rejection. LIC is not responsible for non-receipt of bid by 4.00 PM on 13.03.2015 due to any reason. 3.4: TERMS OF PAYMENT: Payment towards service charges will be paid on monthly basis within a fortnight of the following month. SECTION 4: GENERAL TERMS AND CONDITIONS 4.1: ASSIGNMENT: The Bidder shall not assign in whole or in part, the obligations to perform under the contract. 4.2: DISPUTE: All disputes or differences between LIC and the Bidder shall be settled amicably. In the event of any dispute or disagreement over the interpretation of any of the terms in this bid document or claim of liability, the same shall be referred to Head of HI dept, whose decision shall be final and binding upon both the parties. All matters relating to this effect of this agreement and any amendment hereto shall be governed by the relevant laws of land, under the jurisdiction of courts in Hyderabad only. 4.3: PRE-BID MEETING : A Pre-Bid Meeting will be held with all the interested Bidders at 11.00 a.m. on 03.03.2015 at the address given in the activity schedule. 4.4: RIGHTS RESERVED BY THE CORPORATION: (a) If it is found that the bidder had made a statement which is factually incorrect, Corporation reserves the right to cancel the agreement (b) The Corporation reserves the right to accept or reject any or all Bids without assigning any reasons (c) Any bid not containing sufficient information may be rejected. (d) The Corporation reserves the right to verify the validity of bid information, and to reject any bid/quotation where the same appears to be incorrect.

8 (e) The Corporation shall have the right to cancel the RFP process at any time without assigning any reason, prior to finalization of award of the contract, without thereby incurring any liability to the affected bidder or bidders. (f) The decision of Corporation in all such matters will be final and binding on all bidders participating in this bid. 4.5: EVALUATION CRITERIA: Evaluation of the responses to the RFP and subsequent selection will be entirely at the discretion of the Corporation and will be binding on the bidders. Corporation s decision shall be final and no correspondence about the decision shall be entertained by the Corporation. (please see the Annexure I to VI) 4.6: CONFIDENTIALITY: The contents of this RFP and the annexure are confidential in nature and are provided solely for the purpose of response to the RFP. All documents submitted in response to the RFP become the property of the Corporation and will be used only for tender process. Executive Director (HI)