Answers to queries for EOI dated 21-12-2012. · 2017. 7. 25. · Answers to queries for EOI dated 21-12-2012. SI. No. Functional Area / Section Page No. Clause Query / Clarification

Answers to queries for EOI dated 21-12-2012.

SI.

No.

Functional

Area / Section

Page

No.

Clause Query / Clarification

Items

Response Clarification

Date

1 2. Introduction 3 Support functions – Finance,

Accounting, HR, Admin and facility

management, vendor management

The overall intent is that the above

solution blocks should seamlessly

integrate such that the end to end

capabilities are provided to all Business

functions of the JV TPA. In addition, the

holistic solution should have operational

interfaces to ensure effective support to

the Core and Support functions of the

TPA.

What are the specific

requirements around

Admin and Facility

management?

Technology solutions for end to end

management of support functions -

Finance, Accounting, Purchase Module,

HR, Admin, Facility Management, Asset

Management etc is what is expected to

be taken care of by the Service Provider.

All aspects of the support function, its

interaction/integration with other

business units is also considered part of

scope.

08-Jan-13

2 4.1 Some key

considerations

7 The proposed IT solution should have

capability to provide seamless service

and support to proposed JV TPA’s

manpower sitting in centralized

processing center(s) and branches

located in all major cities in India

How many CPC and

branches are envisaged

to be covered as part of

the solution?

How many users by

branch/ role needs to be

covered?

Initially one CPC is planned to be set up,

followed by another processing center in

3 years time. To provide for Business

Continuity one branch in Delhi NCR will

have the capacity to handle processing at

the level of 10-20% of the main CPC.

TPA shall have branches in all major

cities by 3rd/4th year of its operation. A

branch shall have field staff ranging from

5 to 20-25 employees attached to it

depending on business needs.

08-Jan-13

3 4.1 Some key

considerations

7 The proposed IT solution should be

compatible and capable of seamless

integration with insurers, their operating

offices as well as controlling offices

including life insurers

How many offices are

envisaged for

integration?

How many users from

insurance companies are

expected to access the

proposed IT system?

Applicants are advised to refer to market

data on PSGIC office network. The

integration would follow a gradual tiered

approach depending on business

migration and specific business function.

08-Jan-13

4 4.1 Some key

considerations

8 Principal Insurer Management – ‘SLA

terms, service rule engine, organization

hierarchy protocols’

What is the expectation

from a ‘service rule

engine’?

Service rule engine should lay framework

for adherence to all agreed terms as per

contract e.g. service standards, turn

around time, login rights for different

levels and roles at insurer end, auto

escalation in case of breach etc.

08-Jan-13

5 4.1 Some key

considerations

8 Principal Insurer Management - Self-

help portal with login rights

How many users from

insurance/IRDA company

are expected to be given

login rights?

Will be detailed in RFP. At present

applicants may use market information.

08-Jan-13

6 4.1 Some key

considerations

9 Product configuration & Membership

Management - Enrolment (customer

unique id across products and

insurers), special status flagging,

compatibility with Aadhaar Id, field

enrolment capability

Customer self-help portal

Does field enrolment

require to be done over

mobile or hand-held

devices?

Are there any other

mobility requirements –

for example, customer

self service through

smart phones & mobile

devices?

Capability for field enrolment should

include all media - mobile, hand held

devices, smart card machines etc. It is

expected that customers shall access

self service portal through smart phones,

mobile devices.

08-Jan-13

7 4.1 Some key

considerations

9 Pre-authorization - Overseas travel

claims authorization

How would overseas

travel pre-authorization

requests be received?

Are there any

requirements to integrate

with any other system/

application?

Are there any special

requirements around

communicating the

approval – for example

any defined EDI format

such as HIPPA 270?

Overseas pre-authorization would usually

be received through mail, fax and other

electronic media. At present no

integration with a system outside India is

envisaged, however interaction and

exchange of documents and information

over electronic media is envisaged.

Approval formats may need to be

compatible with local laws and formats

(e.g. HIPAA) prevailing in the country.

08-Jan-13

8 4.1 Some key

considerations

11 Customer Service – Call centre set-up

and Management

We assume that the

selected vendor is

expected to provide

functionality to manage

the call centre. Please

confirm.

Yes, the selected SI is expected to

provide functionality to manage the

Technology solution component of

contact center operations and its

integration with other business functions.

08-Jan-13

9 4.1 Some key

considerations

12 Business Process Management -

Standard data formats as per IIB,

ACCORD, industry standards

ACORD standards for

India Health Insurance

are not yet defined. What

is the expectation around

conforming to ACORD

standards?

The system should be so designed as to

be compatible with Indian industry and

Regulator requirements from the

beginning and to eventually be compliant

with international standards like ACORD

in future/as and when implemented in

India.

08-Jan-13

10 4.1 Some key

considerations

12 Infrastructure Services – Records

facility management

We assume that the

selected vendor is

expected to provide

functionality for archival

and retrieval of records.

Please confirm.

Yes. 08-Jan-13

11 4.1 Some key

considerations

15 Providing facility management (FM) for

the period of contract including

helpdesk and end user computing

(Laptop/Desktop support).

What is the scope of

facility management? Is it

limited to end user

support?

It is intended that service provider shall

facilitate facility management through

technology solution and application. End

user support for laptops and desktops

and few peripheral activities like physical

security (electronic badges, bar codes,

access cards etc) are also required. IT

Service Desk support should be ITIL

compliant.

08-Jan-13

12 6.1.5 Section 5

– Functional

and Technical

capabilities

29 Question 2.3 Question 2.3 is missing

in this section. Can you

please provide the

question?

Please ignore 08-Jan-13

13 General - - Is PSGIC looking for a

single application that will

service the end to end

requirements or is it okay

if the Vendor proposes a

combination of

interfacing applications

that would provide the

desired service /

functionality ?

It is left for the applicant to propose either

way so long as business needs,

functionality, seamless integration, data

flow and SOA etc. are ensured. In case

applicant proposes combination of

applications then applications belonging

to same family will be preferred.

08-Jan-13

14 General - - Is PSGIC okay with the

Vendor proposing

a) A Commercial Of The

Shelf (COTS) application

with readymade

functionalities or

B) To build a custom

application that would

fulfill the requirements or

C) A combination of

COTS + Custom

application that would

fulfill the requirements ?

JV TPA is open to every option, as long

as all requirements are met as well as

the timelines for operationalization are

complied with. However when a COTS

application is customised then, the

version upgrades of the application will

be the responsibility of vendor including

porting of the customisation in the

upgraded version.

08-Jan-13

15 General - - Would PSGIC be okay if

the Vendor proposes to

partner with other

product

vendors/application

service providers to

jointly propose a solution

for the JV TPA ?

It is envisaged that JV TPA shall enter

into agreement with only one service

provider (i.e. applicant bidder for end to

end solution as per EOI). The applicant

bidder may enter into partnerships with

best fit solution providers at its own

discretion, but it will be responsible and

accountable for the same.

08-Jan-13

16 General - - What is the deal term in

years that the Vendor is

required to Implement,

Support and Maintain the

JV TPA ?

Will be specified in the RFP. 08-Jan-13

17 General - - What are the expected

timelines for the first

implementation (from the

time of the award of the

contract) ?

The pilot implementation is expected to

be completed within 5 months from the

date of award of contract, however

vendor should also propose a timeline for

implementation of project.

08-Jan-13

18 General - - It is mentioned that the IT

solution should be

capable of managing

varied health insurance

products including Life

Insurance; Could you pls.

list down the various

health insurance

products that the solution

should support ?

Applicants are advised to refer to various

health insurance products available in

the market for this purpose. The IT

solution should be capable of managing

future variant of health products too, in

line with IRDA guidelines.

08-Jan-13

19 General - - How is PSGIC handling

the current business and

is there a plan to migrate

the current book of

business (data) into the

new JV TPA solution ?

At present PSGICs utilize services of

empanelled TPAs. There is a standard

process of migration of business that is

followed at the time of change of

empanelled TPA which shall be followed

in this case also.

08-Jan-13

20 General - - Would there be a

situation where PSGIC

would award the contract

to multiple vendors for

various activity blocks

based on the technical

solution (E.g. Pre-

Authorization to Vendor 1

and Member Enrollment

to Vendor 2) ?

Only one vendor to provide end to end

solution is envisaged.

08-Jan-13

21 General - - Would there be a

situation where PSGIC

would award the contract

to multiple vendors for

Software Services and

Infrastructure services

separately ?

No. 08-Jan-13

22 General - - Is PSGIC also looking for

a (the) vendor to provide

TPA manpower (BPO)

services apart from the

Software and

Infrastructure solutions ?

JV TPA is not expecting vendor to

provide the manpower for BPO services,

except for call center solution. In case of

Call Center solution, JV TPA is

considering both options.

Vendor has to provide the manpower for

the maintenance of Infrastructure

solutions though, including System

Administrators, DBAs, IT Service Desk,

Security etc that are required from IT-

Operations perspective.

08-Jan-13

23 4.1 Some key

considerations


capable to seamlessly transact with pan

India network of around 4500 hospitals

initially, growing to more than 15,000

hospitals including those for mass

schemes, international providers for

travel product etc., also extendable to a

large network of pathology labs,

physicians, consultants and other

healthcare entities like pharmacies,

wellness clinics, assistance companies

etc.

According to our

understanding, this will

be a portal based

access. Request you to

please confirm the same.

Yes, apart from that the access can also

be web services based or template

based. It is envisaged that there shall be

a healthcare information exchange

system.

08-Jan-13

24 4.1 Some key

considerations

12 Business Process Management Does the web portal /

security requirement

include single-sign-on

validation for agents etc.

when integrated with

Agency / Broker / Bank

assurance self-service

portal?

Sign-on validation/protocols for different

roles shall be discussed at RFP stage,

and the same shall follow standard

protocols observed to ensure system and

data security at all times.

08-Jan-13

25 6.1.5 Section 5

– Functional

and Technical

capabilities

29 2.2 Describe the limitations of the

solution in terms of size of database,

number of concurrent users supported

etc. ( if any). Please provide details of

benchmarking certificates obtained

The solution would have

various Components viz

Claims Management

System, MIS/Reporting,

Data Warehousing,

Portal, CRM, HR,

Finance, Accounting etc.;

will it be ok to share

Benchmarking Reports

for the solution in

entirety. Benchmarking

reports could be shared

for Individual Solution

components. Request

you to please advise on

the same.

The size of the database

, scalability of the

solution etc. would

depend on the Total no

of users and volumes of

data to be processed.

Request you to please

share the Total Number

of users and the number

of Concurrent users

Benchmarking reports to be submitted for

the system in entirety. However,

individual solution benchmarking reports

should also be submitted along with the

Entire system benchmarking report.

The projected number of users and

transaction volume will be clarified at the

time of RFP.

Further, during the implementation phase

JV TPA expects that appropriate load

testing must be undertaken to ensure

that the performance benchmarks are

complied with.

08-Jan-13

26 6.1.5 Section 5

– Functional

and Technical

capabilities

29 2 Functional and Technical details of the SolutionUnder point 2, point 2.3

seems missing. Request

you to please clarify if

this is intentional

Please ignore the typographical error. 08-Jan-13

27 4.5 Submission

and receipt of

EoIs

18 EOI document states Representative

authorization to be confirmed by Power

of Attorney Or by way of a Board

Solution of Applicant Company.

If authorized

representative is

providing a declaration

through an authenticated

documentary evidence

that he/she is

empowered by the

competent authority to

sign the necessary

documents instead of

having his/her written

Power of Attorney, then

would this be considered

as acceptable? Power of

Attorney for Competent

authority, authorizing the

representative, would be

submitted along with the

EOI response. Please

confirm if this is OK.

The Power of Attorney document may be

vested on a responsible officer of the

applicant organization, by a senior official

who is authorized to delegate the power

of attorney. The same must be

admissible in a court of law and be

subject to further legal scrutiny.

08-Jan-13

28 6.1.1 Section 1

– Eligibility

Criteria

25 Eligibility criteria, “The applicant should

have a turnover of at least INR 1000

crore per annum for the last 5 years”.

Our company “ABC"

(name changed) is a

global organization with

head office in the US,

which is also

incorporated in India as a

Limited Company. Our

global turnover is more

than INR 1000 crore in

the last 5 years.

However, our India

turnover is less than INR

1000 crore in the last 5

years.

We request clarification

on whether we will be

eligible to submit EOI for

the aforesaid project,

from the annual turnover

point of view.

The applicant bidder (not the global or

Indian parent company) must fulfill the

stated criterion mentioned in EOI.

08-Jan-13

29 Consortium

arrangement

- - ABC (name changed) is

an XYZ owned (name

changed) company & we

are one of the industry

leaders in providing the

BPO services, IT

solutions and back office

processing. We are

interested to bid for this

TPA opportunity. We

plan to enter into a

strategic alliance with

one of our preferred

partners to deliver the

requirements jointly. We

want to understand if we

can bid for this

opportunity as a

consortium.

Consortium bids are not allowed. 08-Jan-13

30 Scope of

services

- - We understand that the

existing TPA opportunity

comprise of IT system

build as well as

management of the same

on a go-forward basis.

We want to understand

whether BPO services

(ex. Data entry, any

manual processing

requirements and

exception handling) for

the same & (after the

new system goes live) is

also in scope. If yes,

what is the estimated

size of this BPO services

and are there any

location preferences from

where they are to be

delivered.

BPO Services are not in scope. JV TPA

is not expecting applicant to provide the

manpower except in case of Call Center

support. For Call Center, JV TPA is open

to both considerations at this stage.

Further details will be provided at RFP

stage.

08-Jan-13

31 4.1 Some key

considerations







There is a mention that

proposed JV TPA

manpower will be sitting

in centralized processing

center as well as

branches located in all

major cities in India.

What is going to be role

of this manpower? Is it

the same as BPO

services mentioned in

our S. No. 2. which is

part of this bid or

something else which will

stay with GIC companies

BPO services are not part of scope of

EOI, nor solicited. However, for Call

Center support refer to Question No 30

also.

08-Jan-13

32 4.1 Some key

considerations

7 Branches are expected to house the

fraud management field staff, corporate

liaisons, provider liaisons and insurance

company liaisons

How many TPA branches

across India are

expected to be put in

place. Should we

assume at-least 1-2

branches in each of

states.

Yes, JV TPA shall have a branch in each

of major city by 3rd-4th year of operation

08-Jan-13

33 Facility

management

4 - There is a mention that

applicant is expected to

provide facility

management services as

a part of this opportunity.

We want to understand if

the applicant is expected

to arrange for facility

(either self owned or

rented) & then provide all

services (system related

as well as BPO) from

these facilities across

various offices planned

to be set up in India

(centralized office as well

as branches).

Refer Q No. 11 for facility management

and also refer the EOI document to

understand the requirement

08-Jan-13

34 General - - Can the bidder form a

Consortium and bid?


35 General - - If not, can the Prime

Bidder contract/sub

contract with a software

developer and showcase

their experience?

Yes, if need be and only after ensuring

that the said software developer meets

the requirements. However the JVTPA

shall contract only with prime bidder.

08-Jan-13

36 Eligibility

Criteria

25 - Is it ESSENTIAL to be

Rs 1000 crore turnover?

Yes 08-Jan-13

37 Eligibility

Criteria

25 - If the Indian company

has a member of its

group, which is an

international company

having Rs 1000+ crore

turnover, can the Indian

company bid?

The applicant bidder (not global or Indian

parent company) must fulfill the stated

criterion mentioned in EOI.

08-Jan-13

38 Eligibility

Criteria

25 The Applicant should have a turnover of

at least INR 1000 Crore per annum for

the last 5 years as per the audited

consolidated financial statements.

1. Should the

requirement of INR 1000

crore be met by the

Indian entity only or can

we also consider the

turnover of parent

company (whether in

India or Abroad).

Refer to Question No 37. 08-Jan-13

39 General - - 2. In cases of

merger/Acquisition/Reorg

anization there are

possibilities that different

entities are formed. Can

we combine the entities

to calculate the Turnover

criteria. In such cases

the group will remain the

same.

The revenue criteria will have to be

complied with by the legal entity which is

acting as the Prime Bidder. In the event

of a prior M&A / re-organization, if the

acquiring entity's revenue fails to comply

with the minimum requirement it may not

be satisfactory.

08-Jan-13

40 General - - 3. In case the turnover

criteria is not met by the

Indian entity can the

Global entity participate

in the EOI process

directly. In such case the

contracting party will be

the global entity and

contract support will be

provided by the Indian

entity.

Refer to Question No 37. 08-Jan-13

41 Eligibility

Criteria

26 The Applicant must disclose if it or its

group companies or any of its

promoters or significant shareholders,

have any conflict of interest with respect

to the proposed JV TPA (as on the time

of submitting the EoI), which include,

but are not limited to, the following:

insurance venture/TPA venture in India.

venture in the above businesses over

the course of implementation.

If the Applicant (or any of its promoters

/significant shareholders) do have any

conflict of interest (as stated above or

otherwise), the Applicants must indicate

how the risks arising out of such conflict

would be mitigated. The PSGICs

reserve the right to evaluate each case

and consequently disqualify the

Applicant’s EoI.

Can a consortium

respond to this EOI? If

yes, can members of the

consortium use their

credentials to satisfy

eligibility criteria.


42 Eligibility

Criteria

25 The applicant should have experience

in implementing one or more of health

insurance claims management system

for an Insurance company /TPA within

the last 5 years preceding the date of

submitting the EOI

Please clarify if IT

Applicant (Bidder)

provide both Global

References to satisfy this

eligibility criteria.

Implementation of health insurance

claims management system in any

market - Indian or global shall satisfy the

criteria

08-Jan-13

43 4.1 Some key

Considerations

7 Proposed IT solution should also be

capable of servicing health insurance

claims of other insurers including life

insurers.

Will the life insurance

player be public player or

private player;

Should this be

provisioned for Will this

requirement be part of

RFP?

The system should be capable of

servicing health insurance products of all

insurance players - private, public, life,

non-life, stand alone health insurers.

08-Jan-13

44 6.15 Functional

& Technical

Capabilities

30 User Base in Insurance Industry in

general and in India in particular (Page

30)

Is it a qualifying criteria to

have an installation in

India?

It is a sub-heading, not a qualifying

criteria

08-Jan-13

45 Eligibility

Criteria (Page

5)

5 The Applicant should disclose any

failure to perform on any contract (as

evidenced by imposition of a penalty or

a judicial pronouncement or arbitration

award against the Applicant), or

expulsion from any project or contract,

or termination of any contract for breach

by such Applicant, in the last three

years, preceding the date of submitting

the EoI. Such a contract may be with

the government or private party and

penalty/expulsion/termination may be

levied by the government or such

private party. The PSGICs reserve the

right to evaluate the severity of such a

failure / breach and consequently

disqualify the Applicant’s EoI.

Kindly add public sector

companies across

Industries (Banking,

Insurance,

manufacturing).

Information sought is in respect of all

contracts/awards, across all sectors, not

confined to public sector or BFSI or

manufacturing

08-Jan-13

46 4.1 Some key

considerations







Please clarify the no of

cities, locations

Refer Q No. 2. 08-Jan-13

47 4.1 Some key

considerations

7 The processing centre shall house the

call centre, enrolment, cashless and

claims management team and customer

service with one centralized location

initially and another processing centre

thereafter

Please clarify if the entire

call centre staff is on IT

Service providers roles or

will the JV TPA provide

some of the staff

Service provider may provide staff to

man contact center.

08-Jan-13

48 4.1 Some key

considerations


compatible and capable of seamless

integration with insurers, their operating

offices as well as controlling offices

including life insurers

Please clarify if any

particular integration

standards have to be

followed.

Integration via Web services, File based

integration and standards like MT 940

standard used by insurers and banks

must be complied with.

08-Jan-13

49 Customer

Service

11 Call Centre setup and Management,

multi-lingual support, IVR, domestic and

international toll free

Does the scope include

to actually a setup a call

centre or just application

support?

Application and technology support,

integrated with other business functions

08-Jan-13

50 Eligibility

Criteria

25 Letter of Incorporation, Client Citations /

Copies of Work Order

Due to NDA with

customers and

confidentiality clause we

cannot share copies of

Work Order, but being a

public listed company we

will take ownership of the

information that will be

provided. Hope this is

fine.

For evaluation, copies of work order or

similar credential with actual client

references are required.

08-Jan-13

51 Communication

s

- - Do we also need to

consider implementation

of Exchange server and

any form of SMS

gateway for various

modes of

communications?

Yes 08-Jan-13

52 Infrastructure 12 DRP and BCP capabilities Can you provide any

specific details on this?

Overall solution must provide DR

capabilities at DR site with appropriate

recovery objectives frozen during

implementation with JV TPA.

DR location may be suggested by the

Prime Bidder and agreed with JV TPA

during implementation. The DR solution

should be able to handle the volume of

transactions, as well as provide mirroring

capability in the case of an actual

contingency.

08-Jan-13

53 Hosting 14 The Applicant should be capable of

Supplying, Customizing, Deploying,

Hosting, Maintaining, and Supporting

an integrated solution for the above

mentioned applications.

Is this referring to in-

premise hosting of

PSGICS or out of

premise? In case of out

of premise is it allowed

as per IRDA guidelines?

Out of premise hosting may be

considered, to the effect that appropriate

Security, Access and Hosting support is

declared and provided by an established

Data Centre hosting services entity.

Further details to be clarified at the stage

of RFP.

08-Jan-13

54 4.5 Submission

and receipt of

EoIs

17 The EoI must be prepared as per Form

1, provided in the Annexure.

Assuming that this is

referring to Section 6.1

Format for Expression of

Interest as there is no

Form 1 in the Annexure.

Assumption is correct. 08-Jan-13

55 Analytics 11 Analytics With respect to data

analytics do you have

any requirements for

unstructured data like e-

mail, Web sites, office

productivity tools, content

repositories and rich

media (audio, video) etc?

Current focus is on Business Intelligence

and Data Analytics on the structured data

08-Jan-13

56 Membership

Management

8 Member ID Card Issuance (compatible

with multiple types including value

loadable, smart card with biometrics,

policy, claim and medical records),

upload membership data

Is "value loadable"

referring to loaded with

monetary limits which

can be used as a debit

card depending on the

rules.

Yes 08-Jan-13

57 Claims

Management

System / Pre-

Authorization

10 Concurrent Audit Assumption is that this is

to ensure proper

processing of the claim.

In case of any

discrepancy the auditor

should be able to stop

the further processing

and assign it to the

previous stage.

The assumption is correct. Additionally,

the work-flow must support completion of

processing.

08-Jan-13

58 4.1 Some key

considerations

13 Current & Future requirements Assuming that the RFP

will segregate the current

and the future

requirements as it needs

to be a phased

implementation.

The phasing of implementation of

futuristic requirements shall be discussed

with selected service provider post RFP.

The system should be designed in such a

way that all the futuristic technologies

can be integrated seamlessly.

08-Jan-13

59 Innovative

Feature

14 Reward and recognition to IT Service

Providers basis claim filings efficiency

Is this with reference to

transaction based pricing

model?

No 08-Jan-13

60 EOI Submission - Submission is on 21st Jan 13. Request an extension till

28th Jan 13.

Cannot be extended 08-Jan-13

61 Analytics 12 ICD-CPT Coding Is CPT coding required /

mandatory? ICD codes

are being consistently

used by Insurers.

ICD coding is essential. In times to come,

CPT code capability could become

mandatory as per regulatory guidelines.

Thus the system should be built

accordingly.

08-Jan-13

62 Section 6.1.5 34 - What is expectation from

section 6.1.5 as a part of

EOI response? Are we

supposed to provide a

detailed functional &

technical solution at this

stage?

A detailed Solution Architecture is

expected

08-Jan-13

63 Section 6.1.5 34 - If yes, then can we

change design proposed

in the EOI stage, based

on actual requirements

received during RFP

stage?

The applicant bidder should be in

position to envisage the overall solution

during EOI stage, minor

changes/tweaking can be expected

during RFP

08-Jan-13

64 Section 6.1.5 34 - Do you have any

preferences for the

technologies that will be

used in proposed

solution?

No. 08-Jan-13

65 General - - Request to share the

current landscape, since

understanding of the

same especially around

the non-insurance

components is essential

to come up with a

suitable functional and

technical solution?

It is a Greenfield project, there is no

current landscape so far as JV TPA is

concerned

08-Jan-13

66 General - - Can bidders form a

consortium with another

service provider/software

vendor to meet tender

requirements? If yes,

please detail out specific

conditions for it.


67 General - - Please specify the

geographical scope of

the implementation of

this project. Are there

any rollout locations of

PSGIC where the

application will be rolled

out?

CPC shall be located in NCR, second

processing center shall be set up in 2-3

years time in another center. Branches

across various major cities shall come up

gradually from day zero to 3-4 years

08-Jan-13

68 General - - Please confirm, in case

of bidder qualifying in

EOI stage, is it

mandatory to participate

in the RFP process.

Yes 08-Jan-13

69 General - - Is there any vendor

preference for hardware

required as part of this

project for PSGIC?

Please provide hardware

specifications.

No preference for particular hardware.

Applicant bidder free to choose and offer

suitable proposal, based on the technical

requirements specified in the RFP.

08-Jan-13

70 General - - Does PSGIC have any

preferred

methodology/approach/m

odel for

implementation/project

execution?

No, the applicant Bidder may propose a

methodology that is in-line with the best-

in-class standards

08-Jan-13

71 General - - Please provide indicative

timelines for

“Implementation,

Warranty and Support”

phases of PSGIC project.

Go-live is expected in 5 months of award

of contract, vendor may also propose a

timeline. Warranty and support shall be

defined in RFP.

08-Jan-13

72 Introduction 4 Support functions – Finance,

Accounting, HR, Admin and facility

management, vendor management

What is the functionality

expected out of Facility

and Admin Management,

Vendor Management

Refer Q No. 1 and Q. No. 11 08-Jan-13

73 Key

consideration



and support to proposed JV TPA's




What is the estimated

no. of branches and

location in which JV TPA

will operate

Refer Q No. 2 08-Jan-13

74 Business

Process Block

11 Customer Relationship Management -

end to end integrated for all modes of

communication, CTI

Is the requirement for an

end to end CRM

application?

Yes 08-Jan-13

75 Business

Process Block

11 Call Centre setup and Management,

multi-lingual support, IVR, domestic and

international toll free

Is the setup & operation

of the call center in

scope?

Yes 08-Jan-13

76 Support

Process Block

13 Human Resource Management and

Finance & Accounting

Is TPSA JV ok to go with

a hosted model (SaaS)

No 08-Jan-13

77 Support

Process Block

13 Human Resource Management and

General Administration

What is the

approximation no. of

employees that TPA JV

would be having (who

will be on HRMS) during

the go-live and what is

the year-on-year growth

expected

These relevant volumes will be clarified

at the time of RFP

08-Jan-13

78 Business

Process Block

7/8/9/

10/11

- Is TPA JV looking for

compatibility of the

application on mobile

devices

Yes 08-Jan-13

79 Requirements 14 Providing Data ware house capabilities Can you please

elaborate on the

requirement

The data-ware house must be built to

provide a cross functional view of the

Business, including the data coming from

Hospitals, Insurers and other stake-

holders in the JV TPA eco-system. The

essence of MIS, Fraud Analytics, Claims

Analytics, Regulatory and associated

reports supporting all aspects of Core

and Support functions of the JV TPA

must be enabled.

08-Jan-13

80 Infrastructure

Solution

14 Procurement, installation and

maintenance of hosting solution

(DC/DRC)

Is the requirement only

for setting up the

infrastructure in DC/DR

or is the requirement for

end to end build of the

DC/DR

End to end build and maintenance is in

scope of requirements

08-Jan-13

81 Evaluation

Criteria

19 Relevant CVs upto a maximum of 15 for

the key personnel detailed below

should be provided

Can we provide sample

CVs at this stage instead

of committed CVs.

(Typically it is the sample

CVs that is provided as

earmarking resources for

long periods till the

contract is finalized is

practically difficult). We

assure that resources

with similar skills will be

deployed in the project.

PLs Confirm

No, CVs of actual planned resources

should be provided. In case of any

change in resource, replacement by

similar skilled resource, which is mutually

agreed, would be envisaged.

08-Jan-13

82 Support

Process Block

18 Finance and Accounting -Payroll

processing linked to access enabled

attendance records

Is Payroll functionality in

scope

Yes 08-Jan-13

83 JV TPA 3 - What are the key

business objectives for

the proposed JV TPA?

What is the need to

create this separate JV?

Are these some of the

objectives:

- Increase profitability

- Contain fraudulent

claims

- Streamline claim

management process,

increase efficiency

- Saving on fees paid

currently to the TPA

- Cost benefit and

revenue generation

Kindly refer to EOI document 08-Jan-13

84 JV TPA 3 - What are the drawbacks

in the existing claim

managements systems

of the individual Insurer?

This is a Greenfield project. 08-Jan-13

85 JV TPA setup 3 - By when will PSGICS JV

TPA be incorporated and

by when it will be fully

operational?

Will be detailed in RFP. 08-Jan-13

86 JV TPA

locations /

offices

7 - Please inform in which all

locations will this JV TPA

have its offices / how

many branches? And

approx. people

strength/users at each

office? What is the

employee strength of the

proposed TPA entity?

Refer Q No. 2 08-Jan-13

87 JV TPA DC /

DR

14 - PSGICS is looking for

building DC and DR or

looking at hosting

option?

JV TPA is open to either option for the

DC/DR site; in effect it will have to be

supported by the Applicant Bidder and

must meet SLAs and Recovery

objectives agreed with the JV TPA during

implementation.

08-Jan-13

88 Past

Implementation

Experience

5 - The applicant should

have past

implementation

experience for claims

management in India or

Abroad? Should these

references be on

applicant’s letterhead?

Yes past implementation is necessary.

Work order copy shall be the reference

document

08-Jan-13

89 Claims volumes 7 - Please provide details on

claim volumes and you

growth? 60 – 80 lakh

volume by when?

60-80 lakh claims volume per annum

shall be reached in 5-6 years time

approximately

08-Jan-13

90 Other insurers 3 - The solution to be

scalable to include other

insurers (both public and

private) in future? If yes,

from when? How many

insurers / organizations

are expected to be

serviced by this JV TPA?

Other insurers servicing is not linked to

any time period, capability to service

multiple insurers, as many as possible,

needs to be built in from day 1 - 4

PSGICs to begin with.

08-Jan-13

91 Page 7 to 13 –

Business

Process Block

and Support

Block

7 - Is that list of

functionalities expected

complete? Any more

functionality is expected?

Does PSGICS expect the

applicant to propose

additional functionalities

apart from the innovative

features?

Yes, innovative features and additional

functionalities are expected to be

proposed by Applicant bidders.

08-Jan-13

92 Green field

development

and

maintenance

and support

14 - What is the expectation

on implementation

timelines? For how long

PSGICs expect the

applicant to support the

entire system / solution

post implementation for

all apps, infra and

DC/DR?

Basic implementation should be

completed within 5 months from the date

of award of contract, vendor may also

propose a timeline.

The applicant is expected to support the

entire system for a certain tenure post

implementation that will be specified in

the RFP.

08-Jan-13

93 JV TPA - - Will the JV TPA be

charging back for the

services to the 4

companies and more

insurers in future? Will

the service costing

mechanism have to be

defined?

TPA shall charge respective insurance

principal for services as per service level

agreements signed between two parties.

08-Jan-13

94 Claims –

Current

Scenario

- - How is the claims

administration done

currently? Who does it

for the 4 insurers? Is it In-

house currently?


95 Existing IT

Landscape and

claims

management

systems

- - Will PSGICS reuse the

existing IT landscape

(apps and infra) for the

new JV TPA? If yes,

what all will be reused?

with the new proposed

TPA how will the existing

claims process be

impacted?


96 Networking

amongst

branches

7 - Will the applicant be

required to setup network

connectivity between

branches and HO and

hospital network?

Yes, network connectivity between

branches, CPC and HO will be required

such that they are part of same WAN.

Connectivity with hospitals may be

served via web-services portals, template

based formats, file transfer and other

existing models like fax, e-mail etc.

08-Jan-13

97 Processing

Center

7 - Where is the first

processing center

planned? When and

where will the second

processing center be?

Refer Q. No. 2. 08-Jan-13

98 Data and

backup

- - Please provide details

about size of data,

growth in data, backup

and retention period

Details will be provided in RFP 08-Jan-13

99 Introduction 3 As part of the existing health insurance

business and to bring in greater

efficiency in claims management,

PSGICs are looking to setup a

technology enabled, best-in-class third

party administrator for providing health

insurance claims administration

services. As part of the existing health

insurance business and to bring in

greater efficiency in claims

management, PSGICs are looking to

setup a technology enabled, best-in-

class third party administrator for

providing health insurance claims

administration services

Will the primary

responsibility of

proposed TPA be

specific to Health

insurance or will it also

cater to other general

Insurance like Auto?

JV TPA is proposed to be set up

exclusively to service health business of

all players in the Indian insurance market

08-Jan-13

100 Introduction 4 The systems should ensure seamless

bi-directional data transfer between the

proposed JV TPA and insurance

companies as well as banks and

healthcare service providers like

hospitals, diagnostic centers,

physicians and pharmacies etc. On the

other hand the system should integrate

seamlessly with IRDA portal in order to

meet the required regulatory

requirements.

From integration with

Insurance companies

and IRDA perspective,

are you looking at an

integration platform like a

middleware too?

Yes, applicant bidder are expected to

propose appropriate technology solution

for the same

08-Jan-13

101 Some key

Considerations

8 The processing centre shall house the

call centre, enrolment, cashless and

claims management team and customer

service with one centralized location

initially and another processing centre

thereafter

What are the specific

functions at another

processing center that

the proposed TPA is

planning to conduct

outside of the centralized

location

Second CPC shall perform similar

functions as first CPC. Branch and field

activities like provider empanelment and

monitoring, fraud control investigation,

member enrolment, wellness camps,

relationship management etc would be

conducted outside the centralized

locations

08-Jan-13

102 Some key

Considerations







Can you specify the

location of the

centralized processing

center and branch

locations?

Refer Q No. 2. 08-Jan-13

103 Self-help portal

with login rights

8 - Will the self-help portal

be used by only the

insurance companies or

will it be also available to

end customers/ insured?

what are the likely user

volumes for the portal?

Self help portals will be used by all the

stake holders like customers, insurance

companies, IRDA, hospitals etc.

Volumes shall be specified in RFP.

08-Jan-13

104 Some key

Considerations


capable to seamlessly transact with pan

India network of around 4500 hospitals

initially

What will be the

proposed mode of

interface with other

entities like hospitals/

Physicians/ labs? Will it

be online/ batch/ email

considering the technical

interface limitations at

the hospitals/ labs etc.

Information and data exchange with

hospitals may be served via web-

services portals, template based formats,

file transfer to the extent possible; some

support for existing models like fax, e-

mail should be planned for.

08-Jan-13

105 Some key

Considerations

8 Exchange of policy data, member

details, photographs, premium

payment, endorsement details

Since there will be lot of

document management,

are you also wanting a

document management

solution to manage all

the policy/ claims related

data/ supporting

documentation?

Will the same be

procured separately or is

one already available

with the client?

Yes, DMS is part of scope. Applicant

bidder is expected to procure as part of

end to end solution.

08-Jan-13

106 Legal cases

support

8 - Can you elaborate on

what is expected in terms

of support for Legal

cases?

Expectation from solution is to support

entire process of retrieval, representation

and settlement of Legal / Ombudsman /

Grievance cases, dispute cases etc. and

preserve necessary records for required

time period.

08-Jan-13

107 Data/claim files

archive

8 - With regards to the

existing cases/ archives

of claims data with

NIA/NIC/OICL/UIIC, is it

expected to migrate all

the archived data from

these companies to the

proposed TPA? If yes,

what is the data volume/

data size of the data to

be migrated?

Shall be discussed at RFP stage. 08-Jan-13

108 Enrollment

(customer

unique id across

products and

insurers)

8 - The enrollment of the

customers will happen at

the Insurance company’s

end. How will the

proposed TPA ensure

unique id across

products/ insurers?

It is expected that configuration protocol

of member enrolment of JV TPA system

shall be based on certain data points and

criteria which would enable deduping and

allotting a unique id to each customer

irrespective of product, insurer. Further

details shall be discussed later.

08-Jan-13

109 Member ID

Card Issuance

8 - Will the enrolled

insurance companies

stop customer/ card

issuance post the

formation of this TPA?

Insurance companies are not expected to

issue Member id cards.

08-Jan-13

110 smart card with

biometrics

8 - Will the procurement of

smart card be part of the

current project?

Smart cards are envisaged to be used

during later stage, however capability to

integrate with member enrolment system

should exist and also for mass schemes

like RSBY as and when serviced by JV

TPA

08-Jan-13

111 Rule based

engine,

9 - Do you need a separate

rules engine along with

Business process

management (BPM)

solution? Or will only

BPM suffice the

requirements of

proposed TPA?

It is expected that the Prime Bidder may

suggest the best fit solution to this

requirement, keeping in mind ease of

integration as well as handling of large

volume of claims. Audits and assurance

functions, as well as auto-adjudication

must be supported progressively over

time.

08-Jan-13

112 Concurrent

audit

9 - Can you provide more

elaborate details on the

audit functionality?

This is to ensure proper checks and

balances are applied during processing

of the claims. In case of any discrepancy

the auditor should be able to stop the

further processing and assign it to the

previous stage; as well as take the claim

forward.

08-Jan-13

113 mobile reporting 10 - Incase of mobile

reporting, which are the

devices that the client is

planning to support?

It is envisaged that all standard mobile

devices on major platforms like Android,

iOS (Apple), Blackberry, Symbian,

Windows Phone etc will be supported.

08-Jan-13

114 Repricing 9 - Won’t the repricing

decision be taken by the

insurance companies?

What are the kind of

inputs expected for

repricing from the

proposed solution?

Negotiation, repricing etc. are expected

to be performed by TPA and the

proposed solution should enable

capturing of relevant information, provide

inputs e.g. on possible areas for

negotiation, repricing, benchmark rates,

tariffs etc.

08-Jan-13

115 Master Data

Management

10 - Can you provide more

details on the MDM

requirement?

MDM solution should be easily

maintainable. A unified master data

solution which can handle all the master

data to be maintained under one roof

may be adopted; basic idea is to

dispense with data inconsistencies. JV

TPA is open to suggestions from Prime

Bidders on this component.

08-Jan-13

116 end to end

integrated for all

modes of

communication,

11 - Which all modes of

communication is the

client planning to have?

All standard modes of communication

including web/internet based

communication

08-Jan-13

117 4.1 Some key

considerations

12 - Can you elaborate on the

BCP activities required

by the client?

BCP function must support the business

functions with appropriate Recovery

Objectives agreed during

implementation; it must cover the critical

applications supporting Core and Support

functions.

08-Jan-13

118 General - - Is the TPA also planning

to create a consolidated

claims repository which

will be used by all the

member Insurers before

issuing/ renewing new

policies?

It is envisaged that claims history and

data shall be utilized for various

purposes as permitted by Regulations

and inter company MOU.

08-Jan-13

119 6.1.5 Section 5

– Functional

and Technical

capabilities

29 Please describe the architecture of your

solution with diagram and how is your

solution tiered.

The particular details of

architecture can be

finalized based on the

details provided in RFP,

what are the details

required at this stage of

EOI?

The applicant may propose the best fit

solution architecture, incorporating global

standards from its other implementation

experiences.

08-Jan-13

120 6.1.5 Section 5

– Functional

and Technical

capabilities

29 Describe the limitations of the solution Since it would be difficult

to finalize the exact

solution/ OEM at this EOI

stage, providing

limitations/ benchmarks

at this stage would be

difficult. Please confirm

is the same is required at

this stage?

Same is required at EOI stage. 08-Jan-13

121 6.1.5 Section 5

– Functional

and Technical

capabilities

29 Does your solution provide best

practices in respect of the activity

Blocks mentioned below, which are

those?

Some of the components

of the solutions can be

out of box while some of

the components can be

built based on platforms

like BPM, under such

scenario some of the

capabilities can be built

on the available

platforms based on past

expertise. In such a

scenario where in we are

proposing a platform

based approach, how is

the response to this

query expected?

Applicant bidders are expected to

integrate best-in-class solutions custom

built on robust platforms

08-Jan-13

122 6.1.5 Section 5

– Functional

and Technical

capabilities

30 Please provide a list of testing tools Is the client expecting

automated testing?

Applicant bidder is expected to suggest

the automated Testing tools that would

be used.

08-Jan-13

123 Member

enrollment

8 - Does the member

enrollment require a one

to one meeting with

every policy holders and

capture details and bio

metric information?

If yes, whether the skill

and facility need to be

factored as part IT

services or only the

solution needs to be

covered.

Regular process of member enrolment

does not envisage one to one meeting

and capturing of biometric information

except for mass schemes at present.

However, system should be built such to

accommodate the same in future.

08-Jan-13

124 Processing

Centers

12 - What is the service

window for processing

centers and the expect

number of seats?

Will be detailed in RFP. 08-Jan-13

125 FMS for

Desktops and

Laptops

20 - Whether the IT service

desk to be operated from

JV TPA premises or IT

service provider

premises?

Both options are possible for different

services, subject to adherence to

committed service standards

08-Jan-13

126 Support Post-

Implementation

11 - Post implementation,

what support structure is

PSGICS looking for from

the applicant?

Will be detailed later, applicant bidder

can propose at present from its own end.

08-Jan-13

127 6.1.5 Section 5

– Functional

and Technical

capabilities



solution tiered.

Can SI Provide different

options available in terms

of architectures/

technologies for the

solution? The exact

architecture that suits the

need can only be

identified once all the

technical details are

released in the RFP.

Applicant bidder is expected to propose

best fit architecture, technologies and

solution from EoI stage, few

modifications may be made at later stage

08-Jan-13

128 6.1.5 Section 5

– Functional

and Technical

capabilities



solution tiered.

During the RFP stage,

can the SI propose only

the

architecture/technologies

proposed in the EOI or

can SI propose

architecture/technologies

that suits the

requirements of the RFP

best even if it was not

proposed in the EOI.

Refer Q No. 127. Minor modifications are

permissible.

08-Jan-13

129 6.1.5 Section 5

– Functional

and Technical

capabilities

20 - How will the 30 marks

assigned to “Functional &

Technical capabilities” be

split among the line items

given in Section 5 –

Functional and Technical

capabilities?

All the sub questions will have equal

weightage except the last sub-question

which will carry double weightage.

08-Jan-13

130 6.1.5 Section 5

– Functional

and Technical

capabilities

29 - Line item 2.3 is missing. Please ignore typographical error 08-Jan-13

131 4.1 Some key

considerations

13 Cloud Computing What business initiatives

you have planned for the

Cloud Computing. (Short

/Medium /Long Term)


propose from their end

08-Jan-13

132 4.1 Some key

considerations

13 Cloud Computing What Model of Cloud

Infrastructure is decided?

(Private Cloud/Public

Cloud/Community

Cloud/Hybrid Cloud)



08-Jan-13

133 4.1 Some key

considerations

13 Cloud Computing What are the services

you want to offer?

(IaaS/PaaS/SaaS)



08-Jan-13

134 4.1 Some key

considerations

13 Cloud Computing When do you anticipate

starting your Cloud

project?



08-Jan-13

135 4.1 Some key

considerations

13 Cloud Computing Where do you want to

locate your Cloud

Infrastructure?

DC

DR



08-Jan-13

136 4.1 Some key

considerations

13 Cloud Computing Please provide an

overview of your existing

IT Infrastructure

/Datacenter facilities

(Compute, Storage &

Network)

This is a greenfield IT project. Applicant

bidders are expected to propose from

their end

08-Jan-13

Documents

Answers to queries for EOI dated 21-12-2012. · 2017. 7. 25. · Answers to queries for EOI dated 21-12-2012. SI. No. Functional Area / Section Page No. Clause Query / Clarification