EMBASSY OF THE REPUBLIC OF THE PHILIPPINES fi:}jct) cfl ~ ~ I 0 H:I "'4 cnT id I Cl I fl

NEW DELHI

REQUEST FOR QUOTATIONS FOR GROUP HEAL TH INSURANCE AND GROUP ACCIDENT INSURANCE FOR ONE YEAR (LOCALLY HIRED PERSONNEL OF THE EMBASSY)

1. The EMBASSY OF THE REPUBLIC OF THE PHILIPPINES, NEW DELHI (50 N Nyaya Marg Chanakyapuri New Delhi 110021, India) through the General Appropriation Act intends to apply the sum of INR 200,000.00 being the Approved Budget for the Contract (ABC) to payments under the procurement of group health insurance and group accident insurance for locally hired personnel of the Embassy from 26 June 2019 to 25 June 2020.

2. The EMBASSY OF THE REPUBLIC OF THE PHILIPPINES, NEW DELHI now invites quotations for group health insurance and group accident insurance in accordance with the description below:

Project Specification: Procurement of Group Health Insurance and Group Accident Insurance for one year (please see Annex B)

Approved Budget for the Contract:

INR 180,000.00-Group Health Insurance Coverage for nine (9) locally hired personnel and seventeen (17) dependents (please see Annex B for complete technical specifications).

INR 20,000.00 -Group Accident Insurance Coverage -9 locally hired personnel of the Embassy (please see Annex B for complete technical specifications).

The request for quotation form, detailed technical specifications and requirements for small value procurement for group health insurance and group accident insurance are attached as Annex A, Annex Band Annex C.

3. The Embassy accepts open quotations submitted directly, or e-mail address at bac.phembassy@gmail.com . Quotations should not exceed the Approved Budget for the Contract of INR 180,000.00- health insurance coverage and INR 20,000.00-group accident insurance. The below documents should be submitted to the Bids and Awards Committee (BAC) on or before 10:00 am on 17 June 2019.

Annex A- Signed Quotations Annex B- Acceptance of the attached technical specifications for the procurement of group health insurance coverage and group accident insurance coverage Annex C- Eligibility Requirements for Small Value Procurements

50-N Nyaya Marg, Chanakyapuri , New Oelhi-110021 India Tel. No. (+91-11) 2688-9091 Fax No.: (+91-11) 2687-6401

www.newdelhipedfa.gov.ph

5. The SAC of the Embassy of the Republic of the Philippines reserves the right to accept or reject any offer and to annul the process at any time prior to awarding of contract without thereby incurring any liability to the affected contractor (s).

6. For further information, please refer to:

NEW DELHI PE-BAC Secretariat Embassy of the Republic of the Philippines 50 N Nyaya Marg, Chanakyapuri New Delhi 110021 Tel Number: (+9111)2688-9091,(+9111) 2410-1120 E-mail Address: bac.phembassy@gmail.com

10 June 2019, New Delhi

Sgd. ARVIN R. DE LEON BAC Chairperson

Embassy of the Republic of the Philippines New Delhi

Annex "A"

REQUEST FOR QUOTATION

Tel. Number: Fax Number

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Please quote your lowest price for the for Group Health Insurance and Accident Insurance not later than 10:00 A.M. on 17 June 2019 personally or e-mail at bac@.phembassy@gmail.com

Terms and Conditions: ' 1. All entries must be typewritten/printed legibly. 2. Please fill out this form completely and submit it on or before 17 June 2019. 3. The Approved budget for the contract (ABC) for healthcare coverage is INR 180,000.00

while the ABC for accident insurance is INR 20,000.00

Quantity Unit Item and Specifications Price {INR)

Inclusive of taxes and other charges

1 lot Healthcare Coverage (9 Locally hired personnel

and 17 dependents)

1 lot Accident Insurance ( 9 Locally hired personnel

of the Embassy)

Total Amount (incuding taxes and other charges)

Name

Company (preferably with company stamp)

Date

Annex "B"

Technical Specifications

LOT 1: Healthcare Coverage

The Coverage for the benefit of the local hire personnel and their dependents to ensure their access to health and medical care under health insurance coverage

SCOPE

Provision of group healthcare coverage and to all locally hired personnel (including dependents) of the Embassy from 26 June 2019 to 25 June 2020.

Total number of persons to be insured: 26 (9 Local hire personnel and 17 dependents)

CONTRACT DURATION

This Local Health Insurance Coverage of local Personnel of the Embassy and their dependent shall be for a period of one (1) year.

Period of Insurance: From: 26/06/2019 Time: 00:00 Hours To Midnight of 25/06/2020.

EXTENSION OF CONTRACT

Should no new contract on local health insurance coverage for the following year be awarded by the end of this contract term, the Embassy has the option to extend the contract for three (3) months under the same terms and conditions pursuant to Republic Act 9184 and its Implementing Rules and Regulations (IRR).

Age Band 91days - 80 yrs

Family Definition Employee, Spouse and dependent children up to 21 yrs of age

Sum Insured Sum Insured per person Rs.---200 ,000----------- during the policy period

Corporate Floater -Room Rent No Capping

Maternity Benefit for NA

Normal & C-Section

9 months waiting period NA

Pre-Existing Diseases Pre-Existing Diseases Expenses Covered

Pre - Post Pre Hospitalisation and Post Hospitalisation for 60 days & 90 days respectively are Hospitalisation covered .

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AOY Clause Not Applicable

Baby Day 1 NA

Pre/Post Natal Not covered

Expenses Ambulance Service Ambulance charges covered OPD Cover

Not covered (Reimburement) The policy covers home hea lthcare services to cover the cost of the following treatment:

1. Pre and post hospitalization- Any medical expenses both before and

Home Healthcare after hospitalization such as Physiotherapy, nursing, lab tests , doctor's consultation and etc.

2. Day care- Medical procedures which do not require 24 hours hospitalization Sl.lCh as chemotherapy , radiotherapy and hemodialysis .

3. Domiciliary care- A treatment for diseases, illness, injury that needs hospital ization but are carried out at home.

Health Check Up Executive check up included (Once a year).

Provides services to deliver emergency medical assistance or need medical advice to clients that includes the following :

• 24/7 emergency medical helpline Emergency Support • Routine medical advice over the phone from an accredited and qualified Services doctor

• Ambulance services and • Hospital referrals

1st Year waiting period Waived Off

Lasik Surgery, Septoplasty, Infertil ity & Related Ailments incl.'Male sterility';Treatment

Exclusion on trial/experimental basis; Admin/Registration/Service/Misc. Charges; Expenses on fitting of Prosthesis; Any device/instrument/machine contributing/replacing the function of an organ ; Holter Monitoring are outside the scope of the policy.

Similar to other services, the provider also covers the following treatment and hospitalization:

A. Psychiatric ailments: 1. Inpatient mental care

• Room, meals, nursing care and other related services and supplies . 2. Outpatient mental care

• Visits of psychiatrist or other doctor, visits with a clinical psychologist or clinical social worker, and lab tests ordered by the accredited

Special Condition doctor. 3. Prescription drugs

• The provider covers the cost of drugs needed for treating a mental health condition .

B. Endoscopic functional sinus surgery:

• The provider will cover the surgical treatment for sinus if found by an accredited doctor/specialist that the sinusitis condition is considered medically necessarv for suraerv.

Co-Payment Overall Co-Payment: 10% of Copay in each and every reimbursement claim ,Parental Co-Payment: Nil Copay

Mid term inclusion of dependents will be possible only in case of:a) spouse (on account of marriage during the policy term)b) children (childbirth during the policy

Mid-Term Inclusion term but after the the child has completed 91 days of age) subject to not more than four children. Provision to add employees and dependents subject to payment of premiums.

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Reasonable and Not Applicable

Customary Charges

Claim Intimation & Not Applicable

Network clause Premium to be charged on Short Period Scale for addition/deletion endorsement. ,

Add-Del of Lives No Refund for deletion-if lives less than minimum required & if insured has claimed during policy. Provision to add employee and dependents subject to payment of premium

Special Condition 1 Lasik Surgery is covered if correction index is +/- 6.5 D Special Condition 2 Injuries resulting from terrorism is covered

Special Condition 3 Ayurvedic treatment will be covered in a Government Hospital.on the prescription of a registered medical practitioner.

Special Condition 4 Air Ambulance is covered upto Rs 100,000 or family sum insured whichever is less.

Attendant ch_arges are cover upto Rs 5,000 (Per life in case of Employee only policy or else it's Per Family within Family sum irisured) if length of stay for the patient is

Special Condition 5 more than 5 days. Add on covers cost pertaining to boarding and lodging of the attendant in a hospital/location prescribed by treating Medical Practitioner on reimbursement basis by presenting original Bills for each cost incurred.

Special Condition 6 Lucentis is covered upto Rs 50 ,000 Per family within the Sum Insured

Special Condition 7 Internal Congenital disease is covered and External congenital disease is covered in life threatning situation.

Special Condition 8 50% Co-Pay for cyberknife treatment/Stem Cell Transplantation .Cochlear Implant treatment shall be restricted to 50% of the SI.

Portability Portability is available on this product as per IRDA directive and product features .

Termination Policy will cease to be in effect from the date of termination of relationship with the organization.

DISEASE-WISE SUBLIMITS Appendix

Eye related

Gall Bladder

Hernia

Hydrocele

Hysterectomy

Piles

Urinary Stone (incl DJ stent removal for same stone)

Joint Replacement including Vertebral joints (Per knee)

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Technical Specifications LOT 2: Group Accident Insurance

Period if Insurance: From 26 June 2019 (Time: 00:00 Hours) to Midnight of 25 June 2020.

Total number of persons to be insured: 9 locally hired personnel of the Embassy

Benefits :

• Covers the insured in case of loss of life in an accident. • Pays a benefit if the insured is permanently disabled in an accident in the

performance of official work. • Pays a reimbursement for medical expenses incurred if the insured

requires hospitalization due to an accident. • Pays a daily benefit if the insured needs hospitalization as an inpatient

following an accident in the performance of official work. • Pays medical insurance premiums for the surviving spouse and dependent

child , in case of accidental death of the insured covered under the policy. • Pays the costs of reconstructive surgery following an accident in the

performance of official work. • Reimburses the costs of medical expenses incurred by an insured person

within 12 months of the date of loss resulting from an accident. • Pays the educational fees for the insured person's dependent child(ren) if

an accident causes the insured's death within 12 months of the date of loss.

• Pays the repatriation of mortal remains. • Pays ambulance charges. • Pays the cost of clothing damages. • Covers the expenses related to burns. • Covers transportation allowance (compassionate visit) . • Covers travel expenses for medical treatment. • Covers cost for catastrophe evacuation. • Covers the out-patient medical expenses. • Covers the cost of blood part. • Covers the cost of prosthesis and artificial limbs. • Covers the medical expenses related to procedure of broken bones. • Coversthelegalexpenses.

Conforme to the specification of lot 1 and lot 2

[Sig nature/s] [Name of Bidder's Authorized Representative/s] [Position] Date

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Annex "C"

EMBASSY OF THE REPUBLIC OF THE PHILIPPINES Bids and Awards Committee

CHECKLIST OF ELIGIBILITY DOCUMENTS FOR SMALL VALUE PROCUREMENT THAT NEED TO BE SUBMITTED TOGETHER WITH

ANNEX A, B AND C

1. OMNIBUS SWORN STATEMENT (in the prescribed form , duly notarized in accordance with the Notarized Act).ln the case of a corporation, partnership, cooperative or joint venture, the Omnibus Sworn Statement shall be accompanied by a notarized Secretary's Certificate (Authority of the Signatory) attesting to the fact that the signatory to the Omnibus Sworn Statement is the duly authorized representative of the bidder and is granted full power and authority to execute and perform any and all acts necessary and/or to represent the bidder in the bidding. (copy attached format)

2. Valid and current mayor's permit issued by the city/municipality where the principal place of business of the prospective bidder is located or appropriate equivalent document(s) in India

3. Copy of Income Tax Return

Omnibus Sworn Statement

AFFIDAVIT

I, [Name of Affiant ___________ _, , of legal age, [Civil Status 7, [Nationality , and residing at [Address of Affiant , after having been duly sworn in accordance with law, do hereby depose and state that:

1. Select one, delete the other:

If a sole proprietorship: I am the sole proprietor or authorized representative of [Name of Bidder] with office address at [address of Biddery ____________________ ~

If a partnership, corporation, cooperative, or joint venture: I am the duly authorized and designated representative of [Name of Bidder] ___ _ with office address at [address of Bidder --------------------'

2. Select one, delete the other:

If a sole proprietorship: As the owner and sole proprietor, or authorized representative of [Name of Bidder] , I have full power and authority to do, execute and perform any and all acts necessary to participate, submit the bid/quotation, and to sign and execute the ensuing contract for [Name of the Project] of the [Name of the Procuring Entity], as shown in the attached duly notarized Special Power of Attorney; If a partnership, corporation, cooperative, or joint venture: I am granted full power and authority to do, execute and perform any and all acts necessary to participate, submit the bid/quotation, and to sign and execute the ensuing contract for [Name of the Project] of the [Name of the Procuring Entity], as shown in the attached [state title of attached document showing proof of authorization (e.g., duly notarized Secretary's Certificate, Board/Partnership Resolution, or Special Power of Attorney, whichever is applicable;)] ___________ _

3. [Name of Bidder] is not "blacklisted" or barred from bidding by the Government of the Philippines or any of its agencies, offices, corporations, or Local Government Units, foreign government/foreign or international financing institution whose blacklisting rules have been recognized by the Government Procurement Policy Board;

4. Each of the documents submitted in satisfaction of the bidding requirements/small value procurement is an authentic copy of the original, complete, and all statements and information provided therein are true and correct;

5. [Name of Bidder] is authorizing the Head of the Procuring Entity or its duly authorized representative(s) to verify all the documents submitted ;

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at

6. Select one, delete the rest:

If a sole proprietorship: The owner or sole proprietor is not related to the Head of the Procuring Entity, members of the Bids and Awards Committee (BAC), the Technical Working Group, and the BAC Secretariat, the head of the Project Management Office or the end-user unit, and the project consultants by consanguinity or affinity up to the third civil degree;

If a partnership or cooperative: None of the officers and members of [Name of Bidder} is related to the Head of the Procuring Entity, members of the Bids and Awards Committee (BAC), the Technical Working Group, and the BAC Secretariat, the head of the Project Management Office or the end-user unit, and the project consultants by consanguinity or affinity up to the third civil degree;

If a corporation or joint venture: None of the officers, directors, and controlling stockholders of [Name of Bidder] is related to the Head of the Procuring Entity, members of the Bids and Awards Committee (BAC), the Technical Working Group, and the BAC Secretariat, the head of the Project Management Office or the end-user unit, and the project consultants by consanguinity or affinity up to the third civil degree;

7. [Name of Bidder] ____ _ complies with existing labor laws and standards; and

8. [Name of Bidder] __________ is aware of and has undertaken the following responsibilities as a Bidder:

a) Carefully examine all of the Bidding Documents/technical specifications;

b) Acknowledge all conditions, local or otherwise, affecting the implementation of the Contract;

c) Made an estimate of the facilities available and needed for the contract to be bid/qoute, if any; and

9. [Name of Bidder] did not give or pay directly or indirectly, any comm1ss1on , amount, fee , or any form of consideration , pecuniary or otherwise, to any person or official, personnel or representative of the government in relation to any procurement project or activity.

IN WITNESS WHEREOF, I have hereunto set my hand this_ day of_, 20_

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Bidder's Representative/Authorized Signatory

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