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PUNJAB HEALTHCARE COMMISSION

REQUEST FOR PROPOSAL (RFP)

for

MEDICAL AND HEALTH INSURANCE FOR THE EMPLOYEES OFPUNJAB HEALTHCARE COMMISSION (PHC)

Letter of Invitation Instructions to Insurance Companies (including Data Sheet) Technical Proposal - Standard Forms Financial Proposal - Standard Forms Terms of Reference

______________________________________________________________DIRECTOR BUSINESS SUPPORT

Punjab Healthcare CommissionOffice No. 1-2, 4th. Floor, Shaheen Complex, 38-Abbot Road, Lahore, Pakistan

Tel: +92-42-99206371-78, Fax: +92-42-99206370, Email: procurement@phc.org.pk,

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PUNJAB HEALTHCARE COMMISSION

Request for Proposal

Services for Medical & Health InsuranceThe Punjab Healthcare Commission (PHC) is an independent regulatory authority, established under thePHC Act, 2010. The Commission invites sealed proposals for services for Medical & Health Insurance fromeligible insurance companies registered with Sales Tax and Income Tax Departments.

Tender No. Description Submission Opening

No.12/2017-M&HI

As mentioned in theRequest for Proposal

Till 19th April2017, 3:00 PM

19th April 2017,3:30 PM

Documents are readily available at Procurement Cell of the Punjab Healthcare Commission located at theundermentioned address, which may be obtained on a written request and on payment of prescribed feeRs. 1000 (non-refundable), on any working day during office hours up to 19th April 2017 till 3:00 PM.Bidding will be conducted under PPRA Rule: 38-2 (a) “single stage two envelope bidding procedure”.Proposals should be dropped in the Tender Box kept in the office, on or before 19-04-2017 till 3:00 PM.No Proposals shall be accepted after due date and time.Proposals shall be opened on 19th April 2017 at 03:30 P.M. in the presence of the bidders or theirauthorized representatives, who choose to be present, in the Conference Room of Punjab HealthcareCommission, Office No. 1-2, 4th Floor, Shaheen Complex, 38-Abbot Road, LahoreProposals, not fulfilling minimum requirements as stipulated in the RFP documents, shall be declared non-responsive.Incomplete, conditional and proposals without appropriate bid security shall not be considered.The RFP notice is available on the websites of PPRA and Punjab Healthcare Commission,www.ppra.punjab.gov.pk and www.phc.org.pk.

Procurement CellOffice No. 1-2, 4th Floor, Shaheen Complex, 38-Abbot Road, Lahore - 54000Tel: +92-42-99206371-78, Fax: +92-42-99206370, Email: procurement@phc.org.pk

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Section 1: Letter of InvitationLetter No: ________ Date: ___________________

To

_________________________________________________________________________________________________________________________________

SUBJECT: LETTER OF INVITATION

1. Punjab Healthcare Commission (hereinafter referred “The Commission” or “PHC”) has beenestablished under PHC Act 2010 by the Govt. of Punjab. The Punjab Healthcare Commission (PHC)invites proposals to provide the following services:

MEDICAL AND HEALTH INSURANCE FOR THE EMPLOYEES OF PUNJABHEALTHCARE COMMISSION (PHC)

Details on the services are provided in the Terms of Reference.

2. The Commission now invites proposals for obtaining health insurance coverage for itsemployees, parents, spouses & children from reputed Islamic Insurance (Takaful) Companies eligibleInsurance Companies (hereinafter referred as the “Insurer”) on Lump Sum Contract basis. Moreinformation about the eligibility criteria & services are provided in the Terms of Referenceannexed with the RFP documents. Interested bidders should provide information indicating that theyare qualified to perform the services on the prescribed forms given in the RFP documents.

3. The RFP includes the following documents:

Section 1 - Letter of InvitationSection 2 - Instructions to Insurer (including Data Sheet)Section 3 - Technical Proposal - Standard FormsSection 4 - Financial Proposal - Standard FormsSection 5 - Terms of Reference

4. The Insurer will be selected according to the selection criteria & procedures described in theRFP documents by following “Single Stage-Two Envelops” procedure in accordance with thePunjab Procurement Rules 2014.

5. Two sets of “Technical Proposal” and “Financial Proposal” on the prescribed forms given inthe RFP, separately sealed, signed & stamped, must be delivered to the address given below by no laterthan 19-04-2017 before 03:00 PM, technical proposals will be opened on the same day at 03:30 PM inthe presence of the representatives of the firms who may wish to attend.

Yours sincerely,

DIRECTOR BUSINESS SUPPORTPunjab Healthcare Commission (PHC),Office No. 1-2, 4th. Floor, Shaheen Complex, 38-Abbot Road, Lahore, Pakistan

Tel: +92-42-99206371-78, Fax: +92-42-99206370, Email:procurement@phc.org.pk,

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Section 2: Instructions to Insurers

Definitions (a) “Agreement” means the Agreement signed by the Parties and all theattached documents.

(b) “Client” means The Punjab Healthcare Commission with which theselected Insurer signs the Agreement for the Services.

(c) “Insurer” means any entity or person that may provide or provides theServices to the Client under the Agreement.

(d) “Data Sheet” means such part of the Instructions to Insurers used toreflect specific conditions.

(e) “Day” means calendar day.

(f) “Government” means the Government of the Punjab and all itsassociated departments, agencies, autonomous/semi-autonomous bodies,local governments, boards, universities and similar other organizations.

(g) “Instructions to Insurers” means the document which provides shortlistedInsurers with all information needed to prepare their Proposals.

(h) “LOI” means the Letter of Invitation included in the RFP as Section 1being sent by the Client to the shortlisted Insurers.

(i) “Personnel” means professionals and support staff provided by theInsurer and assigned to perform the Services or any part thereof;“Foreign Personnel” means such professionals and support staff who atthe time of being so provided had their domicile outside Pakistan; “LocalPersonnel” means such professionals and support staff who at the time ofbeing so provided had their domicile inside Pakistan.

(j) “Proposal” means the Technical Proposal and the Financial Proposal.

(k) “RFP” means the Request for Proposal to be prepared by the Client forthe selection of Insurers, based on the Standard RFP.

(l) “Services” means the work to be performed by the Insurer pursuant tothe Agreement.

(m) “SRFP” means the Standard Request for Proposals, which must be usedby the Client as a guide for the preparation of the RFP.

(n) “Sub-Insurer” means any person or entity with whom the Insurer subagreements any part of the Services.

(o) “Terms of Reference” (TOR) means the document included in the RFPas Section 5 which explains the objectives, scope of work, activities,tasks to be performed, respective responsibilities of the Client and theInsurer, and expected results and deliverables of the assignment.

1. Introduction 1.1 The Client named in the Data Sheet will select the Insurer from those

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who are eligible under the criteria provided in Advertisement & TORs,in accordance with the method of selection specified in the Data Sheet.

1.2 The eligible Insurers are invited to submit a Technical Proposal and aFinancial Proposal for Insurance services required for the assignmentnamed in the Data Sheet. The proposals should be in separate markedand sealed envelopes. The Proposal will be the basis for agreementclarification and ultimately for a signed Agreement with the selectedInsurer.

1.3 Insurers should familiarize themselves with assignment conditions andtake them into account in preparing their Proposals. To obtain first-hand information on the assignment, Insurers are encouraged to visitthe Client before submitting a proposal and to attend a pre-proposalconference if one is specified in the Data Sheet. Attending the pre-proposal conference is optional. Insurers should contact the Client’srepresentative named in the Data Sheet to obtain additional informationon the pre-proposal conference. Insurers should ensure these officialsare informed well-ahead of time in case they wish to visit the Client.

1.4 The Client will timely provide at no cost to the Insurers the inputs andfacilities specified in the Data Sheet, assist the firm in obtaininglicenses and permits needed to carry out the services, and makeavailable relevant project data and reports.

1.5 Insurers shall bear all costs associated with the preparation andsubmission of their proposals and agreement clarification. The Client isnot bound to accept any proposal, and reserves the right to annul theselection process at any time prior to Agreement award, withoutthereby incurring any liability to the Insurers.

2. SCOPE OFSERVICES

2.1 The health insurance will cover hospitalization (surgical, maternity &special investigations) as negotiated and agreed by both the parties. Aspart of the Company’s policy, the Company is required to arrangecomprehensive health insurance for its staff and their spouse & childrenand the purpose of this RFP is to provide the same. The selected healthinsurance shall include the provision of the following:

2.1.1 Medical Insurance Benefits as given in Annex “A & B”

2.1.2 Provision of following services:

2.1.3 Special procedure to handle emergency cases efficiently

2.1.4 24 hours operational helpline and Customer Care Department

2.1.5 Reporting system to provide details of patient admissions,premium and Inpatient claims on “as and when required basis”through online computerized system.

2.1.6 Facility to manage client through personalized health cards.

2.1.7 Performance of the Company with previous Clients

2.1.8 “Turnaround Time” for Claims settlement should not be more

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than 15 working days.

2.1.9 New Born Baby should be covered from the day of birth.

2.1.10 The company must have reputable hospitals on its panel in allmajor cities of Pakistan

2.2 Hospitalization (Employees Limits & Detail):

CategoryNo. of

EmployeesNo. of

ParentsNo. of

SpousesNo of

ChildrenA 1 1 1 1B 14 8 13 26C 49 41 46 81D 78 110 46 75

Total 142 160 106 183

Total No. of Beneficiaries: 220 (Anticipated)Employees maximum age = 65 YearsParents maximum age = 90 YearsSpouses maximum age = 65 YearsMale Children maximum age = 24 YearsFemale Children maximum age = 25 Years

3. Conflict ofInterest

3.1 Government of Punjab policy requires that Insurers provideprofessional, objective, and impartial advice and at all times hold theClient’s interests paramount, strictly avoid conflicts with otherassignments or their own corporate interests and act without anyconsideration for future work.

4. Conflictingactivities

4.1 A firm that has been engaged by the Client to provide goods, works orservices other than Insurance services for a project, and any of itsaffiliates, shall be disqualified from providing Insurance services relatedto those goods, works or services. Conversely, a firm hired to provideInsurance services for the preparation or implementation of a project,and any of its affiliates, shall be disqualified from subsequentlyproviding goods or works or services other than Insurance servicesresulting from or directly related to the firm’s Insurance services forsuch preparation or implementation. For the purpose of this paragraph,services other than Insurance services are defined as those leading to ameasurable physical output, for example surveys, exploratory drilling,aerial photography, and satellite imagery.

5. Conflictingassignments

5.1 An Insurer (including its Personnel and Sub-Insurers) or any of itsaffiliates shall not be hired for any assignment that, by its nature, maybe in conflict with another assignment of the Insurer to be executed forthe same or for another Client.

6. Conflictingrelationships

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6.1.1 Insurers have an obligation to disclose any situation of actual orpotential conflict that impacts their capacity to serve the bestinterest of their Client, or that may reasonably be perceived ashaving this effect. Failure to disclose said situations may lead tothe disqualification of the Insurer or the termination of itsAgreement.

7. UnfairAdvantage

7.1 If a shortlisted Insurer could derive a competitive advantage fromhaving provided Insurance services related to the assignment inquestion, the Client shall make available to all shortlisted Insurerstogether with this RFP all information that would in that respect givesuch Insurer any competitive advantage over competing Insurers.

8. Fraud andCorruption

8.1 The Government of Punjab requires Insurers participating in its projectsto adhere to the highest ethical standards, both during the selectionprocess and throughout the execution of an agreement. In pursuance ofthis policy, the Government of Punjab:

8.1.1 defines, for the purpose of this paragraph, the terms set forthbelow as follows:

8.1.2 “corrupt practice” means the offering, giving, receiving, orsoliciting, directly or indirectly, of anything of value to influencethe action of a public official in the selection process or inagreement execution;

8.1.3 “fraudulent practice” means a misrepresentation or omission offacts in order to influence a selection process or the execution ofa agreement;

8.1.4 “collusive practices” means a scheme or arrangement betweentwo or more Insurers with or without the knowledge of theClient, designed to establish prices at artificial, noncompetitivelevels;

8.1.5 “coercive practices” means harming or threatening to harm,directly or indirectly, persons or their property to influence theirparticipation in a procurement process, or affect the execution ofa agreement.

8.1.6 will reject a proposal for award if it determines that the Insurerrecommended for award has, directly or through an agent,engaged in corrupt, fraudulent, collusive or coercive practices incompeting for the agreement in question;

8.1.7 will sanction a Insurer, including declaring the Insurer ineligible,either indefinitely or for a stated period of time, to be awarded aGovernment of Punjab agreement if at any time it determinesthat the Insurer has, directly or through an agent, engaged incorrupt, fraudulent, collusive or coercive practices in competingfor, or in executing, a Government of Punjab agreement; and

8.1.8 will have the right to require that a provision be includedrequiring Insurers to permit the Government of Punjab or the

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Client to inspect their accounts and records and other documentsrelating to the submission of proposals and agreementperformance, and have them audited by auditors appointed bythe Government of Punjab or by the Client.

8.2 Insurers and their associates shall not be under a declaration ofineligibility for corrupt and fraudulent practices issued by theGovernment of Punjab in accordance with the above para. 1.7.Furthermore, the Insurers shall be aware of the provisions on fraud andcorruption stated in the specific clauses in the General Conditions ofAgreement.

8.3 Insurers shall furnish information on commissions and gratuities, if any,paid or to be paid to agents relating to this proposal and duringexecution of the assignment if the Insurer is awarded the Agreement, asrequested in the Financial Proposal submission form (Section 4).

9. Only oneProposal

9.1 Shortlisted Insurers may only submit one proposal. If a Insurer submitsor participates in more than one proposal, such proposals shall bedisqualified.

10. ProposalValidity

10.1 The Data Sheet indicates how long Insurers’ Proposals must remainvalid after the submission date. During this period, Insurers shallmaintain the availability of Professional staff nominated in theProposal. The Client will make its best effort to complete negotiationswithin this period. Should the need arise, however, the Client mayrequest Insurers to extend the validity period of their proposals.Insurers who agree to such extension shall confirm that they maintainthe availability of the Professional staff nominated in the Proposal, or intheir confirmation of extension of validity of the Proposal, Insurerscould submit new staff in replacement, who would be considered in thefinal evaluation for agreement award. Insurers who do not agree havethe right to refuse to extend the validity of their Proposals.

11. ClarificationandAmendment ofRFPDocuments

11.1 Insurers may request a clarification of any of the RFP documents up tothe number of days indicated in the Data Sheet before the proposalsubmission date. Any request for clarification must be sent in writing,or by standard electronic means to the Client’s address indicated in theData Sheet. The Client will respond in writing, or by standardelectronic means and will send written copies of the response(including an explanation of the query but without identifying thesource of inquiry) to all Insurers. Should the Client deem it necessaryto amend the RFP as a result of a clarification, it shall do so followingthe procedure under para. 2.2.

11.1.1 At any time before the submission of Proposals, the Client mayamend the RFP by issuing an addendum in writing or by standardelectronic means. The addendum shall be sent to all Insurers andwill be binding on them. Insurers shall acknowledge receipt of allamendments. To give Insurers reasonable time in which to take an

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amendment into account in their Proposals the Client may, if theamendment is substantial, extend the deadline for the submissionof Proposals.

12. Preparation ofProposals

12.1 The Proposal (see para. 1.2), as well as all related correspondenceexchanged by the Insurers and the Client, shall be written in thelanguage (s) specified in the Data Sheet.

12.2 In preparing their Proposal, Insurers are expected to examine in detailthe documents comprising the RFP. Material deficiencies in providingthe information requested may result in rejection of a Proposal.

12.3 While preparing the Technical Proposal, Insurers must give particularattention to the following:

(a) If a shortlisted Insurer considers that it may enhance itsexpertise for the assignment by associating with other Insurersin a joint venture or sub-consultancy, it may associate witheither (a) non-shortlisted Insurer(s), or (b) shortlisted Insurers ifso indicated in the Data Sheet. A shortlisted Insurer must firstobtain the approval of the Client if it wishes to enter into a jointventure with any other shortlisted Insurer(s). In case ofassociation with non-shortlisted Insurer(s), the shortlistedInsurer shall act as association leader. Any associations must beclearly indicated in the technical proposal. In case of a jointventure, all partners shall be jointly and severally liable andshall indicate who will act as the leader of the joint venture.

13 TechnicalProposalFormat andContent

13.1 The Technical Proposal shall provide the information indicated in thefollowing paras from (a) to (g) using the attached Standard Forms(Section 3). Paragraph (c) (ii) indicates the recommended number ofpages for the description of the approach, methodology and work planof the Technical Proposal. A page is considered to be one printed sideof A4 or letter size paper.

(a) A brief description of the Insurers’ organization and an outlineof recent experience of the Insurers (each partner in case of jointventure) on assignments of a similar nature is required in FormTECH-2 of Section 3. For each assignment, the outline shouldindicate the names of Sub-Insurers/ Professional staff whoparticipated, duration of the assignment, agreement amount, andInsurer’s involvement. Information should be provided only forthose assignments for which the Insurer was legally engaged bythe Client as a firm or as one of the major firms within a jointventure. Assignments completed by individual Professional staffworking privately or through other Insurance firms cannot beclaimed as the experience of the Insurer, or that of the Insurer’sassociates, but can be claimed by the Professional staffthemselves in their CVs. Insurers should be prepared tosubstantiate the claimed experience if so requested by the

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Client.

(b) Comments and suggestions on the Terms of Reference includingworkable suggestions that could improve the quality/ effectivenessof the assignment; and on requirements for counterpart staff andfacilities including: administrative support, office space, localtransportation, equipment, data, etc. to be provided by the Client(Form TECH-3 of Section 3).

(c) A description of the approach, methodology and work plan forperforming the assignment covering the following subjects:technical approach and methodology, work plan, andorganization and staffing schedule. Guidance on the content ofthis section of the Technical Proposals is provided under FormTECH-4 of Section 3.

(d) In short, Technical Proposal besides all shall contain:

a. Company’s profile.

b. Brochures and any other supportive documents

c. List of panel Hospitals all over the Punjab.

d. List of regional medical helpline and Customer Care Contactdetails.

e. List of coverage services being offered by insurance company.

f. List of exclusions which are not part of insurance coverage.

g. Last three year Audited Financial Statements

h. Copies of Income Tax and Sales Tax registration certificates (ifapplicable)

i. SECP registration certificate.

j. Affidavit (on stamp paper) that the Insurance Company is notblacklisted.

k. Certificate of incorporation from SECP.

l. Live demonstration of online claim handling system.

m. Government Client list with their contact details.

n. Non-Government client list with contact details.

(e) Following detail may also be provided for each quoted rate:

a. Criteria of calculation per unit and category wise.

b. Criteria of calculation of premium for additions of employeesand/or their dependents during the policy year.

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c. Proposals must be received no later than (19-Apr-2017 & 03:00PM). The proposals via courier, postal mail or by hand areacceptable.

d. A bidder's failure to submit its proposal prior to the deadline willcause the proposal to be disqualified. Late proposals oramendments will not be accepted for evaluation.

e. Validity of the proposal must be 90 days.

f. Validity of the contract will be one year only, and can beextended further based on quality services and satisfaction of themanagement/employees of Punjab Healthcare Commission.

g. The Insurance Company will be responsible for the all claimsfrom contract starting date to contract ending date.

h. Insurance Company shall be responsible to intimate about theexpiry of yearly contract before 30 days of the stated period.

i. Availability of 24/7 customer care contact.

13.2 The Technical Proposal shall not include any financial information. ATechnical Proposal containing financial information may be declarednon responsive.

14 FinancialProposals

14.1 The Financial Proposal shall be prepared using the attached StandardForms (Section 4). It shall include all costs associated with theassignment, including (a) remuneration for staff (foreign and local, inthe field and at the Insurers’ home office), and (b) reimbursableexpenses indicated in the Data Sheet. If appropriate, these costs shouldbe broken down by activity and, if appropriate, into foreign and localexpenditures. All activities and items described in the TechnicalProposal must be priced separately; activities and items described in theTechnical Proposal but not priced, shall be assumed to be included inthe prices of other activities or items.

15 Taxes 15.1 The Insurer may be subject to local taxes (such as: value added or salestax or income taxes on nonresident Foreign Personnel, duties, fees,levies) on amounts payable by the Client under the Agreement. TheClient will state in the Data Sheet if the Insurer is subject to payment ofany taxes.

15.2 Insurers should express the price of their services in Pakistan Rupees.Prices in other currencies should be converted to Pakistan Rupees usingthe selling rates of exchange given by the State Bank of Pakistan for thedate indicated in the Data Sheet.

15.3 Commissions and gratuities, if any, paid or to be paid by Insurers andrelated to the assignment will be listed in the Financial Proposal FormFIN-1 of Section 4.

15.4 Bid security (refundable on submission of Performance Security andsigning of Agreement) amounting Rs. 200,000/-, in the shape of

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Demand Draft/Pay Order or bank guarantee, must be furnishedsealed within the Financial Proposal

16 Submission,Receipt, andOpening ofProposals

16.1 The original proposal (Technical Proposal and, if required, FinancialProposal; see para. 1.2) shall contain no interlineations or overwriting,except as necessary to correct errors made by the Insurers themselves.The person who signed the proposal must initial such corrections.Submission letters for both Technical and Financial Proposals shouldrespectively be in the format of TECH-1 of Section 3, and FIN-1 ofSection 4.

16.2 An authorized representative of the Insurers shall initial all pages of theoriginal Technical and Financial Proposals. The authorization shall bein the form of a written power of attorney accompanying the Proposalor in any other form demonstrating that the representative has been dulyauthorized to sign. The signed Technical and Financial Proposals shallbe marked “ORIGINAL”.

16.3 The Technical Proposal shall be marked “ORIGINAL” or “COPY” asappropriate. The Technical Proposals shall be sent to the addressesreferred to in para. 4.5 and in the number of copies indicated in theData Sheet. All required copies of the Technical Proposal are to bemade from the original. If there are discrepancies between the originaland the copies of the Technical Proposal, the original governs.

16.4 The original and all copies of the Technical Proposal shall be placed in asealed envelope clearly marked “TECHNICAL PROPOSAL” Similarly, theoriginal Financial Proposal (if required under the selection methodindicated in the Data Sheet) shall be placed in a sealed envelope clearlymarked “FINANCIAL PROPOSAL” followed by the name of theassignment, and with a warning “DO NOT OPEN WITH THETECHNICAL PROPOSAL.” The envelopes containing the Technical andFinancial Proposals shall be placed into an outer envelope and sealed.This outer envelope shall bear the submission address and title of theAssignment, clearly marked “DO NOT OPEN, EXCEPT IN PRESENCE OFTHE OFFICIAL APPOINTED, BEFORE SUBMISSION DEADLINE”. TheClient shall not be responsible for misplacement, losing or prematureopening if the outer envelope is not sealed and/or marked as stipulated.This circumstance may be case for Proposal rejection. If the FinancialProposal is not submitted in a separate sealed envelope duly marked asindicated above, this will constitute grounds for declaring the Proposalnon-responsive.

16.5 The Proposals must be sent to the address/addresses indicated in theData Sheet and received by the Client no later than the time and thedate indicated in the Data Sheet, or any extension to this date inaccordance with para. 2.2. Any proposal received by the Client after thedeadline for submission shall be returned unopened.

16.6 The Client shall open the Technical Proposal immediately after thedeadline for their submission. The envelopes with the FinancialProposal shall remain sealed and securely stored.

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17 ProposalEvaluation

17.1 From the time the Proposals are opened to the time the Agreement isawarded, the Insurers should not contact the Client on any matterrelated to its Technical and/or Financial Proposal. Any effort byInsurers to influence the Client in the examination, evaluation, rankingof Proposals, and recommendation for award of Agreement may resultin the rejection of the Insurers’ Proposal.

Evaluators of Technical Proposals shall have no access to the FinancialProposals until the technical evaluation is concluded.

18 Evaluation ofTechnicalProposals

18.1 The evaluation committee shall evaluate the Technical Proposals on thebasis of their responsiveness to the Terms of Reference, applying theevaluation criteria, sub-criteria, and point system as specified in theData Sheet. Each responsive Proposal will be declared qualified. AProposal shall be rejected at this stage if it does not respond toimportant aspects of the RFP, and particularly the Terms of Referenceor if it fails to achieve the minimum technical score/criteria indicated inthe Data Sheet.

18.2 Only those bids will be evaluated which will successfully meetthe mandatory criteria given in technical proposal as follows:

a) Company profile.

b) The Insurance Company should be One/Single company (not group ofcompanies), providing Group Health services for not less than 5 years.

c) Proof of credit rating, minimum “A” by PACRA/JCR-VIS.

d) List of coverage services being offered by insurance company.

e) Last five year Audited Financial Statements.

f) Copies of Income Tax and Sales Tax registration certificates.

g) Copy of Certificate of Incorporation or Registration or equivalent.

h) List of minimum 20 clients with name and contact persons, telephonenumbers and addresses

i) Certificate on company letterhead for the assurance of data security andconfidentiality.

j) Brochures and other quoted documents

k) Affidavit (on stamp paper) that the Bidder has not been blacklisted ordebarred by Public Procurement, Government, Semi-Government,Private, Autonomous body or any other international organization.

l) Detail of any other additional/extra benefits not mentioned in the tender.

m) Bid Security, as mentioned at 15.4 in shape of PO/DD in favor ofPunjab Healthcare Commission with financial proposal.

n) Note: A bidder's failure to include these items in the proposal may cause

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the proposal to be determined as non-responsive and the proposal maybe rejected.

o) Punjab Healthcare Commission has a right to ask for any documentaryevidence for provision of information related to the RFP. In case theInsurance Company fails to provide the required information, themanagement of Punjab Healthcare Commission has a right to deduct themarks accordingly.

18.3 The final assignment award will be on the basis of combinedtechnical and financial score in the following manner:

Proposal WeightTechnical 70%

Financial 30%

Total 100%

The formula for determining the financial scores is following:

FS= 100 x Fm / F, in which FS is the financial score, Fm is the lowestprice and F the price of the proposal under consideration.

The weights given to the Technical Proposal (T) and Financial Proposal(P) are:

T = 0.70 [Technical weight: 70%], andP = 0.30 [Financial weight: 30%]

18.4 The final score of technical bid will be added to the financialscore and final award of contract decision will be based on total oftechnical score plus financial score.

18.5 The bidders must demonstrate the following:

18.6 Demonstrate web portal facility for claims tracking.

18.7 The bidders must demonstrate that they have the capacity toprovide health insurance services in timely and efficient manner.

19 FinancialProposals forQBS

19.1 Following the ranking of technical Proposals, when selection is basedon quality only (QBS), the first ranked Insurer is invited to negotiate itsproposal and the Agreement in accordance with the instructions givenunder para. 6 of these Instructions.

20 PublicOpening andEvaluation ofFinancialProposals

20.1 After the technical evaluation is completed, the Client shall inform theInsurers who have submitted proposals the technical qualificationobtained by their Technical Proposals, and shall notify those Insurerswhose Proposals did not meet the minimum qualifying criteria or wereconsidered non responsive to the RFP and TOR, that their Financial

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(only forQCBS, FixedBudgetSelection, andLeast-CostSelection)

Proposals will be returned unopened after completing the selectionprocess. The Client shall simultaneously notify in writing Insurers thathave secured the minimum qualifying criteria, the date, time andlocation for opening the Financial Proposals. Insurers’ attendance at theopening of Financial Proposals is optional. The opening date shall beset so as to allow interested Insurers sufficient time to makearrangements for attending the opening.

20.2 Financial Proposals shall be opened publicly in the presence of theInsurers’ representatives who choose to attend. The name of theInsurers and the technical qualification of the Insurers shall be readaloud. The Financial Proposal of the Insurers who met the minimumqualification will then be inspected to confirm that they have remainedsealed and unopened. These Financial Proposals shall be then opened,and the total prices read aloud and recorded.

20.3 The Evaluation Committee will correct any computational errors. Whencorrecting computational errors, in case of discrepancy between apartial amount and the total amount, or between word and figures, theformers will prevail. In addition to the above corrections, as indicatedunder para. 3.6, activities and items described in the Technical Proposalbut not priced, shall be assumed to be included in the prices of otheractivities or items. In case an activity or line item is quantified in theFinancial Proposal differently from the Technical Proposal, (i) if theTime-Based form of agreement has been included in the RFP, theEvaluation Committee shall correct the quantification indicated in theFinancial Proposal so as to make it consistent with that indicated in theTechnical Proposal, apply the relevant unit price included in theFinancial Proposal to the corrected quantity and correct the totalProposal cost, (ii) if the Lump-Sum form of agreement has beenincluded in the RFP, no corrections are applied to the FinancialProposal in this respect.

20.4 In case of QCBS, successful bidder will be invited for contractnegotiations.

20.5 In the case of Fixed-Budget Selection, the Client will select the firm thatsubmitted the highest ranked Technical Proposal within the budget.Proposals that exceed the indicated budget will be rejected. In the caseof the Least-Cost Selection, the Client will select the lowest proposalamong those that passed the minimum technical score. In both cases theevaluated proposal price according to para. 5.6 shall be considered, andthe selected firm is invited for negotiations.

21 Negotiations 21.1 Negotiations will be held at the date and address indicated in the DataSheet. The invited Insurer will, as a pre-requisite for attendance at thenegotiations, confirm availability of all Professional staff. Failure insatisfying such requirements may result in the Client proceeding tonegotiate with the next-ranked Insurer. Representatives conductingnegotiations on behalf of the Insurer must have written authority tonegotiate and conclude an Agreement.

22 Technical 22.1 Negotiations will include a discussion of the Technical Proposal, the

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negotiations proposed technical approach and methodology, work plan, andorganization and staffing, and any suggestions made by the Insurer toimprove the Terms of Reference. The Client and the Insurers willfinalize the Terms of Reference, staffing schedule, work schedule,logistics, and reporting. These documents will then be incorporated inthe Agreement as “Description of Services”. Special attention will bepaid to clearly defining the inputs and facilities required from the Clientto ensure satisfactory implementation of the assignment. The Clientshall prepare minutes of negotiations which will be signed by the Clientand the Insurer.

23 Conclusion ofthenegotiations

23.1 Negotiations will conclude with a review of the draft Agreement. Tocomplete negotiations the Client and the Insurer will initial the agreedAgreement. If negotiations fail, the Client will invite the Insurer whoseProposal received the second highest score to negotiate an Agreement.

24 Award ofAgreement

24.1 After completing negotiations the Client shall award the Agreement tothe selected Insurer. After Agreement signature, the Client shall returnthe unopened Financial Proposals to the unsuccessful Insurers.

24.2 The Insurer is expected to commence the assignment on the date and atthe location specified in the Data Sheet.

25 Confidentiality 25.1 Information relating to evaluation of Proposals and recommendationsconcerning awards shall not be disclosed to the Insurers who submittedthe Proposals or to other persons not officially concerned with theprocess, until the publication of the award of Agreement. The undueuse by any Insurer of confidential information related to the processmay result in the rejection of its Proposal and may be subject to theprovisions of the Insurer Selection Guidelines relating to fraud andcorruption.

26 PerformanceSecurity

26.1 Within seven (07) days of receipt of the Letter of Acceptance from theClient, the successful Insurer shall furnish to the Client theperformance security in the amount equal to 10 % of the ContractPrice as Performance Security in the form of Demand Draft/PayOrder.

26.2 The proceeds of the performance security shall be payable to the Clientas compensation for any loss resulting from the Insurer's failure tocomplete its obligations under the Contract. The Insurer shall cause thevalidity period of the performance security to be extended for suchperiod(s) as the contract performance may be extended.

26.3 The performance security shall be denominated in a currency of theContract i.e. Pak Rupees:

26.4 The performance security will be returned by the Client not later thanfifteen (15) days from the closure of the Contract.”

17 | P a g e

Instructions to InsurersDATA SHEET

ParagraphReference

1.1Name of the Client: Punjab Healthcare Commission

Method of selection: QUALITY & COST BASED (QCBS)

1.2 Financial Proposal to be submitted together with Technical Proposal (sealedin separate envelops):Yes √ NoName of the assignment is Services of Medical & Health Insurance forEmployees of PHC.

1.3 A pre- bid/proposal conference will be held: Yes __√ NoOn April 14, 2017 at 03:00 PM.The Client’s representative is: Director Business SupportAddress: - Office No. 1-2, 4th. Floor, Shaheen Complex, 38-Abbot Road,

Lahore, Pakistan.Tel: +92-42-99206371-78, Fax: +92-42-99206370E-mail: < procurement@phc.org.pk>

1.4 The Client will provide the following inputs and facilities:

Assistance in obtaining requisite information & data, reports etc.

1.6.1 (a) The Client envisages the need for continuity for downstream work:Yes No √

1.12 Proposals must remain valid till 90 days after the last date of submission ofbid.

Clarifications may be requested not later than 7 days before the submissiondate.The address for requesting clarifications is: Director Business SupportAddress: - Office No. 1-2, 4th. Floor, Shaheen Complex, 38-Abbot Road,

Lahore, Pakistan.Tel: +92-42-99206371-78, Fax: +92-42-99206370E-mail: < procurement@phc.org.pk>

3.1 Proposals shall be submitted in the following language:English

3.3 (a) Shortlisted Insurers may associate with other shortlisted Insurers: Yes No√_____(Not Applicable)

3.4 (a) Firms should have multinational/international/Govt./Semi-Govt. clients forsimilar assignments.

18 | P a g e

3.4 (b) Insurer must meet the eligibility criteria provided in Data-Sheet

3.6 List the applicable Reimbursable expenses in local currency.

(1) No out-of-pocket expenses will be reimbursed by the Client.

3.7 Amounts payable by the Client to the Insurer under the Agreement to besubject to local taxation: Yes √ No ___Taxes are deducted at source from payment to the Insurers unless they haveTax Exemption Certificate.

3.8 The date of exchange rate is: Not applicable

4.3 Insurer must submit the original and 01 Duplicate Set of the TechnicalProposal, and the Financial Proposal.

4.5 The Proposal submission address is Director Business SupportAddress: - Office No. 1-2, 4th. Floor, Shaheen Complex, 38-Abbot Road,

Lahore, Pakistan.Proposals must be submitted no later than the following date and time:19-04-2017by 03:00 PM

5.2 (a) The Criteria for evaluation of Technical Proposals are:

i. Copy of Registration with Securities & Exchange Commission ofPakistan.

ii. Copy of Registration with Income Tax.iii. Minimum A- (A minus) or above rated companies by Pakistan

Credit Rating Agency Limited (PACRA) or JCR-VIS.iv. Minimum 5 years of experience in local market.v. Web-based claim tracking facility

Full compliance to all requirements of criteria is compulsory.

5.7 Insurance Companies whose technical proposal will be declared qualifiedonly their financial proposals will be opened and the lowest bidder will beawarded the contract to provide the said services.

6.1 Expected date and address for agreement negotiations:26-04-2017Punjab Healthcare Commission, Office No. 1-2, 4th. Floor,Shaheen Complex, 38-Abbot Road, Lahore, Pakistan

7.2 Expected date for commencement of Insurance servicesJUNE 20TH , 2017

Section 3: Technical Proposal - Standard Forms

[Comments in brackets [ ] provide guidance to the Insurers for the preparation of theirTechnical Proposals; they should not appear on the Technical Proposals to be submitted.]

Refer to Reference Paragraph 3.4 of the Data Sheet for format of Technical Proposal to besubmitted, and paragraph 3.4 of Section 2 of the RFP for Standard Forms required andnumber of pages recommended.

TECH-1 Technical Proposal Submission Form

TECH-2 Insurer’s Organization and ExperienceA Insurer’s OrganizationB Insurer’s Experience

TECH-3 Comments or Suggestions on the Terms of Reference and on Counterpart Staffand Facilities to be provided by the ClientA On the Terms of ReferenceB On the Counterpart Staff and Facilities

TECH-4 Description of the Approach, Methodology and Work Plan for Performing theAssignment

FORM TECH-1 TECHNICAL PROPOSAL SUBMISSION FORM

[Location, Date]

To: Chief Operating Officer ,Punjab Healthcare Commission,Office No. 1-2, 4th. Floor, Shaheen Complex,38-Abbot Road, Lahore.

Dear Sir,

We, the undersigned, offer to provide the services for Services of Medical & HealthInsurance for Employees of PHC in accordance with your Request for Proposal dated________________ we are hereby submitting our Proposal, which includes this TechnicalProposal, and a Financial Proposal sealed under a separate envelope1.

We are submitting our Proposal in association with: [Insert a list with full name andaddress of each associated Insurer (if any, otherwise delete this line)]2

We hereby declare that all the information and statements made in this Proposal aretrue and accept that any misinterpretation contained in it may lead to our disqualification.

If negotiations are held during the period of validity of the Proposal, i.e., before thedate indicated in Paragraph Reference 1.12 of the Data Sheet, we undertake to negotiate onthe basis of the proposed staff/facilities. Our Proposal is binding upon us and subject to themodifications resulting from Agreement negotiations.

We undertake, if our Proposal is accepted, to initiate the Insurance services not laterthan the date indicated in Paragraph Reference 7.2 of the Data Sheet.

We understand you are not bound to accept any Proposal you receive.

We remain,

Yours sincerely,

Authorized Signature [In full and initials]:Name and Title of Signatory:Name of Firm:Address:

FORM TECH-2 INSURER’S ORGANIZATION AND EXPERIENCE

A - Insurer’s Organization

[Provide here a brief (two pages) description of the background and organization of yourfirm/entity (including organogram) and each associate for this assignment.]

B - Insurer’s Experience

[Using the format below, provide information on each assignment for which your firm, andeach associate for this assignment, was legally contracted as a corporate entity or as one ofthe major companies within an association, for carrying out Insurance services similar to theones requested under this Assignment. Use maximum 20 pages. Please provide Client’scertification and/or evidence of the contract agreement.]

Assignment name: Value of the agreement (in current PKR or US$):

Country:Location within country:

Duration of assignment (months):

Name of Client: Total No of staff-months (by your firm) on theassignment:

Start date (month/year):Completion date (month/year):

Value of consultancy services provided by your firmunder the agreement (in current PKR or US$):

Name of associated Insurers, if any: No of professional staff-months provided by associatedInsurers:

Name of senior professional staff of your firm involved and functions performed (indicate most significantprofiles such as Project Director/Coordinator, Team Leader):

Narrative description of Project:

Description of actual services provided by your staff within the assignment:

FORM TECH-3 COMMENTS AND SUGGESTIONS ON THE TERMS OFREFERENCE AND ON COUNTERPART STAFF AND FACILITIES TO BE PROVIDED

BY THE CLIENT

A - On the Terms of Reference

[Present and justify here any modifications or improvement to the Terms of Reference youare proposing to improve performance in carrying out the assignment (such as deleting someactivity you consider unnecessary, or adding another, or proposing a different phasing of theactivities). Such suggestions should be concise and to the point, and incorporated in yourProposal.]

B - On Counterpart Staff and Facilities

[Comment here on counterpart staff and facilities to be provided by the Client according toParagraph Reference 1.4 of the Data Sheet including: administrative support, office space,local transportation, equipment, data, etc.]

FORM TECH-4 DESCRIPTION OF APPROACH, METHODOLOGY AND WORKPLAN FOR PERFORMING THE ASSIGNMENT

[Technical approach, methodology and work plan are key components of the TechnicalProposal. You are suggested to present your Technical Proposal (50 pages, inclusive ofcharts and diagrams) divided into the following three chapters:

a) Technical Approach and Methodology,b) Work Plan, andc) Organization and Staffing,

Section 4: Financial Proposal - Standard Forms

[Comments in brackets [ ] provide guidance to the shortlisted Insurers for the preparation oftheir Financial Proposals; they should not appear on the Financial Proposals to besubmitted.]

Financial Proposal Standard Forms shall be used for the preparation of the Financial Proposalaccording to the instructions provided under para. 3.6 of Section 2. Such Forms are to beused whichever is the selection method indicated in para. 4 of the Letter of Invitation.

[The Appendix “Financial Negotiations - Breakdown of Remuneration Rates” is to be onlyused for financial negotiations when Quality-Based Selection, Selection Based onQualifications, or Single-Source Selection method is adopted, according to the indicationsprovided under para. 6.3 of Section 2.]

FIN-1 Financial Proposal Submission Form

FIN-2 Summary of Costs

FIN-3 Breakdown of Costs

FORM FIN-1 FINANCIAL PROPOSAL SUBMISSION FORM

[Location, Date]

To: Chief Operating Officer ,Punjab Healthcare Commission,Office No. 1-2, 4th. Floor, Shaheen Complex,38-Abbot Road, Lahore.

Dear Sir,

We, the undersigned, offer to provide the services of Medical & Health Insurance forEmployees of PHC in accordance with your Request for Proposal dated ___________ andour Technical Proposal. Our attached Financial Proposal is for the sum of [Insert bothamounts calculated for Individual Employee basis and Family (Spouse, children and parentstill 90 years excluding employee) basis separately in words and figures1]. This amount isinclusive of the taxes, which shall be levy on such services.

Our Financial Proposal shall be binding upon us subject to the modifications resultingfrom Agreement negotiations, up to expiration of the validity period of the Proposal, i.e.before the date indicated in Paragraph Reference 1.12 of the Data Sheet.

No commissions or gratuities have been or are to be paid by us to agents relating tothis Proposal and Agreement execution.

We understand you are not bound to accept any Proposal you receive.

We remain,

Yours sincerely,

Authorized Signature [In full and initials]:Name and Title of Signatory:Name of Firm:Address:

FORM FIN-2 SUMMARY OF COSTS

Item

Cost/Premium in PKR (Lump sum)*

Premium for Employees and families (Spouse,Children and Parents till 90 years)

Total Costs of Financial Proposal 1

*Costs include all taxes & duties.

1 Indicate the total costs. Such total costs must coincide with the sum of the relevant Subtotalsindicated in all Forms provided with the Proposal & compatible with the Technical Proposal &Work Plan.

Note 1: Please mention the amount both in FIGURES and WORDS.

Note 2: The Contract is on LUMP SUM COST basis. Meaning by OUT-OF-POCKETor any other expenses will NOT be reimbursed. Only Lump Sum amount of Cost ofagreement will be paid subject to eligible deductions & applicable taxes.

Note 3:- Total cost may vary due to change in number of employees in any categoryaccording to the quoted premium per employee in that specific category.

FORM FIN-3 BREAKDOWN OF COSTS BY ACTIVITY

CATEGORY WISE COST BREAK-UP

Category A B C D TOTAL

No. of Employee 1 14 49 78 142

No. of Spouse 1 13 46 46 106

No. of children 1 26 81 75 183

Parents till 90years

1 8 41 110 160

Total Lives ineach Category 4 61 217 309 591

Premium per yearper category

excluding OPDPool (Pak Rs.)

Premium per yearexcluding OPDPool (Pak Rs.)

P1=

Premium per yearfor OPD Pool

(Pak Rs.)P2=

TOTALPREMIUM

(Pak Rs.)P1 + P2=

Payment Details:

1. Premium for OPD Pool shall be paid in advance and if OPD Pool utilizationremained less than the Premium paid for OPD Pool till the end of the year, theunutilized amount from the Premium shall be reimbursed to the Client as peractual.

For example: OPD Pool Limit is Rs.1000/-, Premium paid for it is Rs.800/-and utilized OPD Pool Limit is Rs.600/- i.e. then Premium reimbursable to theClient shall be Rs.200/-.

2. Premium, excluding the Premium for OPD Pool, will be paid in advance onquarterly / half yearly/yearly basis as per Client’s discretion.

3. Premium will be adjusted for increase or decrease in number of lives coveredaccording to the unit rates given below.

Please quote Premium per Year per Life in each category to be used for adjustment ofcost in case of increase or decrease in number of lives covered under each category:

Premium per Year per Life (Pak. Rs.)

Category A B C D

Employee

Spouse

Child

Parents till 90 years

1. Form FIN-3 shall be filled for the whole assignment.

Section - 5

Terms of Reference (TOR)

For Services of Medical & Health Insurance for Employees of PHC

Punjab Healthcare Commission (PHC) has been constituted to promote high qualityand safe healthcare service delivery throughout Punjab PHC requires full healthcoverage under a Medical and Hospitalization Insurance for its workers /employeesand their families.

PHC Requests for Rroposals (RFP) from leading insurance companies who areeligible under the criteria given below. Bids are invited for required health coverageof employees both on an individual and family basis. Bids are invited from InsuranceCompanies that meet the following criteria:

i. Copy of Registration with Securities & Exchange Commission of Pakistan.ii. Copy of Registration with Income Tax.

iii. Minimum A- (A minus) or above rated companies by Pakistan Credit RatingAgency Limited (PACRA) or JCR-VIS.

iv. Minimum 5 years of experience in local market.v. Web-based claim tracking facility

Insurance coverage is required in the following medical and hospitalizationcategories:

1. Full Hospital Care :Individual Hospitalization Limit For Each Insured Person2. Major Medical Care (Pre & Post Hospitalization)3. Out Door Medical Facility4. All types of Surgeries (except of cosmetic nature),5. Dread Diseases6. Maternity Care7. Accidental Injuries8. Cover For Day Care Surgeries

The staff at PHC can be segregated in the following categories based on which thefacilities/benefits will be provided to the staff:

Category Designation

Category A CEO/COOCategory B Director/ Additional DirectorCategory C Deputy Director / Sr./ManagerCategory D Asst. Manager / Officer / Support Staff

Clear statement in the bid shall be given for any restrictions of availing thesefacilities.

Coverage and Benefits:

S.No. BenefitsYearly Limit for each category

Category A Category B Category C Category D

01 Hospitalization (Minor) per life PKR 100,000 PKR 100,000 PKR 100,000 PKR 100,000

02 Hospitalization (Major) per life PKR 500,000 PKR 400,000 PKR 300,000 PKR 200,000

03 Room Rent (per day) per life PKR 15,000 PKR 12,000 PKR 10,000 PKR 6,000

05 Pre-Hospitalization Diagnostic Charges PKR 35,000 PKR 25,000 PKR 15,000 PKR 10,000

06 Post-Hospitalization Diagnostic Charges PKR 35,000 PKR 25,000 PKR 15,000 PKR 10,000

07 Physician’s Visit (In Patient visit) Charges

Shall be Covered inHospitalization Limit

without beingconfined in Hospital

08Specialist Consultation (In-Patient visit )

Charges

09 Intensive Care Unit (ICU) Charges

10 Miscellaneous Hospital Expenses

11 Surgical Operation Charges

12 Operation Theatre Charges

13 Medicines & Drugs (In-Patient)

14 Diagnostics Tests

15CT Scan, MRI, Thallium Scan, PET Scans,

Endoscopy, & Angiography

16 Treatment of Cancer

17 Day Care Surgeries

18All Emergency treatment weather medical or

accidental

19 Treatment of Fractures & Lacerated Wounds

20 Blood & Oxygen Supplies

21Emergency Dental Treatment due to

Accidental Injuries

22 Dread Diseases

23 Maternity (Normal) PKR 70,000 PKR 60,000 PKR 50,000 PKR 40,000

24 Maternity (C-Section) PKR 100,000 PKR 90,000 PKR 80,000 PKR 70,000

25Outdoor Patient Diagnosis Pool as per PHC

prescribed limitsCorporate OPD Pool 5 Million

Note: Any pre-existing condition / disease shall also be fully covered within abovegiven limits.

DREAD DISEASES

1. Myocardial Infarction (Heart Attack):

Heart Attack is defined as the death of a portion of heart muscle on a result of inadequatesupply to the relevant area. It is also called as myocardial infarction (MI), Coronary thrombusor Coronary occlusion. The diagnosis must be unequivocal and must be based on all of:

A history of typical chest pain.

Electrocardiograph (ECG) changes

Elevation of cardiac enzymes

2. Coronary Artery Disease Requiring Surgery:

The actual undergoing of open chest surgery for the correction of blocked or narrowed one,two or more coronary arteries i.e. coronary artery bypass graft (CABG). The surgery musthave been proven to be necessary by means of Coronary Angiography.

3. Stroke:

It is defined as any cerebrovascular incident producing neurological sequelae lasting morethan 24 hours and of permanent nature. This includes infarction of brain tissue, hemorrhageand embolism from an extra cranial source. An appropriate consultant Neuro-physician orsurgeon must make the diagnosis along with C.T. scan or MRI report.

4. Cancer:

A disease manifested by the presence of a malignant tumor characterized by the uncontrolledgrowth and spread of malignant cells and invasion of tissue. The term cancer also includesleukemia (other than chronic lymphocyte leukemia) and malignant disease of the lymphaticsystem such as Hodgkin’s disease and the invasive malignant melanoma.

Exclusions:

Any skin cancer or tumors, which are histologically described as pre-malignant or earlymalignant changes, Hodgkin’s disease, stage I, carcinoma in situ, e.g. of the cervix or otherorgans.

5. AIDS:

The Covered Person being infected by Human immune deficiency virus (HIV) leading to thesymptoms of Acquired Immune Deficiency Syndrome (AIDS), proven through the laboratorypositive results.

6. Major Organ Transplantation:

The actual or undergoing completion of surgery, carried out on the Covered Person asrecipient, involving the transplantation of either a liver, heart, lungs, pancreas or kidneyseither in isolation both such organs where relevant, or a combination of organs. The donororgan must have been provided from a live or cadaver human resource.

In this connection Bone marrow transplantation is also covered.

Exclusions:

Any expenses directly or indirectly related to the expenses of the donor, or if the insured is thedonor for a third party and charges for surgeries involving artificial organs

7. Multiple Sclerosis (Ms):

It is defined as unequivocal more than one episode of well-defined neurologicalabnormalities, with persisting signs of involvement of the optic nerves, brain and spinal cordtogether with impairment of coordination and motor and sensory function.

It is to be noted that covered persons not necessarily confined to a wheel chair. Anappropriate consultant Neuro-physician or surgeon must make the diagnosis along with C.T.scan or MRI report.

8. Hepatitis:

Liver cell necrosis and inflammatory cell infiltration only caused by Hepatitis B or C virus.This should be confirmed through reliable laboratory data source.

Exclusions:

This does not cover Hepatitis caused by drugs or other viruses like Hepatitis A virus, Epstein-Barr virus, Herpes simplex virus or Cytomegalovirus.

9. Severe Burns:

A burn is defined as dissolution in tissue continuity resulting from an accident, thermaldamage. The burn injury should be at least twenty percent (20%) of the body surface area asmeasured by the “Rule nine (9) of the Lund and Browder Body surface chart. The depth ofburn should be at least second degree.

10. Coronary Angioplasty:

The actual undergoing of a procedure to widen (dilate) the narrowing in Coronary arterywithout Open Heart Surgery, through insertion of Special Balloon/Catheter with or withoutStent.

11. Aortic Aneurysms:

Aortic aneurysm refers to a permanent localized dilatation of the aorta with a diameter of atleast 1.5 times that of the expected diameter. The commonest site is the abdominal aortabetween renal and iliac arteries, but the thoracic may also be affected.

12. Rheumatic Heart Diseases:

Rheumatic Heart Disease is defined as progressive fibrosis of heart valves such as mitral,tricuspid, aortis and pulmonic producing distortion and rigidity of the cusps and inconsequence, stenosis and incompetence of these heart valves.

13. Organ Failure (With Out Transplantation):

Blood purification process like peritoneal dialysis or Hemo-dialysis, chemotherapy andRadiotherapy is also covered.

14. Liver Cirrhosis:

Cirrhosis is defined as gradually progressive widespread death of liver cells associated withinflammation and fibrosis leading to loss of the normal lobular liver architecture.

Destruction of the liver architecture causes distortion and loss of portal systemic vascularshunts, and in the formation of nodules rather than lobules. An ultrasound report, laboratorydata and physician opinion is required.

15.Meningitis:

Meningitis means inflammation of the menengis of brain. Bacteria, viruses, fungi, otherorganism, drugs and contrast media may cause it.

It should be confirmed through positive CSF report.

16. Paralysis:

Paralysis is characterized by the complete and permanent loss of use of one or more limbsthrough paralysis resulting from an accident or a sickness. An appropriate consultant Neuro-physician or surgeon must make the diagnosis along with C.T. scan or MRI report.

17. Parkinson’s Disease:

Parkinson’s disease comprises of the symptoms like tremor, muscular rigidity and hypokinesis. Pathologically there is depletion of pigmented neuron and atrophic changes insubstantia nigra, hyaline material (Lewy bodies) in nigral cells. An appropriate consultantNeuro-physician or surgeon must make the diagnosis along with C.T. scan or MRI report.

18. MUSCULAR DYSTROPHY:

Muscular dystrophy is a group of hereditary disorders characterized by progressivedegeneration of a group of muscles with out involvement of nervous system. The wastingand weakness are symmetrical.

19. Alzheimer’s Disease:

Alzheimer’s disease is a primary degenerative cerebral disorder with a characteristicneuropathology. The pathological changes results in widespread cerebral atrophy,particularly involving the cortex and hippocampus.

An appropriate consultant Neuro-physician or surgeon must make the diagnosis along withC.T. scan or MRI report.

20. Myasthenia Gravis:

This condition is characterized by progressive failure to sustain a maintained or repeatedcontraction of striated muscles. This acquired condition is characterized by weakens andfatigability of proximal limbs, ocular and bulbar muscles. This involves the thymicabnormalities. The most characterized being germinal centers in the medulla of the gland.

An appropriate consultant Neuro-physician or surgeon must make the diagnosis along withC.T. scan, MRI or Electro-mylography EMG report.

21. Syringomyelia:

In this condition cavities filled with fluid and surrounded by glial cells develop near the centerof the spinal cord and may communicate with the central canal. The expanding cavitydisrupts second-order spinothelamic neurons, may extend laterally to damage the anteriorhorn cells, and may compress the long fiber tracts.

An appropriate consultant Neuro-physician or surgeon must make the diagnosis along withC.T. scan or MRI report.

22. Brain Tumor:

This comprises of the treatment either through chemotherapy, radiotherapy, or open surgeryfor all brain tumors; tumor may be benign or malignant.

23. Motor Neuron Disease:

This disease is characterized by the progressive degeneration of lower and upper motorneuron (LMNS - UPMNS) in the spinal cord, in the somatic motor nuclei of the cranial nervesand with in the cortex.

Three patterns should be noted:

• Progressive muscular dystrophy

• Amyotrophic lateral sclerosis

• Progressive bulbar palsy

24. Pulmonary Embolism:

Pulmonary emboli may occur singly or multiply and vary in size that completely blocks themajor branches of the pulmonary artery.

Evaluation Criteria

Sr.No Requirement

Evaluation

A B C

1.List of Panel Hospitals inmajor cities of Pakistan100-75-50

20 15 10

2.Online access to theutilization of OPD andhospitalization

10 5 0

3.

List of maximum clientagewith name & contactperson, tel. number andaddress.50-40-30

20 15 10

4.

Insurance company’s grosspremium till last yearshould be Rs. 2 billion –Rs.1 Billion – Rs. 0.5 Billion

20 15 10