bsnl

Bharat Sanchar Nigam Ltd,

Chennai Telephone District

Expression of Interest: BSNL Chennai

Telephone District Employees Health Insurance

Scheme (BCHTDEHIS)

of 16 Bharat Sanchar Nigam Ltd, Chennai telephone District

Table of Contents

BACKGROUND 3

NAME OF THE SCHEME 3

BENEFICIARIES 3

STRUCTURE OF BCHTDEHIS 4

Sums Insured / Policy Limits 4

Scheme Floater Sum Insured 4

Expected Number of beneficiary families 5

Family Size / Age Limit 5

Insurance Coverage 7

EXPRESSION OF INTEREST: APPLICANT’S PROFILE 8

Contact Details 8

Experience in Health Insurance 8

Resource Group 9

INPUTS SOUGHT FROM THE APPLICANTS 9

Enrolment of beneficiaries 9

Claims 10

Treatment Outside jurisdiction 10

List of empanelled Hospitals 10

Addition &Deletion of members of Family 10

Benefits for Ayurvedic/Homeo/Unani/Siddha treatment 11

Ambulance Service 11

Free OPD Consultation 11

Capacity Building 11

Smart /ID cards 12

Grievance Redressal 12

Web-based MIS 12

IEC Plans 12

Coverage of AIDS 13

Health Checkup 13

Medical Equipments, Implant Materials, Appliances, etc 13

Dental Procedures 14

Room/Bed Charges for Hospitalisation Treatment 14

Domiciliary Hospitalisation 15

Hospitalisation only for Investigations or Health Checkup 15

Exclusions 15

Period of Insurance Contract 16

Indicative Premium 16


BACKGROUND

Bharat Sanchar Nigam Limited a leading Telecommunication Service Provider in India is a Central Public

Sector Enterprise Wholly owned by Govt. of India. It is having its own Scheme named BSNL Medical

Reimbursement Scheme (BSNL MRS) for providing health care to serving BSNL employees and their

dependant family members. Over the years, the scheme has been extended to cover BSNL pensioners

and their dependant family members.

BSNL, now, proposes to replace the existing inpatient health care services to their Serving Employees of

Chennai Telephone District under BSNL MR Scheme through a Health Insurance Scheme (Group

Mediclaim Insurance Scheme) catering to their inpatient health care requirements. The proposed Group

Mediclaim Insurance scheme shall be compulsory for serving employees of Chennai Telephone District

for inpatient treatment of employees serving in and around Chennai (ie. Chennai Metropolitan City,

Chengalpattu District, Kanchipuram District and Tiruvallur District.)

With the introduction of health insurance scheme, Employees of BSNL Chennai Telephone District will

have the choice to select the best available health facilities for meeting their health care and can get

best available treatment in areas in the close proximity. More No. of hospitals will be covered under this

Scheme than that of the Recognised Hospitals under BSNL MR Scheme.

BSNL Chennai Telephone District invites Expressions of Interest from Govt. /Private

Insurance Organisations having licence from IRDA for the proposed scheme.

NAME OF THE SCHEME

The name of the proposed scheme is BSNL Chennai Telephone District Employees Health

Insurance Scheme (BCHTDEHIS).

BENEFICIARIES

All Serving Employees of BSNL Chennai Telephone District who are covered under the existing BSNL

MR Scheme shall be offered Health Insurance Scheme on compulsorily basis . All the serving

employees of Chennai Telephone District and their families will be the beneficiaries of the Scheme.


STRUCTURE OF BCHTDEHIS

Sums Insured / Policy Limits

The scheme shall provide coverage for meeting all expenses relating to hospitalization of beneficiary

members subject to stated limits on cashless basis through Smart /Insurance ID cards. It has been

proposed to take following Nos. of policies for the Sum assured noted against each.

Sl. No No. of Policies to be

subscribed

Sum Assured for each

policy (Rs)

Total Sum Assured

(Rs.)

1. 4000 25000 100000000

2. 2000 50000 100000000

3. 500 100000 50000000

4. 150 300000 45000000

5 50 500000 25000000

Total 6700 320000000

No policy will be assigned to any specific individual or family but all the above nos. of policies are

common for the entire group of employees of Chennai Telephone District and their families in flexible

manner. The benefit shall also be available to each and every member of the family on floater basis. In

short, the initial claims of each family which are within Rs.25000/- will avail of the benefits of lowest slot

of Policies of Rs. 25000/- . When ever the initial claims or the claims including the benefits availed under

Ist slot of each family exceeds Rs. 25000/-, they will be considered under 2nd

slot of policies. Then the

initial claims or the claims including the benefits availed under the 2nd

slot exceed Rs.50000/-, they will

come under 3rd

slot and so on. All the above said 6700 policies are common for all the 11292 families of

working employees of the BSNL Chennai Telephones.

Scheme Floater Sum Insured

An additional sum of Rs. 3 crore shall be provided as Buffer / corporate floater to take care of

hospitalization expenses of a family (per illness or annual) exceed the original sum insured in the above

said group of policies. In all such cases an additional amount up to Rs. 5.00 lac per family shall be

provided from the Scheme Floater, on the recommendation of the committee set up by BSNL Chennai

Telephone District/ Nodal agency.


Expected Number of beneficiary families

It is approximately estimated that 11292 employees and 37830 Nos. of their dependant and family

members will be covered under the scheme BCHTDEHIS. Approximate age profile of the above said

beneficiaries are as furnished below:

Sl. No. Age Band No. of Serving

Employees

No. of Dependants/

Family Members

Total

1. Upto 25 years 106 19908 20014

2. > 25 to 35 years 583 3460 4043

3. > 35 to 45 years 2324 4562 6886

4. > 45 to 55 years 6414 3132 9546

5. > 55 to 65 years 1865* 1855 3720

6. > 65 to 75 years 4878 4878

7. Above 75 years 35 35

8. T O T A L 11292 37830 49122

* Serving Employees below 60 years only.

Family Size / Age Limit

1. Family size will be of 6 members containing Self, spouse, two dependent children

and two dependent parents (New born shall be considered insured from day one).

2. If any of the above said member is not there for a particular employee, the employee can

choose any other dependant as per the definition of the Central Services (Medical Attendance )

Rules, 1944 upto family size of 6 members. Additional dependent family member over and

above the 6 members can be covered under the scheme by paying the fixed percentage of

premium per additional dependant family member. The extra premium shall be borne by the

beneficiary.

3. All beneficiaries shall be insured till survival or upto the insurance coverage period which ever is

earlier.

4. The definition of dependent shall be as per guidelines issued by Central Government under

Central Services (Medical Attendance) Rules, 1944. The term ‘family’ for the purpose of the

Central Services (Medical Attendance) Rules means BSNL Employee’s Wife or Husband, as the


case may be, and parents, dependent unmarried/ divorced/ abandoned or separated from their

husband/ widowed sisters, dependent divorced/ abandoned or separated from their husband/

widowed daughters, minor brothers upto the age of becoming major, children, step children

and step mother wholly dependent upon the BSNL Employee.

Note 1: A member of the family is treated as dependant only if his/her income from all sources

including pension/ and family pension is less than Rs.3500 plus amount of the dearness relief

drawn on the basic pension of Rs.3500/- on the date of consideration.

Note 2: Son will be dependant of the employee till he starts earning or attains the age of 25

years whichever is earlier. Son suffering from any permanent disability of any kind (physical or

Mental ) irrespective of the age limit will be dependent on the employee. Daughter will be

dependant till she starts earning or gets married irrespective of the age limit which ever is earlier.

The term ‘Children’ will include children adopted legally. It will also include children taken as wards

by the BSNL Employees under the “Guardians and Wards Act,1890”, provided such a ward lives

with the BSNL Employee and is treated as a member of the family, and provided the BSNL Employee

through a special Will, has given such a ward the same status that of a natural born child.

Note 3: Both Husband and Wife are BSNL Employees: In case where both husband and wife are

BSNL employees, only one of them may be allowed to avail the medical benefits according to his /

her status. For this purpose, they should furnish to the respective authorities a joint declaration as

to who will prefer the claim for medical expenses incurred on the treatment in respect of spouse

and children. The above declaration should be submitted in duplicate and copy shall be recorded

in the personal file of each of them in their respective offices. This declaration shall remain in force

till such time it is revised on the express request in writing by both the husband and wife e.g. in the

event of promotion,

transfer, resignation etc of either of the two. In the absence of such a joint declaration, the medical

benefits shall be availed of by the wife and children according to the status of the husband.

Note 4: Spouse employed in Central/ State Govt., etc: The Husband or Wife of the BSNL

Employee, as the case may be, employed in a Central /State Govt. or Corporation/Bodies financed

partly or wholly by the Central or the State Govt., local bodies, and private organisations, which

provide medical facilities would be entitled to choose either the facilities under the BSNL Chennai

Telephone District, or the medical facilities provided by the organisation in which he/she is

employed. The procedure for making the choice or for the revision of option as laid down under

Note 3 above should also be followed in types of cases falling under Note 4.

Note 5: When spouse governed by different medical rules, stationed/residing at different

stations.— In case of BSNL employees covered under CS(MA) Rules and whose spouses are

employed in other organisations providing different medical facilities and stationed and residing at

different places separately at their respective duty stations, the BSNL employee can avail medical


facilities under CS(MA) Rules in respect of himself /herself, as the case may be and the family

members residing with him/her and covered under the rules, provided (a) his/her spouse employed

in other organisations is not in receipt of fixed monthly medical allowance , and (b) he/she produces

a certificate from the employer of his/her spouse and their family members.

Note 6: BSNL Employees can claim medical reimbursement for dependant family members except

spouse who is receipt of fixed medical allowance.

Note 7: Female BSNL employees are permitted to give option to include either their parents, or

their parents in law

Note 8: The above provisions are some of the important provisions every body may frequently

come across. Any other provisions left out has to be effected as per the provisions of the Central

Services (Medical Attendance) Rules, 1944 as amended from time to time.

Insurance Coverage

In addition to the coverage afforded under a standard medical insurance policy, the following shall also

be covered under BCHTDEHIS:

1. Pre-existing diseases/ailments

2. Maternity benefit upto a limit of Rs. 50000/-without waiting for 9 months period

3. Day-one Coverage for all diseases

4. New-born babies

5. Pre and Post hospitalization cover of 30 days and 60 days respectively

6. Waiver of first 4 years exclusions.

7. Group /Corporate discount

8. TPA facility for cashless settlement through network hospitals.


EXPRESSION OF INTEREST: APPLICANT’S PROFILE

Contact Details

Name of the organization

Insurer or Health Insurance

Consultant

Annual Turnover of the organisation

Postal Address

Website

Phone (with STD code)

Fax (with STD code)

Contact person’s name

Contact person’s mobile phone

Contact person’s e-mail ID

Experience in Health Insurance

Please give details of five, government-sponsored major health insurance schemes which you have,

individually or as an organization, been associated with as insurers or as health insurance consultants.

S.No Sponsoring Ministry /

State/Govt.

organization including

PSU

Name of the

Scheme

Insured

persons

Families Insured

(number)

1

2

3

4

5


Resource Group

Please give details of resource persons currently in your employ who would be responsible for

BCHTDEHIS activities

S.No Name Qualifications Experience in

Insurance industry

Area of Specialization

1

2

3

4

INPUTS SOUGHT FROM THE APPLICANTS

Based on the aforementioned background and indicative policy structure, inputs are sought from the

applicants on the issues as follows. It is expected that the applicants will give inputs based on their

experience of other large health insurance schemes and learnings there from. Please slot your response

in the boxes under each heading.

Enrolment of beneficiaries

Details are sought about the end-to-end enrollment process, documentation, logistics, government

intervention, plans to reach out to the beneficiaries and finally delivery of smart cards/Insurance ID

cards with details of dependants. This should take into account multiple locations and sizeable number

of beneficiaries and, therefore, the timelines. (Please give your views in the box)


Claims

Mapping of insured population with the healthcare infrastructure, service indicators, processes,

documentation for all three scenarios need to be elaborated i.e., planned hospitalisation, emergency

hospitalisation and admissions in non-panel hospitals in and outside the jurisdiction of BSNL Chennai

Telephone District (Please give your views in the box)

Treatment Outside Jurisdiction:

Beneficiaries may be on tour/ domestic affairs outside the jurisdiction of Chennai Telephone District

occasionally . In such case availability of inpatient medical benefits to the beneficiaries in the toured

station on Pan India basis within the coverage of proposed Scheme may be elaborated in the box given

below:

List of Empanelled Hospitals:

Details of Hospitals like Name, Category, Address, Speciality, etc within the jurisdiction and outside

jurisdiction on Pan India basis in your empanelment and at which the beneficiaries can avail the

inpatient treatment may be attached.

Addition & Deletion of members of family :

The method of addition or deletion of members according to their eligibility during the currency of

Policy assured period and the effect on premium payable may be furnished in the box given below:


Benefits for Aurvedic/Homeo/Unani / Siddha Treatment:

Availability of benefits for the Aurvedic/ Homeo/Unani/Siddha treatments under the above said scheme

and applicable conditions ,if any, may be furnished in the box given below:

Ambulance Service:

Details of Ambulance service benefits available under this Scheme may be furnished in the box given

below:

Free OPD Consultation

Views are sought on the industry’s ability to organize free OPD consultation in designated hospitals /

nursing homes on panel, free of any charge, in certain designated locations. (Please give your views in

the box)

Capacity Building

A scheme of this magnitude may require that the BSNL plays the crucial roles in creating awareness

about the scheme, its benefits, procedures, documentation and service levels to the beneficiaries as

regards enrollment and claims. This would require building of capacities within the BSNL at multiple

locations through multiple fora by training the facilitators representing the BSNL to ensure seamless

implementation and delivery. Please state your plans and activities to this end. (Please give your views

in the box)


Smart/ ID cards

Single Smart /ID Card for all beneficiaries would be required; carrying all personal details, biometric

data, medical history, policy limits etc. to the BCHTDEHIS members. The authenticity of Personal details

in the Smart/ID Cards should be made by the authorised signatories of BSNL Chennai Telephone District

and Insurance Company. Please elaborate all related issues like smart/ID card specifications, logistics

plans , OTC issuance of cards , card-kiosks , POS machine installations & other hardware at the hospitals’

end, connectivity , transfer of data, payment mechanism etc. (Please give your views in the box)

Grievance Redressal

A structured and layered grievance redressal mechanism needs to be in place to attend to the

beneficiaries’ issues regarding enrollments, cards, claims and service standards. This mechanism is to be

accessible at specified area levels. Please give your observations as regards the structure, processes and

timelines involving grievance redressal. (Please give your views in the box)

Web-based MIS

This is one of the most critical aspects of the scheme. A web-based, real-time MIS is to be created which

will track, on one hand, the status of each beneficiary as regards his enrollment details, smart / ID cards

and claims preferred by him. On the other hand, it should give a wide combination of statistics to BSNL

Chennai telephone District enabling various area level officers of BSNL Chennai Telephone District to

monitor various macros. Please elaborate on the structure and technical specification of the same.

(Please give your views in the box)

IEC Plans

Drilled-down Info/Education/Communication requiring the beneficiaries to understand the scheme.

This should include awareness about the scheme, facilities and “How-to-access-facilities”. Please state

appropriate plans. (Please give your views in the box)


Coverage of AIDS

Coverage of expenses towards treatment of Aids may also be sought by the BSNL which generally

happens to be a exclusion in a standard medical insurance policy. (Please give your views in the box)

Health Check-up

The scheme proposes to include a general health check up for all beneficiaries at least once a year.

Please detail elements of health check-up, process , service network etc. ( Please give your views in the

box)

Medical Equipments, Implant Material, Appliances etc.

Under the BSNL MR Scheme, medical equipments like oxygen concentrators, hearing aids, C Pap

Machines, IOLs for Cataract Surgeries, Implant materials for Hip/ Knee replacement & other artificial

appliances, coronary balloons, coronary stents, Rotablator, Pacemakers, etc. are also provided. Should

these be provided under the proposed health insurance scheme? ( Please give your views in the box)


Dental Procedures

The BSNL MR Scheme provides for certain dental procedures while such procedures are not covered

under most health insurance policies currently available in the market. Should the proposed insurance

scheme also include dental procedures? ( Please give your views in the box)

Room/Bed Charges for Hospitalisation Treatment

Under BSNL MR Scheme, Employee group as detailed below are entitled for Charges applicable for the

Eligible Ward shown against each.

Sl.No Employees Group Eligibility

1. Group D General Ward

2. Group C Semi-Private Ward

3. Group B & Group A ( upto STS) Private Ward(Non-AC)

4. Group A JAG & Above Private Ward (AC)

Insurance company may specify how the above said entitlement can be effectively allowed for the

beneficiaries. Please indicate your plans in the box given below


Domiciliary Hospitalisation

Details of ailments/Diseases covered under Domiciliary Hospitalisation and the discount for deletion or

loading of premium for inclusion may please be furnished in the box given below:

Hospitalisation only for Investigation or Health check up:

Whether the hospitalisation of beneficiaries only for the purpose of laboratory / specialised

investigation or Health Check up will be covered in the above said scheme? (Please give your views in

the box)

Exclusions

BCHTDEHIS aims to be a comprehensive insurance scheme. It is , therefore, imperative that all

exclusions , standard or otherwise , be known to BSNL Chennai Telephone District in ahead of

implementation so that there are no surprises. Please list out the exclusions which the insurance

industry cannot help but impose. (Please give your views in the box)


Period of Insurance Contract

The period of insurance shall be for one year on trial basis but the BSNL may enter into a long-term

contract with insurance companies after assessing the premium commensurate with the performance.

Fully appreciating the pricing issues facing renewals of medical policies , the BSNL may come with the

idea of introducing a renewal pricing mechanism which shall be based on burning cost. Views are sought

for the provision for correction of renewal price by way of discount on premium rate. (Please give your

views in the box)

Indicative Premium

Applicants are requested to indicate the annual premium payable for the above said 6700 policies for a

Total Sum Insured of Rs. 35 Crores per annum, including the Scheme Floater sum insured. Detailed

calculation along with any provision for payment of premium by BSNL Chennai Telephone District on

quarterly basis may be furnished by the applicants. It is clarified that the premium rate so advised by the

applicants shall be purely for building a reasonable estimate of the scheme costs and not for any other

purpose. (Please give your views in the box)

N.B:

ELIGIBLE HEALTH INSURERS AND OR HEALTH INSURANCE CONSULTANTS MAY SEND IN

THEIR EXPRESSION OF INTEREST IN THE GIVEN FORMAT BY E-MAIL TO

[email protected]. HARD COPIES, DULY ATTESTTED BY AN AUTHORISED SIGNATORY

MAY BE SENT TO Shri.K. Chandran, Dy. General Manager (Admn), BSNL, Chennai Telephone

Distrcit, 89, Millers Road, Chennai - 600010. EXPRESSIONS OF INTEREST NOT SUBMITTED

ELECTRONICALLY WOULD NOT BE CONSIDERED.

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