Detail of Rajiv Gandhi Jeevandayee Arogya Yojana Maharashtra

Rs. 3000/-

GOVERNMENT OF MAH M AHARASHTRA ARASHTRA Rajiv Rajiv Gandhi Gandhi Jeev Je evand anday ayee ee Arogya Yojana Yojana Socie ty (Proposed) (Proposed) (Procurement Cell)

Arogya Bhavan Bhavan 1st Floor, St.George's Hospital Hospital Compound, Near C.S.T.Station,Mumbai-400 001. 001. Maharashtra Maharashtra State Stat e www.maharashtra.gov.in .in Website Website : http://maha-arogya.gov.in & www.maharashtra.gov Email: procurementcell procurementcell@gma @gmail il.com .com Phone : 022-22631831/ 022-22631831/22651026, 22651026, Fax : 022022-22625799 22625799 REQUEST REQUE ST FOR PROP RO POSAL (R F P)

Proposals are invited from Gene Generral Insur I nsurance ance Companies (Licensed (Licensed and Registered Re gistered with with IRDA) dealing with Health Insurance for implementation of Rajiv Gandhi Jeevandayee Arogya Yojana (RGJAY) in Maharashtra. Technical and Financial Proposal documents can be downloaded from website http://mahaarogya.gov.in or www.maharashtra.gov.in or can also be obtained in person from below mentioned address on any working day during 2 nd June 2011 to 29 th June 2011 during office hours. Not Tr T ransferable RFP No. 1/DHS/PC/Rajiv Ga ndh ndhii Jeevand Je evandayee ayee Arogya Arogya Yojana/RFP/2011-12 Yojana/RFP/2011-12

R F P SCHEDULE 1. Date of commencement of s ale of RFP RFP

:

02.06.11

2. Pre Proposal Proposa l Confere Co nferen nce 3. Last date for availability of Proposal Proposa l documen docume nts 4. Last date for submission of P roposal documen docume nts 5. Opening of technical Proposals Proposa ls

: : : :

17.06.11 (at 15.00 hrs.) 29.06.11 (up to 17.00 hrs.) 30.06.11 (up to 13.00 hrs.) 30.06.11 (at 14.00 hrs.).

Complete RFP documents should be submitted at the address mentioned below not later than 13.00 hrs. on 30 t h June June 2011. 2011. Proposals received later than the prescribed prescr ibed deadline date and time will not be accepted for opening & evaluation. Address for communication: Office of the Dr. G. S. Chindhe, Chindhe, Joint Joint Director of Health Services Services (Procurement (Procurement Cell) Cell) On behalf of Ra Ra jiv jiv Gandhi Jeevandayee A rogyaYojana rogyaYojana Society Society st

1 Floor, Arogya Bhavan St. Georges Hospital Compound, Mumbai 400 001 Phone NO : 022-22631831 / 22651026 Telefax : 022-22625799 All corresp ondence / communications communications about RFP, FP, RGJA Y sho uld be made made at t he abo ve add ress ress . Issued To M/s.

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___________________________________________________________________

Signature & stamp of Insurance Agency

A complete set of RFP documents may be purchased by interested eligible Insurance Agency upon payment payment of a non refundable refundable fee of Rs. 3000/- (Rupees Three Thousand only ) in the form of a Demand Draft issued issued by Nationalized/Scheduled Bank in favour favo ur of of "Rajiv Gandhi Jeevandayee Arogya Yojana Society , Mumbai" payable at Mumbai during office hours from 10.00 hours to 17.00 hours on all working days on or before date & time of closing of sale of RFP document. In case of RFP which is downloaded from website, the bidder should specifically super scribe "Down loaded from the website" on the top left corner of the envelope. However RFP cost of Rs.3,000.00 in the form of Demand draft will have to be submitted along with the RFP document. The proposal shall be rejected summaril summarily y upon fa ilure ilure to follow procedure procedure prescribed prescribed in the RFP docum document. ent. The conditional proposal is liable to be rejected.

The Joint Director of Health Services (Procurement Cell), Mumbai reserves the right to amend /or to cancel R F P without giving any reason to.

Joint Director of Health Services (Procurement (Proc urement Cell Ce ll)) Mumbai On behalf of Rajiv Gandhi Jeevandayee ArogyaYojana Society

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REQUEST FOR PROPOSAL (RFP) DOCUMENT (DRAFT) Rajiv Gandhi Jeevandayee Arogya Yojana (RGJAY) for BPL / APL population in Maharashtra (Phase I: 8 districts of state of Maharashtra)

Government of Maharashtra has decided to revamp the existing Jeevandayee Yojana by making it more more comprehensive and inclusiv inclus ive. e. I n pursuanc pursuanc e with this, State S tate is la unching unching “Rajiv Gandhi Jeevandayee Arogya Yojana ” (RGJAY) in a phased manner in order to improve access of Below Poverty Line (yellow card holders) and Above Poverty Line (APL-orange card holders) families to quality medical care for identified specialty services requiring hospitalization for surgeries and therapies or consultations through an identified network of health care providers. The insurance policy/coverage under the RGJAY for the eligible benefic beneficiary iary families families in 8 districts o f Phase I will be in force for a n initial initia l period per iod of o f one year from the date date of o f commencement of the policy polic y (From 02.10.2011 PhasePhase-I) I) . The RGJAY – Phase-I Phase-I will cover 30 specialized service categories having 972 procedures and 121 follow up procedures. While implementing the scheme in these 8 Districts the RGJAYS invites a single Proposal being implemented through the interested Insurance Companies. The scheme has following important features as detailed in the scheme. The Proposal Document consists of the following Parts .  Part-I Part-I :- Detail De tailss of the Sch Schee me  Part-II :- Submiss ion of Technical a nd Financial Pro Pro posals  Part- III :- Process Process assignment assignment and an d General Guidelines Section A- Submissio Submission n of Proposa Proposa ls Section B – B – Tec Tec hnica hnicall Information Section C – C – Financial Financial Proposal Pro visional onal  Part – Part – IV IV :- M OU (Mem (Me mo ra ndum of Understand Understandin ing g ) Provisi Appendix 1: General Guidelines Guidelines on the Packages. Appendix 1a: Detailed Deta iled list of specifi spec ifiee d surgeries an a nd therapies Appendix 1b: Follow up package Appendix 2: Working P attern Appendix 3: Aarogyamitras and and the the ir ro le Appendix 4: Procedu Proced ure of e nrolment of o f ne ne twork twork hospitals Appendix 5: Activity C hart for Insurance Insurance Company Appendix 6: Health camp policy Appendix 7: MOU (pro visio vision nal) between betwee n insurer insurer a nd network hospital Rajiv Gandhi Jeevandayee Arogya Yojana Society invites sealed competitive proposals from IRDA (Insurance Regulatory Development Authority) registered General Insurance Companies dealing with Health Insurance and having requisite experience as detailed in Request for Proposal (RFP). Only the financial proposals of those companies who qualify in the technical proposal scrutiny will be opened. The companies which are in agreement with the scheme and clauses in MoU (provisional), which is an integral part of the scheme, only need to participate in the Selection and any disagreement in this regard may invite disqualification/rejection of Proposal at technical level. Hence all the companies are requested to go through the Scheme and MoU carefully and submit their proposal.

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TABLE OF CONTENTS SR. NO. PART – PART – I I 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 PART II 1 2 3 PART III 1 2 3

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DETAILS SECTIONSECTION-A: A: DETAILS OF THE SCHEME NAME OF THE SCHEME OBJECTIVES BEN BEN EFICI EFICIARY ARY FAMILIES HEALTH CARD CA RD FAMILY IDENTIFICATION PRE EXISTING EXIS TING DISEASES SUM INSURED ON FLOATER BASIS BASIS PAYMENT PAYMENT OF PREMIUM PERIOD OF INSURANCE & PERIOD OF AGREEMENT PACKAGE CASHLESS TRANSACTION ONLINE CLAIM S ETTLEMENT ETTLEMENT REFUND PROCEDURES PROCEDURES FOR ENRO ENRO LLMWNT LLMWNT OF HOSPITALS MOU BETWEEN NETWORK HOSPITAL AND RGJAY SOCIETY STANDA STANDARD RDIZA IZATI TION ON OF FORMATS FORMATS IMPLEMENTATION IMPLEMENTATION PROCEDURE PROCEDURE AROGYAMITRA WEB PORTAL ONLINE ON LINE MIS AND 24 HOUR E-PREAUTHORIZA E-PR EAUTHORIZATION TION MEDICAL MEDICAL AUDITORS PUBLICITY IN HOUSE S YSTEM YSTEM PROJECT OFFFICE AND STATE LEVEL COORDINATION CAPACITY BUILDING RUN RUN OFF PERIOD RAJ RAJ IV GANDHI J EEVAN EEVAN DAI MANUAL MANUA L PREP PREP ROPOSAL MEETI MEE TING NG PROPSAL VALIDITY VALIDITY PERIOD FORMATION OF CONSORT CONSO RTIUM IUM SUBMISSION OF TECHNICAL AND FINANCIAL PROPOSALS SUBMISSION SUBMISSION OF PROPOSALS PROPOSALS SIGNATURE SIGNATURE ON EACH EACH P AGE OF DOCUMENT DEADLINE DEADLINE FOR S UBMISSIO UBMISSION N PROPOSALS PROPOSALS / PROPOSALS PROCESS: ASSIGNMENT AND GENERAL GUIDELINES PROCEDURES PROCEDURES FOR EVALUATION EVALUATION OF PROPOSALS PROPOSALS AWARD AWARD OF CONTRACT RIGHT TO NEGOTIATE AT THE TIME TIM E OF AWARD

PAGE 8 8 8 9 9 9 9 10 10 10 10 12 12 12 13 13 13 14 14 15 16 17 17 17 17 17 18 18 19 19 19 19 20 20 20 20 22 22 22 22


SR. NO. 4 5 6 7

1 2

DETAILS RGJAY SOCIETY / GOM‟S RIGHT TO ACCEPT OR REJEC REJEC T AN AN Y OR ALL PROPOSALS NOTIFICATION NOTIFICATION OF AWARD AN AN D SIGNING SIGNING OF MOU CONFIEDENTIALITY CANAVASSING, FRAUD AND CORRUPT PRACTICES SECTION A: SUBMISSION SUBMISSION OF PROPOSAL PROPOS ALS S GEN GEN ERAL INFORMATION DEC DEC LARATION BY THE INSURANCE INSURANC E AGENCY AG ENCY SECTION B :

PAGE 22 22 23 23 24 24 24 25

TECHNICAL TECHNICAL INFORMATION

Annexure-1 Annexure-2

Annexure-3 Annexure-4 Annexure-5

Annexure-6 Annexure-7 Annexure-8 Annexure-9 Annexure-10 Annexure-11

PART IV 1 2 3 4 5 6 7 8

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A. QUALIFYING QUALIF YING C RITERIA

25

B. OTHERS ANNEXURES Ple Ple ase submit the follo following: wing: IRDA license license Insurance company should have an experience in concept conceptu ualizing, des igning igning an a nd imple imple menting larg lar ge healthcare healthcare sc he mes and and have at least three years‟ years‟ experience Declaration from the insurer that the Insurance Agency has not been black listed/debarred An undertaking as per format expressing their explicit agree agree ment to adh ad here with w ith th t he details o f the sc heme An undertaking as per format confirming that they have submitted submitted their Proposal as a s ingle ingle entity e ntity only and have not form a Consortium for the scheme. Tailor made policy of the desired Health Healt h Insur Insurance ance Scheme in conformity conformity to the be ne fits. fits. The details of office infrastructure in the state and in the concer concer ned districts. Activity Activity C hart Pla Pla n for Health Healt h Cam Ca mps. Empanelled Empanelled health healt h facilities with wit h Insu Ins urer Any Other Ot her information, informat ion, if a ny. SECTION SECTION C FINANCIAL PROPOSAL MOU (MEMORANDUM OF UNDERSTANDING) UNDERSTANDING) DEFIN DEFINITION ITION AMD INTER IN TERP P RETATION RETATION BEN BEN EFICI EFICIARY ARY FAMILIES COVERAGE SUM ASSURED PREEXISTING PREEXISTING DISEAS DISEAS E PRE AND POST HOSPITALIZATION HOSPITA LIZATION DEFIN DEFINITION ITION OF FAMILY FAMILY HEALTH HEALTH CARDS

25

28 29

30 32 33

34 35 36 37 38 39 40 41 41 43 44 45 45 45 46 46


SR. NO. 9 10 11 12 13 14

15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49

DETAILS WEB PORTAL PAYMENT PAYMENT OF INSURANCE P REMIUM PERIOD OF INSURANCE & PERIOD OF AGREEMENT ADJUSTMENT/ ADJUSTM ENT/ REFUND OF PREMIUM PREMIU M PROCEDURE PROCEDURE FOR ENRO ENRO LLMEN LLMEN T OF HOSPITALS MOU WITH NETWORK HOSPITAL AND DISCIPLINARY ACTIONS AGAINST THE HOSPITALS CASHLESS CASHLESS S ERVICE ERVICE PACKAGES IMPLEMENTATION IMPLEMENTATION PROCEDURE PROCEDURE HEALTH CAMPS DISTRICT LEVEL CO- ORDINATION ORDINATION IN-HOUSE SYSTEM PROJECT OFFICE AND STATE LEVEL COORDINATION AAROGYAMITRAS WEB PORTAL ONLINE MIS AND – AND – PREAUTHORI PREAUTHORISATION SATION MEDICAL AUDITORS AU DITORS PUBLICITY SERVICING SERVICING OF OTHER SCHEMES ACTIVITY ACTIVITY CHART ASSISTANCE F ROM THE GOVERNMENT GOVE RNMENT CLAIMS CLAIMS PROCEDURE RESPON RESPONSE SE TIME INSURER REPRESENTATIONS, WARRANTIES AND RESPONSIBILITIES JURISDICTION NON PERFORMA PERFORMANCE NCE INFORMATION INFORMATION FLOW RENEWAL THE P REC REC EDENCE EDENCE OF MOU MODIFICATION MODIFICATION OF MOU MONITORING MONITORING MECHANISM GRIEVANCE MECHANISM TERMS TERMS & TERMINATION TERMINA TION FORCE MAJEURE ASSIGNMENT ENTIR ENTIRE E AGREEMENT RELATIONSHIP SEVERABILITY NOTICES NOTICES GOVERNING GOVERNING LAW DISPUTE RESOLUTION RESOLUTION

PAGE 46 47 47 49 49 49

50 50 50 51 52 52 52 54 55 56 56 56 57 57 57 57 59 59 60 60 60 60 60 61 61 61 62 63 63 63 63 63 63 64 64

APPENDICES

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SR. NO. APPENDIX – I I APPENDIX-Ia APPENDIX-Ib APPENDIX- II APPENDIX -III APPENDIX -IV APPENDIX – V APPENDIX- VI APPENDIX-VII

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DETAILS GEN GEN ERAL GUIDELINES ON THE P ACKAGES. ACKAGES. DETAILED LIST OF SPECIFIED SURGERIES AND THERAPIES THERAPIES AND PACKAGE FOLLOW FOLLOW UP P ACKAGE WORKING PATTERN PATTERN AROG AROGYAMI YAMITRA TRA AND THEIR ROLE PROCEDURE FOR ENROLLMENT OF NETWORK HOSPITALS ACTIVITY ACTIVITY CHART FOR INSURANCE COMPANY HEALTH HEALTH CAMP POLI PO LICY CY MOU (PROVISIONAL) BETWEEN INSURER AND NETWORK NETWORK HOSPITAL

PAGE 65 67 143 147 148 151 154 156 159


PART - I Section A: Scheme Rajiv Gandhi Jeevandayee Arogya Yojana (RGJAY) would be implemented throughout the state of Maharashtra in phased manner for a period of 3 years. The insurance policy/coverage under the RGJAY for the eligible beneficiary families in 8 districts of Phase I will be in force for an initial period of one year from the date of commencement of the policy ( “Phase I”). The extension of period of the policy will be subject to review and renewal of the policy on a yearly basis which will be based on the quality of experience and performance as well as annual IRDA renewal. Notwithstanding, anything to the contrary mentioned elsewhere in this RFP the memorandum of understanding will be co – terminus with the insurance policy/co policy/cov verage which which is for a term of 1 year from (From 00.00 hrs. of 02.10.2011 to Midnight of 01.10.2012 for Phase-I). Based on the quality of experience and performance of the RGJAY the State Government may at its sole discretion discre tion and with w ithout out any obligation obligatio n e xtend the RGJAY to cover the whole state. 1. NAME OF THE SCHEME: Name Name of th t he sche me is Rajiv Raj iv Ga Ga nd hi Jeevandayee Jeevandayee Arogya Yoja na (RGJAY). 2. OBJECTIVE OBJECTIVE : To improve access of Below Poverty Line (BPL) and Above Poverty Line (APL) families (excluding White Card Holders as defined by Civil Supplies Department) to quality medical care for identified specialty services requiring hospitalization for surgeries and therapies or consultat consultat ions th t hrough an identified network of health ealt h care provi pro viders. ders. 2.a. BENEFIT: The The scheme would provide provide 972 surg sur geries/t herapies/procedu erapies/proced ures a long with121 with121 follow up packages packages in follo following wing 30 iden ide ntified specia lized cate gories : GENERAL SURGERY SUR GERY 1 ENT SURGERY 2 OPHTHALMOLOGY SURGERY 3 GYNAECOLOGY GYNAECOLOGY AND OBSTETRICS SURGERY 4 ORTHOPEDIC SURGERY AND PROCEDURES 5 SURGICAL GASTRO ENTEROLOGY 6 CARDIAC AND CARDIOTHORACIC CARDIOTHORACIC SURGERY SUR GERY 7 PEDIATRIC SURGERY SUR GERY 8 GENITOURINARY SYSTEM 9 NEUROSURGERY RY 10 NEUROSURGE SURGICAL ONCOLOGY 11 MEDICAL ONCOLOGY 12 RADIATION ONCOLOGY ONCOLOGY 13 PLASTIC SURGERY 14 BURNS 15 POLY TRAUMA 16 PROSTHESES 17 CRITICAL CRITICA L CARE 18 GENERAL MEDICINE 19 INFECTIOUS DISE D ISEASES ASES 20 PEDIATRICS MEDICAL MANAGEMENT 21 CARDIOLOGY 22 NEPHROLOGY 23 NEPHROLOGY NEUROLOGY 24 NEUROLOGY PULMONOLOGY 25 DERMATOLOGY 26

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RHEUMATOLOGY 27 ENDOCRINOLOGY 28 GASTROENTEROLOGY 29 INTERVENTIONAL RADIOLOGY RA DIOLOGY 30 Detailed list of surgeries and therapies falling under above specified categories and their package package rates are give give n at Appendix 1 a and that of follow up package are given at Appendix 1 b of Part-IV of the document. 3. BENEFICIARY FAMILIES: Families holding yellow ration card, Antyodaya Anna Yojana card (AAY), Annapurna card and and ora nge nge rati rat ion card from eight districts viz. Gadchiroli, Amravat Amravatii, Na nded, Solapu Solap ur, Dhul D hule, e, Raigad, Mumbai city and Suburban Mumbai. The families with white ration card holding would not be covered under the scheme. The beneficiary families would be identified through the “Rajiv Gandhi Jeevandayee Health Card” Card ” issued by the Government of Maharashtra or based o n th t he Yellow a nd Orange O range rati rat ion card iss ued b y C ivil Supplies Department. The to tal number of beneficiary families in the state would be around 2,04,30,527; out of which approximately 49 Lakh families in the 8 districts are to be covered under the scheme in first phase phase as on th t he da te o f publishing of the Request Request for Proposal (RFP) doc ument. ument. District wise wise profile of the be ne ficia ficia ry families is given below: below: Districts Distr icts Populati Populat io n *Approximate number o f Phase-I Beneficiary Families 1 Gadchiroli 970294 182889 2 Amravat Amravatii 2607160 559473 3 Nanded 2876259 543961 4 Solapur Solapur 3849543 830011 Dhule Dhule 1707947 397674 5

6

Raigad Raigad

2207929

566231

7 8

Mumbai C ity Mumbai S uburban burba n

3338031 8640419

482073 1340828

26197582 4903140 Total * Based on data furnished by Civil Supplies department as o n 31.05.2010. The total number of beneficiary families for each District is an indicative estimate and may vary. The number of the final beneficiary families for each district will be given within one month of signing MOU. The total premium payable would be based on this final figure of e ligi ligible be neficiary efic iary families. 4. HEALTH CARDS All eligible families in these districts shall be provided with Rajiv Gandhi Jeevandayee Arogya Yojana Health Cards in due course of time. These Health Cards will be used for identification of Beneficiary families in the family under the Scheme. Family Health Cards will be prepared prepa red by using data from valid yellow or orange ration cards coupled with Aadhaar Aadhaar numbers numbers issued by UID authoriti a uthoritiee s. As an a n interim interim measure t ill the issuance issuance of health ealt h cards, th t he valid Orange/Yellow Ration Card with Aadhaar number or in case Aadhaar number not available, any Photo ID card of beneficiary issued by Govt. agencies (Driving license, Election ID,) to correlate the patient name and photograph would be accepted in lieu of health card. 5. FAMILY: Family means members as listed and photographed on the Rajiv Gandhi Jeevandayee Arogya Yojana Yojana Health Cards or holding valid Orange/Yellow Ration Card. 6. IDENTIFICATION: Health card issued by Govt. of Maharashtra/Rajiv Gandhi Jeevandayee Arogya Yojana Society or valid Orange/Yellow Ration Card with Aadhaar number if Health card is not issued would act as a tool for beneficiary identification for availing the health insurance facility. The

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following actions would be undertaken by Network hospitals in case of the possible exceptional situations: No.

1

2

3

Exceptional Exceptio nal Situation

Requirem Require ment for be ne fit fit Aadhaar number and in case Aadhaar number not taken any Photo ID card issued by Govt. ( Driving license, election identity card with photograph) to No Health Health Card with with benefic benefic iary, but correlate the patient name & photograph Valid Yellow or Orange Ration Card (In instance of emergency admission, provisional with name name of beneficiary beneficiary is available preauthoriz preauthorization ation may be given subject to confirmat confirmatiion of it against submission of valid photo identity card issued by Govt. before discharge.) Children born after issue of card i.e. Photograph of child with either parent along with name and photo not available on health Health card/ valid Yellow or Orange ration card of card or on valid yellow/Orange ration parent and Birth Birth certifi certificate cate issued by autho authorr ized off offiice. card Name is there in Yellow Yellow or Orange Not eligi eligible ble for benefit benefit package package Ration Card and matches with name in (The yellow /Orange ration card is cancelled after photo photo identity identity.. But the card is invalid as verification by department but still the family is it does not match with the digitized list. holding it)

7. PRE EXISTING DISEASES: All Diseases under the proposed scheme shall be covered from day one. A person suffering from disease prior to the inception of the policy shall also be covered under approved procedures procedures for that disease. 8. SUM INSURED ON FLOATER FLOATER BASIS: The Scheme shall provide coverage for meeting all expenses relating to hospitalization of bene bene ficiary up to Rs. 1,50,000/- per fa mily mily per year in any of the Empanelled Hospital s ub ject to Package Rates on cashless basis through Health cards or valid Orange/Yellow Ration Card. The benefit shall sha ll be av a va ilable to each eac h and e very er y me me mber of the the family fami ly o n floater basi bas is i.e. the total annual reimbursement of Rs. 1.5 lakh can be availed by one individual or collectively by all members of the family. In case of renal transplant surgery, the immunosuppressive therapy is required for a period of 1 year. So the upper ceiling for Renal Transplant would be Rs. 2,50,000 per operation as an exceptional package exclusively for this procedure. The cases are likely to be very few and well controlled by Human Organ Transplant Act 1994. The claims related to this have to be settled by Insurer. 9. PAYM PAYM ENT OF PREMIUM: Rajiv Gandhi Jeevandayee Arogya Yojana Society / Government of Maharashtra will pay in advance advance t he insu ins urance premiu pre mium m in insta insta llments on behalf of insured ben be nefici efic iary families to the the Insurance Company as mentioned in clause 10 of Memorandum of Understanding (MOU) or as decided by the Society or GoM. 10. PERIOD OF INSURANCE & PERIOD OF AGREEMENT: The insurance coverage under the scheme for the beneficiary families in 8 districts of Phase I shall shall be in force force for an a n initial period of one year from the date of co mme mme ncement of the policy (From 00.00 hrs. of 02.10.2011 to Midnight of 01.10.2012 for Phase-I). The per iod of MOU/a greemen reeme nt sh s hall be for three years with effect from 02.10.2011; subject to review and renewal of policy on yearly basis based on the quality of experience and performance as well as a nnua nnua l IRDA renewal. Based on the quality of e xperien perie nce and performance of o f the scheme, sc heme, the State Government/ Government/ Society Societ y may ma y extend e xtend the scheme to cover the whole state. 10.a. PERFORMANCE SCURITY: 1) The successful insurer shall furnish the security deposit to the RGJAYS within 7 days from the date of communication of Award of Contract for an amount of 5% of the contract contract value, valid up to 90 days after the date of completion o f warra warran nty

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Signature Signature & st amp of Insurance A gency

obligations obligations a nd enter into MOU on o n Rs. Rs. 100/- non-judic on-judicial ial stamp paper. The cost o f Stamp Stamp paper should be born bor ne by the insurer. The The Security Deposit should should be in the form of Bank Guarantee in favour of the „Rajiv Gandhi Jeevandayee Arogya Yoja Yoja na ' pa yable at Mumbai from any a ny Nationa Nationa lized or Scheduled Scheduled ba nk. 2) The Security Deposit will be discharged by the Purchaser and returned to the successful Insurance Agency not later than 30 days following the date of completion of the Insurer‟s performance obligations obligations by the end of first quarter of execut executiion of sc heme, includ including ing the warran warra nty obligati obligat ion, under the MOU. 3) The security deposit shall be discharged (forfeited) as a compensation for any loss resulting from the failure failure to perform the obligations unde unde r the MOU or in the e vent of terminat terminat ion of th t he MOU or in any eve nt as th t he Pu P urchaser thinks fit a nd proper. 4) Security Security deposit depos it will will not carry carr y any interest. 10. b. PERFORMANCE PARAMETERS AND PENALTY CLAUSE: The Insurer is required to perform multiple activities in performance of its obligations arising out of the insurance contract to it. Any activity not performed by the insurer within the given time line shall hamper implementation of Rajiv Gandhi Jeevandayee Health Insurance Scheme from the planned date. Such activities have been listed here under which the success success ful bidder bidder is required to complet completee within the specified peri per iod from fro m the the date of o f award of the insurance contract to it failing which a penalty as specified percentage on total premium against each section per pe r wee k/mo k/mo nth s ha ll ha ha ve to pay pa y to the Society Societ y for for th t he per iod of delay. Sr. No

Acti Acti vi ty

PENALTY PER WEEK Identifying the Project Officer A a) b) Setting up of Project Office with infrastructure in Municipal Corporation of Greater Bombay Preparation and Certification of software on receiving the B specification from Society. C Dedicated Dedicated Website as as per the the requirement requirement (envisag (envis aging ing Empanelment Empanelment M IS,HR IS,HR M IS, IS, Publicity and Ca mp MI S, Eauthorization MIS, Claim MIS, Follow Follow up monitoring MIS, Field o perations perations Support service MIS, MIS, Grievance MIS, Medical Audit MIS, Key performance performance Indicators, Indicators, Operation ma intenance MIS) Estab lish lish ment of 24 Hrs Ca ll Center and Estab Estab lish lish ment of oth er D infrastructure infrastructure in each covered District District E Establishment of sufficient infrastructure in each covered District. District. Installation Installation of kiosk, computer and access ories ories etc.

Time frame from the date of Signing of Agreement

Penalty for the del ay in execut executii on in % of component charges

7 days 30 Days

1% 1%

3 month

1%

3 mont hs

2.0%

3 month

1%

3 month

1%

3 months on ths

0.5%

F

To identify the Hospital Network Providers and networking with with t he m.

G

To arrange cashless treatment of the insured in the empanelled 3 months on ths hosp itals under the scheme and facilitation facilitation of proper prop er networking for quick and error-free processing of preauthorizations. To provide adequate manpower, so as to ensure free flow of 3 months on ths daily MIS and ensure that progress of scheme is reported to Society Society in the d esired format format on a real-time basis. Preparation of various formats used for cashless transactions, 1 months on ths discharge summary, billing pattern and other reports in consultation with with t he Govern ment. PENALTY PER MONTH Processing of claims related to the scheme. Pre-authorization of System to be ready in requests and approval of preauthorization if all the conditions are 3 months (Continuing

H

I

J

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0.5%

0.5%

0.5%

1%


Sr. No

K

L

M

N

Acti Acti vi ty

Time frame from the date of Signing of Agreement

fulfilled, within 12 hours of receiving the preauthoriza preauthorization tion request request from the network network provider if if failure % is more than 5%) Scruti Scrutiniz nizee the bills from ne two rk hosp itals an d give approval for the sanction of the bill and forward payment within 7 working days on receipt of complete claim document from the Network Hospitals. ospitals. (Fail (Failure ure % is more than 5% 5% ) Medical Auditing (by minimum qualification MBBS) for conducting 20% per month concurrent audits of services and quality of service provided to the beneficiary families delivered by Network Hos pitals on p eriodic basis as well as an d required. HR a. Number of network net work hos pitals and number of Aarogymithras /Medical Coordinators, Camp Coordinators post ed- Dist Dist rict rict wise wise,, month wis e, and aggregat ag gregatee b. Number of Public faci lit lit ies (CHCs/PHCs) and number of Aarogymitras posted - District wise, month wise, and aggregate

activity)

Training Training programm programme for Network Hospital Providers Providers and other stake holders ones ones i n a month.

Penalty for the del ay in execut executii on in % of component charges

System to be ready in 3 months & (Continuing (Continuing activity) activity)

1%

3rd month (Continuing (Continuing activity) activity)

0.5%

3rd month Onwards

0.5%

2nd month onwards (Continuing (Continuing activity) activity)

0.5%

11. PACKAGE: The insurer insurer s hould ensu ens ure that t he Network hospitals follow th t he packa ges worked out by b y Ra Ra jiv Gandhi Jeevandayee Society. The package rates will include bed charges in General ward, Nursing Nursing an a nd boarding board ing charges, charges, S urgeons, Anesthet Anesthet ists, ists, Med ical Practitioner, Consultants fees, Anesthesia, Blood, Oxygen, O.T. Charges, Cost of Surgical Appliances, Medicines and Drugs, Cost of Prosthetic Devices, implants, X-Ray and Diagnostic Tests, food to inpatient, one time transport cost etc. In other words the package should cover the entire cost of treatment of patient from date of reporting to his discharge from hospital or 10 days after post surgery discharge including complications if any, making the transaction truly cashless to the patient. In instance instance of death deat h, the carri carr iage o f dead body from network hosp ital ta l to the village/tow village/town nship would a lso be part of o f package. package. 12. CASH LESS TRANSACTION: The Insurer has to ensure that adequate facilities are provided to all beneficiary families so that they do not have to pay any deposits at the commencement of the treatment or at the end of treatment to the extent the Services as covered under the Rajiv Gandhi Jeevandayee Arogya Yojana. It is envisaged that for each hospitalization the transaction shall be cashless for covered procedures. Enrolled beneficiary will go to hospital and come out without making payment to the hospital su s ubject to procedure covered under under the sch sc heme. The The sa me is the case for diagnostics, if, eventually the patient does not end up in undertaking the surgery or therapy. The beneficiary has right to select network hospital and services of selected network hospital should be made available (Subject to availability of beds). In instance of nonavailability of beds at network hospital, the facility of cross referral to nearest another Network Network hospital is to be made available. available. 13. ONLINE CLAIM SETTLEMENT: The Insurance Company shall settle the claims of the hospitals online within 7 working days of receipt of the Originals bills, Diagnostics reports, Case sheet, Satisfaction letter from patient, Discharge Summary Summa ry duly signed by the doctor, acknowledgement of payments of transportation cost and other relevant documents to Insurer for settlement of the claim. The online progress of claim settlement will be scrutinized and reviewed by Rajiv Gandhi Jeevandayee Arogya Yoja Yojan na Society. Soc iety.

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14. REFUND: If there is a surplus after the pure claims experience on the premium (excluding Services Tax) at end of the policy period, after providing 20% of the premium paid towards the Company‟s administrative cost, of the balance 80% after providing for claims payment and outstanding claims, 90% of the left over surplus will be refunded to the Government/ Rajiv Gandhi Jeevandayee Arogya Yojana Society within 30 days after the expiry of the Run-off period. (Refer Para No. 27 related to run off period ). 15. PROCEDURE PROCEDURE FOR ENROLLMENT OF HOSPITAL HOS PITALS: S:

The Public and Private Hospitals will be jointly empanelled within the State of Maharashtra by Rajiv Gan Ga ndhi Jee Je e va ndayee Arogya Arogya Yojana Yojana Soc iety a nd I nsura nce Company C ompany fo llowing llowing t he e mpanelment procedure la id down by Rajiv Gandhi Jeevandayee Arogya Arogya Yojana Yo jana Society. The hospitals having minimum of 50 inpatient hospital beds with adequate facilities and offering the services as stipulated below shall be empanelled after being scrutinized and recommended by the Empanelment Empanelment and Disci D isciplinary plinary Co mmittee. mmittee. Empanelment Empanelment a nd Disci D isciplinary plinary Co mmittee mmittee will constitute a subcommittee of four doctors for this purpose. Two doctors will be nominated by Insurance Company and two by Rajiv Gandhi Jeevandayee Arogya Society. The purpose of o f this empanelment is to ensure e nsure capability of o f the hospital hospital to provide some of the identified 30 specialized categories and seek agreement to the equal or lower price for these 972 procedures and 121 follow up procedures and take an opportunity to assess the current quality of care therein. It would be the responsibility of the Insurer for enrollment of Network Hospitals in the State of Maharashtra to give adequate facilities for the treatment of the patients when they present themselves. The number o f e mpanelled hospitals and and number o f procedures procedures in each eac h hosp hosp ital to be pe rmitted rmitted will be based on t he need and and a t di d iscretion scret ion of o f the society in the interest of beneficiary. Network hospitals are supposed to extend medical aid to the beneficiary under the scheme. Procedure for enrollment of Hospitals is placed as Appendix- IV of Part IV. Preference for empanelment could be given to the hospitals accredited under National Board of Accreditation for Hospitals. It is also desired to accredit ate the empaneled hospital under National Board of Accreditation for Hospitals in order to ensure quality of care. 16. MOU WITH WITH NETWO N ETWORK RK HOSPITAL AND RGJAY SOCIETY. A) (i) MOU with with Network Ne twork Hospital: Hospita l: The Insurer shall sign MOU with all the network hospitals to be empanelled under the scheme. Separate MOU‟s with relevant provisions have to be entered into for Multispeciality, Cancer Treatment etc. This MOU is subject to the approval of the Rajiv Gandhi Jeevandayee Arogya Yojana Society. The number of empanelled hospitals and number of procedures procedures in each hosp hosp ital to be permitted will wil l be based o n the need need a nd at discretion d iscretion of th t he society in the the interest inte rest of beneficiary beneficiar y. Network hospitals are s upposed to extend medical aid to the beneficiary under the scheme. A provision will be made in MOU regarding noncompliance / default clause. Such matter shall be looked in to by the Empanelment and Discip Discip linary linary Committee, th t he decisi decis ion of which w hich will be binding to all concerned. (ii) Disciplinary Disciplinary actions ac tions against the hospitals: On recommendation by the Empanelment and Disciplinary Committee the Insurer shall take various disciplinary actions against Network Hospital including De-listing from the empanelment if it is found that guidelines of the Scheme are not followed by it and services offered are not satisfactory as per laid down standards. Hospital may also be delisted or deempanelled if infrastructure in the hospital is found below the standards laid down by the society any time during the policy period. period. In case of o f any delisting of em e mpanelled hospitals, the insurer shall find alternative immediately. B) (i) MoU with Rajiv Gandhi Jeevandayee Aarogya Yojana society [

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The Insurer shall enter into the MOU with GOM / Rajiv Gandhi Jeevandayee Arogya Yojana Society given in Part IV (Provisional), which is an integral part of the scheme within 24 hours of award of contract. (ii) Nonperformance Nonperformance by in i nsurer sure r In the event of non-performance by the Insurer as per the guidelines ( refer Clause 10.a ) of cla use 11, 11.a and and 17 as per MOU given in Part IV the scheme, the insurer sh s ha ll abide by the clau of the document. document. 17. STANDARDIZATION OF FORMATS: The Insurance Company shall standardize various formats used for cashless transactions, discharges summary, billing pattern and other reports in consultations with Rajiv Gandhi Jeevandayee Society. 18. IMPLEMENTATION PROCEDURE: The Entire scheme is to be implemented as cashless hospitalization arranged by the Insurance Company. Company. The following represe represe nts th t he process flow of treatment to to th t he beneficiary beneficiar y. A) Process Flow of the Beneficiary Treatment in the Network Hospital Step 1 Beneficiary families shall approach nearby PHC/Rural, Sub district, General, Women/District Hospital/Network Hospital. Aarogyamitras placed in the above hospitals shall facilitate the benefic beneficiary. iary. If bene ficiar ficiary y visits Government Health Facility ot her th t han t he Netw N etwork ork Hospital, Hospital, he/she will be given a referral card to the Network Hospital with preliminary diagnosis by the doctors. The Beneficiary may also attend the Health Camps being conducted by the Network Hospital in the Villages and can get that referral card based on the diagnosis. The information on the outpatient and referred cases in the PHC/Rural, Sub district, General, Women/DH and the camps will be collected from all Aarogyamitras/Hospitals on regular basis and captured in the dedicated database through a well-established call center. Step 2 The Aarogyamitras at the Network Hospital examine the referral card and health card or Yellow/Orange Ration Card, register the patients and facilitate the beneficiary to undergo specialist consultation, preliminary diagnosis, basic tests and admission process. The information like admissio admission n notes, notes, test done will be captured in the ded icated icated database b y the Medical Coordinator of the Network Hospital as per the requirement of the Rajiv Gandhi Jeevandayee Arogya Yoja Yojan na Society Soc iety.. Step 3 The Network Hospital, based on the diagnosis, admits the patient and sends E preauthorizatio preauthorization n request to th t he insurer, insurer, same can be reviewed by b y Rajiv Gandhi Jee vandayee Arogya Arogya Yojana Yojana Society. Soc iety. Step 4 Recognized Medica Medica l Specia lists of the Insurer and Rajiv Gandhi Jeevanda yee Arogy Aro gyaa Yojana Society examine the preauthorization request and approve preauthorization, if, all the conditions are satisfied. This will be done within 12 working hours and immediately in case of emerg emer genc y where where in e-preauthorizati e-prea uthorization on is marked as “EM”. Step 5 The Network Hospital extends cashless treatment and surgery to the beneficiary. The Postoperative notes of the Network Hospitals will be updated on the website by the medical coordinator coordinator o f the Network Hospita Hospital. l. Step 6 Network Network Hospital after performing the covered surgery/ therapy/ proced ure forwards the Originals bills, Diagnostics reports, Case sheet, Satisfaction letter from patient, Discharge Summary duly signed by the doctor, acknowledgement of payments of transportation cost and other relevant documents to Insurer for settlement of the claim. The Discharge Summary and follow-up details will be part of the Rajiv Gandhi Jeevandayee Arogya Yojana Society portal. portal.

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Step 7 Insurer scrutinizes the bills and gives approval for the sanction of the bill and shall make the payment within agreed period period as per a greed package rates. The c laim settl sett lemen eme nt module module a long with elec elec tronic clearance and payment gateway will be part of the workflow in Rajiv Gandhi Jeevandayee Arogya Yojana Society portal and will be operated by the Insurer. The reports will be available for scrutiny on the Rajiv Gandhi Jeevandayee Arogya Yojana Society login. login. Step 8 The Network Hospital will provide free follow-up consultation, diagnostics, and medicines under under t he scheme up to 10 da ys from the date of o f dischar dischar ge. B) Health camps Health Camps are to be conducted in Taluka Head Quarters, Major Gram Panchayats and Municipalities. Minimum of one camp per week per empanelled hospital has to be held in the eight districts in the policy year. The insurer shall ensure that at least one free medical camp is conducted by each eac h ne ne twork hosp hospital ital per pe r week week at the place suggested by Rajiv Raj iv Ga Ga ndhi Jeevandayee Arogya Yojana Society. The Rajiv Gandhi Jeevandayee Medical Camp Coordinator Coordinator MCCO s of the the hospital sh s ha ll coord coord inate inate th t he e ntire activity act ivity.. Networ Net work k hosp ita l shall carry necessary screening equipment along with specialists (as suggested by the Rajiv Gandhi Jeevandayee Arogya Yoja Yojan na Society Soc iety)) a nd other Para- medical staff s taff.. The The Insurer shall put in the minimum requi req uire re me nts as regards t he health healt h cam ca mp in the MOU with wit h the hospitals. The e mpaneled hospital sh s ha ll work work in c lose liaison with district coordinator of the the Ins ura nce Company, Civil Surgeon/District Health Officer in consultation with District Collector. Hospital shall follow the Camp policy of Rajiv Gandhi Jeevandayee Arogya Yojana Society. C) District level co-ordination: District level offices with necessary infrastructure have to be set-up by the Insurance Company. The Insurer needs to have district level monitoring staff with District Coordinators, & State Coordinators of the Insurance Company. They should monitor Aarogymitras, coordinate with network hospital, hospital , district administration and people‟s representatives for effective implementation of the Scheme. They should ensure that camps are held as per schedule, schedule, arrange a rrange for canvassing for th t he camp, mobilize obil ize patients and follo fo llow w up the be neficiary families. They should work in close liaison with district administration under the supervision of District Coll Co llector. ector. They should also en e nsure proper flow of MIS and report to society on day to day basis about the progress of the scheme in the district. The Insurance Company should ensure that dedicated staff is made available for the scheme. There shall be at least one doctor to be placed in each district. Further, wherever the concentration of the Network Hospitals is more additional doctors need to be placed. The Insurance Company shall follow the instruct instructiions o f Rajiv Gandhi Gandhi Jeev Jee va nda yee Arogy Aro gyaa Yojan Yoja na Society Soc iety in this regard. regard. 19. AAROGYAMITHRAS a) Aarogyamithras Aarogyamithras in P rimary Heal Hea lth Centers Ce nters (PHC)/Rural Hospi Hosp ital ta ls (RH)/Sub Distr District ict Hospitals(SDH)/District Hospitals (DH)/General Hospitals (GH)/Women Hospitals(WH): The unique nature nature of th t he scheme demands the insura insura nce company compa ny to appoint appoint Aarogyamithras in consultation with Rajiv Gandhi Jeevandayee Arogya Society in PHCs/RH/SDH/GH/WH and district Hospitals of selected 8 Districts for propagating the scheme, mobilizing people for health camps, counseling beneficiary families facilitating the referral/treatment of these patients and follow ollo w up. For e ffective and instant Communicat Communicatiion a ll the Aaro gyamithras gyamithras will have to be provided pro vided with cell phone phone CUG C UG connectivity connect ivity b y the Insurance Company. Company. b) Aarogyamithras Aarogyamithras in Netw N etwork ork Hospitals: The The Insurance Insurance Compa C ompany ny also needs to appoint appo int at least one Aarogyamithra at all network hospitals round the clock to facilitate admission, treatment and cashless transaction of patient. The Aarogyamithras should also help hospitals in pre-authorization, claim settlement and follow-up. They should also ensure proper reception and care in the hospitals and send regular MIS to call center. Insurance Company shall provide all Aarogyamithras with cell phone having CUG connectivity with SMS based

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reporting framework for effective and instant communication. The Insurance Company shall ensure that prefabricated Aarogyamithras kiosks with all additional requirements as per the design approved by the society is put up in all hospitals. The role of Aarogyamithras can be modified odif ied by Rajiv Gandhi Jeevandayee Arogya Yojan Yoja na Soci Soc ie ty from from tim t ime-toe-to-time. time. The Insurer will provide uniform and arrange the workshops/training sessions for the Aarogyamithras as per guidelines specified by Rajiv Gandhi Jeevandayee Society. The detailed note on Aarogyamithras and their role are given at Appendix III of Part-IV of the document. 20. WEB PORTAL: All activities related to the scheme shall be done through a dedicated portal of Rajiv Gandhi Jeevandayee Society, the development and maintenance cost of which will be borne by the Insurer. The source code and system design document for the application exclusively developed by Insurer for Rajiv Gandhi Jeevandayee Arogya Yojana shall be provided in good working condition to Rajiv Gandhi Jeevandayee Arogya Yojana Society. A dedicated data center in the name of Rajiv Gandhi Jeevanda yee Yojan Yoja na will be maintained by the Insurer. The proprietary rights of software will be with Government of Maharashtra and the Insurance Company shall execute all the necessary documents for assignment/transfer of the software to the Rajiv Gandhi Jeevandayee Arogya Yojana Society. Patient records will be property of Rajiv Gandhi Jeevandayee Arogya Yojana Society. Confidentiality of patient records shall be mainta mainta ined ined by t he Insurer. Insurance Company will develop the Software as per the requirement of the Scheme on the directions & guidelines as mandated by Rajiv Gandhi Jeevandayee Arogya Yojana Society. The web portal will be a repository of information and will have the following features and the respective workflows: 1. Genera Genera l Informati Informat ion on the scheme. 2. Details Details of patients patients reporting and and referrals from the PHC PHC / Rural/ S ubdistrict/Women/General/District hospitals on daily basis. 3. E-Health Cam Ca mps system syste m and daily reporting of health ealt h camps. 4. Details Details of patients reporting and ge tting referred from the health ealt h camps. 5. E-Empane E-Empane lment lment system syste m. 6. Emer Emer ge nc y approval system syste m. 7. Call centre application. 8. Patient Patient registration by Aarogyamithra Aarogyamithra in Network Hospi Hosp ita ls. 9. Details Details of in-pat in-patients ients a nd out patients in in the network hospitals. 10. On-bed reporting system syste m. 11. Costing Cost ing o f the Tests Test s don do ne in the network hospitals. 12. E-preauthorization. 13. Surger Surgery y details. 14. Dischar Dischar ge deta ils. ils. 15. Real-t Real-time ime reporting, active data warehousing and analysis system. syste m. 16. Cla Cla im settlem sett lemee nt. 17. Electro Electronic nic clearan cleara nce of bills with payment gateway. gateway. 18. FollowFollow-u up of pati pat ient after surgery surger y. 19. Distr Distriibuti but ion of Follow-up medicines. 20. Rajiv Gandhi Jeevandayee Messaging Messa ging Services. 21. Grie Grie vance a nd Feedback work work flow. flow. 22. Back Tracking Tracking S ystem. 23. E-Office management. management. 24. Accounting Accounting system syste m. 25. TDS TDS workflow. 26. Death reporting system syste m. [

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21. ONLINE ONLINE MIS AND 24 HOURS E- PREAUTHORIZATION. PREAUTHORIZATION. The Insurance Company should post enough dedicated staff, so as to ensure free flow of daily MIS and ensure that progress of scheme is reported to society in the desired format on a realtime basis. The company should establish proper networking for quick and error-free processing of pre-a pre- a uthorizati thorizat ions. The pre-authorization has to be done round the clock in co-ordination with Rajiv Gandhi Jeevandayee Arogya Yojana Society i.e. by a team of doctors from the Rajiv Gandhi Jeevandayee Arogya Yo Yo jana Society an a nd Insurance Insurance Co mpany. The prea uthorization team tea m shall ha ve all the speci spec ialists alis ts concerned with the procedures p rocedures covered in the scheme on a permanent basis. Rajiv Gandhi Jeevandayee Arogya Yojana Society will provide provide necessary spec ialists and technical tec hnical committees to e valuate spec ial ca ses from time- totime. Rajiv Gandhi Jeevandayee Arogya Yojana Society will provide necessary specialists to evaluate special cases. A technical committee consisting of specialist from Government Sector nominated by Rajiv Gandhi Jeevandayee Society in the concerned field, CMO of the Insurer and the Project Manager of the Insurer will evaluate and recommend to the CEO of Rajiv Gandhi Jeevandayee Society. In instance of dispute, the final decision on preauthorizatio preauthorization n rest with with th t he CEO of Rajiv Raj iv Gandhi Gandhi Jeev Jee va ndayee Society. There There s hould be inbuilt inbuilt a nonymity of o f name name of o f network network hospital a nd hea lth card number number in the the software while giving preauthorizatio preauthorizatio n and claim settlement settle ment. 22. MEDICAL AUDITORS : The Insurance Company shall appoint enough number of medical auditors, who do preauthorization in consultation with Rajiv Gandhi Jeevandayee Society. The Insurer shall also recruit specialized doctors for regular inspection of hospitals, attend to complaints from benefic beneficiary iary families ami lies directly or through Aarogya mithras mithras for a ny deficie nc y in services s ervices b y the hospitals and also to ensure proper care and counseling for the patient at network hospital by coordinating coordinating with Aarogyamitras Aarogyamitras a nd hospital authorities. 23. PUBLICITY: The Insurance Company on its its part should s hould e nsure nsure that proper publicit p ublicity y is given to the scheme in all possible ways. This will include publicity on electronic and print media, distribution of brochures, brochures, banners, displ disp lay boards etc. in public at appropriate appropr iate places in consultati consultat io n with RGJAYS. The annual spending on this activity should be two percent of total premium amount received annually by the insurer. They shall also effectively use services of Aarogyamitras Aarogyamitras an a nd district d istrict Coordinators for this p urpose. 24. IN HOUSE SYSTEM: The Insurer will establish in-house system to provide all such facilities elaborated under the scheme. The Insurer will submit detailed list of staff appointed for Rajiv Gandhi Jeevandayee Arogya Yojana with their designations, responsibilities and contact numbers before the commenceme commencemen nt of policy po licy to the RGJAYS. RGJAYS. 25. PROJECT OFFICE AND STATE LEVEL COORDINATION The insurer shall nominate within 7 days of signing the MOU responsible officer/officers to properly coord ina ina te above work work and ens ure proper impleme impleme ntation of scheme up to the satisfaction of Rajiv Gandhi Jeevandayee Society. They shall review the progress with Rajiv Gandhi Jeevandayee Arogya Yojana Society on day-to-day basis and be responsible to implement the suggestions of Rajiv Gandhi Jeevandayee Arogya Yojana Society for effectively running the scheme. The Project Office of the Insurance Company shall be separately separately established es tablished at a place desired by Rajiv Ga ndhi Jeev Jee va ndayee Arogya Yojan Yoja na Society Societ y and also provide adequate space for Society for better coordination. The Project office shall report to the Rajiv Gandhi Jeevandayee Arogya Yojana Society on a daily basis in the prescribed proformas. The following departm depart me nts shall be establish estab lished ed by the Insu Ins urance Company Company in the Project Office: [

[[

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a. 24 hour call call cen ce nter te r with toll free help line and online workflow. sta ff.. b. Fie Fie ld Ope Ope ra tions Depar De partme tment nt to coordinate the d aily activities of field staff – time time basis. This c. MIS Department to collect, collate and report data on a real – department will also have a subunit with operators who collect hourly information from the Aarogyamitras, regional co-coordinators, district coordinators etc. Based on this the reverse flow of dissemination of information shall also take place. There shall be subunits for each district. The MIS department shall also follow-up the cases at all levels. The department shall also generate reports as desired by Rajiv Gandhi Jeevandayee Society. d. HR Department to manage human resources for the scheme. e. Training Departm De partmee nt for capacity building of all stakeholders (those who affect the outcome outcome an a nd those wh w ho are a re affected by outcome) a nd sta ff. ff. f. IT Departm De partmee nt to ensure that the website with e- pre-authorization, claim settlement settlement a nd real – real – time time follow fo llow-up -up is maintain ma intained ed and updated on a 24 hour basis. g. Round the clock pre-authori zation atio n Departme Department nt with specialist doctors for each category of diseases shall work round the clock along with Rajiv Gandhi Jeevandayee Arogya Yojana Society doctors to see that the pre-authorization is given within 12 working hours and immediately in case of emergencies. The doctors doctors shall also undertake undertake inspection of hosp hosp itals. itals. h. Claims Claims se ttlement ttlement Department Departme nt with electronic clearance facilities. i. Health Camp De partment artment to plan intimate implement and follow-up the camps as per the the direction directio ns of Raj iv Gandhi Gandhi Jeevandayee Society. j. j. Publicity and logistics Department to undertake all the publicity and logistics activities as spec spec ified ified by Rajiv Gandhi Jeevandayee Soci Soc iety. et y. k. Grievance Department to be manned by doctors and other staff to address the griev rie vances as per t he instructi instruct ions of the Rajiv Gandhi Jee vandayee Society. l. Follow up Department to coordinate the follow-up consultations and distributions of dr ugs ugs as per th t he instructions of Raj iv Gandhi Gandhi Jeev Jee vandayee Society. m. Empanelm Empanel me nt Departm De partmee nt to empanel the hospitals in the network as per the guidelines given by the society and monitor the compliance. n. Feedback Department to send feedback formats collect and analyze feedback of the patients as per the directions of Rajiv Gandhi Jeevandayee Society. The Department will also document each case and upload the same in the Rajiv Gandhi Jeevandayee Arogya Yoja Yojan na Society Soc iety porta portall. o. Administration Department for office managemen anageme nt. p. Vigilance Department for keeping vigil on all services providers and staff q. Accou Accoun nts Depa De parrtment r. Other Departments required for office work. CAPACITY Y BUILDING 26. CAPACIT I. The The Insurer will will a rrange the workshops workshops / training training sessi sess ions for the the capacity building of the societ societ y personnel, personnel, their repre repre sentatives and other stakeho lders in respect of of specific field of insurance at each district on the convenience of the society. Insurer will e nsure that workshops and medica l camps camps are organized o rganized in associatio n with with th t he ne twork twork hosp itals. itals. II. The help of NGOs/SHGs will be taken by the Rajiv Gandhi Jeevandayee Help Desk/Rajiv Gandhi Jeevandayee Assistance Counters to spread awareness and guid guid e the prospective patie nts to t he network hospitals. The Insu Ins urer will associate associat e in this task. 27. RUN OFF PERIOD A Run off Period of one month will be allowed after the expiry of the policy. This means that pre-author pre-author iza iza tion can be done till the end of policy polic y per iod and surgeries for such prepre -

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authorizations can be done up to one month after the expiry of policy period and all such claims will be honored by the Insurance Company . 28. RAJIV GANDHI JEEVANDAI MANUAL Rajiv Gandhi Jeevandayee Arogya Yojana Society will publish a detailed Manual for the Scheme titled Rajiv Gandhi Jeevandayee Arogya Yojana Manual consisting of all operational guidelines and details of the scheme. Rajiv Gandhi Jeevandayee Arogya Yojana Society may update and modify these guidelines and operational details as per the requirement of the scheme. The insurer shall follow the guidelines and instructions given in the manual while imple imple menting the the scheme. 29. PRE PROPOS PROPOS AL MEETING 1. A Pre Proposal meeting of the prospective bidders will be held at 15.00 hrs. on 17.06.2011 in the Conference Hall of Arogya Bhavan, Directorate of Health Services Mumbai, to clarify any queries the Insurance Agencies may have, and for providing additional information if any. No separate intimation of the Pre Proposal meeting will be sent to th t he prospective prospec tive In I nsura nce Ag A ge nc ies, es , unless t here is a c hange in the time t ime,, date or ve ve nue of the Pre Proposal meeting eet ing.. 2. A copy of the proceedings of the Pre Proposal meeting will be sent to all the prospective Insuran Insura nce Agencies. The decisi decis ions a nd c lar ificat ificatiio ns de noted in the Proceedings of the Pre Proposal meeting shall be final and binding to all the Insurance Agencie Agencie s & minuted minuted dec ision sio n of pre proposal meet ing will be be a p art of RFP docume nt. 30. PROPOSAL VALIDITY PERIOD: 1. The Proposal shall remain valid for a maximum period of six calendar months from the Date Date of o f declaration declaratio n after opening financ financ ial proposal. 2. (Technica (Technicall bid). A bid bid va lid for a shorter period sh s hall be rejected 3.. Prior to the expiration of the bid validity the Purchaser may request the Insurance Agency to extend the bid validity for the period as required by the Purchaser

31. FORM FORMAT ATION ION OF CONSORTIUM: CONSORTIUM : Eligible Insurance Agencies shall submit their Proposal as a single entity only. Formation of Consort Consortium ium is is not a llowed llowed to Proposal. Proposa l. Such Proposals sha ll be cancelled and not ev e valuated.

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PAR PAR T II SUBMISSION OF TECHNICAL TECHNICAL AND FIN FIN ANCIAL ANCIAL PROPOS PROPOS ALS ALS Rajiv Gandhi Jeevandayee Arogya Yojana Society/ Government of Maharashtra seek detailed Proposal documents from insurance companies interested in implementing “Rajiv Gandhi Jeevandayee Yojana for 30 identified specialized categories envisaging 972 procedures and 121 follo follo w up proced ures in all the distri dis tricc ts of Maharashtra for approximate ly 2 crore cror e families for a period of 3 years, with a proviso that initially scheme will be launched in 8 districts of State of Maharashtra for approximately 49 lakh families for 1 year. Renewal of scheme after initial one year and also exte nsion to oth ot her distri distr icts of o f the state will be s ubject to the re vie vie w of qua qua lity of e xperien perie nce and also performan performa nce of th t he scheme. 1. SUBMISSION OF PROPOSALS: The Insuran Insura nce Ag A gency must submit the proposal as per the details details me ntion tio ned below: i. Technical proposa l both hard and soft format should be sealed in a separate B - “TECHNICAL envelop clearly marked in BOLD “SECTION A & BPROPOSAL OF RAJIV GANDHI JEEVANDAI YOJANA FOR EIGHT DISTRICTS” written on the top of the env e nvee lope. Under no circumstances shall the financial quote appear anywhere in Technical Proposal and the technical Proposal shall stand rejected if quoted”. ii. Financial proposal in hard format should be sealed in another envelop clearly marked in BOLD “SECTION CC- FINANCIAL PROPOSAL FOR RAJIV GANDHI JEEVANDAI YOJANA FOR EIGHT DISTRICTS” written on the top top of th t he envelope. iii. Both envelop should have the Insurance Agencies Name and Address clearly written written at th t he Left Bottom Corner of the env e nvee lope. iv. iv. Both envelops should be put in a larger cover / envelop, sealed and clearly marked in BOLD have “SECTION A&B – “TECHNICAL PORPOSAL FOR RAJIV GANDHI JEEVANDAI YOJANA FOR EIGHT DISTRICTS” “SECTION C – FINANCIAL PROPOSAL FOR RAJIV GANDHI JEEVANDAI YOJANA FOR EIGHT DISTRICTS” Written on envelop and have the Insurance Agencies Name and Address clearly written in BOLD at the Left Bottom Corner. v. The Proposals shall be cancelled and not evaluated if the Insurance Agency fails to: a. Clearly mention Technical / Financial Proposal on the respective envelops as mentioned in clause 1.0 – 1.0 – I to IV above under Part III. b. To seal the envelope properly with sealing tape. c. Submit Submit both bot h envelops i.e. financial proposal and Technica Technica l Proposal Proposa l together together keep ing in large large e nve nve lop. Give compl comp lete Proposals in a ll aspects. aspects. d. Give Submit Finan Fina ncial Proposals in the specifi spec ified ed proforma (Section C). e. Submit f. To submit submit so ft copy o f Technical Technical Proposa l in respect respectiv ivee cover. 2. SIGNATURE ON EACH PAGE OF DOCUMENT: The compete compete nt aut hority of the Ins urance Ag A gency must must s ign and put official officia l stamp stamp on o n eac h paper of Proposal. Any doc ume ume nt / sheet not sign s igned ed may ma y lead lead to rejection reject ion of Proposal Proposa l. 3. DEADLINE FOR SUBMISSION of PROPOSAL / PROPOSALS: Complete Proposal documents should be received at the address mentioned below not later than 13.00 hrs. on 30 th June June 2011. 2011. Proposal documen docume nts received received la ter than than the prescribed date a nd time t ime w ill not be e ntertained under any c ircumsta nces. Late Proposal documents on any count shall be rejected summarily. Delay due to Post or any other reason will not be condoned.

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Complete Proposal documents should be submitted in two envelopes i.e. Technical RFP in envelope no.1& no. 1& Commercial bid in Envelope Enve lope no. 2. Both bids i.e i.e.. Technical RFP & Commercial RFP should be put in one envelope indicating RFP No. Subject & Date of opening of RFP Address: Address : Dr. G. S. Chindhe, Joint Director, Procurem Procurement ent cell, Di rector ecto rate of Health Ser Se rvices, On behalf of Rajiv Gandhi Jeevandayee Arogya Yojana Society Arogya Bhava Bhavan n First First Floor Floo r, Procure me nt cell, St. Georges’ Hospital campus, Mumbai 400001Mumbai Phone: 022-22631831, 022-22651026 022-22651026 Fax: 022-22625799 E-ma E-ma il: procurementcell@g procurementcell@gm mail.com

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PART-III PROCESS: PROCESS: ASSIGNMENT AND GENE G ENERAL RAL GUIDEL G UIDELINES INES 1. PROCEDURE FOR EVALUATING PROPOSALS The Proposals received within stipulated period and collected in Proposal Box are opened in the presence of Company Representatives. First the Larger Covers are opened and then Technical and Financial Proposals will be segregated. Then the Technical Proposals will be opened in the presence of Company Representatives. Technical Committee nominated by Rajiv Gandhi Jeevandayee Arogya Society / Government of Maharashtra will evaluate the technical proposals. Once the technical Proposals have been evaluated, the successful Insurance Agencies will be informed about the date of opening of financial Proposals. Financial Proposals of only those Insurance Agencies will be opened who are declared successful in the technical Proposal Evaluation stage. Insurance company which are in full conformity with RFP requirements and conditions shall be declared as Eligible insurance company for for opening ope ning Envelope Envelope no. 2 a nd Env E nvelope elope No. 2 (Comme (Co mmercia rciall bid) of su s uch insu ins urance company shall be opened later, on a given date and time. Financial Proposals will be opened in presence of the representatives of insurance companies that have been declared successful in the technical Proposal evaluation stage. Then Financial Proposals will be evaluated by financial committee nominated by Rajiv Gandhi Jeevandayee Arogya Society / Government of Maharashtra. Maharashtra. The Technical and Financial proposals should be sealed by the Insurance Agency in separate covers duly super-scribed and both these sealed covers are to be put in a bigger cover which should should a lso be sealed a nd duly d uly super- scribed. scribed. The Technical Proposals will be evaluated by the Technical Proposal Evaluation Committee GOM M ”). Financial Proposals of only duly constituted by the Government of Maharashtra (“ GO the tec tec hnically acceptable o ffers shall be opened opened before t he successful success ful Insurance Insurance Agencies. 2. AWARD OF CONTRACT Rajiv Gandhi Jeevandayee Arogya Yojana Society / Government of Maharashtra shall award the contract to the successful Insurance Agency whose Proposal has been determined to be substantially responsive, lowest evaluated Proposal, provided further that the Insurance Agency has been determined by the Rajiv Gandhi Jeevandayee Arogya Yojana Society/ Government of Mah Ma harashtra to be qu q ualified to perf per form the contract satisfactorily. sa tisfactorily. 3. RIGHT TO NEGOTIATE AT THE TIME OF AWARD Rajiv Gandhi Jeevandayee Arogya Yojana Society/ Government of Maharashtra reserve the right to ne ne gotiate with w ith lowes lowestt Insurance Agency after opening the Financial Proposal. 4. RAJIV GANDHI JEEVANDAI AROGYA YOJANA SOCIETY / GOVERNMENT OF MAHARASHTRA‟S RIGHT TO ACCEPT OR REJECT ANY OR ALL PROPOSALS : Rajiv Gandhi Jeevandayee Arogya Yojana Society / Government of Maharashtra reserves the right to accept or reject any Proposal or annul the Selection process and reject all Proposals at any time without assigning any reason prior to award of contract, without thereby incurring any liability to to the affected Insurance Insurance Age Age ncy or Agencies. Rajiv Rajiv Gandhi Jeevandayee Arogya Arogya Yojana Soc ie ty / Government of Mah Ma harash aras htra is not bound to to accept the lowest or any a ny Proposal. Incomplete Proposals and financial Proposals with extra attachments are liable to be disqualified. 5. NOTIFICATION OF AWARD AND SIGNING OF MOU: The Notification of Award will be issued with the approval of the Proposal Accepting Authority. The terms of MOU are non-negotiable and the successful insurance company shall sign the MOU proposed by Rajiv Gandhi Jeevandayee Arogya Yojana Society/ Government of Maharashtra at part IV of the document in duplicate within 24 hours of declaration of „award of contract‟, failing which the contract may be offered to the next Insurance Insurance Ag A ge ncy in order order o f merit. Once the MOU is signed, s igned, the insurer will hav ha ve no right r ight to cancel the MOU signed between Rajiv Gandhi Jeevandayee Arogya Yojana Society/ Government of Mah Ma harashtra and insurer.

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6. CONFIDENTIALITY CONFIDENTIALITY:: Information relating to the examination, clarification, evaluation, and comparison of proposals, proposals, a nd reco mmendat mmendatiions for th t he a ward ward of a Con Co ntract s ha ll not not be disclosed to insurers insurers or any other persons not officially concerned with such process until the notification of Contract award is made. Any effort by the insurer to influence the Purchaser in the Purchaser's proposal evaluation, proposal comparison, or contract contrac t award awa rd dec ision sio ns may result in t he r ejecti eject ion o f th t he I nsurer's proposal. proposal. 7. CANVASSING, FRAUDULENT AND CORRUPT PRACTICES: Insurance Agencies are hereby informed that canvassing in any form for influencing the process of notification otificatio n of a ward ward would result in disqualifica di squalification tion of the Insurance Agenc Agenc y. Further, they shall observe the highest standard of ethics and will not indulge in any corrupt, fraudulent, fraudulent, coercive, undesirable undesirable or restr r estriict ive ive practices, pract ices, as the case may ma y be. be. “Corrupt practice” means the offering, giving, receiving or soliciting of anything of value to influence influence the acti act ion of t he pu p ublic offi o fficc ial “Fraudulent practice” means a misrepresentation of facts in order to influence RFP process or an execution of a contract to the detriment of RGJAY, and includes collusive practice among Insurers/Authorized Representative (prior to or after Proposal submission) designed to establish Proposal prices at artificial non-competitive levels and to deprive RGJAY free and open competition; “Collusive practice” means a scheme or arrangement between two or more Insurance Agency, with or withou w ithoutt the knowledge of the Purch Purc haser, design des igned ed to establish estab lish RFP prices at artificial, noncompetitive level; and “Coer Coe rcive practice practice ” means harming or threatening to harm, directly or indirectly, persons or their property to influence their participation in the procurement procurement process or effec t the exec ution o f the contract Government of Maharashtra will re je ct a pro pro posal for award if it determines that the Insurer/Insurers Insurer/Insurers have e nga nga ged in corrupt co rrupt or frau fra udulent practi pract ices Government of Maharashtra will declare a firm ineligible, either indefinitely or for a stated period of time, to be awarded a contract if it at any time determine deter miness that the Sel Se lecti ect ion Insurer/Insurers has engaged in corrupt and fraudulent practices in competing for, or in executing, a contract. Amendment/C Amendment/Cancellation ancellation o f Proposal Doc uments uments a) At any time prior to the deadline for submission of Proposals, the Rajiv Gandhi Jeevandayee Arogya Yoja Yoja na Society/ Government of o f Ma harashtra may, for any reason modify the RFP RFP documents, doc uments, by amendme amendmen nt or ca ncel ce l the process. process. b) The amendment will be notified in writing/by e-mail/by fax or through website to all prospective Insurance Agencies who have taken the RFP documents and amendments will be binding on them. c) To give prospective Insurance Agencies reasonable time in which to take the amendment into account in preparing their RFP document, the Purchaser shall extend, at its discretion, the deadline for submission of RFP document, in which case, the Purchaser will notify all Insurance Agencies by placing it on website of the extended deadline and will be binding on them. d) Any addendum/corrigendum as well as clarification thus issued shall be a part of the RFP documents and it will be assumed that the information contained in the amendment will have been taken into account by the Insurance Agencies in its RFP. NOTE: Oral statements made by the Insurance Agency at any time regarding quality of service or arra arrang ngeme emen nts of any other other matter at ter sh s ha ll not not be consi cons idered.

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SECTION A GENERAL INFORMATION AND UNDERTAKING BY THE INSURANCE AGENCY IN THE PRESCRIBED PROFORMA ENCLOSED. TECHNICAL PROPOSAL GENERAL GE NERAL INFORMATION 1 Name Name of th t he Ins urance Company 2

Address Address of o f Head Office O ffice

3

Name Name and des igna igna tion of th t he perso n submitting the proposals Status

4

Public Public Sector / Pr ivate Sector

DECLARATION BY THE INSURANCE AGENCY

I, ____________________________ _________________________________ _____ Designated as _______________ at_________________ at____________________________ ____________ _ of _____________________ ___________________________ ______ Insurance Company hereby declare that I have read & the contents of the RFP document , consisting of Part I to IV and having agreed to the contents here by submit the Proposal in the desired format with respective proformas duly signed by me , If our Proposal is found found s uccess ful, ful, th t he company compa ny is agreeab agreeab le to e xecute the MoU as given in part II with in twe twen nty four hours hours (e xc luding luding pu p ublic holidays) after the award.

DATE:

AUTHORIZE AUTHORI ZED D SIGNATORY SIGNATOR Y

Seal

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SECTION B

Technical Information (A) Qualifying Criteria: a. General Insurance Company should be registered with IRDA to undertake insurance related activities. The Insurer should attach a self-attested recent copy of the license license as a proof of o f its registration regis tration (Annexure-1 of Part III). Insurance company should have an experience in conceptualizing, designing and implementing large health insurance schemes and have at least three years‟ experience in catering to health insurance of 10,00,000 families or more enrolled under each group health insurance policy in the year 2008-09, 2009-2010 and 2010-2011 (Annexure (Annexure -2 - 2 of Part III). Health insurance policies issued for various districts within w ithin a State for specific scheme implemented by state/pan India scheme implemented by Central Govt. on all India basis will be considered as one policy during the financial year. b. Insurance Insurance Company Compa ny must must su s ubmit s upporting attested docume docume nts of past per for ma nce along with RFP. Insurance Agency must furnish their complete business address VAT/TAN. PAN registration documents attested copies and a Certificate from Charted Accoun Acc ountant tant showing showing revenue income rec eipts eipts on said business during during last three financ financ ial years. Insurance Company Company shall produce Audited Audited Bal Ba lance Sheet and Profi Pr ofitt and a nd Loss Accounts Accounts for last three years i.e. 2007-08, 2008-09 & 2009-10 certified by the Auditor. c. Decl Dec larati arat ion from from the insurer insurer that that the Insura Insura nce Agen Age ncy has has not not been black black listed/debarred by listed/debarred by any State Government/Central Government/Central Government o r its a ge nc ies or not qualified in participating the Government schemes as per IRDA guidelines. (Annexure -3 of Part III) Declaration from the insurer that the Insurer will establish in-house system to provide a ll such facili fac ilities ties e laborated under the sche me.. (Annexure -3a - 3a of Part III) d. The The Insurer has to provi pro vide de an undertak undertaking, ing, as pe pe r format format expressing their explic explicit it agreement to adhere with the details of the scheme as mentioned in the Part I of the RFP document. (Ann (A nnexure exure -4 of Part III) e. The Insurer has to provide an undertaking, as per format confirming that they have submitted submitted their their Proposal as a single ent ity only and ha ve not form a Consortium for the scheme. (Annexure – 5 5 of Part III) f. Tailor made policy of the desired Health Insurance Scheme in conformity to the bene bene fits available, available, e xc lusio lusion ns, conditions etc. The The re is no no structured format for this. (Annexure – 6 6 of Part III) B. Othe Othe rs: (i) Office Infrastructure Company shall submit the details of office infrastructure in the state and in the concerned districts districts in Anne Anne xure xure 7. A detailed organogram with existing exis ting manpowe manpowe r may be attached at tached apart from the annexure if desired. (Annexure – (Annexure – 7 of Part III) (ii) Activity Chart The scheme covering the valid yellow and orange ration card holders needs to be launched within time frame. Hence the Insurance Company shall submit a time bound action plan, not exceeding the date of launch, in Annexure – 8 to mobilize sufficient infrastructure and manpower manpower as per the requirement. (Annexure-8 of Part III) (iii) Plan of Health Camps The Insurance Agency shall give a detailed action plan on organizing health camps as prescribed in Para 18 D of o f part par t I. There is no structured format for this. (Anne (Anne xure-9 of Part III) (iv) Empanelled Health Facility with the Insurance Agency Fresh empanelment of network hospitals has to be done for this Phase. Hence the number of specialty hospital already empanelled with the Insurance Company in other schemes in the

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State and concerned Districts. Insurer shall enumerate only those hospitals having requisite infrastr infrastru uct ure as per the sch sc heme. (Anne xure-10 xure-10 of o f Part III) (v) Any Other Info rmatio rmation, n, if a ny. Any other information Insurer desires to inform, which is relevant to the scheme. There is no structured format for this. (Annexure-11 of Part III) NOTE: Insurance Agency shall give point wise reply of the RFP document for agreement / disagreeme disagreemen nt and attach attac h the necessary a nnexure nnexure as mentioned above. above.

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Pleas Pleasee submit submit tth he follo follo wing: wing: 1 -Qualifying Details De tails Crite Crite ria: a IRDA license license b Insurance Insurance company sho uld uld have a n e xperien perie nce in conceptualizing, designing and implementing large healthcare schemes and have at least three years‟ experience in catering to health insurance of 10,00,000 families across the country or more underwritten under each group health insurance policy in the financial year 2008-2009, 2009-2010 and 2010-2011 on State / Pan India basis. c Declarat Declaration ion from the insurer that the Insuran Insura nce Agency has not been black listed/debarred by any State Government/Central Government or its agencies or not disqualified in participating the Government schemes as per IRDA guidelines. guidelines. Declaration from the insurer that the Insurer will establish in-house system to provide all such facilities elaborated under under th t he scheme. d An undertak undertaking ing as per for mat expressing express ing their explicit agreement to adhere with the details of the scheme as mentioned in the Part I of the RFP document. e An undertak undertaking ing as per for mat confirming that they the y ha ve submitted their Proposal as a single entity only and have not form a Consortium for the scheme. f Tailor made policy of the desired Health Hea lth Insuran Insura nce Scheme in conformity to the benefits available, exclusions, conditions etc. There is is no struct ured format fo r this. 2 - Others i Company Company shall submit the deta ils of office infrastr infrastru uc ture in the state and in the concerned districts. A detailed organogra organogram m with e xisting manpower manpower may be attached apart from the annexure if desired. ii Activity C hart iii Pla Pla n for Health Healt h Cam Ca mps. There is no struct ured ured format fo r this. iv Empanelled Empanelled health healt h facilities with Insu Ins urer v Any Other Ot her information, informat ion, if a ny. There is no structured str uctured format for this.

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Annex Annexures ures of Part III Annexure-1 Annexure-1 Annexure-2

Annexure-3

Annexure-3a

Annexure-4

Annexure-5

Annexure-6

Annexure-7

Annexure-8 Annexure-9 Annexure-10 Annexure-10 Annexure-11


ANNEXURE-1 ATTACH ATTESTED COPY OF IRDA LICENSE

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ANNEXURE-2 EXPERIENCE EXPERIENCE IN GROUP HEALTH H EALTH INSURANCE INSURANCE OF THE COMPANY IN INDIA

Experience in conceptualizing, designing and implementing large healthcare schemes and have at least three year experience in catering to health insurance of 10,00,000 families across the country or more underwritten under each group health insurance policy in the financ financ ial year 2008-2009, 2009-2010 2009- 2010 and and 2010-2011 on State / Pan India basis. b. Number Number of ben be ne ficia ficia ry families‟ families‟ means enrolled under Group Health Insurance Scheme. c. Insurers having Coinsurance for the purpose of risk sharing shall not qualify under the scheme. a.

Sr. No.

Name of the Group

Name of the

Health

State

Policy period

Number of enrolled Families

Insurance Scheme

1

Premium (in Rs.)

Claims

Number of

Per

Total

Recei ve d

enrolled beneficiary

Family (Rs.)

Premium (Rs in

(no.)

families

2

3

4

5

Lakh)

6

7

Lakh)

8

2008-09

1 2 3 2009-10

1 2 3 2010-11

1 2 3

DATE: Seal

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Settled/ Under Process (Rs in

AUTHORIZE AUTHORI ZED D SIGNATORY SIGNATOR Y


9

ANNEXURE – ANNEXURE – 3 3 NAME AND ADDRESS OF THE INSURANCE COMPANY

DECLARATION (ON BOND PAPER OF RS. 100)

BY THE INSURANCE AGENCY

I, __________________________________________________________ Designated as _____________________ ________________________________ ______________________ ___________at______ at_________________ _________________ ______ _____ of ________________________ ___________________________________ ______________________ ___________ Insuran Insura nce Company hereby declare that Our Insurance Company has not been black listed/debarred by any State Government/Central Government or its agencies or not disqualified disqualified in parti part icipating cipat ing the the Government schemes as per IRDA I RDA guidelines. guidelines.

DATE:

SIGNATURE

Stamp:

Name: Designation Address:

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ANNEXURE-3A NAME AND ADDRESS OF THE INSURANCE COMPANY



I, __________________________________________________________ Designated as _____________________ ________________________________ ___________________at ________at________________ __________________________ __________ __ of _____________________ _______________________________ _____________________ _______________ ____ Insu Ins urance Company Co mpany hereby declare that the Insurer will establish in-house system to provide all such fac ilities ilities elabor e laboraa ted under the scheme.

DATE:

SIGNATURE

Stamp:

Namee : Nam Designation:

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I, __________________________________________________________ Designated as ______________________ _________________________________ __________________at__ _______at_____________ ______________________ _____________ __ __ of _____________________ _______________________________ _____________________ _______________ ____ Insu Ins urance Company Co mpany hereby declare that I have read the contents of the RFP Document consisting of Part I to IV and having explicit agreement to adhere with the details of the scheme as mentioned mentioned in the RFP RFP for implementation of the RGJAY give give n therein. therein. I hereb hereb y submit the Proposal in the desired format with respective proformas duly signed by me. If our Proposal is found successful, the company is agreeable to execute the MoU within twenty four hours hours (ex (e xcluding clud ing public holidays) a fter the award. awa rd.

DATE:

SIGNATURE

Stamp:

Name: Designation: Address:

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UNDERTAKING (ON BOND PAPER OF RS. 100)


,________________________________ _____________________ _____________________ ______________des ___design ignated ated I,_____________________ as ____________________ _______________________________ ____________at_________ _at___________________ _____________________ ______________ ___ _____ of ______________________ ___________________________________ _____________ Insuran Insura nce Com Co mpany __________ hereb hereb y give an a n undertaking t hat the Proposal has bee n s ubmitted as a single entity and has not formed any consortium with other Insurance Agencies under under RGJAY R GJAY scheme. scheme.

DATE:

SIGNATURE

Stamp:


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ANNEXURE – ANNEXURE – 6 6 TAILOR TAILOR MADE POLIC POLICY Y OF THE DESIRED HEALTH HEALTH INSURANCE SCHEME IN CONFORMITY CONFORM ITY TO THE BENEFITS AVAILABLE, EXCLUSIONS, CONDITIONS ETC.

DATE:

SIGNATURE

Stamp:


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ANNEXURE-7 OFFICE INFRASTRUCTURE IN THE STATE AND IN THE CONCERNED CONCERNED DISTRICT D ISTRICTS. S. Office Office

Number Number of B ranches

All India (Numbers)

State ( Numbers)

Number of B ra nches

i l o r i h c d a G

i t d r a e u v d p a a n l r a o m A N S

y t i i n a a C d e l i b b a u g a m r u h i a b D R m u b u u M S M

Head Office Zonal Offices Operating Offices

DATE:

Stamp:

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SIGNATURE



ANNEXURE-8 ACTIVITY CHART Activity

Number of days re quire quire d to compl co mplee te the the activity from from the award date

Remarks

Identifying Identifying th t he Project Officer Setting up up of Project O ffice ffice with infrastructure infrast ructure in the area o f Municipal Municipal Corporation C orporation of Greater Bombay Appointment of Medical Officers Establishment of other staff Preparatory meeting with hospitals Inspection of hospitals hospitals vis-à-vi vis-à- viss sche me require require ments, identification of Rajiv Gan Ga ndhi Jeevandayee Medical Co-ordinator (MCO), Rajiv Gandhi Jeevandayee Medical camp Coordinator (MCCO), signing of MoU and Empanelment Of Hospitals Issue of CUG connections to MCO s and MCCO s Installation of kiosk, computer and Accessor Accessor ies a nd 1m 1 mbps connectivity. Printing and distribution of publicity Material Printing and distribution of statio nary related to work work flow of the scheme. Appointment of Aarogyamithras · In P HCs/Govt. HCs/Govt. Hospitals Hospita ls · In Networ Net work k Hospitals Training Training of o f Aarogya Aarogya mithras, mithras, d istributi str ibution on o f Apro Apro ns and CUG mob iles. iles. Training Training of Doctors Training Training of other staff IT enabling enabling Estab Estab lishment lishment of o f 24 Hrs Call Ce nter Estab Estab lishment lishment of o f other infrastr infrastru uctu ct ure Establishment of infrastructure in the districts Preparator Preparator y meet meeting ingss and trainings at distr ic t level for inaugural mega camps.

DATE:

SIGNATURE

Stamp:


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ANNEXURE-9

PLAN FOR HEALTH HEALTH CAMPS

DATE:

SIGNATURE

Stamp:


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ANNEXURE-10

DETAILS OF EMPAN EMP ANELLED ELLED HEALTH HEALTH FACILI F ACILITIES TIES WITH WITH INSUR INS URERS ERS Dsitrict Dsitrict

1

Gadchiroli

2

Amravati,

3

Nanded,

4

Solapur,

5

Dhule,

6

Raigad,

7

Mumbai Mumbai Urban

8

Mumbai S uburb uburba an

Name Name of Hospital

Tertiary/ General

Private/ Govt.

No. of Beds

Empanelled for specialized category/ies and procedures (Number/s)

Other Districts within Maharashtra

DATE:

SIGNATURE

Stamp:


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ANNEXURE -11 ANY OTHER INFORMATION INFORMATION

DATE:

SIGNATURE

Stamp:


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SECTION C – C – F F INANCIAL PROPOSA PR OPOSAL L A) Premium quote for a sum insured of Rs. 1.50 Lakh per family per annum on floater basis. (For ren re nal impla implan nt th t he ceiling ceil ing is is Rs. 2.5 lakh lak h):

SR. NO.

1

B)

PREMIUM PREMIUM PER PER FAMILY WITHOUT S.T. Rs.

PREMIUM PREMIUM PER PER FAMILY WITH S.T .

Rs.

(Rs. (Rs. in words)

(Rs. (Rs. in words)

Details De tails of Add o n cover cove r without any a dditional dditiona l premium:

Sr. Sr. No. 1 2 3 4

Ben Be nefits

Detai De tails ls

Note: No other documents or attachments are permissible along with Section C. Any deviation will attract disqualification.

----------------------------------------DATE:

SIGNATURE

Stamp:


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Part – Part – IV: IV: M o U (Memorandum of Unde Unde rstanding) standing ) RAJIV GANDHI JEEVANDAYEE AROGYA YOJANA IN MAHARASHTRA. THE FIRST PHASE in 8 DISTRICTS OF GADCHIROLI, , AMRAVATI , NANDED, SOLAPUR, DHULE, , RAIGAD, MUMBAI MUM BAI CITY, MUMBAI MUM BAI SUBURBA DISTRICTS MEMORANDUM MEMORANDUM OF UNDERSTANDING UNDERSTANDING

This Memorandum of Understanding (hereinafter called the MoU) is executed at _________on this ____ day of ________ between the Government of Maharashtra/ Maharas htra/ Rajiv Gandhi Jeevandayee Arogya Yojana (RGJAY) Society (the society is proposed to be incorporated incorporated prior to award of the contract) having its office at F irst Floor Floor o f Arogya Arogya Bhavan, Bhavan, St. Georges‟ Hospital campus, Mumbai 400001 (hereinafter referred to as the “Insured” and Party of the first part) represented by Chief Executive Officer, Rajiv Gandhi Jeevandayee Arogya Arogya Yojana Yojana Societ Societ y, which expressi express ion shall, unless unless repugnant to the contex conte xt or meaning thereof, be deemed to mean and include its successors and permitted assigns; AND (Name o f Ins Ins urance ura nce Comp Comp a ny), ny), an Insura nce Compa Company ny having its re gistered and Head Head Office at___________________ at_______________________ ____ Mumbai Mumbai (hereinaft (here inafter er re ferred to as the “Insurer” and the Party of the second part) represented by Chairman cum Managing Director which expression, shall unless repugnant to the context or meaning thereof, be deemed to mean and include its successors and permitted assigns. WHEREAS:

1. The Gover Gover nment nment o f Maharashtra / Rajiv Gandhi Gandhi Jeev Jee vandayee Arogya A rogya Yoja Yojan na Society, Soc iety, a Nodal Agency has, after a due Selection process involving Technical and Financial Evaluation, awarded the Contract of Insurance under the “Rajiv Gandhi Jeevandayee Arogya Yojana in 8 districts of Mumbai city, Mumbai Suburban District, Dhule, Raigad, Solapur, Nanded, Amravati, and Gadchiroli, of the State of Maharashtra for 30 identified specialized categories envisaging 972 iden ide ntified procedures, to t he Ins urer and the Part y of th t he second part. 2. The In I ns ure ure r has agreed t hat they t hey s ha ll pro pro vide the t he health hea lth ins ins ura nce services ser vices to the families of BPL(yellow ration card holders), Antyodaya, Annapurna and APL (orange ration card holders) holders) belonging to eight Distri Distr icts of Maharashtra under Phase -1 covered under Ra Ra jiv Gandhi Jeevandayee Arogya Arogya Yojana (RGJAY) (RGJAY) on the terms and condition conditio ns of the the policy and and more more parti part ic ularly descr ibed in this Agreement within within the state of Maharashtra. Maharas htra. 3. The commencement of Rajiv Gandhi Jeevandayee Arogya Yojana (RGJAY) through the Insurer under this agreement shall be effective from 2 October 2011 [Date, Month and Year], for o ne year and s ha ll expire on 1 October 2012 2012 [Date, Month and Year]. 4. The Insurer has been registered under Section 3 of the Insurance Act 1938 (Act 4 of 1938) having its Registration No. ____ And is inter alia alia engaged in the business of providing General General In I nsura nce in India. 5. The Insurer has agreed to issue the Policy to the satisfaction and in favour of the Insured cover cover ing the Beneficiary Beneficiar y familie familie s in the ma ma nner nner a greed herein here in.. NOW THEREFORE IT IS AGREED as follows: DEFINITIONS DEFINITIONS & INTERPRETATION 1. 1.1 The following terms and expressions shall have the following meanings for purposes purposes of this Agreeme Agreemen nt: i. “Agreement” shall mean this agreement and all Schedules, supplements, appendices, appendages and modifications thereof made in accordance with the terms of this agreement. ii. “Benefit(s)” shall mean mea n th t he health serv se rviices ce s that the benefic be neficiary iary fa milies are entitled to receiv rece ivee based on the contract contrac t between be tween the Governme nt o f Maharas Maharashtra htra and the Insurer under under Rajiv Gandhi Jeevandayee Arogya

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iii.

iv. v.

vi. vii. viii.

ix. x.

xi.

xii.

xiii.

xiv.

xv.

xvi.

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Yojana (RGJAY) subject to the terms, conditions, limitations and exclusions of the Policy Po licy.. “Beneficiary (ies)” shall mean those existing families of BPL, Antyodaya, Annapurna and APL (except white ration card holders) belonging to Eight Districts of Maharashtra covered under Rajiv Gandhi Jeevandayee Arogya Yojana and enrolled under RGJAY. sha ll mean da ys o n which co mmercia mmerciall ba nks are ope n for “Busines “Businesss Day” sha business business in India. “Government of Maharashtra” Maharashtra ” shall mean either, Government of Maharashtra or Rajiv Gandhi Jeevandayee Arogya Society nominated by the Govt. of Maharashtra. “RGJAY” shall mean Rajiv Gandhi Jeevandayee Arogya Yojana “RGJAS” shall mean Rajiv mean Rajiv Gandhi Jeevandayee Arogya Yojana Society “Claim Payment” shall mean the payment of claim to the Empanelled Hospitals/Nursing Homes under the RGJAY based on the invoice/ Health card or yellow/Orange ration card transaction received by the insurer from the health providers and also it would include the payments made for reimbursement claims. “De-Listing of Empanelled Hospitals/Nursing homes ” shall mean delisting the empa empa ne lled hosp hosp ital ta l by the In I nsurer based on t he criteria cr iteria defined. “Empanelled Hospitals/Nursing Homes” shall mean the Hospital/ Nursing Home as has been empanelled by the Insurer as per parameters defined in this agreement to provide health care services under Rajiv Gandhi Jeevandayee Arogya Yojana . “Family” mean members as listed on the Rajiv Gandhi Jeevandayee Arogya Yojana Yojana Health Hea lth Cards Cards or holding valid Orang Ora nge/Yellow e/Yellow Rati Rat ion Card. The deta ils in the Health Card will be taken as the proof for determining the eligibility of the beneficiary. For those beneficiary families whom the health cards are not distributed, the beneficiary families will be identified based on names displayed on their valid Orange/Yellow Ration Card distributed by Department of Food a nd Civil C ivil Supplies co upled with Aadhar number number or p hoto identity card issued by Govt. agency (driving license, election card) till he/she gets Aadhaar number. number. “Force Majeure Event” shall include: (i) Fire, flood, atmospheric disturba disturban nce, lightning, lightning, s torm, torm, ty t yphoon, tor nado, earthquake ear thquake,, washout, or other acts of God; (ii) War, riot, blockade, insurrection, acts of public enemies, civil disturbances, terrorism and sabotage and threats of such actions; (iii) Strikes, lo ck-outs, or other industr industrial ial disturba nces or Labour dispu disp utes Insura nce Regulatory Regulatory and Development Authority Authority “IRDA” shall mean the Insuran established under the Insurance Regulatory and Development Authority Act 1999. “Insured” shall mean the Government of Maharashtra /Rajiv Gandhi Jeevandayee Arogya Society (RGJAS) / Nodal Agency who has paid the premium on behalf of the ir bene ficiar ficiary y families families to Insurer for availing the health insurance services under RGJAY. “Insurer “Insure r” shall mean an Insurance Company selected by the Government of Maharashtra to provide all such services to the RGJAY beneficiary families as outlined in the agreement under RGJAY. “Law” includes all Statutes, Enactments, Acts of Legislature, Laws, Ordinances, Rules, Bye Laws, Clauses, Regulations, Notifications, Guidelines, Policies, and orders of any Statutory Authority constituted under the provisions provisions of Constitution Const itution of India or Cou Co urts in India. India. Signature Signature & st amp of Insurance A gency

“Party” shall mean either the Insurer or the Government of Maharashtra and “Parties” shall mean both the Insurer and the Government of Maharashtra. xviii. “Period of Agreement” Agreement” shall mean that the agreement will be for three year from the effective date, date, xix. policy ” shall mean the period of one year from the “Period of Insurance policy” inception date as notified during which the Insurance Policy shall be operative to provide the benefit to the RGJAY benefici benefic iary families. fa milies. xx. “Project Office” shall mean the office of the Insurer located at Mumbai to coordinates coordinates t he provision p rovision of RGJAY under under this t his Agreement. xxi. “Policy” shall mean the Health Insurance Policy of the Insurer issued to the Insured on behalf of the families of Below Poverty Line Population (yellow card holders), Antyodaya, Annapurna and Above Poverty Line Population (APL-orange (APL-orange rati rat ion card holders) holders) be longing to e ight Districts of Maharashtra Maharashtra under RGJAY. xxii. “Policy Holder” shall mean the Insured who has paid the premium on behalf of their beneficiary families to Insurer for availing the health insurance services under RGJAY. xxiii. “Premium” shall mean an amount agreed by both Parties charged per family on an annual basis as consideration for providing health insurance services under this Agreement. xxiv. “Package Charges” shall mean the indicative maximum charges per ailment/procedure for benefits including follow up package covered by this Agreement as fixed under Rajiv Gandhi Jeevandayee Arogya Yojana society. xxv. “Provider” shall mean empanelled Hospitals / Nursing homes under the scheme. xxvi. “Scheme” shall mean the Rajiv Gandhi Jeevandayee Arogya Yojana as operatio operatio nal and as oth ot herwise erw ise outlined in this Agreem Agree me nt. ” Health Card shall mean Health Photo Card for RGJAY beneficiary families issued under RGJAY by the Insurer as per specifications given by Government of Maharashtra. xxvii. “Service Area” shall mean within state of Maharashtra basis within which the Government of Maharashtra has authorized the Insurer to provide health insurance service under RGJAY. 1.2 1.2 OTHERS i. Any grammatical form of a defined term herein shall have the same meaning as that of such term. ii. “Headings” are used for convenience only and shall not affect the interpretation of this Agreement. iii. Any reference to an agreement, contract, instrument or other document (including a reference to this Agreement) herein shall be to such agreement, instrument or other document as amended, supplemented or pursuant to the terms thereof. iv. Terms and expressions denoting denoting the singular shall inc inc lude the plural and vice versa. The term “including” shall always a lways mean “inclu “inc lud d ing, without wit hout limitat limitat ion”, for v. purposes purposes of this Agreeme Agreemen nt. The term “her vi. herei ein n”, “he reof”, “hereinaft “hereinaftee r”, “ hereto”, “hereunder “hereunder ” and words of similar import re fer to this Agreeme Agreemen nt as a whole. 2. BENEFICIARY FAMILIES: Families holding yellow ration card, Antyodaya Anna Yojana card (AAY), Annapurna card and and ora nge nge rati rat io n card from eight districts viz. Gadchiroli, Gadchiro li, Amravati, Nanded, Solapur, Solapur, Dhule, Dhule, xvii.

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Raigad, Mumbai city and Suburban Mumbai. The families with white ration card holding would not be covered under the scheme. The total number of beneficiary families in the state would be around 2,04,30, 527; out of which approximately 49 Lakh families in the 8 districts are to be covered under the scheme in first phase as on the date of publishing of the Request for Proposal (RFP) ( RFP) documen docume nt. Di D istrict str ict wise wise pro file file of th t he ben be ne ficiary families is given give n below: Districts Districts Phase-I 1 2 3 4 5 6 7 8

Gadchir Gadchir oli Amravati Nanded Solapur Solapur Dhule Dhule Raigad Mumba Mumbaii City Mumba Mumbaii Suburban

Populat Populatiion 970294 970294 2607160 2607160 2876259 2876259 3849543 3849543 1707947 1707947 2207929 2207929 3338031 3338031 8640419 8640419

*Approximate *Approximate number number of Beneficiary Families 182889 559473 559473 543961 543961 830011 830011 397674 397674 566231 566231 482073 482073 1340828 1340828

26197582 4903140 Total * Based on data data furnis furnish hed by Civil C ivil Supplies departme nt as o n 31.05.2010. The beneficiary families would be identified through the Rajiv Gandhi Jeevandayee Health Card issued by the Government of Maharashtra or based on the Yellow and Orange ration card issued b y Civil Supplies Department. The following actions would be undertaken by Network hospitals in case of the possible exceptional situations: No Exception Exceptionaa l Situat Situatiion Requirement Requirement for for benefit benefit Aadhaar number and in case Aadhaar number not taken any Photo ID card issued by Govt. ( Driving license, election identity card with photograph) to No Healt He alth h Card Car d with beneficiary, beneficiary, but correlate the patient name & photograph 1 Valid Yellow or Orange Ration Card (In instance of emergency admission, provisional with name name of beneficiary beneficiary is available a vailable preauthoriz preauthorization ation may be be given g iven subject subject to conf conf irmation of it against submission of valid photo identity card issued by Govt. before discharge.) Children born after issue of card i.e. Photograph of child with either parent along with name and photo not available on Heal Hea lth card/ ca rd/ valid valid Yellow or Orange ration ration card car d of 2 health card or on valid yellow/Orange either parent and Birth certificate issued by authorized ration card officer. Name is there in Yellow Yellow or Orange Not eligi eligible ble for benefit benefit package Ration Card and matches with name (The yellow /Orange ration card is cancelled after 3 in photo identity. But the card is verification by department but still the family is invalid as it does not match with the holding it) digitized list. 3. COVERAGE: This is a package medical insurance scheme to cover hospitalization for surgeries and therapies through cashless treatment in respect of the following 30 identified specialized categories having 972 procedures and 121 follow up procedures along with follow up packages. packages. GENERAL SURGERY SUR GERY 1 ENT SURGERY 2 OPTHALMOLOGY SURGERY 3 GYNAECOLOGY GYNAECOLOGY AND OBSTETRICS OBSTETRIC S SURGERY 4 ORTHOPEDIC SURGERY AND PROCE PROC EDURES 5 SURGICAL GASTRO ENTEROLOGY 6 CARDIAC AND CARDIOTHORACIC CARDIOTHORACIC SURGERY 7

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PEDIATRIC PED IATRIC SURGERIES 8 GENITOURINARY SYSTEM 9 NEUROSURGE NEUROSURGERY RY 10 SURGICAL ONCOLOGY 11 MEDICAL ONCOLOGY 12 RADIATION ONCOLOGY ONCOLOGY 13 PLASTIC PLA STIC SURGERY 14 BURNS 15 POLY TRAUMA 16 PROSTHESES 17 CRITICAL CRITICA L CARE 18 GENERAL MEDICINE 19 INFECTIOUS DISE DI SEASES ASES 20 PEDIATRICS 21 CARDIOLOGY 22 NEPHROLOGY NEPHROLOGY 23 NEUROLOGY NEUROLOGY 24 PULMONOLOGY 25 DERMATOLOGY 26 RHEUMATOLOGY 27 ENDOCRINOLOGY 28 GASTROENTEROLOGY 29 INTERVENTIONAL RADIOLOGY RA DIOLOGY 30 Detailed list of specified surgeries and therapies falling in the identified groups and packages is given Appendix – Appendix – I I (a) and the follow up package is given Appendix – Appendix – 1 1 (b) of Part IV. The scheme would provide for cashless treatment to patients in the Network Hospitals in case of covered surgical procedures, interventions and therapies connected with the diseases /conditio /condition ns mentioned above. above. 4. SUM ASSURED: The Scheme shall provide coverage for meeting all expenses relating to hospitalization of benefic beneficiary iary up to to Rs. Rs . 1,50,000/- per family family pe r year ye ar in any of the Empanelled Hospital/Nursing Home subject to Package Rates on cashless basis through Health cards. The fami ly on floater floate r basis i.e. the benefit benefit shall b e a va ilable ilable to each and every member member of the family total reimbursement of Rs. 1.5 lakh can be availed by one individual or collectively by all members members o f the fa mily. mily. In case of renal transplant surgery, the immunosuppressive therapy is required for a period of 1 year. year. So the upper price ceiling ceiling for Re Re nal Transplant Transplant would would be Rs. 2, 2, 50,000 50,000 per operat operatiion as an exceptional package exclusively for this procedure. The cases are likely to be very few and well controlled by Human Organ Transplant Act 1994. This would also be part of the coverage. 5. PRE EXISTING DISEASES: All diseases under the proposed scheme will be covered from day one. A person suffering from any disease prior to the inception of the policy shall also be covered under approved procedures procedures for that disease. 6. PRE AND POST HOSPITALIZATION: 6.1 From date of report reporting ing to hospital hospital up to 10 days from the date of discharge from from the hospital s ha ll be part of the package.

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Network Network Hospital will pro vide vide follow- up free cons ultat ultatiion, di d ia gnost gnostics ics a nd medicines when patient is called for follow-up within 10 days of discharge being part o f the package. 7. DEFINITION OF FAMILY: Family means members as enlisted and photographed on the Rajiv Gandhi Jeevandayee Arogya Yojana Health Cards or holding valid Orange/Yellow Ration Card. 8. HEALTH CARDS All eligible families in these districts shall be provided with Rajiv Gandhi Jeevandayee Arogya Yojana Health Cards in due course of time. These Health Cards will be used for identification of Beneficiary families in the family under the Scheme. Family Health Cards will be prepared by using data of valid ration cards (yellow and orange) issued by Food and Civil supplies department coupled with wit h Aadhaar numbe numbe rs issued by UID aut horities, alth alt hough the latter is individual card. As an interim measure till the health card is issued, the valid Orange/Yellow Ration Card with Aadhaar number or in case Aadhaar number not available, any P hoto ID I D card of patient issu iss ued by Govt. ag a gencies (Driving license, Elect Electiion ID) would would be required required to correlate cor relate the pat ient na me and photograph for identificat identification ion of beneficiary. benefic iary. 9. WEB PORTAL: 6.2

All activities related to the scheme shall be done through a dedicated portal of Rajiv Gandhi Jeevandayee Society, the development and maintenance cost of which will be borne by the Insurer. The source code and system design document for the application exclusively developed by Insurer for Rajiv Gandhi Jeevandayee Arogya Yojana shall be provided in good working condition to Rajiv Gandhi Jeevandayee Society. A dedicated data center in the name of Rajiv Gandhi Jeevandayee Yojana will be maintained by the Insurer. The proprietary rights of software will be with Government of Maharashtra .Patient records will be property of Rajiv Gandhi Jeevandayee Society. Confidentiality of patient records should be maintained. The web portal will be a repository of information and will have the following ollo wing features and the respect ive ive work work flows: 1. Genera Genera l Informati Informat ion on the scheme. 2. Details Details of patients reporting and referrals from the PHC / Rural/ Rural/ Subdistrict/Women/General/District hospitals on daily basis. 3. E-Health Cam Ca mps system syste m and daily reporting o f health ealt h camps. 4. Details Details of patients patients report reporting ing and ge ge tting referred from from the the healt health h camps. 5. E-Empane E-Empane lment lment system syste m. 6. Eme Eme rgency approval system syste m. 7. Call centre application. 8. Patient Patient registration by Aarogyamithra Aarogyamithra in Network Hospi Hosp ita ls. 9. Details Details of in-pat in-patients ients a nd out patients in the network network hospitals. 10. On-bed reporting system syste m. 11. Costing Cost ing o f the Tests Test s don do ne in the network network hospita ls. 12. E-preauthorization. 13. Surger Surgery y details. 14. Dischar Dischar ge deta ils. ils. 15. Real-t Real-time ime reporting, active data ware ware housing and analysis system. syste m. 16. Cla Cla im settlem sett lemee nt. 17. Electro Electronic nic clearan cleara nce of bills with payment gateway. gateway. 18. FollowFollow-u up of pat ient after after surger surger y. 19. Distr Distriibuti but ion of Follow-up Follow-up medic medic ines. ines. 20. Rajiv Gandhi Jeevandayee Messa Messa ging Services. 21. Grie Grie vance a nd Feedback workflow. workflow. 22. Back Tracking Tracking S ystem. 23. E-Office management. management. 24. Accounting Accounting system syste m.

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25. TDS TDS workflow. 26. Death reporting system syste m. 10. PAYMENT OF INSURANCE PREMIUM: It is agreed that Government shall pay to the Insurer an amount of Rs. ---------- Plus Service Tax as applicable, app licable, towards the t he entire annual a nnual premium pre mium e tc. The The payme nt s hall be made made in fo ur insta insta llments of Rs. ------------------- Plus services tax each as under:. First Insta Insta llment: Before the commencement of th t he sc heme Second Second installme nt: Before th t he start of second quarter of year Third insta installm llmee nt: Befo Befo re the the start star t of third third quarter o f year year Fourt Fourth h insta installm llment ent : Be Be fore th t he sta rt of fourth quarter quarte r of year The total number of beneficiary families for each District is an indicative estimate and may vary. The number of the final beneficiary families for each district will be given within one month of signing MOU. The total premium payable would be based on this final figure of e ligi ligible be ne ficiary families. Following activities should be completed before inception of scheme within three months of award award of co ntract before release of th t he first install installment ment o f the premium. 1) The successful insurer shall furnish the security deposit to the RGJAYS within 7 days from the date of communication of Award of Contract for an amount of 5% of the contract value, valid up to 90 days after the date of completion of warranty obligations obligations a nd enter into MOU o n Rs. Rs. 100/- non-judic on-judicial ial stamp paper. The cost o f Stamp Stamp paper should be born bor ne by the insurer. The The Security Deposit should should be in the form of Bank Guarantee in favour of the „Rajiv Gandhi Jeevandayee Arogya Society' payable at Mumbai from any Nationalized or Scheduled bank. The Security Deposit will be discharged by the Purchaser and returned to the Supplier not later than 30 days following the date of completion of the Insurer‟s performance obligations by the end of first first quarter of executi execut ion of sc heme, including the warranty obligation, under the MOU. The security deposit shall be discharged (forfeited) as a compensation for any loss resulting from the failure to perform the the ob ligatio ligation ns under the MOU or in the the eve nt of termination of the MOU or in any eve eve nt as the the Purchaser P urchaser thinks fit and proper. 2) The Insurance Company has to empanel minimum 100 network hospitals in the state and it should be ensured that all procedures should be covered cumulatively in empanelled hospitals. 3) The Insurance Company has to start call center with all requisite staff, departments and appointment of field staff with staff at network hospital. An adequate area should be reserved for office of Rajiv Gandhi Jeevandayee Arogya Yojana Society office. Software (if so specifications and certifying authority) and Connectivity should should be established es tablished in order to sta sta rt the scheme. 11. PERIOD PERIOD OF INSURANCE & PERIOD OF AGREEMENT AGREEMENT:: The insurance coverage under the scheme for the beneficiary families shall be in force for a period of one year from the date of commencement of the policy polic y (From 0.00 hrs of 02.10.2011 to Midnight of 01.10.2012 for Phase-I). The period of agreement shall be for three years with effect from 02.10.2011; subject to annual annual review re view and re newal ewa l of policy based o n perfor perform ma nce paramet para metee rs as below. 1. Percentage of health camps in a month (One health camp per week) 2. Claim ratio 3. Number Number a nd Percentage of complaints redressed against total complaints rece ived. ived. 4. Minimum number number hospitals to be be empanelled at start of scheme 100. 5. Time required for preauthorization 12 hours ordinarily and immediately in cases of emergency. 6. Time required required for cl c laim set tlement. tlement. 7. IEC IEC Activities Act ivities accord ing to to norms fixed.    

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8. Any new new issue coming co ming up up in fulfillme nt o f objective objec tive o f RGJAY Society Soc iety / GOM. 11.a. PERFORMANCE RFORMAN CE PARAMETERS AND PENALTY CLAUSE: The Insurer is required to perform multiple activities in performance of its obligations arising out of the insurance contract to it. Any activity not performed by the insurer within the given time line shall hamper implementation of Rajiv Gandhi Jeevandayee Health Insurance Scheme from the planned date. Such activities have been listed here under which the success success ful bidder bidder is required to complet completee within the specified peri per iod from fro m the the date of o f award of the insurance contract to it failing which a penalty as specified percentage on total premium against each section per week/month shall have to pay to the RGJAY society for the period period of o f delay. Sr. No

Activity

PENALTY PER WEEK A a. Identifying the Project Officer b. Setting up of Project Office with infrastructure Municipal Corporation of Greater Bombay B Preparation and Certification of software on receiving the specification from Society. Dedicated Dedicated Website as as per the the requirement requirement (envisag (envis aging ing C Empanelment Empanelment M IS,HR IS,HR M IS, IS, Publicity and Ca mp MI S, Eauthorization MIS, Claim MIS, Follow Follow up monitoring MIS, Field operations Supp ort service MIS, MIS, Grievance M IS, Medical Audit MIS, Key performance Indicato rs and variable salary, Operation maintenan ce MIS) Establishment of 24 Hrs. Call Center and Establishment of D other infrastructure infrastructure E Establishment of sufficient infrastructure in each district. Installation Installation of kiosk, co mputer and accessories etc.

Time Time frame from the date of Signing of Agreement Agreement

Penalty for the delay in execution in % of componen componen t charges

7 days 30 Days

1% 1%

3 month

1%

3 mont hs

2.0%

3 month

1%

3 month

1%

3 mont hs

0.5%

F

To identify the Hospital Network Providers and networking with with t he m.

G

To arrange cashless treatment of the insured in the 3 mont hs empanelled empanelled hos pitals pitals under the scheme and facili facilitation tation of proper prope r networking for quick qu ick and error-free error -free proces sing of pre-auth orizat orizat ions . To provide adequate manpower, so as to ensure free flow of 3 mont hs daily daily MIS and ens ure that progress of s cheme cheme is reported to Society Society in the desired format format on a real-time basis. Preparation of various formats used for cashless 1 mont hs transactions, discharge summary, billing pattern and other reports in consultation with with th e Govern ment. PENALTY PER MONTH Process Processing ing of claim c laimss related related to the schem sc heme. e. Pre-authorization Pre-authorization of System to be ready requests and a pproval pproval of prea p reauthorization uthorization if a ll the conditions conditions are in 3 months fulfilled, within 12 hours of receiving the preauthorization (Continuing request from the network provider if failure % is more than activity) 5%) Scrutinize the bills from network hospitals and give System to be ready approval for the sanction of the bill and forward payment in 3 month month s & within 7 working days on receipt of complete claim document (Continuing from the Network Hospitals. (Failure (Failure % is more than 5%) activity)

0.5%

Medical Auditing (by minimum qualification MBBS) for conducting 20% per month concurrent audits of services and quality of service provided to the beneficiary families delivered by Network Hospitals on periodic basis as well as and required. required.

0.5%

H

I

J

K

L

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3rd month (Continuing activity)

0.5%

0.5%

1%

1%


Sr. No M

Activity

HR

Number of network net work hos pitals and number number of Aarogymitras /Medical Coordinators, Camp Coordinators posted- District wise, month wise, and aggregate Number of Public facilit ies (CHCs/ (CHCs/ PHCs) and number of Aarogymitras posted - District wise, month wise, and aggregate Training programme for Network Hospital Providers and other stake holders holders ones in a month. 

Time Time frame from the date of Signing of Agreement Agreement

Penalty for the delay in execution in % of componen componen t charges

3rd month onwards

0.5%

2n month onwards

0.5%



N

(Continuing activity)

12. ADJUSTMENT/ ADJUSTMENT/ REFU R EFUND ND OF PREMIUM: If there is a surplus after the claims experience on the premium (excluding Service Tax) at the end of the policy period, after providing 20% of the premium paid towards the Company‟s administrative cost, of the balance 80% after providing for claims payment and outstanding claims, 90% of the left over surplus will be refunded to the Government of Maharashtra / Rajiv Gandhi Jeevandayee Arogya Yojana Society within 30 days after the expiry of the Runoff period. 13. PROCEDURE FOR ENROLLMENT OF HOSPITALS: The Public and Private Hospitals will be jointly empanelled within the State of Maharashtra by Rajiv Gan Ga ndhi Jee Je e va ndayee Arogya Arogya Yojana Yojana Soc iety a nd I nsura nce Company C ompany fo llowing llowing t he e mpanelment procedure laid down do wn by Rajiv Gandhi Jeevandayee Jeevandayee Arogya Yoja na Society. The hospitals having minimum of 50 inpatient hospital beds with adequate facilities and offering the services as stipulated below shall be empanelled after being scrutinized and recommended by the Empanelment Empanelment a nd Disciplin D isciplinary ary Co mmittee. mmittee. Empanelment Empanelment and Disci D isciplinary plinary Co mmittee mmittee will constitute a subcommittee of four doctors for this purpose. Two doctors will be nominated by Insurance Company and two by Rajiv Gandhi Jeevandayee Arogya Society. The purpose of o f this empanelment is to ensure e nsure capability of o f the hospital hospital to provide some of the identified 30 specialized categories and seek agreement to the equal or lower price for these 972 procedures and 121 follow up procedures and take an opportunity to assess the current quality of care therein. It would be the responsibility of the Insurer for enrollment of Network Hospitals in the State of Maharashtra to give adequate facilities for the treatment of the patients when they present themselves. The The number of empan empa nelled hospitals and and number o f procedures procedures in each eac h hosp hosp ital to be pe rmitted rmitted will be based on t he need and and a t di d iscretion scret ion of o f the society in the interest of beneficiary. Network hospitals are supposed to extend medical aid to the beneficiary under the scheme. Procedure for enrollment of Hospitals is placed as Appendix- IV of Part IV. Preference for empanelment could be given to the hospitals accredited under National Board Board of Accreditation Ac creditation for Hospitals. It is also also des ired to accreditate acc reditate the empaneled hospital under National Board of Accreditation for Hospitals in order to ensure quality of care. 14. MOU M OU with with Net work Hospi Hos pital tal a nd Disciplinary Disciplinary actions against agai nst the the hos hos pitals: pitals: (i) MOU with Network Hospital: The Insurer shall sign MOU with all the network hospitals to be empanelled under the scheme. Separate MOU‟s with relevant provisions have to be entered into for Multispeciality, speciality, Can C ancer cer Treat Treatm ment e tc. This This MOU MO U is subject to t he approval of the Rajiv Gandhi Jeevandayee Society Societ y. Number Number of o f e mpaneled hospitals an a nd specializations will depend on the benefit the beneficiary. Network hospitals are supposed to extend medical aid to the benefic beneficiary iary under under the scheme. A provision will be made in MOU regarding regard ing noncompliance / default clause. Such matter shall be looked in to by the Empanelment and Disciplinary Committee, the decision of which will be binding to all concerned. The sample sample MOU is attach attac hed as appendix 7 o f Part IV. I V.

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(ii) Disciplinary Disciplinary actions ac tions against the hospitals: On recommendation by the Empanelment and Disciplinary Committee the Insurer shall take various disciplinary actions against Network Hospital including De-listing from the empanelment if it is found that guidelines of the Scheme are not followed by it and services offered are not satisfactory as per laid down standards. Hospital may also be delisted or de-empanelled if infrastructure in the hospital is found below the standards laid down by society any time during the policy period. The Insurer is also liable for any deficiency in the service provided by the network hospital / service provider other than medical services and in case of any delisting the Insurer shall find alternative immediately. 15. CASHLESS SERVICE: SERVIC E: The Insurer has to ensure that adequate facilities are provided to all beneficiary families so that they do not have to pay any deposits at the commencement of the treatment or at the end of treatment to the extent the Services as covered under the Rajiv Gandhi Jeevandayee Arogya Yojana. It is envisaged that for each hospitalization the transaction shall be cashless for covered procedures. Enrolled/Eligible beneficiary along with health card/ orange or yellow ration card will go to hospital and come out without making payment to the hospital subject to procedure procedure covered under under the scheme. The same is the case for diagnostics if ev e ventu ent ually the patient does no t e nd up in undertaking undertaking the surgery surger y or therapy therap y. The The beneficiary beneficiar y has right to select network hospital and services of selected network hospital should be made available. (Subject to availability of beds) In instance of non – availability availability of beds in network hospital, cross referral to another network hospital may be accepted. 16. PACKAGES: The insurer insurer s hould ensu ens ure that t he Network hospitals follow ollo w the the packa ges worked out b y Ra Ra jiv Gandhi Jeevandayee Society. The package rates will include bed charges in General ward, Nursing Nursing an a nd boarding board ing charges, charges, S urgeons, Anesthet Anesthet ists, ists, Med ical Practitioner, Consultants fees, Anesthes Anesthes ia, Blood, Blood, Oxygen, O.T. O.T. C harges, Cost o f Surgica Surgicall Appliances, Med icines and Drugs, Cost of Prosthetic Devices, implants, X-Ray and Diagnostic Tests, food to impatient, one time transport cost etc. In other words the package should cover the entire cost of treatment of patient from date of reporting to his discharge from hospital and 10 days after discharge after surgery including complications if any, making the transaction truly cashless to the patient. In instance of death, the carriage of dead body from network hospital to the village/tow village/town nship would a lso be part of o f packa packag ge. 17. IMPLEMENTATION PROCEDURE: The entire scheme is to be implemented as cashless hospitalization arranged by the insurer. The following table steps represent the process flow of treatment to the beneficiary in the Network Network hospital. The Entire scheme is to be implemented as cashless hospitalization arranged by the Insurance Company. The following table represents the process flow of treatment to the beneficiary A) Process Flow of the Beneficiary Treatment in the Network Hospital Step I Beneficiary families shall approach nearby PHC/Rural, Sub district, General, Women/District Hospital/Network Hospital. Aarogyamitras placed in the above hospitals shall facilitate the benefic beneficiary. iary. If benefi bene ficiar ciary y visits Governm Gover nment ent Health Facility other than th t he Netw N etwork ork Hospital Hosp ital,, he/she will be given a referral card to the Network Hospital with preliminary diagnosis by the doctors. The Beneficiary may also attend the Health Camps being conducted by the Network Hospital in the Villages and can get that referral card based on the diagnosis. The information on the outpatient and referred cases in the PHC/Rural, Sub district, General, Women/DH and the camps will be collected from all Aarogyamitras/Hospitals on regular basis and captured in the dedicated database through a well-established call center.

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Step 2 The Aarogyamitras at the Network Hospital examine the referral card and health card or Yellow/Orange Ration Card, register the patients and facilitate the beneficiary to undergo specialist consultation, preliminary diagnosis, basic tests and admission process. The information like admission notes, test done will be captured in the dedicated database by the Medical Coordinator of the Network Hospital as per the requirement of the Rajiv Gandhi Jeevandayee Arogya Yojana Society. Step 3 The Network Hospital, based on the diagnosis, admits the patient and sends E preauthorizatio preauthorization n requ req uest to the insurer, insurer, same can be reviewed b y Rajiv Gandhi Jeevandayee Arogya Arogya Yojana Yojana Society Societ y. Step 4 Recognized Medical Specialists of the Insurer and Rajiv Gandhi Jeevandayee Arogya Yojana Society examine the preauthorization request and approve preauthorization, if, all the condit conditiions are satisfied. This This will w ill be done within w ithin 12 working working hours a nd immediately immediately in case o f e mergency wherein e-prea uthoriz thor izaa tion is marked as “EM”. Step 5 The Network Hospital extends cashless treatment and surgery to the beneficiary. The Postoperative notes of the Network Hospitals will be updated on the website by the medical coordinator. Step 6 Network Network Hospital Hospita l after per forming forming the covered surgery/ therapy therap y/ proced ure forwards the Originals bills, Diagnostics reports, Case sheet, Satisfaction letter from patient, Discharge Summary Summary d uly signed by th t he doctor, ack nowledgeme owledgeme nt of payments of tra nsportation cost and other relevant documents to Insurer for settlement of the claim. The Discharge Summary and follow-u ollo w-up p deta ils will be part of th t he Rajiv Raj iv Gandhi Gandhi Jeev Jee vandayee Arogya Yoja na Society Societ y portal porta l. Step 7 Insurer scrutinizes the bills and gives approval for the sanction of the bill and shall make the payment within w ithin agreed per iod. The c laim se ttlement module a long with e lectronic ectro nic clearance c learance and payment gateway will be part of the workflow in Rajiv Gandhi Jeevandayee Arogya Yojana Society portal and will be operated by the Insurer. The reports will be available for scrutiny on the the Rajiv Gandhi Gandhi Jeevandayee Jee vandayee Arogya Yo Yo jana Society login. Step 8 The Network Hospital will provide free follow-up consultation, diagnostics, and medicines under under t he scheme up to 10 da ys from the date of d ischar ge. 18. HEALTH CAMPS: Health Camps are to be conducted in Taluka Head Quarters, Major Gram Panchayats and Municipalities. Minimum of one camp per week per empanelled hospital has to be held in the eight districts in the policy year. The insurer shall ensure that at least one free medical camp is conducted by each eac h ne ne twork hosp hospital ital per pe r week week at the place suggested by Rajiv Raj iv Ga Ga ndhi Jeevandayee Society Societ y. The Rajiv Gandhi Gandhi Jeeva ndayee Med Med ical Camp Coordinator (MCCO) of the hospital shall coordinate the entire activity. Network hospital shall carry necessary screening equipment along with specialists (as suggested by the Rajiv Gandhi Jeevandayee Society) and other para-medical staff. The Insurer shall put in the minimum requirements as regards the health camp in the MOU with the hospitals. They shall work in close liaison with district coordinator of the Insurance Company, Civil Surgeon/DHO in consultation with District Collector. Hospital shall follow the Camp policy of Rajiv Gandhi Jeevandayee Society The Insu Ins urer s ha ll in consultation with Rajiv Gandhi Jeevanday Jeevanda yee Arogy Aro gyaa Yojana Soci Soc iety et y plan, plan, prepare and inform the schedule of Health Ca mps well in advance to Rajiv Gandhi Jeevandayee Arogya Yojana Society as per the guidelines and also inform the same to the

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District Collectors, Civil Surgeons/DHO, Public Representatives, Empanelled hospitals and other stakeholders. The Insurer shall ensure that Network Hospital conducts the Camp as per schedule with all necessary equipment and professionals in the concerned fields. They should also submit to Rajiv Gandhi Jeevandayee Arogya Yojana Society the confirmation of participation in the camps from the Network Hospital. The Network hospital shall enter the details of the patients screened and referred in the camps in the assigned login of the workflow of Rajiv Gandhi Jeevandayee Arogya Yo Yo jana Society Portal. 19. DISTRICT LEVEL CO-ORDINATION: District level offices with necessary infrastructure have to be set-up by the Insurance Company. The Insurer needs to have district level monitoring staff with District Coordinators, GM‟s/DGM‟s /Area Managers /Assistant Area Managers /District level doctors / Regional Coordinators of the Insurance Company ( When scheme) is implemented in whole state) should monitor Aarogymitras, co-ordinate with network hospital, district administration and people‟s people‟s representatives r epresentatives for effective impleme impleme ntation of o f programme. They s hould e nsure that camps are held as per schedule, arrange for canvassing for the camp, mobilize patients and follow up the beneficiary families. He/she should work in close liaison with district administration under the supervision of District Collector. He should also ensure proper flow of MIS and report to society on day to day basis about the progress of the scheme in the district. The Insurance Company should ensure that dedicated staff is made available for the scheme. There shall be at least one doctor to be placed in each district. Further wherever the concentration of the Network Hospitals is more additional doctors need to be placed. The Insurance Insurance Com Co mpa ny shall follow the instr instru uct ions of Rajiv Gandhi Gandhi Jeeva ndayee Arogya Yojana Society in this regard. 20. IN-HOUSE SYSTEM: The Insurer will establish in-house system to provide all such facilities elaborated under the scheme. The Insurer will submit detailed list of staff appointed to Rajiv Gandhi Jeevandayee Arogya Yojana Society with their designations, responsibilities and contact numbers before the commencement of policy. 21. PROJECT OFFICE AND STATE LEVEL CO-ORDINATION: The Project Office of the Insurer shall be separately established in the jurisdiction of Municipal Corporation for Greater Bombay for better coordination with the Rajiv Gandhi Jeevandayee Society and would also provide adequate space for society. The project office shall report to the Rajiv Gandhi Jeevandayee Arogya Yojana Society on a daily basis in the prescribed proformas. The The fo llowing departments shall be establish estab lished ed by the Insurer Insurer in the Project Office. i. 24 Hour call centr ce ntree with toll fr f re e help line : The Insurer should nominate within 5 days of award of MOU responsible officer / officers to properly coordinate work and ensure proper impleme impleme ntation of scheme up to the satisfaction satisfact ion of Rajiv Gan Ga nd hi Jeevandayee Society. It should review the progress with Rajiv Gandhi Jeevandayee Arogya Yojana Society on day to day basis and be responsible to implement the suggestions of Rajiv Gandhi Jeevandayee Arogya Yojana Society for effectively running the scheme. The Insurer shall provide telephone services for the guidance and benefit of the beneficiary families whereby the Insured Persons shall receive guidance about various issues by dialing a State Toll free number. Call Centre Information: The Insurer shall operate a call centre for the benefit of all Insured Persons and for real-time reporting. The Call Centre shall function for 24 hours a day, 7 days a week and round the year. The Insurer undertakes to provide services to the Insured Persons in Marathi, English and Hindi. The Insurer will operate a state toll free number with a facility of a minimum of 10 lines. The cost of operating of the Toll free telephone number shall be borne solely by the Insurer. The Insurer will intimate the state toll free number to all beneficiary families along with addresses addresses and other teleph telep hone num bers of o f the Insurer‟s Insurer‟s Project Office O ffice.. Th T he act ion taken take n on

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every call will be routed through an escalation matrix which ends at the level of CEO of the Rajiv Gandhi Jeevandayee Society. As a part of the Call Centre service the Insurer shall provide the following: a.Answ a. Answers ers to queries q ueries related to Coverag Covera ge an a nd Ben Be ne fits under the Po licy. licy. b. Information Information on o n Insurer‟s office, procedures proced ures and products re la ted to health. c.Gener c. General al guidance guidance on th t he Services. d. For cash-less treatment subject to the availability of medical details required by the medical edica l team of th t he I nsurer. e.Informati e. Information on on Netw Ne twork ork Provi Pro viders ders a nd contact numbers. numbers. f. Benefit details under the policy and the balance available with the Beneficiary families. g. Claim Claim status infor infor mat ion. h. Advising the hospital regarding the deficiencies in the documents for a full claim. i. Medical and health related queries to be addressed by medical officer in the call center. j. Any other relevant information to the Beneficiary families including grievances. k. Any information required from the field for the Insurer. l. Any related related ser vice vice to the beneficiary b eneficiary families. m. Detailed MIS from Aarogyamithras in Government Hospitals / Network Hospitals Hospitals a nd Cam Ca mps. n. Any related related Ser vice vice as d irected by Rajiv Gandhi Jeevanda yee Arogy Aro gyaa Yojana Society from time to time. ii) MIS Dep De partment artment to collect, collate and report data on a real-time basis. This department will also have to submit with operators who collect hourly information from the Aarogyamthras, regional coordinators, district coordinators etc. Based on this the reverse flow of dissemination of information shall also take place. There shall be reports for each district. The MIS department sha ll also also follow- up the cases at all a ll levels. Th T he department shall a lso generate reports as desired by Rajiv Gandhi Jeeva Jeeva ndayee Society. iii) Field Operations Operatio ns Department to coordinate the daily activities of field staff. The The operati operat ions o f the field depart ment s hall be monitored monitored onli o nline. ne. iv) HR Department to manage human resources for the scheme and maintain online online database of staff a nd thei the ir man ma na ge ment deta ils. off all stakehol s takeholders ders a nd staff s taff.. v) Training Department De partment for capacity building o vi) Publicity a nd logis tics Department to undertake all the publicity and logistics activities as spe spe cified by Rajiv Gandhi Jeevanda Jeevanda ye e Society Societ y. vii) IT Departm De partmee nt to ensure that the website with e-preauthorization, claim settlement and real-time follow-up is maintained and updated on a 24-hour basis. There There s hould be inbuilt a no nymity nymity of name of o f network network hospital hospita l and health card number in the software while giving preauthorization and claim settlement. The The propri propr ie tary rights of software will be with Gover Gover nment nment of o f Maharashtra Maha rashtra after three years. Patient records will be property of Rajiv Gandhi Jeevandayee Society. Society. Confi Co nfid d entiality of pa pa tient records should be maintained. viii) Round-the-clock Pre-authoriz Pre-aut horiza a tion Departm De partmee nt with specialist doctors for each category of diseases shall work round the clock along with Rajiv Gandhi Jeevandayee Arogya Yojana Society doctors to process the preauthorization within 12 working hours and immediately in cases of emergency. ix) Claims Claims se ttlement ttlement Departm De partmee nt with electronic clearance facilities. x) Health Camp Departm De partmee nt to plan, inform, implement and follow-up the camps as per the directi direct ions of Rajiv Ra jiv Gandhi Jeevandayee Society.

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Grievance Departm De partment ent to be ma nned by docto docto rs a nd o the the r staff to address the grievances from time to time as per the instructions of Rajiv Gandhi Jeevandayee Society. The insurer shall act as a frontline for the redressal of Benefic ia ry fa fa milies / Network Netwo rk Hospital Hospita l grievances. grieva nces. The Insurer Insure r s hall a lso attempt to solve the grievance at their end. The grievances so recorded shall be numbered numbered consecu consec utively tive ly and the Beneficiary fa fa milies milies / Netwo Netwo rk Hospital shall be provided provided with with the number number assigned to the griev rie va nce. The Insurer sha sha ll provide provide t he Ben Be nefici efic iary families / Net work work Hospital with w ith details de tails o f th t he followollo wup action taken as regards the grievance as and when the Beneficiary families require it to do so. The Insurer s ha ll also record the info info rmati rmat io n in pre-a pre- a greed format of any complaint / grievance received by oral, written or any other form of communication. Action Taken Report for Customer Grievance: The INSURER shall record in detail the action taken to solve the grievance of the Beneficiary families / Provider in the form of an Action Taken Report (ATR) within 2 working days of the the recordi ng of the the grievance g rievance and immedi imme dia a tely in case of e mergencies . The Insurer shall provide the society / Government with the comprehensive action taken report (ATR) on the grievances reported in pre-agreed format. The entire process will be done through the call center and Rajiv Gandhi Jeevandayee Arogya Yojana Society portal. The Insurer shall co-ordinate with Provider / Rajiv Gandhi Jeevandayee Arogya Yojana Society in order to solve the grievance as and when required by the nature and circumstances of the grievance. xii) Follow-up Depa De partm rtment ent to coordinate the follow-up consultation and distribution of drugs as per the instructions of Rajiv Gandhi Jeevandayee Society. xiii) Empanel Empanelm ment Dep De partme artme nt to empanel the hospitals in the network as per the guidelines given by Rajiv Gandhi Jeevandayee Arogya Yojana Society and monitor the compliance. xiv) Feedb Fee dback ack departm depart me nt to send feedback formats, collect and analyses feedback of the patients as per the directions of Rajiv Gandhi Jeevandayee Society. The department will also document each case and upload the same in the society portal. portal. The The INSURER shall a lso collect collec t the satisfacti satisfact ion slip from the Beneficiary families at the time of discharge who had obtained the cashless services. The Beneficiary families shall submit the Satisfaction slip issued by the INSURER at the time of discharge through Provider. The INSURER shall also carry out the Customer Satisfaction Survey regularly by using the rating card for the purpose. xv) Administr Adminis tra a tion Departm De partmee nt for office managemen anageme nt. xvi) Vigilance Vigila nce Depar De partment tment for keep ing vigil vigil on all a ll service providers providers and sta ff. xvii) Legal Depar De partme tment nt exclusively for the project. xviii) Accounts Accounts Dep De partment. artment. xix) Other departme departme nts nts requir requi re d for o ffice wo rk. 22. AAROGYAMITRAS: i) Aarogyamithras Aarogyamit hras in R ural / Sub district / Wo Wo me n Hospitals Hospita ls / Government Hospitals etc. The unique nature of the scheme demands the Insurer to appoint Aarogyamithras in consultation with Rajiv Gandhi Jeevandayee Arogya Yojana Society in all Rural / Sub district / Women Hospitals / Government Hospitals for propagating the scheme, mobilizing people for health camps, counseling beneficiary families, facilitating the referral / treatment of these patients and follow-up. For effective and instant communication all the Aarogyamithras will have to be provided with cell phone CUG xi)

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connectivity by the Insurer. The Insurer will provide uniform (White apron with scheme logo) to all a ll the Aarogyamithras an a nd ensure that th t hey wear wea r it when on duty. ii) Aarogyamithras Aarogyamit hras in Netw Ne two o rk Hospi Hos pitals tals:: The Insurer also needs to appoint minimum three Aarogyamithras at all network hospitals to facilitate admission, treatment and cashless transaction of patient. The Aarogyamithras should also help hospitals in preauthorization and claim settlement. They should also ensure proper reception and care in the hospital and send regular MIS. The Aarogyamithras will also ensure cashless followup consultation and facilitate collection, stock maintenance and distribution of follow-up medicine in coordination with pharmacist. For effective and instant communication all the Aarogyamithras will have to be provided with cell phone CUG connectivity by the Insurer. The Insurer will provide with uniform (White apron with scheme logo) to all the Aarogyamithras and ensure that they wear it when on duty. The Insurer shall ensure that prefabricated prefabricated Aarogyamithra Aarogyamithra kiosks with all additio nal requiremen requireme nts as per the design approved by Rajiv Gandhi Jeevandayee Arogya Yojana Society is put up in all hospitals. The The role of Aaro gyamithra gyamithra can ca n be modified b y the society from fro m time-to-time. The Insu Ins urer will provide uniform and arrange the workshops / training sessions for the Aarogyamitras on the guidelines guidelines spec ified ified by Rajiv Gandhi Jeevandayee Society. The detailed note on Aarogyamitras and their role is enclosed at Appendix – III III of Part IV. 23. WEB PORTAL: All activities related to the scheme shall be done through a dedicated portal of Rajiv Gandhi Jeevandayee Society, the development and maintenance cost of which will be borne by the Insurer. The source code and system design document for the application exclusively developed by Insurer for Rajiv Gandhi Jeevandayee Arogya Yojana shall be provided in good working condition to Rajiv Gandhi Jeevandayee Society. A dedicated data center in the name of Rajiv Gandhi Jeevandayee Yojana will be maintained by the Insurer. The web portal will be a repository of information and will have the following features and the respect respectiv ivee workflows: workflo ws: (Who will will prepare) 1. Genera Genera l Informati Informat ion on the scheme. 2. Details Details of patients reporting a nd referrals from the PHC / Rural/ Rural/ S ub district/Women/General/District hospitals on daily basis. 3. E-Health Cam Ca mps system syste m and daily reporting report ing of health ealt h camps. 4. Details Details of patients reporting and ge tting referred from the health ealt h camps. 5. E-Empane E-Empane lment lment system syste m. 6. Eme Eme rgency approval system syste m. 7. Call centre application. 8. Patient Patient registration by Aarogyamithra Aarogyamithra in Network Hospi Hosp ita ls. 9. Details Details of in-pat in-patients ients a nd out patients in in the network hospitals. 10. On-bed reporting system syste m. 11. Costing Cost ing o f the Tests Test s don do ne in the network hospitals. 12. E-preauthorization. 13. Surger Surgery y details. 14. Dischar Dischar ge deta ils. ils. 15. Real-t Real-time ime reporting, active data warehousing a nd a nalysis system. syste m. 16. Cla Cla im settlem sett lemee nt. 17. Electro Electronic nic clearan cleara nce of bills with payment gateway. gateway. 18. FollowFollow-u up of pat ient after surgery surger y. 19. Distr Distriibuti but ion of Follow-up medicines. 20. Rajiv Gandhi Jeevandayee Messaging Messa ging Services. 21. Grie Grie vance a nd Feedback workflow. workflow. 22. Back Tracking Tracking S ystem. 23. E-Office management. management.

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24. Accounting Accounting system syste m. 25. TDS TDS workflow. 26. Death reporting system syste m. 24. ONLINE MIS AND E-PREAUTHORISATIO E-PREAUTHORISATION: N: The Insurance Company should post enough dedicated staff, so as to ensure free flow of daily MIS and ensure that progress of scheme is reported to society in the desired format on a realtime basis. The company should establish proper networking for quick and error-free processing of pre-a pre- a uthorizati thorizat ions. The pre-authorization has to be done round the clock in co-ordination with Rajiv Gandhi Jeevandayee Arogya Yojana Societies. By a team of doctors from the Rajiv Gandhi Jeevandayee Arogya Yo Yo jana Society and Insurance Insurance Company. Co mpany. The prea uthorization team tea m shall ha ve all the speci spec ialists alis ts concer ned with w ith the procedures covered in the scheme on a permanent basis. Rajiv Gandhi Jeevandayee Arogya Yojana Society will provide provide necessary spec ialists and tec hnical committees to e valuate spec ial ca ses from time-totime -totime. Rajiv Gandhi Jeevandayee Arogya Yojana Society will provide necessary specialists to evaluate special cases. A technical committee consisting of specialist from Government Sector nominated by Rajiv Gandhi Jeevandayee Society in the concerned field, CMO of the Insurer and the Project Manager of the Insurer will evaluate and recommend to the CEO of Rajiv Gandhi Jeevandayee Society. The final decision on all the preauthorization would rest with the CEO of Rajiv Gandhi Jeevandayee Arogya Society. There should be inbuilt anonymity of name of network hospital and health card number in the software while giving preaut preauth horization an a nd claim settleme nt. 25. MEDICAL AUDITORS: The Insurer Company shall appoint enough number of medical auditors who does preauthorization in consultation with Rajiv Gandhi Jeevandayee Society. The Insurer shall also recruit specialized doctors for regular inspection of hospitals, attend to complaints from benefic beneficiary iary families ami lies directly or through Aarogya mithras mithras for a ny deficie nc y in services s ervices b y the hospitals and also to ensure proper care and counseling for the patient at network hospital by coordinating coordinating with Aarogyamithras Aarogyamithras and hospital a uthorities. 26. PUBLICITY: The Insurance Company on its part should ensure that proper publicity is given to the scheme in all possible ways. This will include publicity on electronic and print media, distribution of brochures, brochures, banners, displ disp lay boards etc. in public at appropriate places in consultati consultat ion with RGJAYS. The spending on this activity should be two percent of premium amount. They shall also effectively use services of Aarogyamitras and district Coordinators for this purpose. purpose. They shall effectively use services of Aarogyamitras and district Coordinators for this purpose. purpose. In I nsurer will give give wide w ide publicity through through and shall submit time bo und und programme: i. Guidebook: The Insurer shall handover the guidebook and related information to the Beneficiary families through the district administration in regional language- Marathi. The Guidebook will inter-alia inter-alia contains information regarding regarding the following:  Information regarding the Insurer and its address, fax number, website address and and oth ot her contact information. free number number of the Call Centre Service.  Toll free  List of Network Providers.  Information on symptoms of the diseases / systems covered along with diagrammatic representations.  Information Information on fo llowllow- up required. Information on possible preventive a nd curativ curat ivee measu meas ures.  Information

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

Procedure to be followed by the Beneficiary families for availing the Hospitalization Service as Cashless Access Service. Information re garding the Policy and and Ben Be nefits.  Information ii. Theatre Theatre S liders liders iii. Public Publicity ity by Rajiv Ga Ga ndhi Jeevandayee Jee vandayee Help Desk at the PHCs / Raj iv Gandhi Gandhi Jeevandayee Assistance Counters at Network hospitals. CAPACITY BUILDING: I. The The Insurer will a rrange the workshops workshops / tra tra ining ining sessions for the capacit capacity y building of the society personnel, their representatives and other stakeholders in respect of specific field of insurance at each district on the convenience of the society. Insurer will ensure that workshops and medical camps are organized in association with the ne twork twork hosp itals. itals. II. The The help of NGOs/SHGs NGOs /SHGs will be taken by the Rajiv Ga Ga ndhi Jee va ndayee Help Desk / Rajiv Gandhi Jeevandayee Assistance Counters to spread awareness and guide the prospective patie patien nts to the network hospita hospitals. ls. The Insurer Insurer will associate in this task. RAJIV GANDHI JEEVANDA JEEVANDA YEE MANUAL Rajiv Gandhi Jeevandayee Arogya Yojana Society will publish a detailed Manual for the Scheme titled Rajiv Gandhi Jeevandayee Arogya Yojana Manual consisting of all operational guidelines and details of the scheme. Rajiv Gandhi Jeevandayee Arogya Yojana Society may update and modify these guidelines and operational details as per the requirement of the scheme. The insurer has to follow the guidelines and instructions given in the manual while imple imple menting the the scheme. scheme. 27. SERVICING OF OTHER SCHEMES: Rajiv Gandhi Jeevandayee Arogya Yojana Society reserve the right to request the Insurer to extend services for processing of claims generated through any other scheme implemented by Rajiv Gandhi Jeevandayee Society. 28. ACTIVITY CHART: The activity chart submitted by the Insurer as part of the Proposal document and accepted by Rajiv Gandhi Jeevandayee Arogya Society (Appendix-IV) will be followed by the Insurer to take up the the act ivities ivities as narrated in the scheme an a nd MOU. (In (I n appendix time frame to be give give n instead of mentioning before commencement of scheme. This will help in monitoring the process) 29. ASSISTANCE FROM THE GOVERNMENT: The Government will on their their part pa rt re re nder a ll possib possiblle assistance viz. i. To give all necessary support for organizing sensitization programmes for the PHCs and and Government Hospita Hospitals. ls. ii. To provide financial assistance for health camps by network hospitals (@ Rs. 5000 per camp) ii. To e xtend necessa ry s upport in p rovi rov id ing space a nd o ther s upport fo r locating oca ting Rajiv Gandhi Gandhi Jeev Jee va ndayee Help He lp Desks Desks at PHCs / ot her Government Hospitals. To provide provide necessary necessar y professio na ls for tec hnica hnicall committee. committee. iii. 30. CLAIMS CLAIMS PROCEDURE: PROCEDURE: The beneficiary families would be identified by the Rajiv Gandhi Jeevandayee Health card/ at the PHC / Government Hospital level/ Rajiv Gandhi Jeevandayee Assistance Counters in the network hospital. A self-declaration by the beneficiary /patient prior to hospitalization for the covered treatment that he does not belong to any of the excluded categories may be required. The family member having Health card will be referred to Network Hospital on recommendation of the Doctors at these centers. The insurer will make payment of the claims directly to to the hospital hospita l. Paymen Payme nts will be made to the hospita hospitals ls within 07 days days a fter the receipt of all documents. The cost of various tests conducted on health card holders for covered procedures procedures who ultimately ultimately do not undergo undergo surgery, will be included included in the insura insura nce cost. Insurer will ensure that such test are done free of cost to the patient . The The c laims procedur proced uree

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will be carried carr ied in the electronic platform of Rajiv Gandhi Gandhi Jeev Jee va nd ayee Arogya Yojana Soc Soc iety portal. portal. The The payment to the Network Network Hospital Hosp ital will be made online online through thro ugh e lectroni ectro nicc clearance. The procedure of processing of the claims will be handled by the project office of the insurer. The claims procedure will be under taken as detailed below: i) Claim Claim Intim I ntimatio ation n The INSURER shall receive claim intimation from the Network hospital online in the form as agreed under the scheme. Rajiv Gandhi Jeevandayee Society portal will have reports reports indi ind ic ating claim intimations received. ii) Collection o f Claim Clai m document docume ntss The INSURER shall offer single window service at the respective Project office to the Network Network hospital for receiving the claim documents. In case of pre-authorizat pre- authorizatiion for the Cashless Service, the Network hospital will send the claim documents along with the invoice invoice to t he INSURER. INSURER. This T his also also fo llows llows a n e lectronic ectro nic route. iii) Scrutiny of Clai Claim m Document Docume ntss The INSURER shall scrutinize the claim documents at the initial stage regarding the medical and eligibility aspect. Deficiency of any documents, if any, shall be communicated to the Network hospital within 7 working days. A reminder for the same will again be forwarded to the Network hospital once every 3 days of first intimation of the defic deficiient docum doc umee nts are not re re ceived or are partially received. iv) Claim Control Number The INSURER will settle all eligible claims and pay the sum to the Network hospital within within sev se ve n working working day da ys of receipt rece ipt of the claim cla im.. A separate separate Claim Control Number is to be provided by insurer for every claim made by Network hospital. v) Payment of Claims and Claim Turn Around Time The INSURER will settle all eligible claims and pay the sum to the Provider within seven working days of receipt of the claim. vi) Rep Re pudiatio udiation n of claims The INSURER on repudiation of the claim cla im not not covered under under th t he policy, s ha ll me me ntion the reasons for repudiation on writing and online to the Network hospital. The INSURER shall also intimate the same to Rajiv Gandhi Jeevandayee Arogya Yojana Society online. vii) Right of Appeal and reopening of claim Network Network Hospital shall have a right o f appeal appea l to approach the Insurer Insurer if the Provider feels that the claim is payable. If Network Hospital is not agreed with the Insurers‟ decision in this regard, can appeal to the Central Committee and the decision of the Central Committee will be final and binding on the INSURER and Network Hospital. This This r ight of appea l will be be mentioned by the the INSURER in every repudiation advice as mentioned in above. The Central Committee can re-open the claim if proper and relevant documents documents as req uired uired are submitted. viii) Revi Re viee w of paid claim clai ms The Central committee will have the right to reopen a settled claim and to direct the Insurer to settle for an appropriate amount within a period of 3 months of payment of the claim. The Insurer further agrees to provide access to the Central Committee their records for this purpose. All the claims settled by the insurer to the network hospitals based on the bills rece ived ived from the hosp ita ls in conformity confor mity with the package rate arrived at and also based on the pre-authorization given by the reopening by the Insurance company will be reckoned as final and will not be subject to any reopening by a ny a uthority e xcept th t he Cen Ce ntral tra l Comm Co mmittee ittee for gri gr ievances. ix) Claim float and Bank Account The Insurer will have a separate Bank account to pay the Network hospital making a valid claim and all payments will be electronically cleared. Detailed reports will be

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electronically cleared. Detailed reports will be made available online on a real-times basis. x) Co-Ordination Committee A committee shall be constituted under the chairmanship of Chief Executive officer Rajiv Gandhi Jeevandayee Arogya Yojana Society including representative of Insurer and Network Hospital (nominated by Rajiv Gandhi Jeevandayee Society) to review smooth running and functioning of th t he ident ified ified act ivities. 31. RESPONSE RESPONSE TIME: Authorization will be decided within12 Working Hours and the Insurer shall do the settling of claims within 7 working days after receipt of documents. In case of life threatening e mergencies, er gencies, the prea pre a uthoriza uthorizatio tion n shoul sho uld d be given immedia immedia tely. To facilitate ac ilitate this, the e preauthorizatio preauthorization n would would carry carr y a sign of “EM” to seek pri pr ior ity atten atte ntion tio n of authorizers. Insurer‟s response to to the Rajiv Gandhi Jeevandayee Sc heme will be immed iate through: t hrough: i. 24 hour hour call c all cen ce ntre ii. Toll free line, exclusively for this Scheme. iii. Aarogyamithras in Rajiv Gandhi Jeevandayee Help Desks / Rajiv Gandhi Jeevandayee Assistance Counters iv. iv. District Coordinators/ Regional Coordinators who are nominated exclusively for this purpose. 32. INSURER REPRESENTATIONS, WARRANTIES AND RESPONSIBILITIES a. Powe Powe r, Capacity and a nd Autho Autho rity It has full power, capacity and authority to execute, deliver and perform this Agreement and it has taken all necessary action (corporate , statutory or otherwise), to execute, execute, deliver, perform per form and a uthorize the ex e xecution, delivery and per forman orma nce of this Agreement and that it is fully empowered to enter into execute this Agreeme Agreemen nt, as well as perform pe rform all is obliga ob ligatio tion ns hereunder. b. Complia Complianc ncee with with Me mo randum and a nd Article Articless Neither the making o f this Agree Agree ment, ment, nor complianc comp liancee with its will be in conflict co nflict with with or result in the breach of or constitute a default or require any conse nt under. I. Any provision of any agreement agree ment or oth ot her instrume instrumen nt to whi w hich ch s uch party is a party or by which it is bound; bound; II. Any judgment, injunction, order, decree or award which is binding upon such party: and / or III. Such party‟s the Memorandum and/ or Articles of Association. c. Compliance Complia nce with Laws Laws It has complied with all applicable Laws including but not limited to the Insurance Regulator Regulatory y and Developme Developmen nt Au A uthority thor ity Regul Reg ulat at ion. d. Risk Bearing Society as the buyer of insurance selected sold insurer i.e. xx Ltd as 100% risk bearer or carri carr ie r and no other insurer insurer is a llowed to particip part icipaa te in this direct insurance arrangement. e. Insurance Insurance License Throughout the term of this Agreement, the Insurer shall continue to be an Insurer under Law and licensed under IRDA regulations to carry on the activities contemplated contemplated here in f. Capabil Capability ity of Se rvice It is capable of servicing all the products and policies and offered and also have sufficient infrastructure, trained manpower and resources to carry out the activities for servicing ser vicing these products and and policies. polic ies. g. Updating the list of Network Provider

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The The empan empa nelment of Network Providers will be a continuous process process an a nd th t he Ins urer will abide by the instructions of Rajiv Gandhi Jeevandayee Arogya Yojana Society in this regard. h. Disclose INSURER- Netwo Netwo rk Provide Providerr agree agree ment The INSURER agrees that it shall disclose to the society all agreements entered into by the INSURER with wit h any Network Provider Provider i. Steering Committee The INSURER shall have interrelated arrangements for common activities like empanelment of hospitals, planning for camps etc. Under the scheme with the society and other Insurers. A Steering Committee under the chairmanship of the CEO of Rajiv Gandhi Jeevandayee Arogya Yojana Society will oversee these arrangements. j. j. Code of conduct Abide by the code of conduct prescribed by the IRDA or any other governmental body from from time to time. time. k. Discounts Discounts a nd Rebates Disclose and pass on to the Government/ Rajiv Gandhi Jeevandayee Arogya Yojana Society the benefit of any discount or rebates provided by the Network provider provider to the INSURER. l. Indemnity: The Insurer agrees to defend, indemnify and hold harmless the Insured, its employees, representatives and agents against all claims, demands, judgments, liabilities, damages, costs, expenses, proceedings or prosecutions arising from or relating to breach of any of the aforesaid representations, warranties, covenants and responsibilities. RUN-OFF PERIOD A “Run Off period ” of o ne mont month h will will be allow a llowed ed after a fter the the expiry of the policy peri per iod i.e. till the midnight of 1 November 2012 for 8 districts Phase-I. This means that pre-authorizations can be done till the end of policy period and surgeries for such pre-authorizations can be done up to one month after the expiry of policy period and such claim will be honored by the Insurance Insurance Co mpany. 33. JURISDICTION: JURISDICTION: Any dispu disp ute arising aris ing o ut of this MOU sha sha ll be sub sub ject to the jurisdictio n of State of Maharashtra and Mumbai. 34. NON PERFORM PERFORMANCE ANCE:: Failure to perform and abide with the terms will attract the following in the event of termination: i) The Insure Insure r will pay back to to Rajiv Gandhi Gandhi Jeevandayee Arogya Arogya Yoja Yojan na Society within one week the unutilized amount of premium pre mium after settlement plus service tax ii) In addition addition to above, the Insurer will pay the total tota l packa ge amount amount for all the cases for which preauthorization has been given, but not claimed. iii) iii) In additio n to above, above, the Insurer Insurer sh s ha ll pay interests at the ra ra te of 12% per annum on the amount refundable as determined by clauses 18(i) and (ii) above for the period extending from from the date date of premium paid till the date date of date receipt of refund. 35. INFORMATION FLOW: The Insurer will ensure that the information flow takes place on a real-time basis. The Insurer will use use a state sta te of the art ded icated Intern Inter net based network for thi t hiss purpose. 36. RENE R ENEWAL: WAL: The policy may be renewed under the mutual consent of both the parties. The premium for renewal renewal sh s hall be ag a greed upon prior to th t he expiry expir y of the e xist xisting ing policy. 37. THE PRECEDENCE OF MOU: The MOU has precedence ov o ver statements.

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38. MODIF M ODIFICAT ICATION ION OF MOU M OU:: The MOU may be modified as and when the need arises in mutual agreement between Rajiv Gandhi Jee vandayee Arogya Yojana Yojana Society Soc iety a nd Insurer. 39. M ONITORING ONITORING MECHANISM: Regular review meetings on the performance/ administration of the Scheme would be held between between th t he Government of Maharash Maharas htra / Rajiv Gandhi Jeevandayee Aro gya gya Yoja na Soc iety and the Insurer at the Insurer at the District level and at the State Level. The composition of the monitoring monitoring committees sh s hall be as foll fo llows ows:: Distr Di strict ict level: Chairman: District Collector Co-chairman: C hief hief Exec utive O fficer fficer Zillah Zillah Par ishad. Membe Membe rs: 1. District Health Officer. 2. District Supply Officer. 3. District Coordinator of Insurer. 4. Civil Surgeon – Surgeon – Member Member Secretary For Mumbai and suburban Mumbai Chairman: Commissioner, BMC Co-chairman: Additional. Additional. Commissioner C ommissioner Health Healt h BMC. Membe Membe rs: 1. District Collector 2. DMER, BMC or Dean of KEM hospital 3. Dean Grant Grant Medi Med ical Co llege llege M umbai umbai 4. Rationing Con Co ntroller tro ller,, Mumbai M umbai 5. District Coordinator of Insurer 6. Executive Executive Health Officer Officer BMC BMC - Member Member Secretary State Stat e Level: Level: Chief Secretary Secre tary Public Health and Family Welfare Chairman: Additional Chief Membe Membe rs: 1. Director of Health Services 2. Director Director Med ical Education Education and Research. 3. Dy. Commissio Commission ner Health Hea lth BMC 3. Project Manager of the Insu Ins urer. 4. Member Member o f the Rajiv Gandhi Jeevanday Jeevanda yee Society Societ y 5. Technica l Committee Co mmittee me mber no minated by Rajiv Gandhi Jeevandayee Jee vandayee Society. 6. CEO, Rajiv Gandhi Jeevanday Jeevanda yee Arogya Yojana Society Societ y – Member Secretary. The Chairmen of the above committees may invite any non- official member in the project districts for the meetings. Periodical meetings will be organized at both district and State level. The agenda and issues to be discussed would be mutually decided in advance. The minutes of the meeting at the district and state level will be drawn and a copy will be forwarded to Rajiv Gandhi Jeevandayee Society. The Insurer shall also put in place a mechanism of their own to monitor the scheme on a real times basis. Detailed reports on the progress progress o f the sche me a nd issues if any emerging emer ging out of su s uc h meetings s hall be submitted to Government of Mah Ma harashtra / Rajiv Raj iv Gandhi Gandhi Jeev Jee vandayee Soc iet y. 40. GRIEVANCE MECHA M ECHANISM: NISM: A District level Grievance redressal Committee: Grievance redressal Committee chaired by District Collector with following members will for m the the griev grie vance redressa l cell at th t he district lev le vel. The decisi dec ision on by th t he co mmittee mmittee is binding bind ing except except when a n appeal appeal to the ce ntral committee at the t he state leve l is pre pre ferred ferred .

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Members of the Committee: 1. District coordinator of Insu Ins urer. 2. District Health O fficer fficer 3. Mem Me mber from t he Technical Committe Committeee (Nominated b y Rajiv Rajiv Gan Ga ndhi Jeevandayee Society) 4. Represe Represe ntativ tat ivee from the Insurer. 5. Civil S urgeon cum District Coordinator of the soc iety et y – Member Member Secretary. For Mumbai Mumbai a nd suburban Mumbai Chairman: Commissioner, BMC Co-chairman: Additional. Commissioner Health BMC. Membe Membe rs: 1. District Collector 2. DMER, BMC or Dean of KEM hospital 3. Dean Grant Grant Medi Med ical Co llege llege M umbai umbai 4. Rationing Con Co ntroller tro ller,, Mumbai M umbai 5. District Coordinator of Insurer 6. Executive Executive healt health h O fficer fficer BMC BMC - Member Secretary Secret ary B State Grievance redressal Committee: Committee Committee C haired by Chief C hief Exec Exec utive utive Offic O fficee r of Raj iv Gandhi Gandhi Jeevandayee Aro gya gya Yojana Society will entertain all the appeals and grievances at the state level. The decision taken by the committee will be final and binding on the both parties. The committee may call the concer concer ned Network Hosp Hosp ita l against whom su s uc h grie griev va nce is reported. Members of the Committee: 1. Represe Represe ntativ tat ivee of the Rajiv Gandhi Jeevandayee Society Societ y 2. Technical Commi Co mmittee ttee Me mber 3. Represe Represe ntativ tat ivee from the Insuran Insura nce firm C. A tollfree number will be made available at Mumbai where any complaint can be registered. The Insurer will keep track of the complaints and report on the action taken to the Central Committee. The beneficiary families can also send e-mail / fax /letter to CEO of Rajiv Gandhi Jeevandayee Arogya Yojana Society/ Zonal Office of the Insurer. The details of tollfree Numbers/ addresses will be available with PHCs and other Govt. hospitals. A separate set-up under the supervision of Executive Director of the Insurer at the Corporate Office will be setup to deal dea l with with th t he griev grie vances. 41. TERM TERMS S & TERMINAT TERM INATION: ION: 1. This This Agreem Agree ment sha ll take effect on the date of signat signat ure he he reof by both Parties, and shall remain in force till the end of the policy period and the run off period subject to a right to Rajiv Gandhi Jeevandayee Arogya Yojana Society to terminate the Agreement, on a review of the performance of the INSURER before before the same period. Rajiv Gandhi Jeevandayee Jeevandayee Arogya Yoja na Society Soc iety will review the the per forman orma nce of th t he INSURER IN SURER based o n factors factors includ including ing but not limited to: The facilities set up arrangements made by the INSURER toward servicing the beneficiary families. The The ex e xten te nt of Network Hospital; The The qu q ua lity of service provided; pro vided; The The beneficiary beneficiar y fa fa milies satisf satis facti act ion reports received; Withholding of any information as sought by Rajiv Gandhi Jeevandayee Arogya Yojana Society at the Selection and implementation stage of the scheme; and Such other factors as the Rajiv Gandhi Jeevandayee Arogya Yojana Society/Government deems fit. 2. This Agreem Agree ment may be terminated: terminate d: 

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

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a)

By Rajiv Gandhi Jeevandayee Arogya Yojana Society before the period mentioned mentioned abo ve as provided under c lause 41 (1) b) By both parties part ies by mutual conse conse nt; or c) Provided it gives the other party at least 60 days prior written notice; or In case o f terminat terminatiion as given above: i) The Insurer Insurer will pa y back to Rajiv Gandhi Jee vandayee Arogya Arogya Yojana Yojana Society within one week the unutilized amount of premium after settlement plus plus ser vice tax tax ii) In addi add itio n to above, abo ve, the Insurer Ins urer will pay pa y the total package packa ge a mo unt for all the cases for which preauthorization has been given, but not claimed. iii) In addition add ition to abov abo ve, the Insurer Insure r s ha ll pay pa y interest interest s at the rate o f 12% per annum on the amount refundable as determine deter mined d by c lauses above for the period extending from the date of premium paid till the date of date receipt of refund. iv) Rajiv Gandhi Jeevandayee Arogya Yojana Society reserves the right to re-allot the policy to other insurer as it deems fit for the rest of the period in the e vent of terminati terminat ion and the Insurer shall not ha ve a ny claims to it. v) Performance security will be forefeited. forefe ited. 42. FORCE MAJEURE: Neither party shall be in breach of any of its performance is prevented, prevented, phys ically hindered hindered or by an act, e ve nt or circumstance circ umstance (wh (w het her of the kind described herein which is not reasonably within the control of such party (Force Majeure Event). In the event that any Force Majeure Event continues for a period of 4 (four) weeks without interruption, the Party affected by such Force Majeure Event shall be entitled to terminate this agreement by giving notice to the other party, pursuant to, and in accordance with the provisions provisions of clau cla use provided it gives gives t he ot her party at least 60 days pr ior written writte n notice. notice. 43. ASSIGNMENT: 1. 2.

Neither party shall be entitled entitled to assi ass ign its r ights and/or obli ob ligat gatiions under under this Agreement. Subject Subject to the foregoing, foregoing, thi th is Agreement Agree ment shall be fully binding upon Insurer to the benefit benefit of and a nd be enforceable enforceable by the parties hereto and the respe re specti ctive ve successors s uccessors and permitted permitted assigns assigns.

44. ENTIRE AGREEMENT: This Agreement entered into between Rajiv Gandhi Jeevandayee Arogya Yojana Society and the INSURER represents represe nts the the e ntire agreem agree ment between betwee n the parties. 45. REL R ELATIONSHIP: ATIONSHIP: The Parties to this Agreement are independent contractors. Neither Party is an agent, representative or partner of the other other Party. Neither Neither party shall have any r ight, ght, power or authori authority ty to enter into into any agreement or memorandum of understanding for or on behalf of, or incur any obligation or liability of, or to otherwise bind, the other party. This Agreement shall not be interpreted or construed to create an association, agency, joint venture, collaboration or partnership to such relationship upon either party . 46. SEVERABILITY: SEVERABILITY: If any provision of this Agreement is invalid, unenforceable or prohibited by law, this Agreement shall be considered divisible as to such provision shall be inoperative and of the like effect as though such provision was not included herein: 47. NOTICES; Any notice given under or in connection with this Agreement shall be in writing and in the English language. Notices may be given delivered to the address of the addressee as set out below (in which which case the noti ot ice shall be deemed to be served at the time of delivery) by courier courier ser vices or by fa x (in which whic h case th t he original shall be sent by courier se se rvices).

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Name Name of th t he Ins urer: -- ------------------------------------------------------ --------------------- . Attn: ------------------------------------. E-Mai : ----------------------------------. Fax: ------------------------. 48. GOVERNING LAW: The validity, performance, construction and effect of this Agreement shall be governed by the laws of the Republic of India. Any resolution of any disputes arising from or in connection with this Agreement, including a breach thereof, shall also be governed by the laws of the Republic of India. 49. DISP D ISPUTE UTE RESOLUT R ESOLUTION: ION: 1. If any d ispute arises ar ises between be tween the parties pa rties hereto d uring the s ubsistence ubsistenc e of this Agree Agreement ment of the the reafter, in connection with w ith the the validi alid ity Interpretat io n implementation or alleged breach of any provision of this Agreement, the partie partie s shall refer such dispu disp ute to their respective c ha irmen/CEO‟s for resolution. In the event that the chairmen/CEO‟s are unable to resolve the dispute within 30 days of it being referred to them, then either Party may refer the disp disput utee fo fo r resolution reso lution to a sole sole arbitrator who will be Add Additio itional nal Chief Chie f Secretary / Principal Secretary Public Health and Family Welfare Department Government of Ma harash aras htra, or, in the the eve nt th t hat th t he part ie s are unab unab le to to a gree on the person to act as the sole arbitrator within 30 days after any party has claimed for an arbitrators in written form, by three arbitrators, one to be appointed by each party with power to the two arbitrators so appointed, to appoint a thi t hird rd arbitr arb itrator. ator. 2. The law gover ning the arb itration tratio n shall be the Arbitrat Arbitrat ion a nd Con Co nciliati ciliat ion Act, Act, 1996 as ame ame nded or re-enacted from time to to time. t ime. 3. The proceeding proceed ingss of arbitrati arbitrat ion sha ll b e conducted conducted in the English language. language. 4. The arbitration arbitrat ion shall be he ld in Mumbai Mumba i, India (please refer 5 below). This deed is executed in two originals, both of which are operative instruments held by both the parties. For the Government / Rajiv Gandhi For Insura Insura nc e Com Co mpany Jeevandayee Society Chie Chie f Exe Exe cutive Officer Chairman Chairman Mana ging Director Director Witnesses Witnesses : 1.__________ 1. ____________________ _____________ ___ 2. __________________ ________________________ ______

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APPENDIX - I GENERAL GUIDELINES ON THE PACKAGES. incl ud udes es 1. The package incl Consultation, medicines, diagnostics, specialist services Implants, grafts, prosthetics Food to patient Cost of transportation Hospital Charges, etc. In other words the packages should cover the entire cost of treatment of the patient from date of reporting, any complications while in hospital to discharge from hospital and 10 days after discharge, making the transaction truly cashless to the patient. The postoperative hospital stay in all surgical procedures shall be up to 10 days except in case of day c are proced proced ures, Medica l inter interv ve ntion tio ns an a nd chemotherapy for cancers. Civil & crimina l claims arising out of medical negligence while treating beneficiary will be responsibility of network hospital & will be enforced under prevailing legal framework . 2. Hospita Hospitall sha ll conduct conduct all diagnostic tests as per sta ndard protocols free of cost. 3. Hospital shall provide 10 days post discharge free follow up consultation, medicines and diagnostics to the patient within package. However, the extended follow up services are entitled for service elements shown in Appendix 1 – 1 – b of Part IV.     

4. Hospital shall provide reasonably good food to the patient, and shall make alternate arrangement for food wherever in-house pantry is not available. The hospital shall not give mone y as an alternative alternat ive to food. food. 5.Hospital shall pay return fare for patient from hospital to place of residence of patient at ST fare. In instance of death, carriage of dead body from network hospital to village/town of the bene bene ficiary would also be built in this package. 6.Hospita 6.Hospitall shall proc procure ure compatible blood for the surgeri surger ies. The hospital hospital sh s hall pro vide vide blood from their own blood bank if required. In case of non-availability the hospital shall procure from other blood blood banks, Red Cross, voluntary org or ganizations, etc. 7. Hospital shall make all out efforts to apply and get the accreditation from NABH as soon as possible. possible. 8.The general guidelines published by Rajiv Gandhi Jeevandayee Arogya Yojana Society separately separately from time to time s hall be followed while implementing the packa packa ges. SPECIAL SPECIAL NOTES ON PACKAGE PA CKAGES S 1. Re nal package: package: AV fistula and pre-transplant hemodialysis are approved along with ` surgery only and not separately. Hospital sha ll p rovide rovide post-transp po st-transpllant immunosuppressive immunosuppressive therap y for for one year. 2. Cancer package: Chemotherapy and radiotherapy should be administered only by professionals trained in respective therapies (i.e. Medical Oncologists and Radiation Oncologists) and well versed with dealing with the side-effects the treatment can cause. Hospital should have qualified and registered oncologist, oncosurgeon and Radiotherapist. Tumour board comprising of qualified and registered oncologist, oncosurgeon and Radiotherapist will decide comprehensive treatment plan of patient. If hospital has no Radiotherapy equipment equipment a nd Radiotherapist Radiotherap ist it should have tie up with ne arest Radiotherapy center. 

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Hospital should have qualified and registered oncologist, oncosurgeon and Radiotherapist. Tumour board comprising of qualified and registered oncologist, oncosurgeon and Radiotherapist will decide comprehensive treatment plan of patient. If hospital has no Radiotherapy equipment and Radiotherapist it should have tie up with with nearest Rad iotherapy center. ce nter.

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Patients with hematological malignancies (leukemia, lymphomas, multiple myeloma) and pediatric pediatric malignancie malignancie s (Any pati pat ient < 14 years of o f age) should be be treated tre ated by qualified medical edica l oncolo oncolo gists gists o nly. nly. The advanced radiotherapy packages shall be utilized only for the cases and diseases which do not not respond to co nventional nventional radi rad ioth ot herapy packag packa ge. Each cycle cycle cost includes Cost of chemotherapy drugs Hospital charges All infusio infusion nal c hemotherapy cancer cancer cases case s must be treated as inpa inpa tients only. Doctors‟ fees Doctors‟ fees Support Supportiv ivee care medication edica tionss ( i.e. i.v. fluids, fluids, steroids, H2 blockers, anti-emetics) anti-e metics) All investiga investiga tions tions An average of Rs. 2000 to Rs. 5000/- has been added to the above cost, to cover for treatment of complications. Tumors not included in this list, if have a chemotherapy regimen that is proven to be curative, or provide long term improvements in overall survival will be reviewed on a case by case basis by the technical committee of the Society. 3. Polytrauma package: Components of Polytrauma: The components of polytrauma based on the system involved are: 1.Orthopedic 1.Orthopedic tra uma, uma, 2. Ne uro-S urgical rgica l Trauma, Trauma, 3. C hest I njuri jur ies and 4.Abdominal I njuri jur ies. The above co mponents may be treated separately separ ately or combined as the case warra nts. For providing insura insura nce co verage to polytra uma uma cases requiring Hospitalization an a nd / or Surgery Surger y for for Hea lth card holders, man ma nagement of each eac h of the abov abo ve can be classified as given given below: Orthopedic trauma 1. Surgical Corrections Neuro-Surgical Trauma 1. Conservative 2. Surgical Treatment Chest Injuries 1. Conservative 2. Surgical treatment Abdomi Abdominal nal Injuries Injuries 1. Conservative 2. Surgica Surgicall treatment I. All cases, whic whic h requi req uire re conservat co nservativ ivee management mana gement with wit h a minimu minimu m o f o ne-week ne- week hospitalization with evidence of (Imageology based) seriousness of injury to warrant warrant admiss ion, only need to be cov co vered to avoid misuse o f the scheme scheme for minor / trivial cases. II. In case of Neurosurgical trauma, trauma, admissio admission n is is based based on both bot h Imag Ima geology eviden evide nce and clinical evidence. III. All surgeries related to poly-trauma are covered irrespective of hospitalization period. period. IV. IV. Initial evaluation evaluatio n of all trauma patie nts has to be free of cost. 4. Prostheses: i) Cost of prosthesis is is inclusive of foot and shoe, wherever required. ii) Prosthesis Prosthesis must have bee n ma ma nufactured with the materials with BIS (Bu (B urea u of Indian Standards) certification. iii) iii) All p rosthesis shall be funct funct ional in nature. at ure. iv) Manufacturer shall give minimum minimum of 3 years repl rep lacemen aceme nt Guarantee. v) Ma nufac nufacturer turer shall provi pro vide de free replacem replace ment of o f leathe leathe r parts / straps, etc. during d uring this period apart from replaceme nt guarantee. 





      









~ 66 ~


APPENDIX: APPENDIX: 1A

DETAILED LIST OF SPECIFIED SPE CIFIED SURGERIES AND THE T HERAPIES RAPIES 972 procedures procedures Sr No

Specialty

1

General surgery Head and Neck

2


3


4

General surgery Head and Neck General surgery Head and Neck

5

6 7 8

General surgery Head and Neck General surgery Head and Neck General surgery Head and Neck

9


10


11

General surgery Head and Neck General surgery Head and Neck General surgery Head and Neck

12 13

14


15


16

General surgery Head and Neck Thyroid Non Malignant General surgery Head and Neck Thyroid Non Malignant General surgery Head and Neck Thyroid Non Malignant

17

18

~ 67 ~

Indicativ e Rate &

SYSTEM

Brachial Cyst Excision Inv - Clinical Clinical Photog raph Post p rocedure rocedure evidence o f Clinical Clinical phot ograph, Biopsy Cervical Rib excision Inv - Color Doppler , XRA Y Post procedu re evidence of X-Ray/Color X-Ray/Color doppler Re moval o f Submandibular Submandibular Sa livary livary gland Inv Clin Clin ical Photograph , FNAC Post p rocedure evidence of Clin Clin ical photog raph, Biopsy Biopsy Parotid Duct Duct Repai Repairr Inv - Silography Post proced ure evidence eviden ce of Silography Branchial Sinus Sinus Exc Exc ision ision Inv -Clinical -Clinical Photo graph Post p rocedure rocedure evidence of Clin Clin ical photo graph, graph, Biopsy Hemimandibulectomy Hemimandibulectomy Inv - X-Ray X-Ray Post proced ure evidence of X-Ray X-Ray Segmental Segmental Man dible dible Excision Excision Inv - X-Ray Post proced ure evidence eviden ce of X-Ray Carotid Body-tumours Excision Inv - Clinical Photograph , U S Neck Post procedure evidence of Clin Clin ical Photograph, Biops Biops y Partial Partial g lossectomy lossectomy Inv - Clinical Photograph, Biopsy Post Post procedure evidence of Clinical Photograph, Biopsy Cystic Hygroma Excision-Extensive Inv - Clinical Photograph Post Post procedure evidence of Clin Clin ical Photograph, Biopsy Abbe Operation Operation Inv - Clinica linica l Photog raph Post Post proced ure evidence eviden ce of Clin Clinical ical Photog raph Vermilionectom Vermilionectomy y Inv - Clinica Clinica l Photo Photo graph Post proced ure evidence eviden ce of Clin Clinical ical Photog raph Wedge Excision& Vermilionectomy Inv - Clinical Photograph Post Post procedure evidence of Clin Clin ical Photograph, Biopsy Wedg e Excision Excision Inv - Clin Clin ical Photo Photo graph Post proced ure evidence eviden ce of Clin Clinical ical Photog raph,Biop raph,Biopsy sy

Upper ceiling (Rs.) 20000

15000

10000

20000 20000

25000 25000 30000

15000

20000

15000 15000 20000

15000

Cystic Hygroma Excision-Major Inv - Clinical Photograph Post Post procedure evidence of Clin Clin ical Photograph, Biopsy Hemithyroidectom Hemithyroidectomy y Inv - FNAC , T F T , US G Post p rocedure rocedure evidence o f Clinical Clinical Photograph, Biopsy

20000

Isthmectomy Inv - FNAC , T F T , USG Post proced ure evidence eviden ce of Clin Clinical ical Photog raph, Biopsy

20000

Partial Partial Thyroidecto Thyroidecto my Inv - FNAC , T F T , US G Post p rocedure rocedure evidence o f Clinical Clinical Photograph, Biopsy

20000

20000


972 procedures procedures Sr No

19

20

21

22

Specialty

General surgery Head and Neck Thyroid Non Malignant General surgery Head and Neck Thyroid Non Malignant General surgery Head and Neck Thyroid Non Malignant General surgery Head and Neck

23


24

General surgery Head and Neck General surgery Head and Neck

25

26

General surgery Breast

27

General surgery Abdo men Hernia Hernia

28

General surgery Abdomen Hernia

29

General surgery Abdomen Hernia General su rgery Abdomen Hernia

30

31


32


33


34


35

General su rgery Abdomen Hernia

36

General surgery Abdomen

~ 68 ~

Indicativ e Rate &

SYSTEM

Resection Enucleation Inv - FNAC , T F T , USG Post p rocedure rocedure evidence o f Clinical Clinical Photo graph, Biopsy


Subtotal Thyroidectomy Inv - FNAC , T F T , USG Pos Pos t procedu re evidence of Clin Clin ical Photograph, Biopsy

20000

Total Thyroidectomy Inv - FNAC , T F T , USG Post p rocedure rocedure evidence o f Clinical Clinical Photograph, Biopsy

20000

Cystic Hygro ma Exc Exc ision-Minor Inv - Clin Clin ical Photograph Post Post procedure evidence of Clin Clin ical Photograph, Biopsy Excision of Lingual Thyroid Inv - Clinical Photograph , Isotope Scan Post procedu re evidence of Clin Clin ical Photo Photo graph, Biopsy Parathyroidectom Parathyroidectomy y Inv - USG Post p rocedure evidence of Clin Clin ical Photograph, Biopsy Excisi Excision on of Thyroglossal Cys Cys t Fistu Fistu la Inv Inv Clin Clin ical Photograph , Radionucle Radionucle ide Scan Post proced ure evidence eviden ce of Clin Clin ical Photog raph, Biopsy Simp Simp le Mastecto my(NM) y(NM) Inv -Ma mmography Post p rocedure rocedure evidence o f Clinical Clinical Photograph, Biopsy Ep igastric igastric Hernia without M esh Inv - Clin Clin ical Photograph Post Post procedure evidence of Clin Clin ical Photograph Epigastric Hernia with Mesh Inv - Clinical Photograph Post Post procedure evidence of Clin Clin ical Photograph Femoral Femoral Hernia Inv - Clinical Clinical Photograph Post proced ure evidence eviden ce of Clin Clinical ical Photog raph Hiatus Hernia Repair Abdominal Inv -U S Abdo men , UGI Endos copy Post procedure evidence of Clin Clin ical Photograph Rare Hernias (Spigalion,obuturator,sciatic) Inv Clin Clin ical Photograph , USG Post procedure procedure evidence of Clin Clin ical Photograph

10000

Umbilical Hernia without mesh Inv - Clinical Photograph Post Post procedure evidence of Clin Clin ical Photograph Umbilical Hernia with mesh Inv - Clinical Photograph Post Post procedure evidence of Clin Clin ical Photograph Ventral and Sca r Hernia Hernia without mesh Inv Clin Clin ical Photograph , USG Pos t procedure evidence of Clin Clin ical Photograph Ventral and Scar Hernia with mesh Inv - Clinical Photograph , USG Post procedu re evidence of Clin Clin ical Photog raph Lap. Appen dectomy Inv - USG Post procedure evidence of Video, Video, Biopsy , Clinical Clinical Photo

15000

25000

30000 15000

20000

15000

30000

15000 35000

20000

25000

20000

30000

22000



Specialty

37

General surgery Abdomen

38

General surgery Abdomen Stomach, Duodenum, Jejunum General surgery Abdomen Stomach, Duodenum, Jejunum General surgery Abdomen Stomach, Duodenum, Jejunum General surgery Abdomen Stomach, Duodenum, Jejunum General surgery Abdomen Stomach, Duodenum, Jejunum General surgery Abdomen Stomach, Duodenum, Jejunum General surgery Abdomen Stomach, Duodenum, Jejunum General surgery Abdomen Stomach, Duodenum, Jejunum General surgery Abdomen Stomach, Duodenum, Jejunum General surgery Abdomen Stomach, Duodenum, Jejunum General surgery Abdomen Small Intestine General surgery Abdomen Small Intestine

39

40

41

42

43

44

45

46

47

48

49

Indicativ e Rate &

SYSTEM

Appendicular Appendicular perfo perfo ration ration Inv - USG Pos t proced ure evidence eviden ce of Clin Clinical ical photo ph oto graph, graph , Biopsy Highly Selective Vagotomised Inv - Endoscopy Post p rocedure rocedure evidence of Clin Clin ical photog raph raph


25000

Duodenal perforation perforation Inv - CT-Abdomen CT-Abdomen , US G , X-Ray X-Ray Pos t procedu re evidence of Clin Clin ical pho tograph Selective Vagotomy Drainage Inv - Endoscopy Post p rocedure rocedure evidence o f Clinical Clinical phot ograph

20000

Vagotomy Vagotomy Pyloroplasty Inv - Endos Endos copy Post proced ure evidence eviden ce of Clin Clinical ical photo ph oto graph

30000

Gastrojejunostomy & Vagotomy Inv - EndoscopyVideo Video Photo Post procedure evidence of Clinical Clinical pho tograph Operation Operation for bleeding peptic ulcer Inv Endos copy Pos t p rocedure rocedure evidence of Clinical Clinical pho tograph Partial/subtotal Gastrectomy for ulcer Inv Endos copy Post procedure evidence evidence of Clin Clin ical pho tograph Pyloro Pyloro myotomy Inv Inv - Endos copy Post procedure procedure evidence of Clin Clin ical photog raph

30000

Gastrostomy Gastrostomy Inv - Biopsy , CT , Endos copy , USG Post p rocedure rocedure evidence o f Clinical Clinical phot ograph

20000

Gastrostomy Gastrostomy Closu re Inv -Clinical Photograph Post p rocedure rocedure evidence o f Clinical Clinical phot ograph

20000

Intussusception Inv - Endos Endos copy , USG , X-Ray ABD Post procedure evidence of Clinical pho tograph/Biops tograph/Biops y Operation Operation for A cute intes tinal obstruction Inv Biopsy , Endos Endos copy , USG USG , X -Ray ABD Post proced ure evidence eviden ce of Clin Clinical ical photo ph oto graph/Bi graph /Biop opsy sy

30000

30000

40000

40000

40000

20000

30000

50

General surgery Abdomen Small Intestine

51


Operation Operation for Acute intestinal perforation perforation Inv Biopsy , CXR , Endos Endos copy , USG USG , X-Ray A BD Post procedure procedure evidence of Clin Clin ical pho tograph/Biops tograph/Biops y Operation Operation for Haemorrhage of the s ma ll intestine Inv - CT With Contrast , Endos copy Post proced ure evidence eviden ce of Clin Clinical ical photo ph oto graph/Bi graph /Biop opsy sy

52


Operations Operations for Recurrent Recurrent intes tinal obstruction (Noble (Noble p licat licat ion other) Inv Inv - CT-Contrast Post proced ure evidence eviden ce of Clin Clinical ical photo ph oto graph/Bi graph /Biop opsy sy

35000

53


Resection & A nas tomos tomos is of s mall intestine Inv CT , X-Ray X-Ray ABD Pos t procedure evidence of Clin Clin ical p hotog raph/Bi raph/Biops ops y

35000

~ 69 ~

40000



54

55

56

57

58

59

60

61

62

63

64

65

66 67

68 69

Specialty

Indicativ e Rate &

SYSTEM

General surgery Abdomen Small Intestine General surgery Abdomen Small Intestine General surgery Abdomen Large Intestine General surgery Abdomen Large Intestine General surgery Abdomen Large Intestine General surgery Abdomen Large Intestine General surgery Abdomen Large Intestine General surgery Abdomen Large Intestine General surgery Abdomen Large Intestine General surgery Abdomen Large Intestine General surgery Abdomen Rectum and anus General surgery Abdomen Rectum and anus

Ileos Ileos tomy Inv Inv - Biopsy , Endos copy , USG Pos Pos t proced ure evidence eviden ce of Clin Clinical ical photo ph oto graph

General surgery Liver General surgery Liver General su rgery Gall bladder bladde r General su rgery Gall bladder bladde r

70

General su rgery Gall bladder bladde r

71


72


~ 70 ~


Ileos Ileos tomy Clos Clos ure Inv - Clinica Clinica l Photog Photog raph Post proced ure evidence eviden ce of Clin Clinical ical photo ph oto grap hy

20000

Mal-rotation & Volvulus of the midgut Inv - CT , X-Ray X-Ray ABD Post p rocedure evidence of XRay/Clinical pho tograph Operation Operation for Vo lvulus lvulus of large large bo wel Inv - CTContrast , X-Ray X-Ray Abdo men Post procedure evidence of X-Ray/ X-Ray/ Clinical Clinical phot ograph Operation Operation of the Duplication Duplication o f th e intestines Inv CT-Contrast Pos t p rocedure rocedure evidence o f Clinical Clinical pho tograph Le ft Hemi Co Co lectomy Inv - Barium , CT , Endos copy , USG USG Pos t procedure evidence of Clin Clin ical p hotog raph/Bi raph/Biops ops y Right Hemi colectomy Inv - Barium , CT , Endos copy , USG USG Pos t procedure evidence of Clin Clin ical p hotog raph/Bi raph/Biops ops y Total Colectomy Inv - Barium , CT , Endoscopy , USG Pos Pos t procedu re evidence of Clin Clin ical pho tograph/Biops tograph/Biops y Colostomy Inv - Barium , CT , Endoscopy , USG Post p rocedure rocedure evidence o f Clinical Clinical phot ograph

35000

Colostomy Closure Inv - Clinical Photograph Post proced ure evidence eviden ce of Clin Clinical ical photo ph oto grap h

20000

Pull through abdominal resection Inv - Clinical Photograph Post Post procedure evidence of Clin Clin ical pho tograph Anterior Resection Resection Inv - Biopsy , Clinical Clinical Photograph , Colonos Colonos copy Post procedure evidence of Clin Clin ical photo graph/Biopsy graph/Biopsy

30000

Operation for Hydatid cyst of liver Inv - CT , USG Post procedure evidence of USG Portocaval Anastomos Anastomos is Inv - MRI , U GI Endos copy , USG USG Pos t procedure evidence of USG,Endoscopy Cholecystectomy Inv - CT , LFT , USG Post proced ure evidence eviden ce of Clin Clinical ical photo ph oto graph,USG graph ,USG Lap.Cholecystectomy Inv - CT , LFT , USG Post proced ure evidence eviden ce of Clin Clinical ical photo ph oto graph,USG, graph ,USG, Video Cholecystectomy & Exploration CBD Inv - CT , LFT , USG Post procedure evidence o f Clinical Clinical pho tograph,USG, T-Tube, Cholang iogram iogra m Lap Cholecystostomy with Exploration CBD Inv CT , LFT , U SG Post procedu re evidence evidence o f Clin Clin ical phot ograph,USG ograph,USG Cystojejunostomy Inv - CT , LFT , USG Post proced ure evidence eviden ce of Clin Clinical ical photo ph oto graph,USG graph ,USG

30000

40000

40000

30000

30000

40000

20000

50000

80000

20000 25000

25000

30000

40000



73

Specialty

Indicativ e Rate &

SYSTEM


General surgery Gall bladder bladde r General su rgery Gall bladder bladde r

Cystogastrostomy Inv - CT , LFT , USG Post proced ure evidence eviden ce of Clin Clinical ical photo ph oto graph,USG graph ,USG Repair of CBD Inv - CT , LFT , USG Post proced ure evidence eviden ce of Clin Clinical ical photo ph oto graph,USG, graph ,USG, T-Tube, T-Tube, Cholangiogram Cholangiogram

75

General surgery Adrenals

40000

76

General surgery Adrenals

77

General surgery Spleen

78

General surgery Spleen

79 80

General surgery Spleen ENT su rgery Ear

81

ENT su rgery Ear

82

ENT su rgery Ear

Operation Operation of Ad renal glands , bilateral bilateral fo r tu mour Inv - Bioche Bioche mical mical Inves tigations tigations , CT , U SG Post proced ure evidence eviden ce of USG,Biop USG,Biopsy sy Operation Operation on Adrenal glands unilateral unilateral for tu mour Inv - Bioche Bioche mical mical Inves tigations tigations , CT , U SG Post proced ure evidence eviden ce of USG,Biop USG,Biopsy sy Splenectom Splenecto my fo fo r Hyp Hypersp ersplenism lenism Inv - CT , Peripheral Peripheral Smear , USG Pos t procedure evidence of USG Splenorenal Anastomosis Inv - MRI , UGI Endos copy , USG USG Pos t procedure evidence of USG,Endoscopy Warren shu nt Inv - MRI , UGI Endos copy , USG Post p rocedure rocedure evidence o f USG,Endosco USG,Endosco py Laby rinthecto rinth ectom my Inv - CT-Scan PTI , IA Post proced ure evidence eviden ce of Clin Clinical ical photo ph oto graph Facial Nerve Deco mpres sion Inv - CT-Scan Post proced ure evidence eviden ce of Clin Clinical ical photo ph oto graph Tempora Tempora l Bone Exc Exc ision Inv - CT-Scan MRI Scan Post p rocedure rocedure evidence o f Clinical Clinical phot ograph

83

ENT su rgery Throat

12000

84

ENT su rgery Throat

85

ENT su rgery Throat

86

ENT su rgery Throat

87

ENT su rgery Throat

88

ENT su rgery Throat

89

ENT su rgery Throat

90

ENT su rgery Nose

91

ENT su rgery Nose

92

ENT su rgery Nose

Microlaryngeal Microlaryngeal Surgery Surgery Inv - Nasal Endos copy Post p rocedure rocedure evidence o f Clinical Clinical phot ograph Phono Surgery Surgery for Voca l cord paralysis Inv - CTCTScan MRI Scan Pos Pos t procedure evidence o f Clin Clin ical p hotog raph raph La ryngo Fiss Fiss urectom urectomy y Inv - CT-Scan CT-Scan Post proced ure evidence eviden ce of Clin Clinical ical photo ph oto graph Excisi Excision on of Tumours in Pharynx Inv - FNA FNA C Post proced ure evidence eviden ce of Clin Clinical ical photo ph oto graph, graph , Biopsy Parapharyn geal tumour Excision Inv - CT-Scan MRI Scan Scan , F NAC Post procedure evidence of Clin Clin ical phot ograph,Bi ograph,Biops ops y Adenoide Ade noidectom ctomy y - Gromet insertion Inv Impedance Impedance Audiometry Audiometry , X-Ray Naso pharynx Post p rocedure rocedure evidence o f Clinical Clinical phot ograph Uvulo-palato Uvulo-palato Pharyngoplasty Inv Polys Polys omnography omnography Post procedure evidence of Clin Clin ical p hotog raph raph Endos nd os cop ic Sinus Sinus Surgery Inv - CT PNS , DNE Photo graph Post Post p rocedure rocedure evidence of Endos copy photo Mastoidectomy Mastoidectomy Inv - CT Temporal Bone , PTA Post p rocedure rocedure evidence o f X-Ray X-Ray masto ids Tympanop Tympanop lasty Inv - PTA , X-Ray X-Ray Mas toids Post proced ure evidence eviden ce of PTA,Per PTA,Per OP photo ph oto .

74

~ 71 ~

25000

25000

35000

60000

60000 20000 20000 50000

25000

20000 20000

20000

10000

25000

15000

15000 15000



Specialty

Indicativ e Rate &

SYSTEM

93

ENT su rgery Nose

94

ENT su rgery Nose

95

ENT su rgery Nose

96

ENT su rgery Nose

97

ENT

98

Ophthalmology Cornea Cornea Sclera Sclera

Stapedecto Staped ecto my + Ve ingraft Inv - CT Tem Te mporal Bone , Impedance Aud iometry iometry , PTA Post proced ure evidence eviden ce of Clin Clinical ical photo ph oto with pisto n+vein graft. Excisi Excision on of benign tu mour nos e Inv - CT PNS , DNE Post p rocedure evidence o f Clin Clin ical pho tograph Angiofibro Angiofibro ma nos e Inv - CT PNS , DNE Post proced ure evidence eviden ce of Clin Clinical ical photo ph oto graph Endos copic DCR Inv - Clinical Clinical Photograph Post proced ure evidence eviden ce of End Endos os copic phot o Bronc Bronchos hos copic foreign bod y remova removall Inv Re levant X-Ray X-Ray Post procedure evidence of Clin Clin ical p hotog raph raph Therapeutic penetrating keratoplasty keratoplasty Inv - B Scan Scan Post p rocedure rocedure evidence o f Clinical Clinical phot ograph

99

Ophthalmology Cornea Cornea Sclera Sclera Ophthalmology Cornea Cornea Sclera Sclera Ophthalmology Cornea Cornea Sclera Sclera Ophthalmology Cornea Cornea Sclera Sclera

La me llar keratoplasty Inv - B Scan Post procedu re evidence of Clin Clin ical photog raph Corneal patch graft Inv Inv -Clinical Photo Photo graph Post proced ure evidence eviden ce of Clin Clinical ical photo ph oto graph Scleral Scleral patch g raft raft Inv - Clin Clin ical Photog Photog raph Post proced ure evidence eviden ce of Clin Clinical ical photo ph oto graph Penetrating Penetrating keratoplasty keratoplasty Inv - Clinical Photograph Post p rocedure rocedure evidence o f Clinical Clinical phot ograph

Ophthalmology Cornea Cornea Sclera Sclera Ophthalmology Cornea Cornea Sclera Sclera

Double Z plasty Inv - Clin Clin ical Photog Photog raph Post proced ure evidence eviden ce of Clin Clinical ical photo ph oto graph Amniotic membrane graft Inv - Clinical Photograph Post Post procedure evidence of Clin Clin ical pho tograph Vitrectomy Vitrectomy Inv - B Scan Post p rocedure evidence of Clinica Clinica l photog raph Vitrectomy Vitrectomy + Membrane peeling+ endolaser Inv B.Scan , Fundus Photog raph raph Post procedure procedure evidence of Fundus photograph Month ly Intravitr Intravitreal eal Anti-VEGF for macular degeneration - per injection injection (maximum - 6) Inv B.Scan , Fundus Photog raph raph Post procedure procedure evidence of Fundus ph oto, Fundus Fundus fluorescenc fluorescenc e angiography and o ptical coherence to mography. Vitrectomy Vitrectomy - Me mbrane peeling en dolaser , Silicon Silicon oil or gas Inv - B.Scan , Fundus Photograph Post p rocedure rocedure evidence of Fundus pho tograph Sclera Sclerall buckle buc kle for Retinal detach det ach ment Inv B.Scan , Fundus Photog raph raph Post procedure procedure evidence of Fundus photograph Photocoagulation Photocoagulation for diabetic diabetic retinopat retinopat hy p er sitting Inv - B.Scan B.Scan , Fundus Photograph Post proced ure evidence eviden ce of Fundus p hotog raph Vitrectomy Vitrectomy plus s ilicon ilicon o il or gas Inv - B.Scan , Fundus Photograph Post procedure evidence of Fundus photograph

100 101 102

103 104

105 106

Ophthalmology Vitreo Ophthalmology Vitreo

107

Ophthalmology Vitreo

108


109

Ophthalmology Retina

110

Ophthalmology Retina

111


~ 72 ~


15000

40000 20000 20000

15000

3000 4000 6000 15000

4000 7000

6000 25000

7000

30000

15000

1500

20000



112

113 114 115

Specialty

Indicativ e Rate &

SYSTEM


Removal Of Silicon Oil Or Gas Inv - B.Scan , Fundus Photograph Post procedure evidence of Fundus photograph Ophthalmo Ophthalmo logy Orb Orb it Socket Socket reconstruction Inv - Clin Clin ical Photograph Post p rocedure rocedure evidence o f Clinical Clinical Photog raph Ophthalmo Ophthalmo logy Orb Orb it Dermis Dermis fat graft Inv - Clinica Clinica l Photograph Post proced ure evidence eviden ce of Clin Clinical ical Photog raph Ophthalmo Ophthalmo logy Orb Orb it Orbitoto Orbitoto my Inv - CT Scan Post procedure procedure evidence of Clin Clin ical Photograph


7000 9000 10000

116

Ophth almo almo logy Orbit

Enuleation nu leation with with orb ital implant Inv - CT Skull , Clin Clin ical Photograph , Orbit Post procedure evidence of Clin Clin ical Photograph

20000

117

Ophthalmology Squint correction correction surgery Ophthalmology Squint correction correction surgery Ophthalmology Squint correction correction surgery Ophthalmo Ophthalmo logy Lid Lid surgery

Rectus muscle s urgery single Inv - Clinical Clinical Photograph Post Post procedure evidence of Clin Clin ical Photograph Rectus muscle s urgery Two/Three Two/Three Inv - Clinical Photograph Post Post procedure evidence of Clin Clin ical Photograph Oblique Oblique mus cle Inv Inv - Clinical Clinical Photograph Pos t proced ure evidence eviden ce of Clin Clinical ical Photog raph

6000

118

119

120

121

Pediatric Pediatric Ophth almic surgery

122


123


124

Obstetrics

125

Obstetrics

126

Obstetrics

127

Obstetrics

128

Gynaecology

~ 73 ~

12000

6000

Lid reconstruction surgery Inv - Clinical Photograph Post Post procedure evidence of Clin Clin ical Photograph Photocoagulation Photocoagulation for Ret Ret inopathy of prematuri prematurity ty Inv - Fundu Fundu s Fluorescence Angiography , Fundus Photograph , Optical Coherence Coherence To mography Post proced ure evidence eviden ce of Clin Clinical ical Photog raph sho wing wing procedure.

15000

Pediatri Pediatricc cataract su rgery - Phacoe mulsification ulsification IOL Inv Inv - B.Scan B.Scan , Fund us Photograph Post proced ure evidence eviden ce of Clin Clinical ical Photog raph Glaucoma filtering surgery for paediatric Glauco Glauco ma Inv Inv - USG Fundu s Fluoresc Fluorescence ence Angiography , Fundus Photograph Photograph Post procedure evidence of Clin Clin ical Photograph

15000

Caesarean Hysterectomy Hysterectomy with Bladder Repair Repair Inv - USG Post procedure evidence of Post op USG/Photograph Ruptu re Uterus Uterus Inv - USG Post procedure evidence of USG USG Ec lampsia lampsia with with co mplication plication requiring requiring ventilatory support Inv - ABG , APTT , CUE , Haematocrit , LFT , PT , Platelet Count , RFT , S.Fibrinogen Level Post procedure evidence of Clinical Clinical Photograph, Biochemica iochemica l investigations investigations Abruptioo placenta with with coagulation defect - DIC. Inv - APTT , Heamatocr it , PT , Platelet Platelet Coun t , S.Fibrinogen Level , USG Post procedure evidence of Clin Clin ical Photograph of retroplacental clots, USG

30000

LA VH Inv - USG Post procedure evidence of Post op USG,Bi USG,Biops ops y,Video. y,Video.

30000

7500

15000

25000 20000

20000



Specialty

Indicativ e Rate &

SYSTEM

129

Gynaecology

130

Gynaecology

131

Gynaecology

132

Gynaecology

Pelvic Pelvic floor Recons truction with with mesh Inv - USG Post procedure evidence of Post o p USG,Biops USG,Biops y

20000

133

Gynaecology

30000

134

Gynaecology

135

Gynaecolog yna ecology y

136

Gynaecology

137

Gynaecology

138

Gynaecology

139

Gynaecology

140

Gynaecology

141

Gynaecology

142

Gynaecology

143

Gynaecology

Mc Indo-s repair repair for Vag inal Atresia Inv - Post proced ure evidence eviden ce of Post o p USG,Biopsy USG,Biopsy Slings Slings with with mesh repair repair for prolapse Inv - USG Post procedure evidence of USG Vault prolaps e abdominal abd ominal repair Inv - Clinical Photograph , USG Post procedu re evidence of USG Vault Vault prolapse abdominal repair repair with mesh Inv Clin Clin ical Photograph , USG Pos t procedure evidence of USG USG Laparosco pic Cys tectomy Inv - USG Post proced ure evidence eviden ce of USG,Biop USG,Biopsy sy ,Video ,Video . Laparosco pic Ectopic Resection Inv - USG Post proced ure evidence eviden ce of USG,Biop USG,Biopsy sy ,Video ,Video . Laparosco pic ovarian drilling drilling Inv - USG Post proced ure evidence eviden ce of USG,Biop USG,Biopsy sy ,Video ,Video . Laparosco pic Myomectomy Myomectomy Inv - USG Post proced ure evidence eviden ce of USG,Biop USG,Biopsy sy ,Video ,Video . Laparosco pic recanalisati recanalisation on Inv - USG Post proced ure evidence eviden ce of USG,Biops USG,Biops y, Video. Laparosco pic Sling Sling operations Inv - USG Post proced ure evidence eviden ce of USG,Biop USG,Biopsy sy ,Video ,Video . Laparosco pic adhesolysis Inv - USG Post proced ure evidence eviden ce of USG,Biop USG,Biopsy sy ,Video ,Video .

144

Gynaecology

Vaginal Vaginal Hysterectomy Hysterectomy Inv - Scan Post procedure evidence of Post op USG AND Biops y

20000

145

Orthop Orthop edics Fracture Fracture Correction Correction Surgeries Surgeries Orthop Orthop edics Fracture Fracture Correction Correction Surgeries Surgeries

Bone Grafti Grafting ng as exclusive procedure Inv - X-Ray Post procedure evidence evidence of Post o p X-Ray X-Ray Excisi Excision on or other Operations Operations for Scaphoid Fractures Fractures Inv - X-Ray Post proced ure evidence of Post op X-Ray X-Ray Open Reduction & Internal Fixation of Fingers & Toes @Rs5000 @Rs5000 each up to ma ma ximu ximu m of Rs 15000 Inv - X-Ray X-Ray Post procedure evidence of Post op X-Ray Reduction of Compound Fractures & External fixation fixation Inv Inv -X-Ray Post procedure evidence of Post op X-Ray X-Ray ILIZA ILIZA ROV Ring Fixator Fixator App lication lication Inv - X -Ray Post p rocedure rocedure evidence o f Clinical Clinical phot ograph,XRay

20000

146

147

Orthop Orthop edics Fracture Fracture Correction Correction Surgeries Surgeries

148


149


~ 74 ~

Vaginal Vaginal Hysterectomy Hysterectomy with pelvic pelvic floor repair Inv - Scan Scan Post p rocedure evidence of Post Post op USG,Biopsy Vaginal Vaginal Hysterectomy Hysterectomy with Mes h repair repair Inv USG Post procedu re evidence evidence of Post o p USG,Biopsy Cys tocele ,Rectocele ,Rectocele & Perineor Perineor raphy Inv - USG Post procedure evidence of Post o p USG,Biops USG,Biops y


25000

20000

40000 25000

25000

20000 20000 15000 25000 20000 25000 25000

15000

15000

15000

40000



Specialty

150


151

Orthop Orthop edics

152

Orthop Orthop edics

153

Orthop Orthop edics

154

Orthop Orthop edics Bone and Joint Surgery Surgery proced ures Orthop Orthop edics Bone and Joint Surgery Surgery proced ures Orthop Orthop edics Bone and Joint Surgery Surgery proced ures Orthop Orthop edics Bone and Joint Surgery Surgery proced ures Orthop Orthop edics Bone and Joint Surgery Surgery proced ures

155

156

157

158

Indicativ e Rate &

SYSTEM

CTEV Neglected . JESS Fixator Inv - Clinical Photograph Post Post procedure evidence of Clin Clin ical pho tograph,X-Ray tograph,X-Ray Open Reduction of Dislocations Dislocations - Deep Inv - XRay Post p rocedure evidence of Post Post op X-Ray X-Ray Amputations Amputations - Forequarter Inv - X-Ray X-Ray Post proced ure evidence eviden ce of Clin Clinical ical ph oto graph ,X-Ray ,X-Ray


30000 30000

Amputations Amputations - Hind Hind Quarter Quarter and Hemipelvectomy Hemipelvectomy Inv - X-Ray Post p rocedure evidence of Clin Clin ical pho tograph,X-Ray tograph,X-Ray Arthrodesis Arthrodesis o f - Major Major Joints Inv - Flu Flu id Analysis , X-Ray X-Ray Post procedure evidence of Post op X-Ray X-Ray

40000

Arthroscopy - Diagnos Diagnos tic Inv Inv - M RI Post proced ure evidence eviden ce of Arthros copy picture

20000

Arthroscopy . Operative Operative Men iscectomy iscectomy Inv - M RI Post p rocedure rocedure evidence o f Arthroscopy p icture icture

25000

Arthroscopy - ACL Repair Repair Inv - MRI Pos t proced ure evidence eviden ce of Arthros copy picture

30000

Avascular Necrosis of Femoral Head (core decompress decompress ion) Inv Inv - MRI , X-Ray Pos Pos t procedure evidence of Post op X-Ray X-Ray

15000

30000

159

Orthop Orthop edics Bone and Joint Surgery Surgery proced ures

Soft Tiss Tiss ue reconstruction Procedures for Joints/Osteotom Joints/Osteotomy y Inv - Clinica linica l Photog raph Post proced ure evidence eviden ce of Clin Clinical ical photo ph oto graph,X-R graph ,X-Ray ay

30000

160

Orthop Orthop edics spine Surgery

50000

161

Orthop Orthop edics Spine Spine surgery Orthop Orthop edics Spine Spine surgery Orthop Orthop edics Soft Tiss Tiss ue Surgery Surgery

Anterolateral Clearance for Tuberculosis Inv MRI Post procedu re evidence of Post op X-Ray, Biopsy Cos to Transversectomy Transversectomy Inv - MRI Pos t procedure evidence of Post op X-Ray X-Ray Spinal Spinal Ostect omy omy and Internal Fixations Fixations Inv MRI Post procedu re evidence of Post op X-Ray Nerve Repair with Graft Graft ing Inv - Cl inical Photograph Post Post procedure evidence evidence of Clinica Clinica l Photograph Neurolysis /Nerve Suture Inv - Clin Clin ical Photograph Post Post procedure evidence of Clin Clin ical Photograph Operations for Brachial Plexus & Cervical Rib Inv - MRI Pos t procedu re evidence of Clinical Clinical Photograph,X-Ray Excision of Bone Tumours . Deep with reconstruction with with co nvent ional prosthesis prosthesis Inv MRI Pos Pos t procedure evidence evidence of Clin Clin ical Photograph,X-Ray Surgery Surgery for Bleeding Ulcers Inv - Endos copy Post proced ure evidence eviden ce of End Endos os copy pictu re Surgery for Obscure GI Bleed Inv - Endoscopy Post procedure evidence of Endos Endos copy picture

60000

162 163

164

Orthop Orthop edics Soft Tiss Tiss ue Surgery Surgery

165

Orthop Orthop edics Soft Tiss Tiss ue Surgery Surgery

166

Orthop Orthop edics Bone tumours

167

Surgical Gastroenterology Emergency Surgical Gastroenterology

168

~ 75 ~

30000 40000 30000

25000

30000

40000

40000



Specialty

Indicativ e Rate &

SYSTEM

Upper ceiling (Rs.) Emergency 169

Surgical Gastroenterology Emergency

170

Surgical Gastroenterology Liver Surgical Gastroenterology Liver Surgical Gastroenterology Liver Surgical Gastroenterology Pancreas Surgical Gastroenterology Pancreas Surgical Gastroenterology Pancreas Surgical Gastroenterology Pancreas Surgical Gastroenterology Pancreas Surgical Gastroenterology Oesophagus Surgical Gastroenterology Oesophagus Surgical Gastroenterology Oesophagus Surgical Gastroenterology Oesophagus Surgical Gastroenterology Oesophagus Surgical Gastroenterology Stomach Surgical Gastroenterology Stomach Surgical Gastroenterology Stomach

171

172

173

174

175

176

177

178

179

180

181

182

183

184

185

~ 76 ~

Diaphragmatic Hernia (Gortex Mesh Repair) Inv Ba.Study , CXR , Endos copy , USG Pos Pos t proced ure evidence eviden ce of Clin Clinical ical photo ph oto graph, graph , Biopsy Rt Hepatectomy Inv - CT , ERClinical Photograph , USG Post procedure evidence of Clin Clin ical pho tograph, USG Lt Hepatectomy Hepatectomy Inv - CT , ERClini ERClinical cal Photograph , USG Post procedure evidence of Clin Clin ical pho tograph, USG Segmentectomy Inv - CT , ERClinical Photograph , USG Post procedure evidence of Clin Clin ical pho tograph, USG Dist Distal al Pancreat Pancreatecto ecto my Inv Inv - CT , ERCP ERCP Post proced ure evidence eviden ce of Clin Clinical ical photo ph oto graph, graph , USG USG

40000

75000

75000

50000

100000

Enucleation of cys t Inv - CT Pos Pos t procedure evidence of Clin Clin ical photog raph, USG

75000

Whipples any type Inv - CT , ERCP Post proced ure evidence eviden ce of Clin Clinical ical photo ph oto graph, graph , USG USG

75000

Trip Trip le bypass Inv - CT Pos Pos t procedure evidence o f Clin Clin ical photog raph, raph, USG

25000

Other Bypasses Inv - CT Post Post procedure evidence of Clinica Clinica l photog raph, USG

25000

Colonic Pull up Inv - Biopsy , CT-Scan , Endos copy Post procedure procedure evidence of Clinical Clinical pho tograph, Biops Biops y Oesophagectomy Inv - Biopsy , CT-Scan , Endos copy Post p rocedure rocedure evidence of Endoscopy picture, Biops y Oesophago-Gastrectomy Inv - Biopsy , CT-Scan , Endos copy Post procedure evidence of Endos Endos copy picture, Biops y Lap Heller‟s myotomy Inv - Biopsy , CT-Scan , Endos copy Post p rocedure rocedure evidence of Endoscopy picture, Biops y Lap Fundo plicat plicat ions Inv - Biopsy , CT-Scan CT-Scan , Endos copy Post p rocedure rocedure evidence of Endoscopy picture, Biops y Partial Partial Gastrectomy Inv - Biops y , EUS , US G Post procedure procedure evidence of Clin Clin ical pho tograph,Biopsy Total Gastrectomy Inv - Biopsy , CT-Scan , Endos copy , USG USG Pos t procedure evidence of Clin Clin ical phot ograph,Bi ograph,Biops ops y Truncal vagot omy omy + Gastro Jejunos Jejunos tomy tomy Inv Biopsy , CT-Scan CT-Scan , Endos Endos copy , USG Post proced ure evidence eviden ce of Clin Clin ical pho tograph,Biopsy

30000

60000

75000

30000

45000

40000

40000

40000



Specialty

186

Surgical Gastroenterology Stomach

187

Surgical Gastroenterology Stomach

188

Surgical Gastroenterology Small Intestine Surgical Gastroenterology Small Intestine Surgical Gastroenterology Small Intestine Surgical Gastroenterology La rge Intes tine Surgical Gastroenterology La rge Intes tine Surgical Gastroenterology La rge Intes tine

189

190

191

192

193

194

195

Surgical Gastroenterology La rge Intes tine Surgical Gastroenterology La rge Intes tine

196

Surgical Gastroenterology La rge Intes tine

197

Surgical Gastroenterology La rge Intes tine

198

Surgical Gastroenterology Ulcerative colitis III stage p rocedure

199

Surgical Gastroenterology Ulcerative colitis III stage p rocedure Surgical Gastroenterology Ulcerative colitis III stage p rocedure

200

~ 77 ~

Indicativ e Rate &

SYSTEM

Distal Gastrectomy for Gastric Outlet obstruction Inv - Biopsy , CT-Scan , Endoscopy , USG Post proced ure evidence eviden ce of Clin Clin ical pho tograph,Biops y Surgery Surgery for Corrosive injury Sto mach Inv Biopsy , CT-Scan CT-Scan , Endos copy , USG Pos Pos t proced ure evidence eviden ce of Clin Clin ical pho tograph,Biopsy Vo lvulus lvulus Inv - CT-Scan CT-Scan , X-Ray ABD Post proced ure evidence eviden ce of Clin Clin ical pho tograph,Biopsy Malrotation Malrotation Inv - CT-Scan , X -Ray ABD Post proced ure evidence eviden ce of Clin Clin ical pho tograph,Biopsy Lap Ad hes iolys iolys is Inv - CT-Scan CT-Scan , X-Ray ABD Post procedure evidence evidence of Clinical Clinical pho tograph,Biopsy Right Hemicolectomy Hemicolectomy Inv - Biopsy , CT-Scan CT-Scan , Colonos copy , Endos copy Post Post procedure procedure evidence of Clinica Clinica l photo graph,Biopsy graph,Biopsy Left Hemicolectomy Inv - Biopsy , CT-Scan , Colonos copy , Endos copy Post Post procedure procedure evidence of Clinical Clinical photog raph,Biopsy raph,Biopsy Extended Extended Right Hemicolectomy Hemicolectomy Inv - Biopsy , CT-Scan , Co lonoscopy , Endoscopy Post proced ure evidence eviden ce of Clin Clin ical pho tograph,Biopsy Anterior Resection Resection Inv - Biops y , CT-Scan CT-Scan , Colonos copy , Endos copy Post Post procedure procedure evidence of Clinical Clinical photog raph,Biopsy raph,Biopsy Anterior Resection Resection w ith Ileostomy Inv - Biopsy , CT-Scan , Co lonoscopy , Endoscopy Post proced ure evidence eviden ce of Clin Clin ical pho tograph,Biops y Abdo mino Perineal Perineal Resection(Non Resection(Non -Malignant) -Malignant) Inv - Biops Biops y , CT-Scan , Colonos Colonos copy , Endos copy Post procedure evidence evidence of Clin Clin ical pho tograph,Biopsy Hartman.s Procedure with Colostomy Inv - Biopsy , CT-Scan CT-Scan , Colonos Colonos copy , Endos Endos copy Post proced ure evidence eviden ce of Clin Clin ical pho tograph,Biopsy I Stage-Sub Total Colectomy + Ileostomy Inv CT-Scan with Contrast , Colonos Colonos copy , Endos copy Post procedure evidence evidence of Clin Clin ical pho tograph,Biopsy


50000

40000

40000

40000

30000

30000

35000

40000

50000

50000

45000

50000

II Stage-J - Pouch Inv - Colonos Colonos copy Post Post proced ure evidence eviden ce of Clinical pho tograph,Biopsy

30000

III III Stage-Ileostomy Closure Inv - Endos copy Post proced ure evidence eviden ce of Clin Clin ical pho tograph,Biopsy

20000



Specialty

Indicativ e Rate &

SYSTEM


201

Surgical Gastroenterology Ulcerative colitis II stage p rocedure

I Stage- Sub Total Colectomy + Ileostomy + J Pouch Inv - CT-Scan CT-Scan with Contrast Contrast , Co Co lonoscopy , Endoscopy Post procedure evidence of Clinical Clinical pho tograph,Biopsy

202

Surgical Gastroenterology Ulcerative colitis II stage p rocedure Surgical Gastroenterology Liver

II Stage- Ileostomy Closure Inv - CT-Scan with Contrast , Colonos Colonos copy , Endos Endos copy Post proced ure evidence eviden ce of Clin Clin ical pho tograph,Biopsy Hepato Cellular Carcinoma(Advanced) Radio Frequency Frequency Ablation Ablation Inv - Biops Biops y , CT-Scan CT-Scan , EUSDiagnostic EUSDiagnostic Laparosco Laparosco py , Intra operative Ultrasoun Ultrasoun d Post procedure evidence evidence of Clin Clin ical pho tograph/USG Haemangioma SOL Liver Hepatectomy + Wedge Resection Inv - CT-Scan , Endosco py , USG Post proced ure evidence eviden ce of Clin Clin ical pho tograph/Biops tograph/Biops y/USG

20000

203

60000

204

Surgical Gastroenterology Liver

205

Surgical Gastroenterology Liver

Hydatid cyst -Marsupil -Marsupilisation isation Inv - Biopsy , CTCTScan , USG Post procedu re evidence evidence of Clinica Clinica l pho tograph/Biops tograph/Biops y/USG

30000

206

Surgical Gastroenterology Gall Bladder Surgical Gastroenterology Gall Bladder

Cys t exc exc ision ision + Hepatic Jejunosto my Inv - CT , USG Post procedu re evidence evidence of Clinical Clinical pho tograph,Biopsy GB+ Calculi CBD Stones or Dilated CBD Inv CBD CBD , ERClinica ERClinica l Photog Photog raph , USG Post proced ure evidence eviden ce of Clin Clin ical pho tograph,Biopsy Hepatico Hepatico Jejunost omy omy Inv - Biops y , CT-Scan CT-Scan Post procedure evidence evidence of Clinical Clinical pho tograph,Biopsy Choledochod uodenostomy uodenostomy Or Choledocho jejuno jejuno stomy st omy Inv - CT , USG Pos t proced ure evidence of Clinical Clinical photog raph,Biopsy raph,Biopsy Splenectomy Inv - CT , USG Post procedure evidence of Clinical Clinical photog raph,USG raph,USG

45000

Splenectomy + Devascularisation + Spleno Renal Shunt Inv - CT CT , USG Post procedu re evidence evidence o f Clin Clin ical phot ograph,Bi ograph,Biops ops y Spleenectomy Spleenectomy for Space occupy ing lesion lesion Inv CT , USG Post Pos t procedu re evidence eviden ce of Clinical pho tograph,USG Lap- Pancreatic Necrosectomy Inv - CT-Scan , ERCP ERCP , ERClinica ERClinica l Photog Photog raph , Endos copy Post Post proced ure evidence eviden ce of Clin Clin ical pho tograph,Biopsy Lateral PancreaticoJejunostomy(Non- Malignant) Inv - CT-Scan , ERCP , ERClinical Photograph , Endos copy Post procedure evidence evidence of Clin Clin ical pho tograph,Biopsy Pancreatic Pancreatic Necros Necros ectomy ectomy (ope n) Inv - CT-Scan , ERCP ERCP , ERClinica ERClinica l Photog Photog raph , Endos copy Post Post proced ure evidence eviden ce of Clin Clin ical pho tograph,Biopsy

60000

207

208

209

210

211

212

213

Surgical Gastroenterology Gall Bladder Surgical Gastroenterology Gall Bladder Surgical Gastroenterology Spleen Surgical Gastroenterology Spleen Surgical Gastroenterology Spleen Surgical Gastroenterology Pancreas

214

Surgical Gastroenterology Pancreas

215


~ 78 ~

75000

25000

45000

35000

35000

35000

100000

100000

100000



Specialty

216


217


218

220

Surgical Gastroenterology Pseudocyst Surgical Gastroenterology Pseudocyst Card Card iology iology

221

Card Card iology iology

222

Card Card iology

223

Card Card iology

224


225

Card Card iology

226


227

Card Card iology

228

Card Card iology iology Ba lloon proced ures

229

Card Card iology iology Ba lloon proced ures

230

219

231

232

233

Indicativ e Rate &

SYSTEM

Distal Pancreatectomy + Splenectomy Inv - CTScan , ERCP , ERClinical Photograph , Endos copy Post procedure evidence evidence of Clin Clin ical pho tograph,Biopsy Central Pancreatectomy Inv - CT-Scan , ERCP , ERClinical ERClinical Photograph , Endosco py Post proced ure evidence eviden ce of Clin Clin ical pho tograph,Biopsy Cysto Jejunostomy Inv - CT , USG Post procedure evidence of Clinical Clinical photog raph,Biopsy raph,Biopsy


100000

40000

Cysto Gastrostomy Inv - CT , USG Post procedure evidence of Clinical Clinical photog raph,Biops raph,Biops y

40000

Coronary ballon Angioplasty Inv - 2 CAD Post proced ure evidence eviden ce of Clin Clinical ical photo ph oto graph PTCA PTCA Addit ional Stent Inv - CAG Post procedure evidence of Clin Clin ical photog raph

60000

80000

Cardiology Pacemaker implantation Cardiology Pacemaker implantation Cardiology Coarctation Coarctation o f Aorta repair repair / A ortoplasty

ASD Device c losu re Inv - 2D ECHO ECHO Post proced ure evidence eviden ce of Clin Clinical ical photo ph oto graph, graph , 2D 2D Echo VSD Device c losu re Inv - 2D ECHO ECHO Post proced ure evidence eviden ce of Clin Clinical ical photo ph oto graph, graph , 2D 2D Echo PDA PDA Stenting Inv - 2D ECHO Post procedure evidence of Clin Clin ical photog raph, 2D Echo Echo PDA PDA Device c losu re Inv - 2D ECHO ECHO Post proced ure evidence eviden ce of Clin Clinical ical photo ph oto graph, graph , 2D 2D Echo Coil Closure Single Single coil Inv - 2D ECHO Post proced ure evidence eviden ce of Clin Clinical ical photo ph oto graph, graph , 2D Echo Coil Closu re Multiple co ils ils Inv - 2D ECHO Post Pos t proced ure evidence eviden ce of Clin Clinical ical photo ph oto graph, graph , 2D 2D Echo Ba lloon lloon Valvoto my Inv - 2D ECHO Pos t proced ure evidence eviden ce of Clin Clinical ical photo ph oto graph, graph , 2D 2D Echo Balloon Atrial septostomy Inv - 2D ECHO Post proced ure evidence eviden ce of Clin Clinical ical photo ph oto graph, graph , 2D 2D Echo Permanent pacemaker implantation Inv - CAG , ECG Pos Pos t procedu re evidence of Clin Clin ical pho tograph, 2D Echo Echo Tempora Tempora ry pacema pacema ker imp imp lantation lantation Inv - CA G , ECG Pos Pos t procedu re evidence of Clin Clin ical pho tograph, 2D Echo Echo Coarctation of Aorta Repair With st ent Inv - 2D 2D ECHO ECHO , CA G Post procedu re evidence of Clin Clin ical pho tograph, Dopp ler

Cardiology Coarctation Coarctation o f Aorta repair repair / A ortoplasty

Coarctation of Aorta Repair Repair W ithout s tent Inv Aortogram Pos Pos t procedu re evidence o f Clinical Clinical pho tograph, Dopp ler

~ 79 ~

20000

80000

65000 60000

20000

30000

20000

30000

75000

10000

80000

30000



Specialty

234

Cardiology Angioplasty

235


236


237


238

CVTS Surgery for fo r CAD

239

CVTS Surgery for fo r CAD

240

CVTS Vascu lar Surgeries

241

Indicativ e Rate &

SYSTEM

Renal Angioplasty Inv - Angiogram Pos Pos t proced ure evidence eviden ce of Clin Clinical ical photo ph oto graph, graph , Doppler Peripheral Peripheral Angioplasty Inv - 2D ECHO , Angiogram Post procedure procedure ev idence of Clinical pho tograph, Dopp ler Vertebral Vertebral Ang ioplasty ioplasty Inv - Ang iogram Post proced ure evidence eviden ce of Clin Clinical ical photo ph oto graph, graph , Doppler Angioplasty Add itional itional Stent Inv - Angiogram Post p rocedure rocedure evidence of Clin Clin ical photog raph, raph, Doppler Coronary byp ass Surgery on p ump ump with IABP Inv - CA CA G, 2D ECHO Post procedure evidence evidence of Clin Clin ical p hotog raph raph


60000

75000

40000

150000

Coronary byp ass Surgery off pu mp with IA BP Inv - 2D ECHO Post procedure evidence o f Clinical Clinical pho tograph. Peripheral Peripheral embolecto embolecto my without graft Inv Inv Angiogram , Sp ira ira l CT Angiogram Post p rocedure evidence of Color Color Doppler

150000


Excisi Excision on o f AV Ma lformation lformation Large Inv - M RI Angiogram , Sp ira ira l CT Angiogram Post p rocedure evidence of Color Color Doppler

75000

242


Excisi Excision on of AV Ma lformation lformation Small Inv - MRI Angiogram , Sp ira ira l CT Angiogram Post p rocedure evidence of Color Color Doppler

40000

243


20000

244


Arterial Arterial e mbolecto my Inv - A ngiogram , Color Doppler Pos Pos t procedu re evidence of Colo Colo r Doppler/SBP/PVR A V Fistula at Wrist Inv - Color Doppler Post proced ure eviden ce of Color Color Dopp ler

245


A V Fistula at Elbow Inv - Color Doppler Post proced ure evidence eviden ce of Color Color Dopp ler

20000

246


247

CVTS Vascu lar Surgeries CVTS Vascu lar Surgeries

D V T - IVC Filter Inv - Color Doppler Post proced ure evidence eviden ce of Pla Pla in X-Ray ab dom do men, Clin Clin ical p hotog raph raph Vascular tumours Inv - Angiogram , Spiral CT Post procedure evidence of Colo Colo r Doppler Small Small arterial aneurysms - Repair Repair Inv Angiogram , Sp ira ira l CT Pos t procedure evidence o f Color Doppler Medium size size arterial aneurysms - Repair Inv Angiogram , Sp ira ira l CT Post p rocedure evidence of Color Doppler Medium size size arterial aneurysms with with s ynth etic graft Inv Inv - An giogram , Spiral CT Post procedure evidence of Color Color Doppler Aorto Billac Billac - Bife Bife moral bypass with synth etic graft Inv Inv - An giogram , Spiral CT Post procedure evidence of Color Color Doppler

248

249


250


251


~ 80 ~

25000

10000

100000

40000 15000

50000

75000

125000



Specialty

252

CVTS Vascular Surgeries

253


254


255


256


257


258


259

CVTS - Surgery for Cardiac injuries CVTS - su rgery for Cardiac injuries CVTS - Surgery for CAD

Indicativ e Rate &

SYSTEM

Axillo Bifemoral Bypass with synthetic graft Inv Angiogram , Sp ira ira l CT Post p rocedure evidence of Color Doppler Femorodistal Femorodistal Bypass with with vein graft Inv Inv Angiogram , Sp ira ira l CT Post procedu re evidence of Color Doppler Femorodistal Femorodistal Bypass with with s ynthetic graft graft Inv Angiogram , Sp ira ira l CT Post p rocedure evidence of Color Doppler Axillo Axillo b rachial rachial by pass using with with s ynthetic graft Inv - Angiogram , Spiral Spiral CT Pos t procedure evidence of Color Color Doppler

262

CVTS - Surgery for CAD

263

268

CVTS - Surgery for CAD CVTS Valve replacement CVTS Valve replacement CVTS Valve replacement CVTS Valve replacement CVTS Pericardium Pericard ium

269

CVTS Pericardiu Pericardiu m

270

CVTS Pericardiu Pericardiu m

271

CVTS Coarctation of Aorta repair

Brachioradia rachioradia l bypass with with s ynthetic graft graft Inv Angiogram , Sp ira ira l CT Post p rocedure evidence of Color Doppler Carotid body tumour Excision Inv - Angiogram , Spiral CT Post procedure evidence of Color Doppler Carotid arotid a rtery rtery by pass with with s ynthetic graft graft Inv Angiogram , Sp ira ira l CT Post p rocedure evidence of Color Doppler Surgery without CPB Inv - 2D Echo Post proced ure evidence eviden ce of 2D Echo Surgery with with CPB Inv - 2D Echo Post proced ure evidence of 2D Echo CABG on pu mp without IABP IABP Inv - 2 D ECHO , CAG Post procedure evidence of Clinical pho tograph CABG of pump without IABP Inv - 2D ECHO , CAG Post procedure evidence of Clinical pho tograph CABG with aneurysmal repair Inv - CAG Post proced ure evidence eviden ce of Clin Clinical ical photo ph oto graph Mitral Mitral valve rep lacement lacement (with valve) Inv - 2D ECHO ECHO Post p rocedure evidence of 2D 2D Echo Aortic valve replacement (with valve) Inv - 2D ECHO ECHO Post p rocedure evidence of 2D 2D Echo Tricuspid valve replacement Inv - 2D ECHO Post proced ure evidence eviden ce of 2D Echo Double valve valve rep lacement lacement (with valve) Inv - 2D ECHO ECHO Post p rocedure evidence of 2D 2D Echo Percardiosto my Inv - 2D ECHO ECHO Post proced ure evidence of 2D Echo Percardectom Percardectomy y Inv - 2D ECHO ECHO Post procedure evidence of 2D Echo Pericardi Pericardiocentes ocentes is Inv - 2D ECHO Post procedure evidence of 2D Echo Coarctation of aorta Repair with graft Inv - 2D ECHO ECHO , CA G Pos Pos t procedure evidence of Doppler

272

CVTS Coarctation of Aorta repair

Coarctation of aorta Repair without graft Inv - 2D ECHO ECHO , CA G Pos Pos t procedure evidence of Doppler

273

CVTS Aorta repair repair

Aneurysm resection & grafting Inv - 2D ECHO , CA G Pos Pos t procedure evidence o f Doppler Doppler

260 261

264 265 266 267

~ 81 ~


60000

80000

65000

50000

60000

100000

40000 75000 125000

125000

110000 120000 120000 120000 150000 10000 30000 2000 32000

25000

125000



Specialty

274


275


276

CVTS Aorta Ao rta repair

277


278

CVTS

279

CVTS

280

Indicativ e Rate &

SYSTEM

Intrathoracic Intrathoracic Aneu rysm-Aneurys rysm-Aneurys m not requiring requiring byp ass ass (with (with gra ft) Inv - CT-Ang io , Cath Pos t proced ure evidence eviden ce of Doppler Intrathoracic Intrathoracic Aneurys m-Aneurysm requiring requiring byp ass ass (with (with gra ft) Inv - CT-Ang io , Cath Pos t proced ure eviden ce of Doppler Diss Diss ecting Aneurysms Ane urysms Inv - CT-An CT-Angio gio , Cath Post proced ure evidence eviden ce of Doppler Annu lus lus aortic aortic ectasia with with valved condu its Inv Angio Post procedure evidence evidence o f Echo, Echo, Doppler


125000

75000 150000

Aorto-aorto bypass bypass with with graft Inv - Angio Post proced ure evidence eviden ce of Doppler Aorto-aorto bypass bypass withou withou t graft Inv - Angio Post proced ure evidence eviden ce of Doppler

60000

CVTS

Femoro Femoro popliteal bypass with with graft Inv - Angio Post p rocedure rocedure evidence of Doppler

45000

281

CVTS

30000

282

CVTS

Femoro Femoro popliteal bypass withou withou t graft Inv - Angio Post procedure evidence of Doppler Femoroileal Femoroileal bypass With Graft Graft Inv - Angio Post proced ure evidence eviden ce of Doppler

283

CVTS

Femoroileal Femoroileal byp ass Without Graft Graft Inv - Angio Post procedure evidence of Doppler

25000

284

CVTS

Femoro-f Femoro-fee mo ral bypass With Graft Inv - Angio Post procedure evidence of Doppler

45000

285

CVTS

25000

286

CVTS

Femoro-f Femoro-fee mo ral bypass Without Graft Graft Inv Angio Post p rocedure rocedure evidence of Doppler TGA Arterial Arter ial Switch Inv - 2D ECHO , angio ang io Post proced ure evidence eviden ce of 2D Echo

287

CVTS

TGA TGA Sennings Procedure Procedure Inv - 2D ECHO , angio Post procedure evidence of 2D Echo

120000

288

CVTS

50000

289

CVTS

290

CVTS

291

CVTS

292

CVTS Systemi Sys temicc Pulmonary Pulmonary s hunts CVTS Systemi Sys temicc Pulmonary Pulmonary s hunts

Carotid arotid Embolectomy Inv - Angiogra m Post proced ure evidence eviden ce of Doppler Surgery for Intracardiac tu mours ou rs Inv - 2D ECHO , CA G Pos Pos t procedure evidence of Echo/HPE/Clin cho/HPE/Clin ical phot ograph Ruptu red sinus of valsalva correction correction Inv - CA G Post procedure procedure evidence of Echo Echo /Clinica /Clinica l pho tograph TAPVC correction Inv - 2D ECHO Post proced ure evidence eviden ce of Echo Echo /Clin /Clin ical photog pho tog raph Systemic pulmonary Shunts with graft Inv - 2D ECHO ECHO Post p rocedure evidence of 2D 2D ECHO Systemic Systemic pul monary Shunts withou withou t graft Inv - 2D ECHO ECHO Post p rocedure evidence of 2D 2D ECHO Total correction of Tetralogy Tetra logy of Fallots Inv - 2D ECHO ECHO Pos t p rocedure evidence o f Clinical Clinical pho tograph/Echo Intracardiac Repair of ASD AS D Inv - 2D ECHO Post Pos t proced ure evidence eviden ce of 2D ECHO Intracardiac Repair of VSD Inv - 2D ECHO Post Pos t proced ure evidence eviden ce of 2D ECHO

95000

293

294

CVTS Systemi Sys temicc Pulmonary Pulmonary s hunts

295

CVTS

296

CVTS

~ 82 ~

45000

45000

150000

75000

95000

95000 20000 20000

75000 75000



Specialty

297

CVTS

298

300

CVTS Ross proced ure Intracardiac Intracardiac repa ir of complex congenital heart diseas es CVTS Ross proced ure Intracardiac Intracardiac repa ir of complex congenital heart diseas es CVTS Valve repairs

301

CVTS Valve repairs

302

CVTS Valve repairs

303

CVTS Valve repairs

304

CVTS Valve repairs

305

CVTS Lungs

306

299

Indicativ e Rate &

SYSTEM

Surgery-PDA Surgery-PDA Inv - 2D ECHO Post procedure evidence of 2D 2D ECHO ECHO With spe cial condu its Inv - 2D ECHO Post proced ure evidence eviden ce of 2D ECHO

Without special condu its Inv - 2D ECHO Post proced ure evidence eviden ce of 2D ECHO

Upper ceiling (Rs.) 20000 125000

95000

With prosthetic ring ring Inv - 2D ECHO Post proced ure evidence eviden ce of 2D ECHO Without prosthetic prosthetic ring ring Inv - 2D ECHO Post proced ure evidence eviden ce of 2D ECHO Open pulmonary valvotomy valvotomy Inv - 2D ECHO Post proced ure evidence eviden ce of 2D ECHO Closed mitral valvot omy Inv - 2D ECHO Post proced ure evidence eviden ce of 2D ECHO

100000

Mitral valvot omy (Open) Inv - 2D ECHO Post proced ure evidence eviden ce of 2D ECHO Pneumonectomy Pneumonectomy Inv - CT-Chest CT-Chest , X-Ray Post proced ure evidence eviden ce of Clin Clinical ical Photog raph/X-R raph/ X-Ray ay

80000

CVTS Lungs

Lobecto my Inv - CT-Chest CT-Chest , X-Ray Post proced ure evidence eviden ce of Clin Clinical ical Photog raph/X-R raph/ X-Ray ay

50000

307

CVTS Lungs

Decorticati Decortication on Inv - CT-Chest , X-Ray Post proced ure evidence eviden ce of Clin Clinical ical Photog raph/X-R raph/ X-Ray ay

50000

308

CVTS Lungs

Lung cys t Inv - CT- Chest , X-Ray X-Ray Post procedure evidence of Clin Clin ical Photo Photo graph/X-Ray graph/X-Ray

50000

309

CVTS Lungs

SOL Mediastinum Inv - CT-Chest , X-Ray X-Ray Post proced ure evidence eviden ce of Clin Clinical ical Photog raph/X-R raph/ X-Ray ay

50000

310

Thorocoplasty Inv - CT-Chest , X-Ray Post proced ure evidence eviden ce of Clin Clinical ical Photog raph/X-R raph/ X-Ray ay

50000

Myop lasty lasty Inv - CTCT- Ches t , X-Ray X-Ray Post procedure evidence of Clin Clin ical Photo Photo graph/X-Ray graph/X-Ray

50000

Transpleural BPF Closure Inv - CT-Chest , X-Ray Post procedure procedure evidence of Clin Clin ical Photograph/X-Ray

50000

313

CVTS Surgical correction of Bronchopleural fistula CVTS Surgical correction of Bronchopleural fistula CVTS Surgical correction of Bronchopleural fistula CVTS Chest

Diaph Diaphrag rag matic Eventeration ven teration Inv - Barium stud st udies ies , CT-Scan Post p rocedure evidence of USG

40000

314

CVTS Chest

Diaphrag Diaphrag matic Hernia Inv - CT-Scan CT-Scan , USG Post proced ure evidence eviden ce of USG

40000

311

312

~ 83 ~

85000 75000 20000

50000



Specialty

315

CVTS Chest

316

CVTS Diaphragmatic injuries CVTS Bronch ial injuries

317

Indicativ e Rate &

SYSTEM

Oesop hageal diverticula /Achlasia /Ac hlasia cardia Inv Barium stud ies , CT-Scan CT-Scan Post p rocedure rocedure evidence of USG Thoracotomy, Thoracotomy, Thoraco abd omina omina l approach Inv CT-Scan Pos t p rocedure evidence of Clin Clin ical pho tograph with operative s cars Foreign Foreign b ody removal removal with sco pe Inv Bronchos copy , CT CT -Scan -Scan Pos t procedure evidence of Endoscopic picture Repair su rgery Injuries Injuries d ue to Foreign Foreign b ody Inv Bronchos copy , CT CT -Scan -Scan Pos t procedure evidence of Endoscopic picture


40000

20000

318

CVTS Bronchial Bronc hial injuries

319

CVTS Oesophagus injuries

320

CVTS Vascu lar Injuries

321


322


323


324


325


326


327


328


329


Thoracic Thoracic vascu lar injuries injuries Inv - Angiogra m , Doppler Post procedu re evidence of Color Color dop pler

Up to 150000

330

Pediatri Pediatricc Surgeries Surgeries Congenital malformations - GI Tract

Oesophageal atresis Inv - X- Ray, Oesoph agoscopy Post p rocedure rocedure evidence o f Clinical Clinical Photograph

60000

~ 84 ~

Gastro study follow followed ed b y Thoracoto my and repairs repairs for oeso phageal injury injury for Corros Corros ive Injuries/FB Inv - Gastroscopy Post procedure evidence of Endos Endos copic picture Surgery Surgery w ithout graft for Arterial injuries, injuries, ven ous injur injuries ies Inv Inv - Angiogra An giogra m , Dopp Dopp ler Post Pos t proced ure evidence eviden ce of Clin Clinical ical photo ph oto graph with scar Vascular Injury in upper limbs limbs Axillary,branchial,Radial and Ulnar - Repair with Vein Vein Graft Inv - Angiogram , Doppler Post Post proced ure evidence eviden ce of Color Color do ppler Major Vascular Injury -in lower limbs-Repair Inv - Angiogra m , Doppler Post procedure evidence of Co Co lor dopp ler Minor Vascular Injury Repair- Tibial vessels in leg Inv - Angiogram , Doppler Post procedure evidence of Color Color dop pler Minor Vascular Injury Repair -vessels in Foot Inv - Angiogra m , Doppler Post procedure evidence of Co Co lor dopp ler Surgery with Ve Ve in graft Inv - Ang iogram iogra m , Doppler Pos Pos t procedu re evidence of Clinical pho tograph with sca r Color Color do ppler With prosthetic graft Inv Inv - Angiogra m , Doppler Post p rocedure rocedure evidence o f Clinical Clinical phot ograph with with s car Neck vas cular injury - Carot Carot id vessels ves sels Inv Ang iogram , Dop Doppler pler Pos Pos t procedure evidence of Color Doppler Abdominal vascular injuries - Aorta, Iliac arteries, IVC, IVC, Iliac Iliac veins Inv - Angiogram , Doppler Pos Pos t proced ure eviden ce of Color Color dopp d opp ler

40000

50000

10000

Up to 40000

Up to 60000 Up to 20000 Up to 20000 15000

40000

Up to 100000 Up to 100000



331

332

333

334

335

336

337

338

339

340

341

342

343

344

Specialty

Pediatric Surgeries Congenital malformations - GI Tract Pediatri Pediatricc Surgeries Surgeries Congenital malformations - GI Tract Pediatri Pediatricc Surgeries Surgeries Congenital malformations - GI Tract Pediatri Pediatricc Surgeries Surgeries Congenital malformations - GI Tract Pediatri Pediatricc Surgeries Surgeries Congenital malformations - GI Tract Pediatri Pediatricc Surgeries Surgeries Congenital malformations - GI Tract Pediatri Pediatricc Surgeries Surgeries Congenital malformations - GI Tract Pediatri Pediatricc Surgeries Surgeries Congenital malformations – malformations – Urogenital Pediatri Pediatricc Surgeries Surgeries Congenital malformations Urogenital Pediatri Pediatricc Surgeries Surgeries Congenital malformations Urogenital Pediatri Pediatricc Surgeries Surgeries Congenital malformations Urogenital Pediatri Pediatricc Surgeries Surgeries Congenital malformations Urogenital Pediatri Pediatricc Surgeries Surgeries Congenital malformations Urogenital Pediatri Pediatricc Surgeries Surgeries Congenital malformations Urogenital

~ 85 ~

Indicativ e Rate &

SYSTEM

Diaphragmatic hernia Inv - USG, CT Post proced ure evidence eviden ce of Clin Clinical ical Photog raph


Intestinal atresias & Obstructions Inv - x-Ray, CT Post p rocedure rocedure evidence o f Clinical Clinical Photograph

50000

Biliary Biliary atresis & Choledocal cy st Inv - CT, Clin Clin ical Photograph Post p rocedure evidence of Clin Clin ical Photog raph

55000

Anorectal malformations Stage 1 Inv - Clinical Photograph, Proctoscopy Post procedure evidence of Clinica Clinica l Photo Photo graph

45000

Anorectal malformations Stage 2 Inv - Clinical Photograph, Proctoscopy Post procedure evidence of Clinica Clinica l Photo Photo graph

60000

Hirsch Hirsch sprung Diseas Diseas e Stage 1 Inv - Clinical Clinical Photograph, Proctoscopy Biops Biops y Pos t procedure evidence of Clin Clin ical Photograph

45000

Hirsch Hirsch sprung Diseas Diseas e Stage 2 Inv - Clinical Photograph, Proctoscopy Proctoscopy Biops Biops y Post procedure evidence of Clin Clin ical Photograph

60000

Congen ital hydronep hrosis hrosis Inv USG/ USG/ IVP/Renogra IVP/Renogra m Post p rocedure evidence of Clin Clin ical Photograph, IVP IVP

50000

Ureteric Ureteric rei mp lantations lantations Inv - Clinical Clinical Photograph/USG Pos Pos t procedu re evidence of Clin Clin ical Phot ograph,IVP ograph,IVP

65000

Extrophy bladder Stage 1 Inv - Clinical Photograph/USG Post Post procedure evidence of Clin Clin ical Photog raph

65000

Extrophy bladder Stage 2 Inv - Clinical Photograph/USG Pos Pos t procedu re evidence of Clin Clin ical Photog raph

60000

Posterior Posterior urethral va lves Inv - MCU Post proced ure evidence eviden ce of Clin Clinical ical Photog raph,IVP

30000

Hypospadias single stage Inv - Clin Clin ical Photograph Post Post procedure evidence of Clin Clin ical Photograph

40000

Hypospadius stage 2 Inv Inv - Clinical linical Photograph Post p rocedure rocedure evidence o f Clinical Clinical Photograph

35000



345

346

347

348

349

350

351

352

353

354

355

356

Specialty

Pediatric Surgeries Congenital malformations Pediatri Pediatricc Surgeries Surgeries Congenital malformations Plastic Plastic repair Pediatri Pediatricc Surgeries Surgeries Congenital malformations Plastic Plastic repair Pediatri Pediatricc Surgeries Surgeries Congenital malformations Plastic Plastic repair Pediatri Pediatricc Surgeries Surgeries Congenital malformations Plastic Plastic repair Pediatri Pediatricc Surgeries Congenital malformations Plastic Plastic repair Pediatri Pediatricc Surgeries Surgeries Congenital malformations Plastic Plastic repair Pediatri Pediatricc Surgeries Surgeries Congenital malformations – malformations – Urogenital Pediatri Pediatricc Surgeries Surgeries Congenital malformations Pediatri Pediatricc Surgeries Surgeries Congenital malformations Pediatri Pediatricc Surgeries Surgeries Congenital malformations Pediatri Pediatricc Surgeries Surgeries Head and neck

Indicativ e Rate &

SYSTEM

Pediatri Pediatricc tumours Inv - CT/Biops T/Biops y Post procedure evidence of Clin Clin ical Photograph


Cleft lip Inv - Clinical Photograph Post procedure evidence of Clin Clin ical Photograph

10000

Cleft palate Inv - Clinical Photograph Post proced ure evidence eviden ce of Clin Clinical ical Photog raph

15000

Velo-Pharyngial Velo-Pharyngial Inco mpetence Inv - Endoscopy Post p rocedure rocedure evidence o f Clinical Clinical Photograph

15000

Syndactyly of hand for each hand Inv - Clinical Clinical Photograph Post Post procedure evidence of Clin Clin ical Photograph

15000

Microtia/ Microtia/ Anotia Inv - Clinica Clinica l Photog Photog raph Post proced ure evidence eviden ce of Clin Clinical ical Photog raph

30000

TM joint joint anky losis Inv -Clinica -Clinica l Photog Photog raph / XRay Pos t procedu re evidence of Clin Clin ical Photograph

40000

Hypospadius stage 1 Inv Inv - Clinical linical Photograph Post p rocedure rocedure evidence o f Clinical Clinical Photograph

35000

Hamartoma Excision Inv - CT/ Clinical Photograph Post Post procedure evidence of Clin Clin ical Photograph Hemangioma Excision Inv - Neuro USG+CT Post proced ure evidence eviden ce of Clin Clinical ical Photog raph

20000

Lymphangioma Excision Inv -Neuro USG+CT Post p rocedure rocedure evidence o f Clinical Clinical Photograph

40000

Neuroblastoma Neuroblas toma Inv Inv - CT/USG/FNAC CT/USG/FNAC Pos t proced ure evidence eviden ce of Clin Clin ical Photog raph,Biop raph,Biopsy sy

25000

Congenital Dermal Sinus Inv - Neuro USG+CT Post procedure procedure evidence of Clin Clin ical Photograph,Biopsy Cys tic Lesions Lesions of the Neck Inv Inv USG,MRI,CT,Cli USG,MRI,CT,Clin n ical Photograph Post procedure evidence of Clin Clin ical Photograph,Biopsy Photograph,Biopsy

30000

25000

357

Pediatri Pediatricc Surgeries Surgeries Head and neck

358


359


Encephalocele Inv - Neuro USG+CT Post proced ure evidence eviden ce of Clin Clinical ical Photog raph,Biop raph,Biopsy sy

20000

360


Sinuses & Fistula of the Neck Inv - CT,Clinical Photograph Post Post procedure evidence evidence of Clinica Clinica l Photograph,Biopsy

20000

~ 86 ~

20000



Specialty

Indicativ e Rate &

SYSTEM


361

Pediatric Surgeries Chest

362

Pediatri Pediatricc Surgeries Surgeries Chest

363


364


Bronchos copy foreign foreign body removal removal Inv Endos copic Video Video Pos t procedure evidence o f Clin Clin ical Photog raph Paediatric Esophageal obstructions-Surgical correction correction Inv -Contrast UGI UGI Post procedure evidence of Clin Clin ical Photograph Paediatri Paediatricc Esop hageal Subs Subs titutions titutions Inv - Contrast Contrast study Post procedure evidence of Clinical Clinical Photograph Thoracoscopic cysts excisi excision on Inv - US G, CT CT Pos t proced ure evidence eviden ce of Clin Clinical ical Photog raph/Bi raph/ Biopsy opsy

365


Thoracoscopic decortication decortication Inv - US G, CT CT Pos t proced ure evidence eviden ce of Clin Clinical ical Photog raph/Bi raph/ Biopsy opsy

40000

366


Thoracic Duplications Inv - X-Ray, CT Post proced ure evidence eviden ce of Clin Clinical ical Photog raph/Bi raph/ Biopsy opsy

40000

367


50000

368

Pediatri Pediatricc Surgeries Surgeries Abdomen

369


370


371


372


373


374


375

Pediatri Pediatricc Surgeries Surgeries Abdomen Pediatri Pediatricc Surgeries Surgeries Abdomen

Thoracic Thoracic Wal l defects- Correction Correction Inv - X-Ray, CT Post procedure evidence of Clinical Photograph Gastric Gastric ou tlet obst ructions ructions Inv - Contrast Contrast USG, XRay Pos t procedu re evidence of Clin Clin ical Photograph Laparosco pic pull through su rgeries rgeries for HD Inv USG,Cli USG,Clin n ical Photograph Post proced ure evidence of Clinica Clinica l Photograph,USG, Photograph,USG, Video Video Paediatric Splenectomy (Non Traumatic) Inv USG,Hemogram USG,Hemogram Post p rocedure evidence of Clin Clin ical Photog raph Surgeries on adrenal gland in Children Inv - CT, Hormone Hormone as says Post Post procedure evidence evidence o f Clin Clin ical Phot ograph,USG Gastro Esop Esop hageal Reflu Reflu x Correction Correction Inv Endos copy, CT CT Scan Pos t procedure evidence o f Clin Clin ical Photog raph Hydatid cysts in Paediatric Paediatric patient Inv - CT,USG Post procedure procedure evidence of Clin Clin ical Photograph,USG Intestinal Polypos Polypos is Surgical correction correction Inv UG,Endos UG,Endos copy Post Post procedure evidence of Clin Clin ical Photog raph,Biopsy raph,Biopsy Intussusception Inv - USG,CT USG,CT Post procedure evidence of Clin Clin ical Photograph,USG Paediatri Paediatricc Acute Intestinal Intestinal Obstruction Inv USG,CT Post procedure evidence of Clinical Photograph,USG Laparosco pic Appendectomy Inv - USG,Clin USG,Clin ical Photograph Post Post procedure evidence of Clin Clin ical Photograph,USG,Video Laparosco pic Choleycys Choleycys tectomy tectomy Inv USG,Cli USG,Clin n ical Photograph Post proced ure evidence of Cl inica inica l Photog raph,USG,Vi raph,USG,Video deo

376

377


378


~ 87 ~

30000

60000

40000

30000

60000

35000

25000

30000

40000

50000

40000 40000

30000

40000



Specialty

379

Pediatric Surgeries Abdomen

380

Pediatri Pediatricc Surgeries Surgeries Urogenital

381

Pediatri Pediatricc Surgeries Urogenital

382

Pediatri Pediatricc Surgeries Surgeries Urogenital Pediatri Pediatricc Surgeries Surgeries Urogenital

383

384


385


386


387

Urology Urology Renal Transplantation

388

Urology Urology Renal Transplantation Urology Urology Renal Transplantation

389

Indicativ e Rate &

SYSTEM

Laparosco pic pull through for Ano Rectal Anomalies Anomalies Inv - USG,Clinical USG,Clinical Photograph Post proced ure evidence eviden ce of Clin Clinical ical Photograph,USG,Video Nephrecto my Inv - U SG,CT,Clinical Phot ograp h Post procedure procedure evidence of Clin Clin ical Photograph,USG Epispadiasis - Correction Inv - Clinical Photograph Post Post procedure evidence of Clin Clin ical Photograph Scrotal Scrotal transpos ition ition repair Inv Inv - US G Pos Pos t proced ure evidence eviden ce of Clin Clinical ical Photog raph Undescended Testis Testis Inv - USG,Clinical Photograph Post Post procedure evidence of Clin Clin ical Photograph Torsion Testis Inv - Color Color do ppler, Clin Clin ical Photograph Post Post procedure evidence evidence o f Clin Clin ical Photograph Laparoscopic Orchidopexy Inv - USG,Clinical Photograph Post Post procedure evidence of Clin Clin ical Photograph,USG,Video Laparoscopic Varicocele ligation Inv USG,Cli USG,Clin n ical Photo Photo graph Post procedu re evidence of Cl inica inica l Photog raph,USG,Vi raph,USG,Video deo A.V. Fistula (Pretransplant procedure only) Inv Renal function tests, Serum electrolytes electrolytes Post proced ure evidence eviden ce of Clin Clinical ical photo ph oto grap h Renal trans plantation plantation surgery Inv - USG,RFT USG,RFT Pos t proced ure evidence eviden ce of Clin Clinical ical photo ph oto graph Post-transp Post-transp lant immunos immunos uppression treatment treatment Fro Fro m 1st to 6th month after transplantation Inv USG,RF USG,RFT T Post p rocedure evidence of Bills Bills copy


40000

40000

20000 25000

25000

25000

25000

10000

140000 50000

390

Urology Urology Testis, Testis and Penis

Orchidopexy Bilateral Inv - USG Post procedure evidence of Clin Clin ical photog raph

15000

391

Urology Urology Testis, Testis and Penis Urology Urology Testis, Testis and Penis

Torsion testis Inv -USG Post p rocedure rocedure evidence of Clinica Clinica l photog raph Chordae correction correction Inv - US G Post Post procedure evidence of Clin Clin ical photog raph

12000

393


15000

394


395

Urology Urology Renal Calculi

396


397


Partial Partial amputation of Pen is(Non is(Non -Malignan -Malignan t) Inv Clin Clin ical Photograph Post procedu re evidence of Clin Clin ical phot ograph,Bi ograph,Biops ops y Total amputation of Penis(Non-Ma Penis(Non-Ma lignant lignant ) Inv Clin Clin ical Photograph Post procedu re evidence of Clin Clin ical phot ograph,Bi ograph,Biops ops y Open Pyelolithoto Pyelolithoto my Inv - U SG,KUB,IVP SG,KUB,IVP Post proced ure evidence eviden ce of Clin Clinical ical photo ph oto graph,Xgraph ,XRay,USG Open Nephrolithotomy Nephrolithotomy Inv - USG,KUB,IVP Post proced ure evidence eviden ce of Clin Clinical ical photo ph oto graph,Xgraph ,XRay,USG Open cys tolithotom tolithotomy y Inv - U SG,KUB,IVP SG,KUB,IVP Post proced ure evidence eviden ce of Clin Clinical ical photo ph oto graph,Xgraph ,XRay,USG

392

~ 88 ~

15000

25000

10000

10000

10000



Specialty

398

Urology Renal Calculi

399

Urology Urology Lithotripsy Lithotripsy

400

Urology Urology Lithotrips y

401


402


403


404


405

Urology Urology Correct Correct ive proced ures

406


407


408


409


410


411

Indicativ e Rate &

SYSTEM

Laparosco pic Pyelolithotomy Pyelolithotomy Inv USG,KUB,IVP USG,KUB,IVP Post procedure evidence o f Clin Clin ical phot ograph,X-Ray,Vi ograph,X-Ray,Video deo Cys tolithotripsy tolithotripsy Inv - USG,KUB USG,KUB Post procedure evidence o f Clin Clin ical pho tograph,X-Ray,USG tograph,X-Ray,USG PCNL Inv - USG,KUB, USG,KU B,IVP IVP Post proced ure evidence of Clin Clin ical photo graph,X-Ray graph,X-Ray


10000 30000

ESWL Inv - USG,KUB,IVP USG,KUB,IVP Post procedure evidence of Clin Clin ical photo graph,X-Ray, graph,X-Ray,IVP IVP URSL Inv - USG,KUB, USG,KU B,IVP IVP Post proced ure evidence of Clin Clin ical photo graph,X-Ray graph,X-Ray

20000

Nephrostomy Inv -USG,IVP -USG,IVP Post procedure evidence of Clin Clin ical photog raph DJ Stent (One (One side) Inv - USG,IVP Post Pos t proced ure evidence of X-Ray X-Ray Urethroplasty Urethroplasty for Stricture Stricture Urethra S ingle ingle s tage Inv - RUG Post procedure evidence of Clinical pho tograph Urethroplasty for Stricture Urethra Double Stage Stage-1 Inv Inv - RUG Pos Pos t procedure evidence of Clin Clin ical p hotog raph raph

2000

25000

5000 50000

30000

Urethroplasty Urethroplasty for Stricture Stricture Urethra Double Stage Stage-2 Inv Inv - RUG Pos Pos t procedure evidence of Clin Clin ical p hotog raph raph Urethroplasty for Stricture Urethra Double Stage Recons truction Procedure Inv - Clinical Clinical Photograph Post procedure eviden eviden ce of Photo Hypospadius Adult Single Stage Inv - Clinical Photograph Post Post procedure evidence evidence of Clinica Clinica l pho tograph Hypospadius Adult Double Stage Stage - Stage-1 Inv Clin Clin ical Photograph Post p rocedure evidence of Clin Clin ical p hotog raph raph

30000


Hypospadius Adult Double Stage Stage - Stage-2 Inv Clin Clin ical Photograph Post procedu re evidence of Clin Clin ical p hotog raph raph

35000

412


30000

413

Urology Urology

Hypospadius Adult Double Stage Stage - TURBT Inv CT,USG,Cyso T,USG,Cyso scopy, Biops Biops y Pos t procedure evidence of Clin Clin ical photog raph, CT CT Post -Transplant immuno immuno su ppressive Treatment Treatment fro fro m 7th 7th to 1 2 th Month after transplantation Inv USG/ USG/ RFT Post procedure evidence evidence o f Bills Bills copy

414

Urology Urology Kidney

10000

415


Nephrostomy Inv - USG,IVP Post procedure evidence of USG USG Nephrectomy Nephrectomy Pyonephros is/XGP is/XGP Inv - USG,IVP USG,IVP Post procedure evidence of USG

416


40000

417


Simp Simp le Nephrectomy Nephrect omy Inv - USG,IVP Post Pos t proced ure evidence eviden ce of USG Lap. Nephrecto my Simple Inv - USG,IVP Post Pos t proced ure evidence eviden ce of USG

418


Lap. Nephrecto my Radical Inv - USG,IVP Post Pos t proced ure evidence eviden ce of USG

40000

~ 89 ~

50000

40000

35000

50000

40000

30000



Specialty

419


420


421


422

Urology Urology Kidney Stone

423

Urology Urology Kidney Stone

424


425

Urology Urology Correct Correct ive proced ures Urology Urology Correct Correct ive proced ures

Indicativ e Rate &

SYSTEM

Lap. Part Part ial Nephrectomy Nephrectomy Inv -USG,IVP Post proced ure evidence eviden ce of USG Bilateral Bilateral Nephroureterectomy Nephroureterectomy Inv - USG,IVP Post proced ure evidence eviden ce of USG

Upper ceiling (Rs.) 35000 25000

Renal Cyst Excision Inv - USG,IVP Post proced ure evidence eviden ce of USG Endos cope Removal Removal of s tone in Bladder Inv USG, USG, I VP,Scopy. VP,Scopy. X-Ray. K UB Post procedu re evidence of Endos Endos copic picture

15000

50000

10000

427

Urology Urology Corrective Corrective proced ures

Anatrophic Pyelolithotomy Pyelolithotomy fo r Staghorn Ca lculus lculus Inv - USG,KUB,IVP USG,KUB,IVP Pos t procedure evidence o f Clin Clin ical pho tograph/X-R tograph/X-Ray, USG Anderson Hynes Pyeloplasty Inv - X-Ray, X-Ray, USG,IVP USG,IVP Post procedure evidence of Clin Clin ical pho tograph Vasico Vaginal Vaginal Fistula Inv - IVP,Scopy, RGP RGP Pos t proced ure evidence eviden ce of Clin Clinical ical photo ph oto graph Epispadiasis - Correction Inv - Clinical pho tograph Post pro cedure evidenc e of Clinical pho tograph Closure of Urethral Urethral Fistu Fistu la Inv Inv - RGU Post proced ure evidence eviden ce of Clin Clinical ical photo ph oto graph

428

Urology Urology Correct Correct ive proced ures Urology Urology Correct Correct ive procedures proce dures Urology Urology Correct Correct ive proced ures Urology Urology Correct Correct ive proced ures Urology Urology Correct Correct ive proced ures

Optical Optical Urethrotomy Inv - X -Ray, RGU Post proced ure evidence eviden ce of End Endos os copic picture Perineal Urethrostomy Inv -X-Ray, RGU Post proced ure evidence eviden ce of End Endos os copic picture Ureteric Reimplantation Inv -X Ray,USG,IVP Post procedure evidence of USG Ileal Conduit formation Inv - X Ray,USG,IVP Post p rocedure rocedure evidence o f Clinical Clinical phot ograph Ureterocele Ureterocele Inv - X Ray,RGU Post p rocedure evidence of Clin Clin ical photog raph

20000

Transurethral resect resect ion of prostate (TURP) (TURP) Inv USG,U.S USG,U.Scopy copy Post p rocedure evidence of USG TURP TURP Cyst l ithotrips ithotrips y Inv - X-Ray,USG X-Ray,USG Post proced ure evidence eviden ce of USG Open prostatectomy prostatectomy Inv - X-Ray,USG Pos Pos t proced ure evidence eviden ce of Clin Clinical ical photo ph oto graph Caecocys toplasty toplasty Inv - USG,U.Scopy USG,U.Scopy Pos t proced ure evidence eviden ce of USG Total cystectomy cystectomy Inv - USG,U.Scopy USG,U.Scopy Pos t proced ure evidence eviden ce of USG Diverticulectomy Diverticulectomy Inv Inv -USG,U.Scopy Post proced ure evidence eviden ce of USG Incontinence Urine (Female) Inv -USG,U.Scopy Post procedure procedure evidence of USG Incontinence Urine (male) Inv - USG,U.Scopy Post procedure evidence of USG Craniotomy and evacuation of Hemato Hemato ma Subdural Inv Inv - CT Pos t procedu re evidence evidence o f Clin Clin ical p hotog raph raph

30000

441

Urology Urology Bladd Bladder er Prostate Urology Urology Bladd Bladder er Prostate Urology Urology Bladd Bladder er Prostate Urology Urology Bladd Bladder er Prostate Urology Urology Bladd Bladder er Prostate Urology Urology Bladd Bladder er Prostate Urology Urology Bladd Bladder er Prostate Urology Urology Bladd Bladder er Prostate Neurosurgery Brain

442

Neurosurgery Brain

Craniotomy and evacuation of Hemato Hemato ma Extradural Extradural Inv - CT Pos t procedure evidence o f

40000

426

429 430 431 432 433 434 435 436 437 438 439 440

~ 90 ~

40000

40000 40000

25000

20000 25000 20000 15000

30000 30000 30000 35000 10000 20000 20000 40000



Specialty

Indicativ e Rate &

SYSTEM

Upper ceiling (Rs.) Clin Clin ical p hotog raph raph

443

Neurosurgery Brain

25000

Neurosurgery Brain Tumours

Evacuation of Brain Abs cess cess - Bu rr hole Inv - CT Post p rocedure rocedure evidence o f Clinical Clinical phot ograph Excision Excision of Lobe ob e (Frontal,Temporal,Cerebel (Fron tal,Temporal,Cerebel lum etc.) Inv Inv - CT Pos t procedu re evidence of Clin Clin ical pho tograph/Biops tograph/Biops y Parasag Parasag ittal Inv - CT Post procedu re evidence of Clin Clin ical p hotog raph/Bi raph/Biops ops y

444

Neurosurgery Neuros urgery Bra Bra in

445

446


Basal Inv - CT Post procedu re evidence evidence of Clin Clin ical phot ograph/Biopsy ograph/Biopsy

60000

447


Brain Ste Ste m Inv Inv -CT Post procedure evidence of Clin Clin ical p hotog raph/Bi raph/Biops ops y

70000

448


C P Angle Inv Inv - CT Pos t procedure evidence evidence of Clin Clin ical p hotog raph/Bi raph/Biops ops y

70000

449

Neurosurgery Excision of Brain tumours

Others Inv -CT Post procedure evidence o f Clin Clin ical p hotog raph/Bi raph/Biops ops y

40000

450

Neurosurgery Excision of Brain Tumours Neurosurgery Excision of Brain Tumours Neurosurgery Excision of Brain Tumours Neurosurgery Excision of Brain Tumours Neurosurgery Excision of Brain Tumours Neurosurgery Excision of Brain Tumours Neurosurgery Excision of Brain Tumours Neurosurgery Excision of Brain Tumours Neurosurgery Excision of Brain Tumours Neurosurgery Brain Tumours Neurosurgery Brain Tumours

Excisi Excision on of b rain rain tu mours Subtentorial Inv - CT Post procedure procedure evidence of Clin Clin ical pho tograph/Biops tograph/Biops y Ventriculolateral Ventriculolateral / Ventriculoperitoneal sh unt Inv - CT Post procedure evidence of Clinical pho tograph Twist Twist drill craniotomy craniotomy Inv - CT Pos t procedure evidence of Clin Clin ical photog raph

45000

Subdural taping taping Inv - CT Pos t procedure evidence of Clinica Clinica l photog raph

15000

Ventricular Ventricular tapping Inv - CT Pos t procedure evidence of Clin Clin ical photog raph

15000

Abscess tapping Inv - CT CT Pos t procedure evidence of Clinica Clinica l photog raph

20000

Vascular malformations malformations Inv - MRI,Ang MRI,Ang io Post proced ure evidence eviden ce of Clin Clinical ical photo ph oto graph

40000

Peritoneal Peritoneal shunt Inv - CT Post p rocedure evidence of Clinica Clinica l photog raph

20000

Atrial Atrial shunt Inv - CT Post procedu re evidence evidence o f Clin Clin ical p hotog raph raph

20000

Meningoencephalocele Meningoencephalocele Inv - M RI Post procedure evidence of Clin Clin ical photog raph Meningomylocel Meningomylocelee Inv - MRI Post procedure evidence of Clin Clin ical photog raph

25000

451

452

453

454

455

456

457

458

459 460

~ 91 ~

40000

50000

20000

15000

25000



461

Specialty

Indicativ e Rate &

SYSTEM


Neurosurgery Neuros urgery Brain Tumours Neurosurgery Brain Tumours Neurosurgery Brain Tumours Neurosurgery Brain Tumours Neurosurgery Brain Tumours Neurosurgery Brain Tumours

C.S.F. Rhinorrhoea Inv -CT,Clinical -CT,Clinical pho tograph Post p rocedure rocedure evidence o f Clinical Clinical phot ograph Cranioplasty Inv - MRI Pos Pos t procedure ev idence of Clinica Clinica l photog raph Meningocele excision excision Inv - MRI Post p rocedure rocedure evidence of Clin Clin ical photog raph Ventriculoatrial Ventriculoatrial shun t Inv - CT Post procedure evidence of Clin Clin ical photog raph Excisi Excision on of Brain Abscess - Inv -CT Post proced ure evidence eviden ce of Clin Clinical ical photo ph oto graph Aneurysm Clipping Clipping Inv -MRI,Angio Post proced ure evidence eviden ce of Clin Clinical ical photo ph oto grap h, X-Ray

Neurosurgery Brain Tumours Neurosurgery Neuros urgery Spinal Surgeries

External Ventricular Drainage (EVD) Inv - CT Post p rocedure rocedure evidence o f Clinical Clinical phot ograph Surgery Surgery on co rd tumours tumours Inv - MRI Post proced ure evidence eviden ce of Clin Clinical ical ph oto graph /Biops /Biops y

40000

469

Neurosurgery Neuros urgery Spinal Surgeries

50000

470


Spinal Spinal intramedullary intramedullary tumours Inv -MRI Post proced ure evidence eviden ce of Clin Clinical ical photo ph oto graph/Xgraph /XRay/Biopsy Spina bifida surgery major Inv -MRI Post proced ure eviden ce of Clin Clinical ical pho tog raph/X-Ray

471


Spina Spina bifida surgery minor minor Inv - M RI Post proced ure evidence eviden ce of Clin Clinical ical photo ph oto graph/X-Ray graph /X-Ray

15000

472


Excisi Excision on of ce rvica rvica l intervertebral intervertebral discs Inv - MRI Post p rocedure rocedure evidence o f Clinical Clinical phot ograph

25000

473

Neurosurgery Neuros urgery Spinal Surgeries Neurosurgery Neuros urgery Spinal Surgeries Neurosurgery Neuros urgery Spinal Surgeries

Posterior Posterior cervica cervica l discecto discecto my Inv - M RI Post proced ure evidence eviden ce of Clin Clinical ical photo ph oto graph Anterior cervical cervical discectomy discectomy Inv - M RI Post proced ure evidence eviden ce of Clin Clinical ical photo ph oto graph Anterior cervical cervical spine s urgery with with fus ion Inv MRI, X-Ray X-Ray Cervical ervical s pine Post procedu re evidence of X-Ray X-Ray

15000

476


Anterolateral decompress decompress ion Inv Inv -MRI Post proced ure evidence eviden ce of Clin Clinical ical photo ph oto graph/X-Ray graph /X-Ray

30000

477

Neurosurgery Neuros urgery Spinal Surgeries Neurosurgery Neuros urgery Spinal Surgeries Neurosurgery Neuros urgery Spinal Surgeries

La minectomy minectomy Inv - M RI Pos Pos t procedure evidence of Clinica Clinica l photo graph/X-Ray graph/X-Ray Discecto Discecto my Inv - MRI Post proced ure evidence of Clin Clin ical pho tograph/X-R tograph/X-Ray Spinal Spinal fus ion procedure Inv - MRI Post p rocedure rocedure evidence of Clin Clin ical photo graph/Biopsy graph/Biopsy

25000

Neurosurgery - Other Surgical Surgical Procedures Neurosurgery - Other Surgical Surgical Procedures

Stereotactic Stereotactic procedu procedu res - Post procedure evidence evidence of Clinica Clinica l photog raph Trans sphenoidal su rgery Inv Inv - CT Post proced ure evidence of Clin Clin ical photo graph/Biopsy graph/Biopsy

20000

Neurosurgery - Other Surgical Surgical Procedures

Trans oral su rgery Inv Inv - CT Pos t procedure evidence of Clin Clin ical photo graph/Biopsy graph/Biopsy

25000

462 463 464 465 466

467 468

474 475

478 479

480 481

482

~ 92 ~

30000 25000 20000 60000 100000

25000

20000

15000 45000

25000 50000

20000



483

484

485 486

Specialty

Indicativ e Rate &

SYSTEM

Neurosurgery Neuros urgery - Other Surgical Surgical Procedures

Co mbined trans oral surgery and CV Junct ion fusion Inv - MRI,X-Ray MRI,X-Ray cerv ical spine Post proced ure evidence eviden ce of Clin Clinical ical photo ph oto grap h Neurosurgery - Other C.V. Junct ion fusion Inv - MRI,X-Ray MRI,X-Ray cerv ical Surgical Surgical Procedures spine Post procedure evidence of Clinical Clinical pho tograph Neurosurgery Brain Endos copy procedures procedures Inv - MRI Post procedure evidence of Endos Endos copy picture Neurosurgery Brain De-co De-co mpress ive Cran Cran iotomy(Non iotomy(Non Traumatic) Traumatic) Inv - Post procedu re evidence of Clin Clin ical photog raph raph

487

Neurosurgery Brain

488

Neurosurgery Brain

489

Neurosurgery Spine Spine

490


491


492


493


494

Neurosurgery - Soft Tissue and Vascular Injuries Neurosurgery - Soft Tissue and Vascular Injuries


20000

65000 50000

Intra-Cerebral Intra-Cerebral Hematoma Hematoma evacuation Inv - M RI Post p rocedure rocedure evidence o f Clinical Clinical phot ograph Endos copic Third Third Ventriculostomy - Post proced ure evidence eviden ce of Clin Clinical ical photo ph oto graph

60000

Anterior discectomy & bone grafting grafting Inv - M RI Post procedure evidence of X-Ray Discecto Discecto my with with Implants Implants Inv -MRI Post proced ure evidence eviden ce of X-Ray Corpectomy for Spinal Spinal Fixat Fixat ion Inv - M RI Post proced ure evidence eviden ce of X-Ray Spinal Spinal Fixat Fixat ion Rods and Plates, Plates, Artifici Artificiaa l d iscs Inv -MRI Post procedure procedure evidence of X-Ray Syringo Syringo myelia Inv -MRI Post procedure evidence of Clinica Clinica l photog raph Repair of Brachial ple ple xus injury injury Inv - M RI Post proced ure eviden ce of Clin Clinical ical pho tog raph

40000

Cervical Sy mpathecto my Inv -EMG,Nerve -EMG,Nerve condu ction ction MRI Post p rocedure rocedure evidence o f Clin Clin ical p hotog raph raph

50000

Neurosurgery - Soft Tissue and Vascular Injuries Neurosurgery - Soft Tissue and Vascular Injuries Neurosurgery - Soft Tissue and Vascular Injuries Neurosurgery - Soft Tissue and Vascular Injuries Neurosurgery Ep ileps ileps y Surgery Surgery

Lu mbar sy mpathecto my Inv - EMG,Nerve condu ction ction M RI Color dopp ler Post p rocedure evidence of Clin Clin ical photo graph/Biopsy graph/Biopsy Decompress Decompress ion/Excision ion/Excision of Optic Optic nerve lesions Inv - M RI Pos t procedu re evidence of Clinical Clinical pho tograph Peripheral nerve injury repair Inv -EMG,Nerve condu ction ction Post procedure evidence evidence of Clin Clin ical pho tograph Propto Propto sis Inv - MRI Post procedure evidence of Clin Clin ical p hotog raph raph

50000

Temporal Lobectomy Inv - MRI,Video EEG, Psychologic assessment assessment Post procedure evidence evidence of Clinica Clinica l photog raph

90000

501

Neurosurgery Ep ileps ileps y Surgery

Lesionectomy type 1 Inv -MRI,Video EEG, Psychologic assessment assessment Post procedure evidence evidence of Clinica Clinica l photog raph

150000

502

Neurosurgery Ep ileps ileps y Surgery Surgery

Lesionectomy type 2 Inv -MRI,Video EEG, Psychologic assessment assessment Post procedure evidence evidence of Clinica Clinica l photo graph

150000

495

496

497

498

499

500

~ 93 ~

30000

65000 70000 85000 65000 60000

65000

50000

60000



Specialty

Indicativ e Rate &

SYSTEM


503

Neurosurgery Neuros urgery Ep ileps ileps y Surgery Surgery

Tempora Tempora l lobectomy lobectomy plus Depth Electrodes Electrodes Inv MRI,Video MRI,Video EEG, EEG, Psychologic ass essment Post proced ure evidence eviden ce of Clin Clinical ical photo ph oto graph/X-Ray graph /X-Ray

504

Neurosurgery Trige Trige minal minal Neura Neura lgia lgia

30000

505

Neurosurgery Trige Trige minal minal Neura Neura lgia lgia

506

Neurosurgery Management of Aneurysms Neurosurgery Management of Aneurysms Surgical Surgical Oncology Head and neck

Radiofrequency ablation ablation Inv - EM G,Nerve G,Nerve condu ction ction Post procedure procedure ev idence of Clinica Clinica l pho tograph Micro Micro v ascu lar decompress decompress ion Inv - EM G,Nerve G,Nerve condu ction ction Post procedure procedure ev idence of Clinica Clinica l pho tograph Embo Embo lizat lizat ion Inv - M RI,Angiogram Post proced ure evidence eviden ce of Clin Clinical ical photo ph oto graph Cos t of each coil Inv - M RI,Angiogra RI,Angiogra m Post proced ure evidence eviden ce of Clin Clinical ical photo ph oto graph

30000

Co mpos ite resection resection & Reconst ruction ruction Inv Clin Clin ical photo graph, X-Ray,USG,Bi X-Ray,USG,Biops ops y Post proced ure evidence eviden ce of Clin Clinical ical photo ph oto graph, graph , Biopsy Wide e xcision cision Inv - Clin Clin ical phot ograph, XRay,USG,Biops ay,USG,Biops y Pos t procedure evidence o f Clin Clin ical photo graph, Biops Biops y Nech diss ection any ty pe Inv - Clin Clin ical pho tograph, X-Ray, X-Ray, USG,Biops y Post proced ure evidence of Clin Clin ical photog raph, Biopsy Biopsy Hemigloss Hemigloss ectomy ectomy Inv - Clinical photo graph, XRay,USG,Biops ay,USG,Biops y Pos t p rocedure rocedure evidence o f Clin Clin ical photo graph, Biops Biops y Maxillectomy Maxillectomy any typ e Inv - Clinica linica l photograph, X-Ray,USG,Biopsy X-Ray,USG,Biopsy Post Post procedure evidence of Clin Clin ical photo graph, Biops Biops y Thyroidectomy Thyroidectomy any type Inv - Clinical pho tograph, X-Ray, X-Ray, USG,Biops y Post proced ure evidence of Clin Clin ical photog raph, Biopsy Biopsy Parotidectom Parotidectomy y any type Inv - Clin Clin ical photo graph, X-Ray,USG,Biopsy X-Ray,USG,Biopsy Post Post procedure procedure evidence of Clin Clin ical photo graph, Biops Biops y La ryngectomy any ty pe Inv - Clinical Clinical photo graph, X-Ray,USG,Biopsy X-Ray,USG,Biopsy Post Post procedure procedure evidence o f Clin Clin ical photo graph, Biops Biops y La ryngo p haryngo oesophagectomy oesophagectomy Inv - Clinical pho tograph, X-Ray, X-Ray, USG,Biops y Post proced ure evidence of Clin Clin ical photog raph, Biopsy Biopsy

60000

Hemimandibulectomy Hemimandibulectomy Inv - Clinical Clinical ph otograph, X-Ray,USG,Biopsy X-Ray,USG,Biopsy Post Post procedure procedure evidence of Clin Clin ical photo graph, Biops Biops y Orbital Orbital exenteration Inv - CT Pos t procedure evidence of Clin Clin ical photog raph, Biops Biops y

25000

Maxillectomy + Orbital exenteration Inv - CT Post proced ure evidence eviden ce of Clin Clinical ical photo ph oto graph, graph , Biopsy

35000

507

508

509

Surgical Surgical Oncology Oncology Head and neck

510


511

Surgical Surgical Oncology Head and neck

512


513


514


515


516


517


518

Surgical Surgical Oncology Oncology Ca.Eye/ Maxilla /Para Nasal Sinus Surgical Surgical Oncology Oncology Ca.Eye/ Maxilla /Para Nasal Sinus

519

~ 94 ~

60000

50000

25000

25000

15000

25000

20000

20000

40000

75000

25000



520

521

522

523 524

Specialty

Surgical Surgical Oncology Oncology Ca.Eye/ Maxilla /Para Nasal Sinus Surgical Surgical Oncology Oncology Ca.Eye/ Maxilla /Para Nasal Sinus Surgical Surgical Oncology Nasopha Naso pharynx rynx Surgical Surgical Oncology Oncology Ca.Soft Palate Surgical Surgical Oncology Oncology Ca.ear

525

Surgical Surgical Oncology Oncology Ca.ear

526


527


528

Surgical Oncology

529

Surgical Surgical Oncology Oncology Ca.Thyroid

530

Surgical Surgical Oncology Oncology Ca Trachea

531

Surgical Surgical Oncology Oncology Ca Trachea

532

Surgical Surgical Oncology Oncology Ca Parathyroid

533

Surgical Surgical Oncology Oncology Ca GIT

534

Surgical Surgical Oncology Oncology Ca GIT Surgical Surgical Oncology Ca GIT Surgical Surgical Oncology Oncology Ca Rectu Rectu m

535 536

537

Surgical Surgical Oncology Oncology Ca Rectu Rectu m

538

Surgical Surgical Oncology Oncology Ca Rectu Rectu m

~ 95 ~

Indicativ e Rate &

SYSTEM

Maxillectomy Maxillectomy + In frate frate mporal Fos sa clearance clearance Inv - CT Post procedure evidence of Clinical pho tograph, Biops Biops y Cranio Facial Resection Inv - CT,M RI Pos t proced ure evidence eviden ce of Clin Clinical ical photo ph oto graph, graph , Biopsy Resection o f Naso Naso pharyngeal Tu Tu mour Inv CT,MRI Post procedure evidence of Clin Clin ical pho tograph, Biops Biops y Palatectomy Palatectomy Any ty pe Inv - CT Post procedure procedure evidence of Clin Clin ical photog raph, Biops Biops y Sleeve Resection Inv - CT Post procedure evidence of Clin Clin ical photog raph, Biopsy Biopsy Lateral Temporal bone resection Inv - CT,MRI Post p rocedure rocedure evidence o f Clinical Clinical phot ograph, Biopsy Subtotal Tempora Tempora l bone resect ion Inv - CT,MRI Post p rocedure rocedure evidence o f Clinical Clinical phot ograph, Biopsy Total Temporal Temporal bo ne resection Inv - CT,MRI CT,MRI Pos t proced ure evidence eviden ce of Clin Clinical ical photo graph , Biopsy Submandibula r Gland Gland Excision Excision Inv - Clinica Clinicall pho tograph, FNAC Post p rocedu re evidence o f Clin Clin ical photo graph, Biops Biops y Tracheal Resection Resection Inv - CT,Brochscopy Post proced ure evidenc e of Clin Clinical ical photo ph oto graph , Biopsy Sternotomy + Superior Mediastinal Dissection Inv - CT Post procedure evidence of Clinical pho tograph, Biops Biops y Tracheal Resection Resection Inv - CT,Brochoscopy Post proced ure evidence eviden ce of Clin Clinical ical photo ph oto graph, graph , Biopsy Parathyroidectomy Inv - CT,Nuclear scan, S.PTH Post p rocedure rocedure evidence o f Clinical Clinical phot ograph, Biopsy Small bowel resection Inv - CT,Barium follow through Post procedure procedure evidence o f Clinical Clinical pho tograph, Biops Biops y Closure of Ileostomy Ileostomy Inv Inv - Colonos Colonos copy Post proced ure evidence eviden ce of Clin Clinical ical photo ph oto graph Closure of Co Co lostomy Inv -Colonoscopy Post proced ure evidence eviden ce of Clin Clinical ical photo ph oto graph Abdomino Perineal Resection (APR) + Sacrectomy Sacrectomy Inv - CT,BMFT,Co CT,BMFT,Co lonoscopy,Biops lonoscopy,Biops y Post p rocedure rocedure evidence o f Clinical Clinical ph otog raph, raph, Biopsy Posterior Exenteration Inv CT,BMFT,Colonos T,BMFT,Colonos copy,Biopsy copy,Biopsy Post procedure evidence of Clin Clin ical photog raph, Biopsy Biopsy Total Exenteration Inv CT,BMFT,Colonos T,BMFT,Colonos copy,Biopsy copy,Biopsy Post procedure evidence of Clin Clin ical photog raph, Biopsy Biopsy


70000

50000

30000 25000 30000

50000

60000

20000

52000

45000

40000

30000

40000

20000 20000 50000

50000

75000



Specialty

539


540


541


542


543


544


545


546


547

Surgical Surgical Oncology Oncology Ca Gall Bladder

548

Surgical Surgical Oncology Oncology Ca Spleen Surgical Surgical Oncology Oncology Ca Retroperitoneal Tumors Surgical Surgical Oncology Oncology Ca Abdominal wall tumour Surgical Surgical Oncology Oncology Ca Abdominal wall tumour Surgical Surgical Oncology Oncology Gynec

549

550

551

552

553 554

Surgical Surgical Oncology Oncology Gynec Surgical Surgical Oncology Oncology Gynec

555

Surgical Surgical Oncology Oncology Gynec

556

Surgical Surgical Oncology Oncology Ca Cervix

~ 96 ~

Indicativ e Rate &

SYSTEM

Oesophagectomy any type Inv USG,CTBiopsy,Endoscopy USG,CTBiopsy,Endoscopy Post procedure evidence of Clin Clin ical photo graph, Biops Biops y/USG Gastrectomy Gastrectomy any t ype Inv USG,CTBiopsy,Endoscopy USG,CTBiopsy,Endoscopy Post procedure evidence of Clin Clin ical photo graph, Biops Biops y/USG Colectomy any ty pe Inv USG,CTBiopsy,Endoscopy USG,CTBiopsy,Endoscopy Post procedure evidence of Clin Clin ical photo graph, Biops Biops y/USG Anterior resection resection Inv USG,CTBiopsy,Endoscopy USG,CTBiopsy,Endoscopy Post procedure evidence of Clin Clin ical photo graph, Biops Biops y/USG Abdominoperineal resection Inv USG,CTBiopsy,Endoscopy USG,CTBiopsy,Endoscopy Post procedure evidence of Clinical pho tograph, Biops Biops y/USG Whipples any type Inv USG,CTBiopsy,Endoscopy USG,CTBiopsy,Endoscopy Post procedure evidence of Clin Clin ical photo graph, Biops Biops y/USG Tripple Tripple bypass Inv -USG,CTBi -USG,CTBiops ops y,Endos y,Endos copy Post p rocedure rocedure evidence of Clin Clin ical photog raph, raph, Biopsy/USG Other Bypasses-Pancreas Bypasses-Pancreas Inv USG,CTBiopsy,Endoscopy USG,CTBiopsy,Endoscopy Post procedure evidence of Clin Clin ical photo graph, Biops Biops y/USG Radical Cholecystect omy omy Inv -CT Pos Pos t procedu re evidence of Clin Clin ical photog raph, Biopsy Biopsy Splenectomy Splenectomy Inv - CT Pos t procedure evidence of Clin Clin ical photo graph, Biops Biops y Resection o f Retroperitoneal Retroperitoneal Tumours Inv CT,FNAC Post procedure evidence of Clinical pho tograph, Biops Biops y Abdominal wall tumour Resection Inv CT,FNAC Post procedure evidence of Clinical pho tograph, Biop Biopsy sy Resection with with reconstruction Inv - CT,FNAC CT,FNAC Post p rocedure rocedure evidence o f Clinical Clinical phot ograph, Biopsy Bilateral pelvic lymph Node Dissection(BPLND) Inv - CT Post procedure evidence of Clinical pho tograph, Biops Biops y Radical Trachelectomy Trachelectomy Inv - CT Pos t procedu re evidence of Clin Clin ical photog raph, Biopsy Biopsy Radical vaginectomy vaginectomy Inv - CT,Biopsy Pos t proced ure evidenc e of Clin Clinical ical photo ph oto graph , Biopsy Radical vaginectomy + Reconstruction Inv CT,Biopsy Post procedure evidence of Clinica linica l pho tograph, Biops Biops y Radical Hysterectomy +Bilateral Pelvic Lymph Node Diss ection ection (BPL (BP LND) + Bilatera Bilatera l Salpingo Ophorectomy Ophorectomy (BSO) / Ovarian Ovarian transpos ition ition Inv PAP Smear, Biops Biops y, CT CT Post procedure evidence of Clinica Clinica l photo graph, Biops Biops y


40000

40000

50000

40000

75000

25000

25000

60000

35000 45000

35000

45000

25000

40000 40000

45000

45000



Specialty

Indicativ e Rate &

SYSTEM

557


558


559


560


561

Surgical Surgical Oncology Oncology Ca Endo Endo metriu etriu m

562

Surgical Surgical Oncology Oncology Soft tiss tiss ue /Bone tumours . Chest wall Surgical Surgical Oncology Oncology Soft tiss tiss ue /Bone tumours . Chest wall

Ches t wall resection Inv - CT Ches t, Bone Bone s can Post p rocedure rocedure evidence o f Clinical Clinical phot ograph, Biopsy Ches t wall resection + Recons truction truction Inv - CT CT Ches t, Bone Bone scan Post procedure evidence of Clin Clin ical photo graph, Biops Biops y

20000

564

Surgical Surgical Oncology Oncology Limb Salvage Surgery

Without prosthesis Inv - CT Local part, CT Chest, MRI, Bone scan Post procedure ev idence of Clin Clin ical photo graph, Biops Biops y

40000

565

Surgical Surgical Oncology Oncology Limb Salvage Surgery Surgical Surgical Oncology Oncology Limb Salvage Surgery Surgical Surgical Oncology Oncology Limb Salvage Surgery Surgical Surgical Oncology Oncology Limb Salvage Surgery Surgical Surgical Oncology Oncology Limb Salvage Surgery

With Custom made made Pros thesis Inv - CT Local part, CT Chest, MRI, Bone Bone scan Post procedure evidence of Clin Clin ical photog raph, Biopsy Biopsy With Modular Prosthesis Inv - CT Local part, CT Ches t, MRI, MRI, Bone scan Post procedure evidence of Clinica Clinica l photo graph, Biops Biops y Forequarter a mputation Inv - CT Chest Pos t proced ure evidence eviden ce of Clin Clin ical pho tog raph/X-R raph/ X-Ray ay Biopsy Hemipelvectomy Inv - CT,MRI Pelvis, CT Chest Post procedure procedure evidence of Clin Clin ical pho tograph/X-Ray tograph/X-Ray Biops Biops y Internal hemipelvectomy Inv - CT,MRI Pelvis, CT Ches t Pos t procedure evidence o f Clinical Clinical pho tograph/X-Ray tograph/X-Ray Biops Biops y

50000

Surgical Surgical Oncology Oncology Limb Salvage Surgery Surgical Surgical Oncology Oncology Limb Salvage Surgery Surgical Surgical Oncology Oncology Limb Salvage Surgery Surgical Surgical Oncology Oncology Limb Salvage Surgery

Curettage & bone cement Inv - CT,M CT,M RI Post Post proced ure evidence eviden ce of Clin Clinical ical photo ph oto graph/X-Ray graph /X-Ray Biopsy Bone resection Inv - CT,MRI CT,MRI Post procedure evidence of Clin Clin ical photo graph/X-Ray graph/X-Ray Biopsy

30000

Shoulder girdle girdle resection Inv - CT,MRI,Bone scan Post procedure procedure evidence of Clin Clin ical pho tograph/X-Ray tograph/X-Ray Biops Biops y Sacral Sacral resection Inv - CT,MRI Post p rocedure evidence of Clin Clin ical photo graph/X-Ray graph/X-Ray Biopsy

40000

563

566

567

568

569

570

571

572

573

~ 97 ~

Anterior Exenteration Inv - PAP Smear, Biopsy, CT Post procedure evidence of Clinical pho tograph, Biops Biops y Posterior Exenteration Inv -PAP Smear, Biopsy, CT Post proced ure eviden ce of Clin Clin ical pho tograph, Biops Biops y Total Pelvic Exenteration Inv - PAP Smear, Biopsy, CT Pos Pos t procedu re evidence of Clin Clin ical pho tograph, Biops Biops y Supra Levator Exenteration Inv -PAP Smear, Biopsy, CT CT Post procedure evidence evidence of Clinica Clinica l pho tograph, tograph , Biops Biops y Total Abdo minal ina l Hysterectomy(TA Hyst erectomy(TA H) + Bilatera Bilatera l Salpingo Salpingo o phorectomy (BSO) + Bilateral Bilateral pelvic lymph Node Dissection (BPLND) + Omentectomy Inv - Endometrial Endometrial Biopsy, CT Post Post procedure evidence of Clin Clin ical photo graph, Biops Biops y


50000

75000

70000

35000

30000

75000

40000

55000

65000

30000

60000



Specialty

574

Surgical Surgical Oncology Oncology Genitourinary

575


576


577

Surgical Surgical Oncology Oncology Genitourinary Surgical Surgical Oncology Oncology Genitourinary

578

579


580


581


582


583


584


585


586

Surgical Surgical Oncology Oncology Testis Cancer

587

Surgical Surgical Oncology Oncology Testis Cancer

588

Surgical Surgical Oncology Oncology Testis Cancer Surgical Surgical Oncology Oncology Testis Cancer

589

590

Surgical Surgical Oncology Oncology Ca Urinary Bladder

591

Surgical Surgical Oncology Ca Urinary Bladder

~ 98 ~

Indicativ e Rate &

SYSTEM

Partial Nephrectomy Inv - CT,Isotope renogram Post p rocedure rocedure evidence o f Clinical Clinical phot ograph, Biopsy Nephroureterecto Nephrou reterectom my for Trans itiona itionall Cell Carcinima of renal pe lvis lvis Inv - CT Post p rocedure evidence of Clin Clin ical photog raph, Biopsy Biopsy


50000

Radical nephrectomy Inv USG,KUB,IVP USG,KUB,IVP,CT,Bi ,CT,Biops ops y Post procedure evidence of Clin Clin ical photo graph, Biops Biops y/USG Emascu Emascu lation lation Inv - USG,,Biops USG,,Biops y Post procedure evidence of Clin Clin ical phot ograph, Biops Biops y/USG Radical cys tectomy Inv USG,KUB,IVP USG,KUB,IVP,CT,Bi ,CT,Biops ops y Post procedure evidence of Clin Clin ical photo graph, Biops Biops y/USG Other cystectomies Inv USG,KUB,IVP USG,KUB,IVP,CT,Bi ,CT,Biops ops y Post procedure evidence of Clin Clin ical photo graph, Biops Biops y/USG Total penectomy Inv -Clinical Photograph Post proced ure evidence eviden ce of Clin Clinical ical photo ph oto graph, graph , Biopsy/USG Partial penectomy Inv - Clinical Photograph Post proced ure evidence eviden ce of Clin Clinical ical photo ph oto graph, graph , Biopsy/USG Inguinal block block d issection o ne side Inv - Clinica Clinica l Photograph Biopsy Post Post procedure procedure evidence o f Clin Clin ical pho tograph, Biopsy/ USG USG Radical prostatect omy omy Inv - USG,KUB,CT USG,KUB,CT Pos t proced ure evidence eviden ce of Clin Clinical ical photo ph oto graph, graph , Biopsy/USG High High orchidecto my Inv - USG,Biops USG,Biops y Post proced ure evidenc e of Clin Clinical ical photo ph oto graph, graph , Biopsy/USG Bilateral Bilateral orchidectomy Inv - U SG,Biops SG,Biops y Post proced ure evidence eviden ce of Clin Clinical ical photo ph oto graph, graph , Biopsy/USG Retro Peritoneal Lymph Node Dissection(RPLND) (for Residual Disease) Inv CT Chest, CT Abdomen pelvis, Tumour markers Post procedure procedure evidence of Clin Clin ical pho tograph,biopsy tograph,b iopsy Adrenalectomy Adrenalectomy Inv - CT,M RI,Urinary I,Urinary ho rmones rmones Post procedure evidence of Clin Clin ical pho tograph,biopsy tograph,b iopsy Urinary Urinary diversion Inv - Post p rocedure evidence of Clin Clin ical pho tograph,biopsy tograph,biopsy Retro Peritoneal Lymph Node Dissection RPLND as part of st aging Inv - CT Post procedure evidence of Clin Clin ical photo graph,biopsy graph,biopsy

40000

Anterior Exenteration Inv - Cystoscopy, Biopsy, CT Post procedure evidence of Clinical pho tograph, Biops Biops y Total Exenteration Inv - Cystoscopy, Biopsy, CT Post p rocedure rocedure evidence o f Clinical Clinical phot ograph, Biopsy

60000

30000 60000

40000

25000

15000

15000

60000

15000

10000

60000

45000

40000 20000

75000



592

593

594 595 596 597

598

599 600

601 602 603

Specialty

Indicativ e Rate &

SYSTEM

Surgical Surgical Oncology Oncology Ca Urinary Bladder

Bilateral pelvic lymph Node Dissection(BPLND) Inv - CT Post procedure evidence of Clinical pho tograph, Biops Biops y Surgical Surgical Oncology Oncology Mediastinal tumour tumour resection Inv - CT Post Thorax, Mediastinu m proced ure evidence eviden ce of Clin Clinical ical photo ph oto graph, graph , Biopsy Surgical Surgical Oncology Oncology Lung metastatectomy . Solitary Inv - CT Post Lung proced ure evidence eviden ce of X-Ray , Biops y Surgical Surgical Oncology Oncology Lung metastatectomy . Multiple Inv - CT Post Lung proced ure evidence eviden ce of X-Ray , Biops y Surgical Surgical Oncology Oncology Sleeve Sleeve resection o f Lung cancer.Inv cancer.Inv - CT Post Lung proced ure evidence eviden ce of X-Ray , Biops y Surgical Surgical Oncology Oncology Oesophagectomy with with Two f ield Oesophagus Ly mphaden ectomy Inv Inv - UGI, Endos copy, Biopsy, CT Pos Pos t procedu re evidence of Clin Clin ical pho tograph, Biops Biops y Surgical Surgical Oncology Oncology Oesophagectomy with Three field Oesophagus Ly mphaden ectomy Inv Inv - UGI, Endos copy, Biopsy, CT Pos Pos t procedu re evidence of Clin Clin ical pho tograph, Biops Biops y Surgical Surgical Oncology Oncology Tracheostomy Tracheostomy Inv - Clinica Clinica l Photog raph Post Post Palliative Palliative Surgeries Surgeries proced ure evidence eviden ce of Clin Clinical ical photo ph oto graph Surgical Surgical Oncology Oncology Substernal bypass Inv - Clinical Photo Photo graph Post Palliative Palliative Surgeries Surgeries proced ure evidence eviden ce of Clin Clinical ical photo ph oto graph, graph , Biopsy Surgical Surgical Oncology Oncology Gastrostomy Gastrostomy Inv - Clinical Clinical Photograph Post Palliative Palliative Surgeries Surgeries proced ure eviden ce of Clin Clinical ical pho tog raph Surgical Surgical Oncology Oncology Jejunos Jejunos tomy tomy Inv - Clinica Clinica l Photograph Post Palliative Palliative Surgeries Surgeries proced ure evidence eviden ce of Clin Clinical ical photo ph oto graph Surgical Surgical Oncology Oncology Ileos Ileos tomy Inv Inv - Clinica Clinica l Photog raph Post Post Palliative Palliative Surgeries Surgeries proced ure evidence eviden ce of Clin Clinical ical photo ph oto graph


50000

50000 60000 90000 90000

100000

5000 35000

20000 20000 20000

604

Surgical Surgical Oncology Oncology Palliative Palliative Surgeries Surgeries

Colostomy Inv - Clinica linica l Photograph Post Post proced ure evidence eviden ce of Clin Clinical ical photo ph oto graph

20000

605


Suprapubic Cys Cys tostomy Inv Inv - Clin Clin ical Photog Photog raph Post p rocedure rocedure evidence o f Clinical Clinical phot ograph

10000

606


3000

607


608


609

Surgical Surgical Oncology Oncology Reconstruction

610

Surgical Surgical Oncology Oncology Reconstruction

611

Surgical Surgical Oncology Oncology Gynecology

Intercostal Drainage(ICD) Inv - Clinical Photograph Post Post procedure evidence of Clin Clin ical pho tograph Gastro Jejunos Jejunos tomy tomy Inv - Clinical Phot ograph Post proced ure evidence eviden ce of Clin Clinical ical photo ph oto graph, graph , Biopsy Ileotransverse Colostomy Inv - Clinical Photograph Post Post procedure evidence of Clin Clin ical pho tograph, tograph , Biops Biops y Myocutaneous / cutaneous cutaneous flap flap Inv -Clinical Photograph Post Post procedure evidence evidence of Clinica Clinica l pho tograph Micro Micro v ascu lar recons recons truction Inv - Clinical Clinical Photograph Post Post p rocedure rocedure evidence of Clinical Clinical pho tograph Hysterectomy Hysterectomy Inv - USG/ USG/ CT, Biopsy /Endoscopy /Endoscopy Post procedure procedure evidence of Clin Clin ical pho tograph,Biopsy /USG

~ 99 ~

35000

50000

25000

45000

25000



Specialty

612


613


614


615


616


617

Surgical Surgical Oncology Oncology Breast

618


619


620


621


622


623

Surgical Surgical Oncology Oncology Skin Skin Tu mours

624


625


626

Surgical Surgical Oncology Oncology Soft tiss tiss ue /Bone tumours . Surgical Surgical Oncology Oncology Soft tiss tiss ue /Bone tumours . Surgical Surgical Oncology Oncology Soft tiss tiss ue /Bone tumours . Surgical Surgical Oncology Oncology Lung

627

628

629

~ 100 ~

Indicativ e Rate &

SYSTEM

Radical Hys terectomy terectomy Inv - USG/CT /Endos /Endos copy, Biopsy Post Post procedure evidence of Clinical pho tograph,Biopsy /USG Surgery Surgery for ca Ovary Ovary ea rly rly s tage Inv - USG/ USG/ CT /Endos /Endos copy, Biopsy Biopsy Post p rocedure rocedure evidence o f Clin Clin ical phot ograph,Bi ograph,Biops ops y/USG Surgery Surgery for ca Ovary Advan ce stage Inv Inv USG/ USG/ CT / Endos copy, Biopsy Biopsy Post procedure procedure evidence of Clin Clin ical photo graph,Biopsy/USG graph,Biopsy/USG Vu lvectomy lvectomy Inv - USG/CT USG/CT / Endos copy, Biopsy Biopsy Post procedure procedure evidence of Clin Clin ical pho tograph,Biopsy /USG Salpino Salpino oop horectomy Inv Inv - USG/CT /Endos copy, Biopsy Post Post procedure evidence of Clinical pho tograph,Biopsy /USG Mastectomy any typ e Inv - Clin Clin ical photog raph, raph, Mammography, Mammography, Biopsy Post Post procedure evidence evidence of Clinica Clinica l photo graph,Biopsy graph,Biopsy Axillary Axillary diss ection Inv - Clinical photo graph, Biopsy Post procedure procedure evidence of Clinical Clinical pho tograph,Biops y Wide excision excision Inv - Clin Clin ical phot ograph, Biopsy Post procedure evidence evidence of Clinical Clinical pho tograph,Biopsy Lu mpectomy Inv - Clinical photog raph, Biopsy Biopsy Post procedure evidence of Clinical pho tograph,Biopsy Breast recons truction Inv - Clin Clin ical photog raph, raph, Biopsy Post procedure procedure evidence of Clinical Clinical pho tograph,Biopsy Ches t wall resection resection Inv -Clin -Clin ical photog raph, raph, Biopsy Post procedure procedure evidence of Clinica linica l pho tograph,Biopsy Skin tumours wide excision Inv - Clinical pho tograph, Biops Biops y Post Pos t procedure eviden ce of Clin Clin ical phot ograph,Bi ograph,Biops ops y Skin Skin tu mours wide wide e xcision xcision + Reconstruction Inv - Clinical Clinical photo graph, Biops Biops y Pos t procedure evidence of Clinical Clinical photog raph,Biopsy raph,Biopsy Skin Skin tu mours amputation amputation Inv - Clin Clin ical pho tograph, Biops Biops y Post Pos t procedu re evidence o f Clin Clin ical phot ograph,Bi ograph,Biops ops y Wide excision Inv - Clinical photograph, Biops Biops y Post procedure evidence evidence of Clinical Clinical pho tograph,Biopsy Wide e xc ision ision + reconstruction reconstruction Inv -Clinical -Clinical pho tograph, Biops Biops y Post p rocedure eviden ce of Clin Clin ical phot ograph,Bi ograph,Biops ops y Amputation Amputation Inv - Clinical photog raph, Biopsy Biopsy Post procedure evidence of Clinica Clinica l pho tograph,Biopsy Lung cancer pnumenectomy Inv - XRay/CT,Biops ay/CT,Biops y Pos t procedure evidence of Clinical photograph,Biopsy/X-Ray


25000

40000

15000

25000

25000

15000

5000

3000

25000

20000

10000

20000

20000

15000

25000

20000

50000

Signature & s tam tam p of Insurance Insurance Agency


Specialty

630

Surgical Surgical Oncology Oncology Lung

631

Surgical Surgical Oncology Oncology Lung

632

Surgical Surgical Oncology Oncology bronchoplural bron choplural fist fist ula

633


634


635

Surgical Surgical Oncology Oncology Ora Ora l cavity cavity

636


637


638


639

Medical Oncology Oncology Breast

640


641

Indicativ e Rate &

SYSTEM

Lung can cer Lobectomy Lobectomy Inv - X-Ray/CT,Biops X-Ray/CT,Biops y Post procedure procedure evidence of Clin Clin ical pho tograph,Biopsy /X-Ray /X-Ray Lung Cancer Decortication Inv - XRay/CT,Biops ay/CT,Biops y Pos t procedure evidence of Clinical photograph,Biopsy/X-Ray Surgical Surgical co rrect rrect ion of b ronchoplural fistula Thoracoplasty Inv - X- Ray/CT,Biops ay/CT,Biops y Post proced ure evidence eviden ce of Clin Clinical ical pho tograph,Biopsy /X-Ray /X-Ray Surgical Surgical co rrect rrect ion of b ronchoplural fistula . Myop lasty lasty Inv -X-Ray/C -X-Ray/CT, T, Biopsy Post p rocedure rocedure evidence of Clin Clin ical photo graph,Biopsy/X-R graph,Biopsy/X-Ray ay


50000

50000

50000

Surgical Surgical correction of bronchop lural lural fistu fistu la Trans plural BPF closu re Inv - X-Ray/CT, Biops y Post proced ure evidence eviden ce of Clin Clinical ical pho tograph,Biopsy /X-Ray /X-Ray Marginal Marginal Mandibulecto my Inv - Orthopantogram Post procedure procedure evidence of Clin Clin ical pho tograph,Biopsy Segmental Mandibulectomy Inv Orthop Orthop antogram/ antogram/ CT Post p rocedure evidence of Clin Clin ical phot ograph,Bi ograph,Biops ops y Total glos glos sectomy sectomy + Recons truction truction Inv CT,Biopsy Post procedure evidence of Clinica linica l pho tograph,Biopsy Full thickness Buccal mucosal resection & Recons truction Inv - Biopsy Post p rocedure rocedure evidence of Clin Clin ical photog raph,Biopsy raph,Biopsy Adriamycin/C Adriamycin/Cyc yc lophosphamide lophosphamide (AC) Inv Clin Clin ical photog raph, raph, Mammography, Mammography, Biopsy Post Post proced ure evidence eviden ce of Clin Clin ical pho tog raph 5- Flurouracil A-C (FAC) Inv - Clinical pho tograph, Mammography , Biop Biopsy sy Post Po st proced ure evidence eviden ce of Clin Clinical ical photo ph oto graph

50000


AC (A (A C Then T ) Inv Inv - Clinical linical phot ograph, Mammography, Mammography, Biopsy Post Post procedure evidence evidence of Clinica Clinica l photog raph

3000

642


9500

643


Paclita Paclita xe l Inv Inv - Clinical photograph, Mammography, Mammography, Biopsy Post Post procedure evidence evidence of Clinica Clinica l photog raph Cyclophos phamide phamide / Metho traxate traxate / 5Flurouracil 5Flurouracil (CM (CM F) Inv - Clinica Clinica l photog raph, Mammography, Mammography, Biopsy Post Post procedure evidence of Clinical pho tograph

644


Tamo Tamo xifen xifen Tabs Inv - Clin Clin ical photog raph, raph, Mammography, Mammography, Biopsy Post Post procedure evidence evidence of Clinica Clinica l photog raph

85 per month

645


Aromatase Aromatase inhibitors inhibitors Inv - Clinical photo graph, Mammography, Mammography, Biopsy Post Post procedure evidence evidence of Clinica Clinica l photog raph

835 per month

~ 101 ~

25000

25000

40000

50000

3000

3100

1500



Specialty

646

Medical Oncology Urinary Bladder

647

Medical Oncology Oncology Urinary Bladder

648

Medical Oncology Non sm s ma ll cell Lun Lung g cancer Medical OncologyOesophagu s Medical Oncology Oncology Stomach

649

650

Indicativ e Rate &

SYSTEM

Bladder cancer week week ly Cisplas Cisplas tin Inv USG,Biosy USG,Biosy Post procedure evidence o f Clinical Clinical pho tograph Meth otraxate Vinblastin Adriam Adria myc in Cyclophos phamide phamide (M VA C) Inv -USG/CT,Bios -USG/CT,Bios y Post p rocedure rocedure evidence o f Clinical Clinical phot ograph Cisplastin/Etoposide (IIIB) Inv - X-Ray/CT Scan,Biops Scan,Biops y Post procedure ev idence of Clinical Clinical pho tograph Cisplastin- 5FU Inv - Endoscopy/CT Scan, Biopsy Post p rocedure rocedure evidence o f Clinical Clinical ph otog raph raph


5000

7000

5000

5-FU Leucovorin (MCDONALD Regimen) Inv Endos copy/CT Scan, Biops Biops y Post procedure evidence of Clin Clin ical photog raph Month ly 5-FU 5-FU Inv - Endos copy/CT copy/CT Scan, Biops Biops y Post p rocedure rocedure evidence of Clin Clin ical photog raph raph

5000

651

Medical Oncology Oncology Colon Rectum

652

Medical Oncology Oncology Colon Rectum

5- Flurouracil-Oxaliplastin Leucovorin (Folfox) (Stage (Stage III only) Inv - Endos copy/CT copy/CT Scan, Biopsy Post p rocedure rocedure evidence o f Clinical Clinical phot ograph

10000

653

Medical Oncology Oncology Bone tumors/Osteosarcom a Medical Oncology Oncology Lumphoma, Hoggkin's

Cisplastin/Adriamycin Inv - X-Ray/CT Scan, Biopsy Post Post procedure evidence of Clinical pho tograph

20000

Adriamycin Bleomycin Vinblastin Dacarbazine (ABVD) (ABVD) Inv - Biops y Post procedure evidence of Clin Clin ical p hotog raph raph

4000

655

Medical Oncology Oncology Lu mpho ma NH L

3500

656

Medical Oncology Oncology Multiple Multiple Myelo ma

657


658

Medical Oncology Oncology Multiple Multiple Myelo ma Medical Oncology Oncology Wilm's Wilm's Tu mor

Cyclophosphamide Adriamycin Vincristin Prdnison Prdnison e (CHOP) (CHOP) Inv - Biopsy Pos t procedure evidence of Clin Clin ical photog raph Vincristin, Vincristin, Adriamyc Adriamyc in,Dexa in,Dexa methasone (VAD) (VAD) Inv - He matology Pos t procedure evidence evidence o f Clin Clin ical p hotog raph raph Thalido Thalido mide+D mide+Dee xamethas xamethas one(oral) one(oral) Inv Hematology Hematology Post procedure evidence of Clinical Clinical pho tograph Melphalan Melphalan Prednison Prednison e oral Inv Inv - Hematology Hematology Post proced ure evidence eviden ce of Clin Clinical ical photo ph oto graph SIOP/NWTS Regimen (Stages I III) Inv USG/ USG/ CT, Biopsy Post procedure procedure evidence of Clin Clin ical p hotog raph raph Cisplastin Adriam Adriamyc yc in Inv Inv - U SG/ SG/ CT,Biopsy Post proced ure evidence eviden ce of Clin Clinical ical photo ph oto graph

654

659

660

661

662

663

Medical Oncology Oncology Hepatoblastoma Hepatoblastoma Operable Medical Oncology Oncology Cervix Medical Oncology Oncology Childhoo Childhoo d B-Cell B-Cell Lymphomas Medical Oncology Oncology Neuroblastoma Neuroblas toma Stag Stagee I – III III

~ 102 ~

4000

4000

3000

1500 7000 per month 15000

Cervical cancer week ly Cisp Cisp lastin lastin Inv USG,Biopsy USG,Biopsy Post Post procedure procedure evidence of Cl inica inica l pho tograph Variabe Variabe regimen Inv - Hematology Hematology Pos t procedure evidence of Clin Clin ical photog raph

2000

up to 12000

Variabe regimen Inv - CT,Biopsy CT,Biopsy Post procedure evidence of Clin Clin ical photog raph

up to 10000



664

Specialty

Indicativ e Rate &

SYSTEM

Medical Oncology Retinoblastoma Medical Oncology Oncology Histocytosis

Carbo/Etopo arbo/Etopo side/Vincri side/Vincristin stin Inv - Biops y Post proced ure evidence eviden ce of Clin Clinical ical photo ph oto graph Variabe regimen Inv Inv - Hematology, Biopsy Pos t proced ure evidence eviden ce of Clin Clinical ical photo ph oto graph

666

Medical Oncology Oncology Rhabdomyosarcoma

667

Medical Oncology Ewing's Ewing's Sarco ma

Vincristin-Actinomycin-Cyclophosphamide (VA (VA CTC) Based Based chemo Inv -Biopsy -Biopsy Post proced ure evidence eviden ce of Clin Clinical ical photo ph oto graph Variabe regimen Inv - X-Ray/CT Scan, Biopsy Post p rocedure rocedure evidence o f Clinical Clinical phot ograph

668

Medical Oncology Oncology Acute My eloid eloid Leukemia Medical Oncology Oncology Acute My eloid eloid Leukemia Medical Oncology Oncology Acute My eloid eloid Leukemia Medical Oncology Oncology Acute Lymphatic Leukemia Medical Oncology Oncology Acute Lymphatic Leukemia Medical Oncology Oncology Acute Lymphatic Leukemia Medical Oncology For Unlisted regimen regimen

665

669

670

671

672

673

674

675

Medical Oncology Oncology Terminally ill

676

Medical Oncology Oncology Vu lval cancer

677

Medical Oncology Oncology Colo Rectal Cancer Stage 2 and 3

678


679

Medical Oncology Oncology Febrile Neutropenia FN High Risk 1

~ 103 ~

Upper ceiling (Rs.) 4000 up to 8000 p m 9000 per month up to 9000 per month

Induction phase Inv - Hematology Hematology Pos t procedure evidence of Clin Clin ical photo graph

up to 60000

Co mso lidation lidation phas e Inv - Hematology Hematology Post proced ure evidence eviden ce of Clin Clinical ical photo ph oto graph

up to 40000

Maintenance phase Inv - Hematology Hematology Pos t proced ure eviden ce of Clin Clinical ical pho tog raph

3000 per month

Induction 1st and 2 nd months Inv - Hematology Hematology Post p rocedure rocedure evidence o f Clinical Clinical phot ograph

up to 50000

Induction 3RD, 4TH, 5TH Inv - Hematology Post proced ure evidence eviden ce of Clin Clinical ical photo ph oto graph

up to 20000

Maintenance phase Inv - Hematology Hematology Pos t proced ure evidence eviden ce of Clin Clinical ical photo ph oto graph

3000 per month

Palliative Palliative Che motherapy Inv - US G/ CT,Biopsy Post p rocedure rocedure evidence o f Clinical Clinical phot ograph

up to 5000per cycle 3000 per month

Palliative Palliative and s upportive upportive therapy Inv USG/ USG/ CT, Biopsy Post procedure procedure evidence of Clin Clin ical p hotog raph raph Cisplastin/5-F Cisplastin/5-FU U Inv - Cl inica inica l Photo Photo graph, Biopsy Post p rocedure rocedure evidence o f Clinical Clinical phot ograph XELOX XELOX along w ith Adjuvant chemotherapy chemotherapy of AS-I Inv - CT Ab domen,pelvi domen,pelvis, s, T issue biopsy biopsy , pho tograph Post pro cedure evidenc e of USG/CT/Biopsy/Biochemical investigations Zoledronic Zoledronic acid along w ith Adjuvant Che motherapy of AS-I Inv - SIEP,Urine for Bence Jones protein, Skeltal survey, Bone marrow aspiration, Biopsy, S. Electrolytes, 2D ECHO Post proced ure evidence eviden ce of USG/CT/Biopsy/Biochemical investigations 1ST 1ST Line iv antibiotics A nd o ther su pportive pportive therapy ( third generation cep halosporin, halosporin, aminoglycoside etc.,) Inv - Blood C.S. Urine C.S., Ches t X-Ray, Tissue biopsy biopsy Post Post procedure evidence of USG/CT/Biopsy/Biochemi USG/CT/Biopsy/Biochemical cal investigations

5000

4000

3000

9000



Specialty

680

Medical Oncology Febrile Neutropenia FN High Risk 2

681

Medical Oncology Oncology Vaginal Vaginal cancer

682

Medical Oncology Oncology Ovary Medical Oncology Oncology Ovary Germ Cell Tumour Medical Oncology Oncology Gestational Trophoblast Ds. Low Risk Medical Oncology Oncology Gestational Trophoblast Ds. Low Risk Medical Oncology Gestational Trophoblast High Risk Medical Oncology Oncology Testis

683

684

685

686

Indicativ e Rate &

SYSTEM

2nd line iv iv antib iotics iotics and o ther supportive therapy(Carbapenem therapy(Carbapenems, s, Fourth generation cephalosporins cephalosporins , Piperacillin, Piperacillin, anti-fungal . a zo les etc.,) Inv - Blood C.S. Urine C.S., Chest X-Ray, Tiss Tiss ue biopsy Post Post procedure procedure evidence o f USG/ USG/ CT/Biops y/Biochemical y/Biochemical investigations Cisplastin/5-F Cisplastin/5-FU U Inv - Cl inica inica l photog raph, Biopsy Biopsy Post p rocedure rocedure evidence o f Clinical Clinical phot ograph


5000

Carboplastin/ Paclitaxel Inv - USG/CT,Biopsy Post p rocedure rocedure evidence o f Clinical Clinical phot ograph Bleomycin-Etoposide-Cisplastin (BEP) Inv USG/ USG/ CT, Biopsy Post procedure procedure evidence of Clin Clin ical p hotog raph raph Weekly Weekly Meth otrexate otrexate Inv - USG/CT,Biopsy USG/CT,Biopsy Post Post proced ure evidence eviden ce of Clin Clinical ical photo ph oto graph

10500

Actinomycin Actinomycin Inv - USG/ USG/ CT, Biopsy Pos t proced ure evidence eviden ce of Clin Clinical ical photo ph oto graph

3000

6000

8000

600

688

Medical Oncology Oncology Prostate

Etopo side - Metho trexate trexate -Actinomycin -Actinomycin / Cyclophos phamide phamide Avincristine (EMA- CO) Inv USG/ USG/ CT, Biopsy Post procedure procedure evidence of Clin Clin ical p hotog raph raph Bleomycin-Etoposide-Cisplastin (BEP) Inv USG,Biosy USG,Biosy Post procedure evidence o f Clinical Clinical pho tograph Hormonal Hormonal Therapy Inv - USG,Biosy Post proced ure evidence eviden ce of Clin Clinical ical photo ph oto graph

689

Radit Radit ion Oncology Cobalt 60 External Beam Radiotherapy

Radical Treat ment Inv - USG/CT/X-Ray,Biopy USG/CT/X-Ray,Biopy Post procedure procedure evidence of Clin Clin ical pho tograph,RT Treat Treat ment ch arts

20000

690

Radit Radit ion Oncology Cobalt60 External Beam Radiotherapy

Palliative Palliative Treatment Inv - USG/ USG/ CT/X-Ray,Biopy T/X-Ray,Biopy Post p rocedure rocedure evidence o f Clinical Clinical pho tograph,RT Treat Treat ment ch arts

10000

691

Radit Radit ion Oncology Cobalt 60 External Beam Radiotherapy

Adjuvant Treatment Treatment Inv -USG/ -USG/ CT/X-Ray,Biopy T/X-Ray,Biopy Post procedure procedure evidence of Clin Clin ical pho tograph,RT Treat Treat ment ch arts

15000

692

Radit Radit ion Oncology External Beam Radiotherapy (On Linear Linear A cclerator) Radit Radit ion Oncology External Beam Radiotherapy (On Linear Linear A cclerator) Radit Radit ion Oncology External Beam Radiotherapy (On Linear Linear A cclerator)

Radical Treat ment w ith photons Inv - USG/ USG/ CT/XRay,Biopy ay,Biopy Post procedure evidence of Clin Clin ical pho tograph,RT Treat Treat ment ch arts

50000

Palliative Palliative Treat Treat ment with ph otons Inv USG/ USG/ CT/X-Ray,Biopy Post procedure evidence evidence of Clinica Clinica l photo graph,RT graph,RT Treatment charts

20000

Adjuvant Treatment Treatment with pho tons/Electrons tons/Electrons Inv USG/ USG/ CT/X-Ray,Biopy Post procedure evidence of Clin Clin ical phot ograph,RT ograph,RT Treatment charts

35000

687

693

694

~ 104 ~

8000

3000 per month



695

696

697

698

699

700

701

702

Specialty

Radit Radit ion Oncology Brachytherapy Intracavity Radit Radit ion Oncology Brachytherapy Intracavity Radiat Radiat ion Oncology Brachytherapy Interstitial Radiat Radiat ion Oncology Brachytherapy Interstitial Radiat Radiat ion Oncology Specialized Radiat Radiat ion Therapy IMRT IMRT ( Intensity modulated radiotherapy) Radiat Radiat ion Oncology S Specialized Radiat Radiat ion Therapy 3DCRT(3-D conformational radiotherapy) Radiat Radiat ion Oncology Specialized Radiat Radiat ion Therapy SRS/SRT Radiat Radiat ion Oncology Specialized Radiat Radiat ion Therapy Rapid Rapid A x therapy

703

704

Radiat Radiat ion Oncology Specialized Radiat Radiat ion Therapy IMRT IMRT With IGRT Plas Plastic tic Surgery

705

Plastic Plastic Surgery Surgery

706


707


708


709


~ 105 ~

Indicativ e Rate &

SYSTEM

A) Intracavitary I. LDR per application Inv USG/ USG/ CT/X-Ray,Biopy Post procedure evidence of


A) Intracavitar Intracavitary y II. HDR per app licat licat ion Inv Inv USG/ USG/ CT/X-Ray,Biopy Post procedure evidence of

2500

B) Interstitial Inters titial I. LDR per app licat licat ion Inv Inv USG/ USG/ CT/X-Ray,Biopy Post procedure evidence o f

15000

B) Interstitial II. HD R one application application an d mu ltip ltip le dos e fractions fractions Inv -USG/CT/X-USG/CT/XRay,Biopy ay,Biopy Post procedure evidence of Clin Clin ical pho tograph, RT Treat Treat ment ch arts

25000

Up to 40 fractions fractions in 8 weeks Inv - CT w ith contrast, Biops Biops y, MRI Post Post procedure evidence o f USG/CT/Tumour marker/RT Treatment charts

100000

Up to 30 fractions fractions in 6 weeks Inv -CT w ith contrast, Biops Biops y, MRI Post Post procedure evidence o f USG/CT/Tumour marker/RT Treatment charts

75000

Up to 30 fractions in 6 weeks Inv - CT with contrast, con trast, Biops Biopsy, y, MRI MRI Post procedure evidence of USG/CT/Tumour marker/RT Treatment charts

75000

Up to 40 fractions fractions in 8 weeks Inv - CT w ith contrast, Biops Biops y, MRI MRI Post procedure evidence of USG/CT/Tumour marker/RT Treatment charts

150000

Up to 40 fractions fractions in 8 weeks Inv - CT w ith contrast, Biopsy, MRI MRI Post procedu re evidence of USG/CT/Tumour marker/RT Treatment charts

150000

Cleft lip lip Inv - Clinical Phoptog Phop tog raph Post proced ure evidence eviden ce of Clin Clinical ical Phopto graph Cleft Cleft Palate Inv - Clinical Phoptog raph Post Post proced ure eviden ce of Clin Clinical ical Phopto graph Velo-Pharyngial Velo-Pharyngial Inco mpetence Inv - Endos copy Post p rocedure rocedure evidence o f Clinical Clinical Phoptog raph

10000

Syndactyly of Hand for each hand Inv - Clin Clin ical Phoptograph Post procedu re evidence o f Clini Clinical cal Phoptograph Microtia/Anotia Microtia/Anotia Inv - Clin Clin ical Phoptog raph Post proced ure evidence eviden ce of Clin Clinical ical Phopto graph

15000

TM joint joint ankylos is Inv - Clinica linica l Phoptog raph, XRay Pos t procedu re evidence of Clin Clin ical Phoptograph

40000

15000 15000

30000



Specialty

Indicativ e Rate &

SYSTEM

710

Burns Burns 30% to 50%

711

Burns Burns 30% to 50% 50%

712

Burns Burns 30% to 50% 50%

713

Burns Burns 3 0% to 50% 50%

714

Burns Burns Ab ove 50% 50%

715

Burns Burns Abov e 50% 50%

Up to -60% Mixed Burns Burns ( With surgeries) Inv Clin Clin ical Phoptograph Post Post procedure evidence evidence o f Clin Clin ical Phoptog raph

100000

716

Burns Burns Abov e 50% 50%

120000

717

720

Burns Burns Post Burn contracture surgeries for functional improvement (Package including sp lints lints pressure pressure garments garments an d Physiotherapy) Burns Burns Post Burn contracture surgeries for functional improvement (Package including sp lints lints pressure pressure garments garments an d Physiotherapy) Burns Burns Post Burn contracture surgeries for functional improvement (Package including sp lints lints pressure pressure garments garments an d Physiotherapy) Plastic Plastic Surgery Surgery

ABOVE ABOVE 60% M ixed ixed Burns( With su rgeries) rgeries) Inv Clin Clin ical Phoptograph Post Post procedure evidence evidence o f Clin Clin ical Phoptog raph Mild Mild Inv - Clinical Phopt Phopt ograph Post procedure evidence of Clin Clin ical Phopt Phopt ograph

721


722


723


718

719

~ 106 ~

Up to -40% With scalds ( cons ervative) ervative) Inv Clin Clin ical Photograph Post procedu re evidence of Clin Clin ical Phoptog raph Upto-40% Upto-40% Mixed Burns Burns ( With su rgeries) rgeries) Inv Clin Clin ical Phoptograph Post Post procedure procedure evidence o f Clin Clin ical Phoptog raph Upto-50% Upto-50% with with scalds(Conservative) Inv Clin Clin ical Phoptograph Post Post procedure evidence evidence o f Clin Clin ical Phoptog raph Up to -50% Mixed Burns Burns ( With surg eries) eries) Inv Clin Clin ical Phoptograph Post Post procedure evidence evidence o f Clin Clin ical Phoptog raph Up to -60% With scalds ( cons ervative) ervative) Inv Clin Clin ical Phoptograph Post Post procedure evidence evidence o f Clin Clin ical Phoptog raph


50000

60000

70000

80000

20000

Moderate Inv -Clin -Clin ical Phopto Phopto graph Post proced ure evidence eviden ce of Clin Clinical ical Phopto graph

30000

Severe Inv Inv - Clinical Clinical Phoptog raph raph Post procedure evidence of Clin Clin ical Phopt Phopt ograph

40000

Hemifacial Hemifacial Microsmia Microsmia Inv - 3 D CT, M RI Post proced ure evidence eviden ce of Clin Clin ical Phopto graph Leprosy reconstructive reconstructive su rgery Inv - Nerve Nerve condu ction ction s tudy Post Post p rocedure rocedure evidence of Clin Clin ical Phoptog raph Nerve Nerve and tendon repair repair + Vascular repair repair Inv Nerve cond uction uct ion study, CT CT Scan Post p rocedu re evidence of Clin Clin ical Phopt Phopt ograph Ptosis Inv -Clini -Clinica ca l phot ograph Post procedure evidence of Clin Clin ical Phopt Phopt ograph

50000 20000

30000

25000



Specialty

724

Plas Plastic tic Surgery

725


726


727


728


729


730


731


732


733

Polytrauma Orthped Orthped ic Trauma Trauma

734

Polytrauma Orthped Orthped ic Trauma Trauma Polytrauma Orthped Orthped ic Trauma Trauma Polytrauma Neurosurgical Neuros urgical trauma trauma cons ertative ertative Polytrauma Neurosurgical Neuros urgical trauma trauma cons ertative ertative Polytrauma Neurosurgical Neuros urgical trauma Polytrau Polytrau ma Ches t consertative treatment Polytrau Polytrau ma Ches t consertative treatment Polytrau Polytrau ma Ches t

735 736

737

738

739

740

741 742

743

Polytrauma Abdomen consertative treatment Polytrauma Abdomen consertative treatment

~ 107 ~

Indicativ e Rate &

SYSTEM

Tumour of mandible and ible and ma xilla xilla Inv CT/M RI/HPE/Biopsy I/HPE/Biopsy Post p rocedu rocedu re evidence of Clin Clin ical Phoptog raph Vaginal Vaginal atresia Inv - USG Abdo men Post proced ure evidence eviden ce of Clin Clinical ical Phopto graph Vascular ma lformations lformations Inv - Angiogram Post proced ure evidence eviden ce of Clin Clinical ical Phopto graph Correct Correct ive Surgery for Congen ital defor mity of hand (per hand) Inv - X-Ray/CT Scan Post proced ure evidence eviden ce of Clin Clinical ical Phopto graph Correct Correct ive Surgery for Cran Cran iosynostosis iosy nostosis Inv - 3D CT/M RI Post procedure ev idence of Clinical Clinical Phoptograph Cup and Bat ears Inv - Clinical linical phot ograph Post proced ure evidence eviden ce of Clin Clinical ical Phopto graph Flap Flap cover for Electri Electrical cal burns with vitals vitals e xpos ed Inv - Clinical pho tograph Pos t procedure evidence of Clinica Clinica l Phoptograph Reduction su rgery for Filarial lymphedem lymphed emaa Inv Clin Clin ical photog raph raph Pos t procedure evidence of Clin Clin ical Phoptog raph Hemifacial Hemifacial atrophy Inv - 3 D CT, M RI Post proced ure evidence eviden ce of Clin Clinical ical Phopto graph Open Reduction Reduction an d internal fixation fixation of long bon e fractures fractures Inv - X-Ray Post proced ure evidence of X-Ray Amputation Amputation Surgery Inv - X- Ray Post p rocedure evidence of Clin Clin ical Phopt Phopt ograph Soft tiss tiss ue injury injury Inv - Clinical photog raph Post Post proced ure evidence eviden ce of Clin Clinical ical Phopto graph Stay in general ward @RS.500/ Day Inv - XRay/CT Pos t p rocedure evidence o f Clini Clinical cal Phoptograph Stay in in NEURO [email protected]/DA Y Inv - XRay/CT Pos t p rocedure evidence o f Clini Clinical cal Phoptograph Surgical Surgical treat ment ( Up to) Inv - X -Ray/CT -Ray/CT Pos t proced ure evidence eviden ce of Clin Clinical ical Phopto graph Chest injuries Conservative stay in General ward @RS.500/D @RS.500/Day ay Inv -X-Ray/CT Post p rocedure evidence of Clin Clin ical Phopt Phopt ograph Stay in Respiratory ICU [email protected]/Day Inv X-Ray/CT X-Ray/CT Pos t p rocedure evidence of Clin Clin ical Phoptograph Surgical Surgical treatment Inv - X-Ray/ X-Ray/ CT Post procedure evidence of X-Ray X-Ray Abdominal injuries Conservative stay in General ward ward @ RS.500/DAY RS.500/DAY Inv - X -Ray/USG/ -Ray/USG/ CT Post proced ure evidence eviden ce of USG Stay in in Surg Surg ical [email protected]/DA ICU@ RS.1000/DA Y Inv - XXRay/USG/CT Post p rocedure evidence o f USG


25000 25000 15000

50000

20000 50000

20000

30000 15000

5000 5000 6000

28000

150000

3000

20000

50000 3000

7000



Specialty

744

Polytrauma Abdomen

745

Polytrauma Emergen Emergen cy room proced ures Polytrauma Emergency Emergency room proced ures Orthop Orthop edic and facia facia l trauma wound management for compoun compoun d fractures fractures Orthop Orthop edic and facial facial trauma wound management for compoun compoun d fractures fractures Orthop Orthop edic and facial facial trauma wound management for compoun compoun d fractures fractures Orthop Orthop edic and facial facial trauma other s mall bone bo ne fractures -Kwiring wiring (to be co vered along with other injuries injuries on ly and not as exc exc lusive proced ure) Orthop Orthop edic and facial facial trauma other s mall bone bo ne fractures -Kwiring wiring (to be co vered along with other injuries injuries only and not as exc exc lusive proced ure) Orthop Orthop edic and facial facial trauma Facial injuries Orthop Orthop edic and facial facial trauma Pelvic bone fracture Hearing Hearing aid

746

747

748

749

750

751

752

753

754

Indicativ e Rate &

SYSTEM

Abdominal injuries surgical treatment Inv - XRay/USG/CT Post procedu re evidence of USG/ USG/ Clinica Clinica l pho tograph Tracheostomy Tracheostomy Inv - Clinica Clinica l photograph Post Post proced ure evidence eviden ce of Clin Clinical ical photo ph oto graph


3000

Thoracostomy Thoracostomy Inv - Clinica Clinica l photograph Post Post proced ure evidence eviden ce of Clin Clinical ical photo ph oto graph

3000

Grade I& II Inv - Clinical photograph,X-Ray Post proced ure evidence eviden ce of Clin Clinical ical photo ph oto graph

10000

Grade Grade - III Inv Inv -Clinical -Clinical photo graph,X-R graph,X-Ray Post proced ure evidence eviden ce of Clin Clinical ical photo ph oto graph

20000

Flap Flap cover surgery for for wound in co mpoun d fracture fracture Inv - Clinical Clinical photo graph,X-R graph,X-Ray Post proced ure eviden ce of Clin Clinical ical pho tog raph

20000

Surgery for Patella Fracture (To be covered with other injuries injuries only and no t as exclusive exclusive proced ure) Inv -X-Ray Post p rocedu re evidence of X-Ray X-Ray

5000

Small Small bone fractures K-Wiring K-Wiring (To be covered with with other injuries injuries on ly and not as exclusive exclusive proced ure) Inv - X-Ray Post p rocedu re evidence of X-Ray X-Ray

5000

Facia Facia l bone fractures fractures (Fac (Fac iomaxillary iomaxillary in juries) juries) Inv -Clinical -Clinical photo graph,X-Ray graph,X-Ray Post procedure evidence of Clin Clin ical photog raph, X-R X-Ray Surgical Surgical correction o f Pelvic Pelvic Bone f ractures. Inv X-Ray X-Ray Post p rocedure evidence of X-Ray X-Ray

15000

20000

Behind the ear analogue hearing hearing a id. Inv Audiometry Audiometry with po st treatment treatment ev idence of Clin Clin ical phot ograph Prosth esis lower limb HDP/PP HDP/PP with p ost treatment treatment evidence of Clinical Symes Symes Prosth eses pho tograph Prosth esis lower limb Fibre Fibre with po st treatment treatment ev idence of Clin Clin ical Symes Symes Prosth eses pho tograph

10000

757

Prosth esis lower limb Modu lar with with pos t treatment treatment ev idence of Clinical Clinical Symes Symes Prosth eses pho tograph

1500

758

Prost Prost hesis Below Below Knee(BK/PTB) Prostheses

1200

755 756

~ 108 ~

HDP/PP HDP/PP with p ost treatment treatment evidence of Clinical pho tograph

1000 1200



759

760

761 762 763 764

765

766

767

768

769

770

771 772 773 774 775 776 777

778

779

Specialty

Prosthesis Below Knee(BK/PTB) Prostheses Prost Prost hesis Below Below Knee(BK/PTB) Prostheses Prost Prost hesis Through Knee Prost Prost hes es Prost Prost hesis Through Knee Prost Prost hes es Prost Prost hesis Through Knee Prost Prost hes es Prost Prost hesis Above Knee(AK) Prostheses Prost Prost hesis Above Knee(AK) Prostheses Prost Prost hesis Above Knee(AK) Prostheses Prost Prost hesis Hip Hip disarticulation pros thes thes is Prost Prost hesis Hip Hip disarticulation pros thesis Prost Prost hesis Hip Hip disarticulation pros thes thes is Prost Prost hesis Hip Hip disarticulation pros thes thes is Prost Prost hesis Upper Limb Limb be low e lbow Prost Prost hesis Upper Limb Limb be low e lbow Prost Prost hesis Upper Limb Limb be low e lbow Prost Prost hesis Upper Limb Limb abov e elbow Prost Prost hesis Upper Limb Limb abov e elbow Prost Prost hesis Upper Limb Limb abov e elbow Prost Prost hesis Upper Limb whole upper limb limb Prost Prost hesis Upper Limb whole upper limb limb Prost Prost hesis Upper Limb whole upper limb limb

~ 109 ~

Indicativ e Rate &

SYSTEM

Fibre Fibre with po st treatment treatment ev idence of Clin Clin ical pho tograph


Modu lar with with pos t treatment treatment ev idence of Clinical Clinical pho tograph

3000

HDP/PP HDP/PP with p ost treatment treatment evidence of Clinical pho tograph Fibre Fibre with po st treatment treatment ev idence of Clin Clin ical pho tograph Modu lar with with pos t treatment evidence o f Clini Clinica ca l pho tograph HDP/PP HDP/PP with p ost treatment treatment evidence of Clinical pho tograph

1500


1800


3500

HDP/PP HDP/PP with p ost treatment treatment evidence of Clinical pho tograph

2500


3000


6000

Partial Partial foot prostheses with with p ost treatment treatment evidence of Clin Clin ical photog raph

500

HDP/PP HDP/PP with p ost treatment treatment evidence of Clinical pho tograph Fibre Fibre with po st treatment treatment ev idence of Clin Clin ical pho tograph Modu lar with with pos t treatment treatment ev idence of Clinical Clinical pho tograph HDP/PP HDP/PP with p ost treatment treatment evidence of Clinical pho tograph Fibre Fibre with po st treatment treatment ev idence of Clin Clin ical pho tograph Modu lar with with pos t treatment treatment ev idence of Clinical Clinical pho tograph HDP/PP HDP/PP with po st treatment treatment ev idence of Clinical pho tograph

1500


1200


1500

1800 3500 1500

1800 3500 1500 2000 4000 1000



Specialty

Sr No 780

Category

781

Critica Critica l Care

782


783


784


785

Critical Critical Care

786


787


788

Critica Critica l Care Gen Medicine

789



~ 110 ~

Indicativ e Rate &

SYSTEM

Diseas Diseas e, stay , Investigations, Investigations, Post treatment treatment evidence Acute sev ere asthma asthma with Acute respiratory respiratory failure failure Inv - ABG , Serum IgE , Spirometry , clinical pho to intu intu bated bat ed with with ventil vent ilato atorr , serum electrolytes electrolytes 10 days stay with with pos t treatment treatment evidence of ABG and ot her lab lab inves tigations tigations COPD Respiratory Failure (infective exacerbation) exacerbation) Inv - Blood gas es , HRCT HRCT Chest , ventilator ventilator when necess ary, clinical clinical ph otograph, spirometry, spirometry, serum electrolytes electrolytes , 2 D Echo 1 4 days stay with post treatment treatment evidence of ABG and other lab investigations investigations Acute Acu te Bronc Bronchitis hitis and Pneumonia with with Respiratory failure failure Inv -clinical -clinical photo graph HRCT Ches Ches t, ABG, ABG, ven tilator tilator 1 0 days stay with with po st treatment treatment evidence of ABG and ot her lab lab inves tigations tigations ARDS with ventil ven tilatory atory care Inv - HRCT Chest, Chest , clin clin ical photog raph,ABG raph,ABG 14 days s tay with with pos t treatment treatment ev idence of ABG and other lab investigations ARDS with with Mult i Organ failure with ven tilato tilatory ry care Inv - HRCT Ches Ches t, clinical clinica l pho tog raph,ABG raph,AB G, Sputum CS 14 days stay with with po st treatment treatment evidence of ABG and ot her lab lab inves tigations tigations

Upper ceiling (Rs.) Cost 45000

70000

50000

80000

100000

ARDS plus DIC (Blood & Blood products) with with ventil ven tilatory atory care Inv - HRCT Ches Ches t, clin ical pho tograph,ABG tograph,A BG,, Sput Sput um CS 14 day s s tay with with post treatm t reatment ent ev idence of o f ABG and o ther the r lab lab investigations OP Poison Poison ing requiring requiring ventilatory ventilatory ass istance istance Clin Clin ical photo Inv - Renal Renal che mistry Drug/Poison level in in blood, Blood gas es 1 week stay with pos t treatment treatment ev idence of ABG and other lab investigations Septic Septic Shock(ICU Management) with ventilatory ventilatory assistance Inv - Blood Blood Culture Culture , Blood gases , Clinical photo, Renal Chemistry , USG , Urine Culture 14 days stay with with po st treatment treatment ev idence of ABG and oth er lab lab investigations investigations

120000

Thrombocyt Thrombocyt openia with with bleeding bleeding d iathesis Inv Bone M arrow arrow , Leptospira Leptospira , PT APTT , Pa rasite F / V , Platelet count , Report and video clip "on line"o line"o ne week stay with with p ost treatment treatment evidence of lab inves inves tigations tigations Haemophilia with Inv - Factor VIII VIII / IX , PT APTT Report and video clip clip "online "online 1 week stay with with pos t treatment treatment evidence of lab inves inves tigations tigations

20000

Treatment proto col Asthma Guide lines GINA /India, Ventilatory Care According to International Guide lines, Ventilatory Care IP 10 days, day s, Inhalers, LA BA, Ventilatory Care Antimicrobial s, MICU, O2, Ventilatory Care Antimicrobial s, MICU, O2, Ventilatory Care

Cryo precipitate, FFP, Ventilatory Care 30000 MICU, O2, Ventilatory Care, atropine

50000

50000

Antimicrobial s, MICU, O2, Ventilatory Care and other supportive measures IV fluids, fluids , PRP, SDPIV - IgIV antimicrobial s IV FPP, Factor VIII / Cryoprecipita te



Specialty

Indicativ e Rate &

SYSTEM


790

Critical Care Gen Medicine

Other Coagulation Coagulation d isorders with with Von willi brands factor, 1 week week stay with with with pos t treatment treatment evidence of lab inves inves tigations tigations

791


20000

792


Chelation Therapy for Thalass Thalass emia emia s erum Inv Ferritin , Heamatocrit , Heamogram , Peripheral Smear Smear , S.Iron S.Iron , 5 days stay with with po st treatment treatment evidence of lab inves inves tigations tigations Cerebra Cerebra l Ma laria (Falciparu (Falciparu m) Inv - CSF Analysis , Parasite Parasite F Test and QBC, 7 days stay with with pos t treatment treatment evidence of clinical and lab investigations

793


TB meningit is Inv - ABG , CT Scan Scan Brain Brain CSF ADA Analysis, 2 weeks weeks s tay with with pos t treatment treatment evidence of lab inves inves tigations tigations

30000

794


Snake Snake bite requiring requiring v entilator entilator s uppo rt Inv - 8 hourly ABG seven days , CT Scan brain, Blood sugar 4 hourly 2 weeks stay with post treatment treatment evidence of lab inves inves tigations tigations

50000

~ 111 ~

20000

IV FPP, Factor VIII / Cryoprecipatt e Chelation Therapy

Blood and Platelet Transfusion, IV antibiotics, IV fluids, Mefloquine, IV quinine or IV artesu nate, Paracetamol, Ventilatiory Support Anticonvulsa nts (Midazolam or Lorazepam, Phenobarbito ne or Phenytoin), Antitubercula r therapy, IV Mannitol, IV antibiotics, IV dexamethaso ne and oral steroids, IV fluids, Mechanical Ventilatory support, Naso Naso gastric feeds, Paracetamol Antisnake Venom, IV fluids, Inj.Antibiotic s, Inotropes(Do but amine, amine, Dopamine, Adrenaline, Noradrenalin e), Mechanical Ventilation, oxygen



Specialty

Indicativ e Rate &

SYSTEM


795

Critical Care Gen Medicine

Scorpion Scorpion Sting requir requir ing ventilator ventilator sup port Inv Eight Eight h ourly ABG for for 7days ,Blood ,Blood su gar 8 hourly hourly ECH, ECG, CVP CVP Mon itoring itoring 2 weeks st ay with with post treatm t reatment ent ev idence of o f lab invest inve st igations

796


Metabolic Co Co ma requiring requiring Ventilatory Suppo rt Inv - ABG , Arterial Blood Press ure , Blood Blood Sugar , Blood Urea , CVP monitoring , ECG , Echo , S.Creati S.Creatin n inine inine , Thyroid Profile, Profile, 2 weeks weeks stay with with pos t treatment treatment evidence of lab inves inves tigations tigations

30000

797

Infectious Infectious diseases diseases

Tetanus severe Inv - A BG, swab for culture sensitivity sensitivity 3 weeks stay with with pos t treatment treatment evidence of cl inical inical photograph

20000

798

Infectious diseases

Dipht Dipht heria Complicated Inv - ECG-5 times , Throat swab for c/s-3 times , Urine for ketone bod ies clinical clinical photo ph oto graph 4 weeks st ay with pos t treatment treatment evidence of and lab investigations

25000

Medical, Tracheostom y, ventilator

799

Infectious Infectious diseases diseases

Cryptococcal Meningitis Meningitis Inv - investigation of cryprococcal antigen, antigen, treatment treatment of 2 weeks weeks s tay with with pos t treatment treatment evidence of lab inves inves tigations tigations

20000

Amphotericin B +Fluconazole

800

Paediatri Paediatrics cs Neonatal

Term baby with culture pos itive itive sepsis - Non ventilated Hyperbilirubinemia Inv - Blood culture, CRP, CRP, Seru m bilirubin, bilirubin, CSF CSF An alysis, 14 days stay with with p ost treatment treatment evidence of clinical improve improve ment an d lab invest igations igations

25000

25 % dextrose, Calcium gluconate, Fluconazole, IV antibiotics -Meropenem , Maintenance IV Fluids Isolyte P, Nasogastric Naso gastric tube feeds, feeds, Phototherapy, Tobramyc Tobramyc in 80mg

~ 112 ~

Antiscorption Venom, IV fluids, Antibiotics, prazocin, Mechanical Ventilation, Oxygen Oxygen an d other treatment such as SNP drip drip etc. Inotrop es IV antibiotics, IV fluids, Inj.Midazola m infusion, Mechanical Ventilation, Oxygen, Sodium Nitroprus Nitroprus side Medical, Ventilator, tracheostomy



Specialty

Indicativ e Rate &

SYSTEM

801

Pediatrics Pediatrics Neonatal Neonat al

30 to 32 weeks preter m Severe Hyaline me mb rane disease Clin lin ical seps is Patent du ctus arterios arterios us Medical manage manage ment Mechanical ventilat ventilat ion Hyperbilirub inemia inemia Inv - 2D ECHO , Neurosonogram Neuros onogram , Blood c ulture, CRP, A BG, 8 weeks weeks s tay with pos t treatment treatment evidence o f clin clin ical imp imp rovement rovement and lab inves tigations tigations

802

Pediatrics Pediatrics Neonatal Neonat al

<30 weeks preter m Severe Hyaline me mb rane disease Clin lin ical/ ical/ Culture Culture po sitive sep sis Patent Patent ductus arteriosus arteriosus - M edical manage manage ment Mechanical ventilation Hyperbilirubinemia Inv 2D ECHO , Neuros Neuros onogram, on ogram, Blood culture, CRP, CRP, ABG 8 weeks stay with post treatment treatment evidence of clinical improve improve ment an d lab investigations

~ 113 ~


90000

25 % dextrose, Calcium gluconate, Dobutamine, Dopamine, FFP, Frusemide, Heparin, IV antibiotics (Meropenem - , Tobramycin Fluconazole), Maintenance IV Fluids , Mechanical ventilation, Midazolam, Nasogastric Naso gastric tube feeds, feeds, PRBC, FFP, PRP, PhototherapyUmbilical venous and arterial lines, Supplemental Oxygen, Surfactant therapy Neosurf, Neos urf, Vecuronium 25 % dextrose, Aminoven, Calcium gluconate, Dobutamine, Dopamine, FFP, Frusemide, Heparin, IV antibiotics (Meropenem, Tobramycin ,Fluconazole) , Maintenan Maintenan ce IV Fluids - , Mechanical ventilation, Midazolam, Nasogastric Naso gastric tube feeds, feeds, Normal saline, PRBC,



Specialty

Indicativ e Rate &

SYSTEM

Upper ceiling (Rs.) PRP, FFP, PhototherapyUmbilical venous and arterial lines, Supplemental Oxygen Oxygen 7 days, Surfactant therapy Neosurf, Neos urf, Vecuronium

803


~ 114 ~

Term baby with persistent pulm pulmonary hypertension Ventilation-HFO Hyperbilirubinemia Clin Clin ical seps se ps is Inv - 2D ECHO , Neurosonogram Neuroso nogram , Blood culture, CRP, CRP, A BG, 6 weeks s tay with with post treatment treatment ev idence of c lin lin ical imp imp rovement rovement and lab investigations

80000

25 % dextrose, Aminoven, Calcium gluconate, Dobutamine, Dopamine, FFP, Frusemide, Heparin, IV antibiotics (Meropenem - , Tobramycin Fluconazole), Maintenance IV Fluids - , Mechanical ventilation, Midazolam, Nasogastric Naso gastric tube feeds, feeds, Normal saline, PRBC, PRP, FFP PhototherapyUmbilical venous and arterial lines, Sodium bicarbonate, bicarbon ate, Supplemental Oxygen, Surfactant therapy Neosurf, Neos urf, Vecuronium



Specialty

Indicativ e Rate &

SYSTEM

804

Paediatri Paediatrics cs Neonatal Neonatal

Term baby with with severe perinatal perinatal asp hyxia hyxia - Non ventilated Clinical sepsis Hyperbilirubinemia Inv CSF analysis(LP) , CT-Scan , Neurosonogram ,Blood ,Blood culture, CRP, CRP, X-Ray X-Ray ches t 10 days s tay with with p ost treatment treatment evidence of clinical improve improve ment an d lab invest igations igations

805


Term baby with severe perinatal perinatal asp hyxia hyxia Ventilated Clinical sepsis Hyperbilirubinemia, Inv - Neuros ono gram, gram, CT CT Scan CSF ana lysis(LP) , ABG, Blood Blood cu lture, CRP, Seru m bilirubin, bilirub in, 3 weeks weeks s tay with post treatment treatment evidence o f clin clin ical imp imp rovement rovement and lab inves tigations tigations

~ 115 ~


40000

Supplemental Oxygen Oxygen 2 5 % dextrose, Calcium gluconate, IV Phenobarbito ne, IV Phenytoin, IV antibiotics (Piperacillin Tazobactum, Tobramycin ), Maintenance IV Fluids , Midazolam, Nasogastric Naso gastric tube feeds, feeds, Normal saline, Physiotherap y, Supplemental Oxygen, Mechanical ventilation, 25 % dextrose, Aminoven, Calcium gluconate, Dobutamine, Dopamine, FFP, Heparin, Aminoven, IV Phenobarbito ne, IV Phenytoin, IV antibiotics (Meropenem, Tobramycin Fluconazole), Maintenance IV Fluids Midazolam, Nasogastric Naso gastric tube feeds, feeds, Calcium gluconate, Normal saline, PRBC, FFP, PRP, Physiotherap y, Phototherapy-



Specialty

Indicativ e Rate &

SYSTEM

Upper ceiling (Rs.) Umbilical venous and arterial lines, Vecuronium

806

Paediatrics Neonatal Neonat al

Term bab y Severe hyp erbilirubine mia Clinica Clinicall sepsis se psis Inv - Seru m bilirubin, Blood culture, CRP, X-Ray X-Ray ches t, CSF CSF Analysis, 10 days st ay with with post treatm t reatment ent ev idence of o f clinica clinica l improv improvee ment and lab investigations investigations

25000

807


Term baby with seizures seizures ventilated ventilated Inv Neurosonogram, Neuros onogram, CT-Scan b rain, Ultraso und abdomen, CSF CSF an alysis , Blood a mmonia mmonia , Lactate, Metabolilc Metabolilc screening-blood and urine urine ABG , Blood culture, 10 days s tay with with po st treatment treatment ev idence of c lin lin ical imp imp rovement rovement and lab investigations

25000

~ 116 ~

Double volume exchange transfusion, Double surface Phototherapy, IV antibiotics (Piperacillin Tazobactum, Tobramycin )Maintenance IV Fluids, 25 % de xtrose, Calcium gluconate, Nasogastric Naso gastric tube feeds, feeds, Who le blood, blood, Supplemental Oxygen, IV antibiotics (Meropenem Tobramycin, Fluconazole), Maintenance IV Fluids , 25 % de xtrose, Calcium gluconate, Nasogastric Naso gastric tube feeds, Umbilical venous and arterial lines, Aminoven Aminoven , , Dobutamine, Dopamine, PRBC, FFP, PRP, midazolam,



Specialty

Indicativ e Rate &

SYSTEM

Upper ceiling (Rs.) Heparin, IV Phenobarbito ne, IV Phenytoin, Phototherapy, Mechanical ventilation.

808


Necrotising Necrotising enterocolitis, enterocolitis, Clin Clin ical sep sis Non ventil ven tilated ated Hyp Hyperbilir erbilirub ub inemia inemia Inv Inv - Bloo Blood d culture, Abdo men radiograph and u ltrasou ltrasou nd , LFT , Stool for occult blood , serum bilirubin, bilirubin, 4 weeks weeks s tay with post treatment treatment evidence o f clin clin ical imp imp rovement rovement and lab inves tigations tigations

25000

809


Term baby, fulminant culture pos itive itive sepsis, septic shock, Ventilated, Hyperbilirubinemia Renal failure, with with Inv - Neuros onogram , Ultra sound of abdomen, 2D ECHO , Abdomen radiograph, radiograph , , CSF analysis(LP) ,Bloo ,Blood d culture, ABG, LFT , Stool for occu lt blood , Renal function tests, 5 weeks weeks s tay with pos t treatment treatment evidence of clinical improv improv ement and lab investigations

40000

~ 117 ~

IV antibiotics (Meropenem , Tobramycin Fluconazole), Maintenance IV Fluids , Metronidazol e, 25 % dextrose, Calcium gluconate, Nasogastric Naso gastric tube feeds, feeds, Albumin, Aminoven, Central line, Heparin, ,Normal saline, Phototherapy, Total parent eral nutrition Supplemental Oxygen, mechanical ventilation, IV antibiotics (Meropenem , Tobra mycin, Fluconazole), 25 % dextrose, Maintenance IV Fluids , Calcium gluconate, Nasogastric Naso gastric tube feeds, feeds, PhototherapyUmbilical venous and arterial lines,



Specialty

Indicativ e Rate &

SYSTEM

Upper ceiling (Rs.)

810


33 to 34 weeks weeks preterm preterm baby Severe Severe Hyaline Hyaline membrane disease Clinical Clinical sep sis Bubble CPAP Hyperbilirubinemia Inv - X-Ray chest, ABG, Neurosonogram Neuros onogram blood c ulture, CRP, Serum bilirubin, bilirubin, 2 D ECHO, Neuros onogram, 3 weeks stay with with p ost treatment treatment ev idence of clinical improve improve ment an d lab invest igations igations

40000

811


33 to 34 weeks weeks preterm baby Severe Hyaline Hyaline membrane d isease with Clinica Clinica l seps is, Mechanical ventilation Hyperbilirubinemia Inv X-Ray chest, ABG, CRP, Serum bilirubin, Blood culture, 4 weeks stay with with po st treatment treatment evidence of clinica clinica l improve improve ment an d lab invest igations igations

60000

~ 118 ~

Dobutamine, Dopamine, PRBC, PRP, FFP, Midazolam, vecurnium, Heparin, Aminoven, Adrenaline, Albumin, , Frusemide, Noradrenalin e, Normal sali sa line, ne, , Peritoneal dialysis, Sodium bicarbonate, bicarbon ate, Total parent eral nutrition, Supplemental Oxygen, CPAP CPAP,, IV antibiotics (Piperacillin Tazobactum1, Tobramycin ), Maintenance IV Fluids , 25 % de xtrose, Aminoven, Calcium gluconate, Heparin, Midazolam, Nasogastric Naso gastric tube feeds, feeds, PhototherapyUmbilical venous and arterial lines, Supplemental Oxygen, Mechanical ventilation, 25 % dextrose, IV antibiotics (Piperacillin Tazobactum1, Tobramycin), Maintenance



Specialty

Indicativ e Rate &

SYSTEM

Upper ceiling (Rs.)

812


35 to 36 weeks weeks Preterm M ild Hyaline Hyaline me me mb rane disease Culture pos itive itive s epsis Nonventilated Nonventilated Hyperbilirubinemi Hyperbilirubinemiaa Inv - X-Ray chest, Blood Blood culture, CRP, CSF CSF Analysis, An alysis, Seru Seru m bilirubin, 3 weeks weeks s tay with post treatment treatment evidence o f clin clin ical imp imp rovement rovement and lab inves tigations tigations

35000

813


33 to 34 weeks weeks preterm Mild Hyaline Hyaline membrane membrane disease Culture positive sepsis - Nonventilated Nonventilated Hyperbilirubinemia Inv - Neurosonogram 2D ECHO , CSF CSF analys is ,Blood ,Blood culture , CRP, Seru Seru m b ilirubin, ilirubin, X-Ray ches t, 4 weeks weeks stay with with post treatm t reatment ent ev idence of o f clinica clinica l improv improvee ment and lab investigations investigations

45000

~ 119 ~

IV Fluids , Calcium gluconate, Nasogastric Naso gastric tube feeds, feeds, PhototherapyUmbilical venous and arterial lines, Aminoven, FFP, Heparin, Dopamine, Dobutamine, Midazolam, PRBC, FFP, PRP Supplemental Oxygen, 25 % de xtrose, IV antibiotics -Meropenem , Tobramycin, Fluconazole, Calcium gluconate, , Maintenance IV Fluids , Nasogastric Naso gastric tube feeds, feeds, Phototherapy, Supplemental Oxygen, 25 % de xtrose, IV antibiotics -Meropenem Tobramycin, Fluconazole, Calcium gluconate, Maintenance IV Fluids , Nasogastric Naso gastric tube feeds, feeds, PRBC, PRP, FFP, Phototherapy,



814

815

Specialty



~ 120 ~

Indicativ e Rate &

SYSTEM

33 to 34 weeks weeks preterm preterm Severe Hyaline Hyaline membrane membrane disease Culture pos itive itive sepsis Mechanical Mechanical ventilation/ Bubble CPAP Hyperbilirubinemia. Inv - Neurosonogram, 2D ECHO, CSF Analysis, blood cu lture, CRP, S.Bilirub S.Bilirub in, X-Ray ches t, ABG. ABG. 6 weeks stay with with pos t treatment treatment evidence of clinica clinica l improve improve ment an d lab invest igations igations

30 to 32 weeks weeks preterm Severe Hyaline Hyaline membrane disease Clin lin ical/ ical/ Culture pos itive itive s eps is Mechanical ventilation Hyperbilirubinemia Inv 2D ECHO, Lumbar Puncture CSF analysis , Neurosonogram Neuros onogram blood c ulture, CRP, S. Bilirubin, X-Ray X-Ray ches t, ABG 8 weeks weeks s tay. with with po st treatment treatment ev idence of c lin lin ical imp imp rovement rovement and lab investigations


90000

Supplemental Oxygen, Mechanical ventilation, Surfactant therapy Neosurf, Neos urf, IV antibiotics antibiotics Meropenem Tobramycin Fluconazole, Maintenance IV Fluids Isolyte P, 25 % de xtrose, Calcium gluconate, Nasogastric Naso gastric tube feeds, feeds, Phototherapy Umbilical venous and arterial lines, Aminoven, Dobutamine, Dopamine, FFP, Heparin, Normal saline, PRBC, PRP, Vecuronium Supplemental Oxygen, Mechanical ventilation, Surfactant therapy Neosurf, Neos urf, IV antibiotics (Meropenem Tobramycin Fluconazole), Maintenance IV Fluids ,25 % de xtrose, Nasogastric Naso gastric tube feeds, feeds, PhototherapyUmbilical venous and arterial lines, Aminoven, Dobutamine, Dopamine,



Specialty

Indicativ e Rate &

SYSTEM

Upper ceiling (Rs.) FFP, Heparin, Midazolam, PRBC, PRP, Vecuronium

816

Paediatrics Neonatal Neonat al

<30 weeks preter m Severe Hyaline me mb rane disease Clin lin ical/ ical/ Culture pos itive itive s eps is Mechanical ventilation Hyperbilirubinemia Inv 2D ECHO , Lumbar Puncture CSF analysis , Neurosonogram Neuros onogram , b lood culture, cu lture, CRP,S. Bilirubin, X-Ray X-Ray ches t, ABG 10 weeks weeks s tay, with with p os t treatment treatment ev idence of c lin lin ical imp imp rovement rovement and lab investigations

90000

817


33 to 34 weeks weeks preterm Severe Hyaline Hyaline Me mbrane disease Clin lin ical/ ical/ Culture pos itive itive sep sis Patent Patent ductus arteriosusarteriosus- Medical management Mechanical ventilation Hyperbilirubinemia, Inv 2D ECHO , Neurosonogram, blood culture, CRP, ABG, ABG, X- Ray chest Serum bilirubin bilirubin 6 weeks st ay with with p ost treatment treatment evidence of clinica clinica l improve improve ment an d lab invest igations igations

70000

~ 121 ~

Supplemental Oxygen, Mechanical ventilation, Surfactant therapy Neosurf, Neos urf, IV antibiotics (Meropenem Tobramycin Fluconazole), IV Fluids - , 25 % dextrose, Nasogastric Naso gastric tube feeds, feeds, PhototherapyUmbilical venous and arterial lines, Aminoven, Calcium gluconate, Dobutamine, Dopamine, FFP, Heparin, Maintenance Midazolam, Normal saline, PRBC, PRP, Vecuronium Supplemental Oxygen, Mechanical ventilation, Surfactant therapy Neosurf, Neos urf, IV antibiotics (Meropenem Tobramycin Fluconazole),



Specialty

Indicativ e Rate &

SYSTEM

Upper ceiling (Rs.)

818

Pediatric Pediatric Ic Care Respiratory

Severe Bronchiolitis (Non Ventilated) Clinical Photo Inv - ABG OD (ABG -5), X-Ray Chest, 7 days s tay PICU PICU with po st treatment treatment evidence o f X-Ray X-Ray and Pulse Oxymetry/ABG

15000

819


Severe Bronchiolitis (Ventilated) Inv - CXR ABG 8th hrly (3/day X 7 days), Clin Clin ical Photo Photo with with 10 days stay PICU PICU po st treatment treatment evidence o f X-Ray X-Ray and Pulse Oxymetry/ABG

20000

820


Severe Bronchopneumonia (non Ventilated) Inv CXR ABG OD 7 days stay PICU PICU with po st treatment treatment evidence o f X-Ray X-Ray and Pulse Oxymetry/ABG

15000

~ 122 ~

IV Fluids - , 25 % dextrose, Nasogastric Naso gastric tube feeds, feeds, PhototherapyUmbilical venous and arterial lines, Aminoven, Calcium gluconate, Dobutamine, Frusemide, Dopamine, FFP, Heparin, Maintenance Midazolam, Normal saline, PRBC, PRP, Vecuronium Oxyge Oxygen, n, I. V fluids, Inj. Ceftriaxone, Inj. Hydrocortiso ne, Salbutamol, Budesonide, nebulisations. Oxyge Oxygen, n, I. V fluids, Inj. Pipracillin Tazobactum, Inj. Amikacin, Inj. Meth yl predn isolone, isolone , Salbutamol, Budesonide, nebulisations, Mechanical Ventilation, Inj. Midazolam Infusion Oxyge Oxygen, n, I. V fluids, Inj. Ceftriaxone + Inj. Amikacin, Salbutamol, nebulisations.



Specialty

Indicativ e Rate &

SYSTEM


821


Severe Bronchopneumonia (Ventilated) (Ventilated) Inv - Serial ABG (3/day (3/day X 7 days) X-Ray Chest Clin Clin ical Photo Photo 10 day s stay in PICU PICU with po st t reatment reatment evidence o f X-Ray X-Ray and Pulse Oxymetry/ABG

822


Acute Severe Asthma (Ventilated) Inv - Serial ABG X-Ray X-Ray Ches t 10 days PICU PICU st ay with with pos t treatment treatment evidence of X-Ray and Pulse Oxymetry/ABG

35000

823


Severe As piration piration Pneumonia (Non (Non Venti lated) Inv - Se Se ria ria l A BG X-Ray X-Ray Ches t 5 days PICU PICU s tay with pos t treatment treatment ev idence of X-Ray and Pulse Oxymetry/ABG

20000

824


Severe Aspiration Pneumonia (Ventilated) Inv Serial ABG X-Ray X-Ray Ches t 7 days PICU PICU s tay with pos t treatment treatment ev idence of X-Ray and Pulse Oxymetry/ABG

25000

825


ARDS with Multiorgan failure Clinical Photo, Inv - Blood Culture, LFT, RFT, ABG, X-Ray Chest 14 days stay with post treatm t reatment ent ev idence of o f ABG and o ther the r Lab Lab Investigations

100000

~ 123 ~

Oxyge Oxygen, n, IV fluids, Inj. Pipracillin Tazobactum, Inj. Amikacin, Salbutamol, nebulisations, Mechanical ventilation, Inj. Midazolam Infusion. Oxyge Oxygen, n, IV fluids, Inj. Pipracillin Tazobactum, Inj. Amikacin, Salbutamol, nebulisations, Mechanical ventilation, Inj. Midazolam Infusion. Oxyge Oxygen, n, IV fluids, Inj. Pipracillin Tazobactum, Inj. Amikacin, Salbutamol, nebulisations Oxyg Oxygen, en, IV fluids, Inj. Pipracillin Tazobactum, Inj. Amikacin, Salbutamol, nebulisations, Mechanical ventilation, Inj. Midazolam Infusion. MICU, O2, Antimicrobial s, Ventilatiory Care



Specialty

Indicativ e Rate &

SYSTEM

826


827

Pediatric Pediatric Ic Care Cardiovascular

828


Congen ital heart diseas e with with in fection fection (non Ventilated Ventilated ) Inv Inv - Pulse Oxymetry, Echo X-Ray X-Ray Ches t, CRP CRP 7 d ays stay in PICU PICU with po st treatment treatment evidence o f X-Ray X-Ray and Pulse Pulse Oxy Oxy metry/ABG

30000

829


Congen ital heart diseas e with with in fection fection and cardiogenic cardiogenic s hock (Ventilated) (Ventilated) Inv - X -Ray Chest, Serial ABG, Echo, CVP monitoring, arterial blood pressu re monito monitoring ring 10 day s PICU PICU s tay with pos t treatment treatment ev idence of X-Ray and Pulse O xy metry/ABG

50000

830


Cardiogenic sh ock Inv - ABG X-Ray ches t, Echo, CVP mon mon itoring, itoring, arterial arterial b lood pressure monitoring 10 days PICU PICU s tay with pos t treatment treatment ev idence of X-Ray and Pulse O xy metry/ABG

50000

~ 124 ~

ARDS plus plus DIC (Blood & Blood products) Clinical Photo, Inv LFT, RFT, Blood Culture, X-Ray Chest, ABG, Coagulation Pro Pro file file 14 days s tay with with post treatment treatment ev idence of ABG and other Lab Investigations Severe Myocarditis Myocarditis Inv - A BG 12 h rly rly + ECHO + ECG, CVP monitoring, arterial blood pressure monitoring 10 days stay with with pos t treatment treatment evidence of X-Ray X-Ray and Pulse Pulse Oxy Oxy metry/ABG


40000

FFP, Cryo Cryo Precip Precip itate, Ventilatiory Care

Oxyge Oxygen, n, IV fluids, Inj. Pipracillin Tazobactum, Inj. Amikacin, Salbutamol, nebulisations, Mechanical ventilation, Inj. Midazolam Infusion. Oxygen, Oxygen, I.V fluids, Inj. Ceftriaxone, Inj. Tobramycin, Inj. Dobutamine, Inj. Dopamine. Oxygen, Oxygen, I.V fluids, Inj. Meropenem, Inj. Vancomycin, Mechanical ventilation X, Inj. Midazolam, Inotropes, Dobutamine, Dopamine, adrenaline, noradrenaline , milirinone. Oxygen, I.V fluids, Inj. Meropenem, Inj. Vancomycin, Inj. Midazolam, Inotropes, (Dobutamine, Dopamine, adrenaline, noradrenaline, milirinone.



Specialty

Indicativ e Rate &

SYSTEM


831


Infective Endocarditis Inv - 3 Blood cultures at half hourly intervals, ABG X-Ray X-Ray Chest, Echo Echo 15 days PICU PICU s tay with pos t treatment treatment ev idence of X-Ray and Pulse O xy metry/ABG

832

Pediatric Pediatric Ic Care CNS

Meningo-encephalitis (Non Ventilated) Inv - CSF analysis, CT-Scan, EEG 14 days PICU PICU st ay with with pos t treatment treatment evidence for Clin Clin ical Improve Improve ment w ith lab inves tigations tigations

40000

833


Meningo- en cephalitis cephalitis (Ventilated) (Ventilated) Inv Inv - Serial ABG, CSF analysis, CT scan, EEG, arterial monitoring monitoring 1 4 days PICU PICU s tay with pos t treatment treatment ev idence for Clin Clin ical Improve Improve ment w ith lab inves tigations tigations

60000

834


Status Epilepticus Inv - Serial ABG, CSF analysis, CT scan, EEG 14 days PICU PICU s tay with pos t treatment treatment ev idence for Clin Clin ical Improve Improve ment w ith lab inves tigation tigation s

50000

835

Pediatric Pediatric Ic Care

Febrile Seizures (atypical - mechanica echa nicall ven tilated)

25000

~ 125 ~

Oxygen, I.V fluids, Inj. Meropenem, Inj. Vancomycin, Mechanical ventilation, Inj. Midazolam, Inotropes, (Dobutamine, Dopamine, adrenaline, noradrenaline, milirinone, Inj. Heparin, low molecular weight weight heparin Oxygen, I.V fluids, Inj. Cefepime, Inj. Vancomycin, Inj. Acyclovir, Anticonvulsant s (Inj. Lorazepam, Inj. Phenytoin (Inj. Phenobarbitone ) Inj. Midazolam infusion Oxygen, I.V fluids, Inj. Cefepime, Inj. Vancomycin, Inj. Acyclovir, Anticonvulsant s (Inj. Lorazepam, Inj. Phenytoin Inj. Phenobarbitone ), Mechanical ventilation, Inj. Midazolam infusion Oxygen, I.V fluids, Inj. Cefepime, Inj. Vancomycin, Inj. Acyclovir, Anticonvulsant s (Inj. Lorazepam, Inj. Phenytoin Inj. Phenobarbitone ), Mechanical ventilation, Inj. Midazolam infusion Oxygen, I.V



Specialty

Indicativ e Rate &

SYSTEM

Upper ceiling (Rs.) CNS

Inv - Serial A BG, CSF analys is, CT Scan, EEG 5 days PICU PICU s tay with pos t treatment treatment ev idence for Clin Clin ical Improve Improve ment w ith lab inves tigations tigations

836


Intra cranial cranial b leed Inv - Serial Serial ABG, CSF analysis, CT Scan, EEG 10 days PICU PICU s tay with pos t treatment treatment ev idence for Clin Clin ical Improve Improve ment w ith lab investigations

40000

837

Pediatric Pediatric Ic Care GIT

Acute Acu te Gastro as tro intes tinal bleed Inv - A BG/ BG/ Upper GI Endoscopy, USG abdomen 10 days PICU PICU s tay with pos t treatment treatment ev idence for Clin Clin ical Improve Improve ment w ith lab inves tigations tigations

30000

838

Pediatric Pediatric Ic Care GIT

Acute Acu te Pancreatitis Inv - ABG, USG US G abdomen, abd omen, CT Scan Abdomen, serum amylase, lipase, CVP monitoring, arterial BP monitoring 10 day s PICU PICU st ay with with pos t treatment treatment evidence for Clin Clin ical Improve Improve ment w ith lab inves tigations tigations

50000

~ 126 ~

fluids, Inj. Cefepime, Inj. Amikacin, Inj. Anticonvulsant s (Inj. Lorazepam, Inj. Phenytoin Inj. Phenobarbitone ), Mechanical ventilation, Inj. Midazolam infusion Oxygen, I.V fluids, Antibiotics Inj. Meropenem, Inj. Tobramycin, Mechanical ventilation, Inj. Midazolam infusion, Inotropes Dobutamine, Dopamine, Adrenaline, noradrenaline, Milrinone, Anticonvulsant s (Inj. Lorazepam, Inj. Phenytoin Inj. Phenobarbitone ), Inj. Calcium Oxygen, I.V fluids, Antibiotics (Inj. Ceftriaxone, Inj. Ofloxacin, Inj. Amikacin) Mechanical ventilation, Inj. Midazolam infusion, endoscopic sclerotherapy, Inotropes (Dobutamine, Dopamine) Oxygen, I.V fluids, Antibiotics (Inj. Meropenem, Inj. Vancomycin) Mechanical ventilation, Inj. Midazolam



Specialty

Indicativ e Rate &

SYSTEM

Upper ceiling (Rs.) infusion, Inotropes (Dobutamine, Dopamine, Adrenaline, noradrenaline, Milrinone, Insulin, Inj. Calcium, TPN)

839

Pediatri Pediatricc Ic Care GIT GIT

Acute hepatitis hepatitis with with hepatic encephalopathy Inv Serial ABG, Bloodsugar 4 hrly, USG abdomen, CT Scan (brain), Hepatic v iral iral s tudies (Hepatiti (Hepatitiss B, Hepat Hepatitis itis C, Hepatitis A , LFT, LFT, S. Ammonia) 10 days PICU PICU s tay with pos t treatment treatment ev idence for Clin Clin ical Improve Improve ment w ith lab inves tigations tigations

50000

840

Pediatric Ic Care Renal

Acute Renal Failu Failu re with dialysis Inv - Seria Seria l ABG, X-Ray Chest, Blood Urea cum Serum Creatinine 4 hr ly, USG abdomen, S.Electro S.Electro lytes 10 days PICU PICU s tay with pos t treatment treatment ev idence for Clin Clin ical Improve Improve ment w ith lab inves tigations tigations

40000

841

Pediatric Pediatric Ic Care Endocrine

Diabetic Diabetic Ketoacidosis Inv - Seria Seria l ABG, Blood sugar 4 hrly, Serum Electrolytes, CVP monitoring 8 days PICU PICU s tay with pos t treatment treatment ev idence for Clinical Improvement with biochemical parameters

30000

~ 127 ~

Oxygen, I.V fluids, Antibiotics (Inj. Meropenem) Mechanical ventilation, Inj. Midazolam infusion, Inotropes, Dobutamine, Dopamine, Adrenaline, noradrenaline, Milrinone, Inj. Calcium, Inj. N-Acetyl Cystein, Inj. Lornathine, LCarnitine, Anticonvulsant s (Inj. Lorazepam, Inj. Phenytoin, Inj. Phenobarbitone ) Oxygen, I.V fluids, Antibiotics (Inj. Meropenem, Inj. Ofloxacin) Inotropes, (Dobutamine, Dopamine) peritoneal dialysis, dialysis, Inj. Calcium, Mechanical ventilation, Inj. Midazolam infusion. Oxygen, I.V fluids, Antibiotics (Inj. Piperacillin Tazobactum, Inj. Tobramycin), Inotropes (Dobutamine,



Specialty

Indicativ e Rate &

SYSTEM

Upper ceiling (Rs.) Dopamine) Calcium, Insulin infusion.

842

Pediatric Pediatric Ic Care Infection

Septic Septic shock Inv Inv - Serial Serial A BG, Blood Blood s ugar 4 hrly, EEG, USG abdomen, CT scan Brain, Echo, ECG, Blood culture, X-Ray Chest, CRP 10 days PICU PICU s tay with with po st treatment treatment evidenc e for Clin Clin ical Improve Improve ment w ith lab inves tigations tigations

50000

843

Pediatric Pediatric Ic Care Toxicology Toxicology

Snake Snake bite requiring requiring v entilatory entilatory as sistance Inv Serial ABG, S. Electrolytes, Blood sugar 4 hrly, EEG, EEG, CT s can Bra Bra in with with 10 days PICU PICU s tay with with po st treatment treatment evidenc e for Clinical Improvement with biochemical parameters

50000

844


Scorpion Scorpion sting with with myocarditis and cardiogenic cardiogenic shock requiring requiring ventilatory ventilatory As sistance Inv - Serial Serial ABG, Blood sugar 8 hrly, Echo, ECG, CVP monitoring, arterial blood press ure 10 days PICU PICU s tay with pos t treatment treatment ev idence for Clin Clin ical Improve Improve ment w ith lab inves tigations tigations

25000

~ 128 ~

Oxygen, I.V fluids, Inj. Meropenem, Inj. Vancomycin, Anticonvulsant s (Inj. Lorazepam, Inj. Phenytoin, Inj. Phenobarbitone ), Inotropes (Dobutamine, Dopamine, Adrenaline, noradrenaline, Milrinone). Mechanical ventilation, Inj. Midazolam infusion, infusion, T PN. Oxygen, I.V fluids, Inj. Meropenem, Inj. Vancomycin, Anticonvulsant s (Inj. Lorazepam, Inj. Phenytoin, Inj. Phenobarbitone ), Inotropes (Dobutamine, Dopamine, Adrenaline, noradrenaline, Milrinone). Mechanical ventilation, Inj. Midazolam infusion, antisnake venom Oxygen, I.V fluids, Inj. Meropenem, Inj. Vancomycin, Inotropes (Dobutamine, Dopamine, Adrenaline, noradrenaline, Sodium nitroprusside),



Specialty

Indicativ e Rate &

SYSTEM

Upper ceiling (Rs.) Mechanical ventilation, Inj. Midazolam infusion, antiscorpion venom

845


Poiso Poiso n ingestion/ aspiration aspiration requiring requiring ventilatory ventilatory assistance Inv Inv - Seria Seria l A BG, Blood Blood s ugar 8 hrly hrly , Echo, X-Ray Chest, ECG, CVP monitoring, arterial arterial blood blood p ressu re 7 days PICU PICU s tay with pos t treatment treatment ev idence for Clinical Improvement with biochemical parameters

40000

846

Gen Paediatrics Paediatrics Respiratory

Acute Broncho/ lobarpneumonia lobarpneumonia with e mpyema/ pleural effusion Inv - X-Ray, Pus culture, Blood Culture 14 days stay with with po st treatment treatment ev idence of X-Ray X-Ray Ches t

20000

847

Gen Paediatrics Paediatrics Respiratory

Acute Broncho/ lobarpneumonia with with py o pneumothorax pne umothorax Inv - X-Ray, Pus culture, Blood Culture 14 days stay with with po st treatment treatment ev idence of X-Ray Chest

20000

848

Gen Paediatrics Paediatrics CVS

Congen ital heart disease with with conges tive cardiac cardiac failure Inv - X-Ray, 2D Echo, ECG, Serial ABG 7 days s tay with with pos t treatment treatment evidence o f X-Ray Chest, 2D Echo, ECG

15000

~ 129 ~

Oxygen, I.V fluids, Mechanical ventilation, Inj. Midazolam infusion, Inotropes (Dobutamine, Dopamine), specific antidote IV fluids, oxy oxy gen, I V Antibiotics (Amoxycillin clavulanate or ceftriaxone, Amikacin, vancomycin), Oral antibiotics, Nebulisations, Nebulisations, ICD chest drain, chest physiotherapy, physiotherapy, Mechanical ventilation if required and oral antibiotics/ Anti tubercular drugs after discharge IV fluids, oxy oxy gen, I V Antibiotics, Nebulisations, Nebulisations, ICD chest drain, chest physiotherapy, physiotherapy, Mechanical ventilation if required and oral antibiotics/ Anti tubercular drugs after discharge IV fluids, oxy oxy gen, I V Antibiotics (Ceftriaxone, Amikacin or ofloxacin), Nebulisations, Nebulisations, diuretics,



Specialty

Indicativ e Rate &

SYSTEM

Upper ceiling (Rs.) Digoxin and mechanical ventilation.

849

Gen Paediatrics Paediatrics CVS

Acquired heart disease with with conges tive cardiac cardiac failure Inv - X-Ray, 2D Echo, ECG, Serial ABG 7 days s tay with with post treatment treatment evidence o f X-Ray X-Ray Chest, 2D Echo, ECG

15000

850

Gen Paediatrics CVS

Viral Myo carditis Inv - X-Ray, 2D Echo , ECG 7 days s tay with with pos t treatment treatment evidence o f 2D 2D ECHO , ECG , X-Ray Chest

15000

851

General Paediatrics Paediatrics Renal

Steroid Resistant Nephrotic syndrome Co mplicated or Resistan Resistan t Inv - Renal Renal biops y, Electrolytes, Urea, creatinine, Urine exam, X-Ray Ches t 2 weeks stay with post treatment treatment evidence of RFT

25000

852


Urinary tract infection with complications like pyeloneph pye loneph ritis ritis and renal failure failure Inv - MCU G (Micturating cysto urethrogram), Urine for Culture and Sensitivity, Sensitivity, Ultrasound 10 days s tay with with post treatment treatment evidence o f Urine Cu Cu lture lture and U SG

15000

853


Acute Renal Failure RFT, Serum Electrolytes, C3, C1, Complement levels, Collagen Vascular profile 10 days stay with with po st t reatment reatment evidence o f RFT RFT

10000

854


Acute Renal Failu Failu re with dialysis Inv - RFT, Serum Electrolytes, C3, C1, Complement levels, Collagen Vascu lar profile 10 day s stay with post treatment evidence of RFT.

20000

~ 130 ~

IV fluids, oxy oxy gen, I V Antibiotics (ceftriaxone, Amikacin or ofloxacin), Nebulisations, Nebulisations, diuretics, Ace inhibitors, Digoxin and mechanical ventilation. IV fluids, oxy oxy gen, I V Antibiotics (ceftriaxone, Amikacin or ofloxacin), diuretics, inotropes and steroids Antibiotics ceftriaxone, Amikacin or ofloxacin), Antihypertensi ve, Diuretics. Immunosuppre ssive, pleural tap/ascitic tap IV fluids,IV Antibiotics (Amoxycillin clavulanate, ceftriaxone, Amikacin or ofloxacin paracetamol, paracetamol, oral antibiotics (Amoxycillin clavulanate, cefixime). Dialysis. Antibiotics, Antihypertensi ve, Diuretics Supportive Management, Haemo or Peritoneal dialysis Antibiotics, Antihypertensi ve, Diuretics Supportive Management, Haemo or



Specialty

Indicativ e Rate &

SYSTEM

Upper ceiling (Rs.) Peritoneal dialysis

855

General Paediatrics Paediatrics Severe anaemia anaemia

856


857


858

General Paediatrics Paediatrics Infections

859


~ 131 ~

Thalassemia Thalassemia Majo r requiring ch elation elation Therapy Inv - Hb electrophoresis, Osmotic fragility test, Seru Seru m Ferri Ferritt in 7 days stay with with post treatment treatment evidence of Clin Clin ical and Haematological Haematological Improvements Haemophilia including Inv - Von Will brands Coagulation stu dies and Factor analys analys is 7 days stay with with p ost treatment treatment evidence of Clinical and Haematological Haematological Imp Imp rovements rovements Anaemia Anaemia o f unknown cause Inv - Hb electropho electropho resis, bone marrow e xa mination, mination, Hierogra Hierogra m 5 days s tay with with pos t treatment treatment evidence of Clin Clin ical and Haematological Haematological Improvements Pyogenic men men ingitis ingitis Inv - CSF Analysis & CTScan Brain, Brain, Blood Culture, X-Ray Chest with with po st 10 days stay with with po st treatment treatment evidence o f Repeat CSF

Neuro tub erculosis erculos is Inv - CT-Scan Brain CSF ADA analysis, X-Ray X-Ray Chest 12 days s tay with with post treatm t reatment ent ev idence of o f Clinica Clinica l and lab investigation

Up to 20000

Blood transfusion., Chelating Agents (Oral or Parenteral)

Blood and Blood products, Factor concentrate Bloods Up transfusion, to 10000 Haematinics etc., IV fluids fluids

20000

35000

10000 + DOTS Rx free free

IV fluids, IV antibiotics (Amoxycillin clavulanate, ceftriaxone, Amikacin or ofloxacin, vancomycin), Paracetamol, IV dexamethasone for below 5 yr. old children, Anticonvulsant s (midazolam or lorazepam, Phenobarbitone or Phenytoin), Ventilatory Support. IV fluids, Naso gastric feeds, IV antibiotics anti tubercular therapy, Paracetamol, IV Manni M annitol, tol, Anticonvulsant s (midazolam or lorazepam, Phenobarbitone or Phenytoin), IV dexamethasone and oral steroids, Mechanical Ventilatory Support.



Specialty

Indicativ e Rate &

SYSTEM

Upper ceiling (Rs.) 20000 + DOT SRx free

860


Neuro tub erculosis erculos is with with ventilation ve ntilation Inv - A BG, CT-Scan Brain CSF CSF ADA an alysis 12 days stay with with p ost treatment treatment ev idence of Clinica Clinica l and lab investigation

861


Suspected Dengue sh ock syndrome syndrome with thrombocyt thrombocyt openia Inv – Inv – Platelet Platelet count an d serology with pos t treatment treatment ev idence of platelet platelet transfusion and clinical clinical ph otog raph

20000

862


Cerebral Malaria (Falciparum) Inv - CSF analysis, Parasite F Test and QBC, Electrolytes, ABG 7 days s tay with with pos t treatment treatment ev idence of Clin Clin ical and lab investigation

10000

863

General Paediatrics Paediatrics Neurology

Convu lsive lsive Disorders/Status Disorders/Status Epilepticus (Fits) (Fits) Inv - EEG, CT Electrolytes, Bl. Sugar, S.calcium, Phosphorous 7 days s tay with with p ost treatment treatment evidence of clinical clinical and lab inves tigation tigation

10000

864


Stroke Syndrome Inv - CT, Angiogram, EEG, 2D Echo 1 4 days stay with with po st treatment treatment evidence o f clin clin ical and lab investigation

20000

865


Encephalitis / Encephalopathy Inv - CSF, CT 10 days s tay with with pos t treatment treatment ev idence of clin clin ical and lab investigation

15000

866


Guillian-Barre Syndrome Inv - CSF Analysis, ENM ENM G Ne Ne rve Condu Condu ction studies, ABG 15 days stay with with p ost treatment treatment ev idence of clinica clinica l and lab investigation

60000

~ 132 ~

IV fluids, Naso gastric feeds, IV antibiotics anti tubercular therapy, Paracetamol, IV Manni M annitol, tol, Anticonvulsant s (midazolam or lorazepam, Phenobarbitone or Phenytoin), IV dexamethasone and oral steroids, Mechanical Ventilatory Support. IV fluids, Inotrpopes, Platelet transfusion and supportive treatment. IV fluids, IV antibiotics ceftriaxone, Amikacin, ofloxacin), Oral chloroquine or IV quinine or IV artesunate, Paracetamol, mefloquine, blood and platelet transfusion, mechanical ventilation Anticonvulsant s, IV fluids, Oxygen, ventilator Oxygen, IV Fluids, Anti Epieptics, Low Molecular, heparin IV fluids, Mannitol, Anticonvulsan ts, Acyclovir, Acyclovir, Inj. Ventilator care Immunoglobuli n, IV fluids, ventilary and supportive care,



Specialty

Indicativ e Rate &

SYSTEM

Upper ceiling (Rs.) Physioherapy

867


868


869

Card Card iology

870

Card Card iology

871

Card Card iology

872

Card Card iology

873


874

Card Card iology

875


876


877

Nephrology

878

Nephrology Nephrology

879

Nephrology Nephrology

~ 133 ~

Acute MI (Cons (Cons ervative ervative Management withou withou t Ang iogram) iogram) Inv Inv - ECG, CPKMB, Tropo Tropo nin, 2D Echo 1 week stay with with po st t reatment reatment evidence o f ECG, 2D Echo, Lab Investigations Acute MI (Cons (Cons ervative ervative Management with with Angiogram) Inv - ECG, CPKMB, Troponin, 2D Echo, Coronary Coronary A ngiography 1 week s tay with post treatm t reatment ent ev idence of o f ECG, ECG, 2D Ech o, Lab Investigations Acute Acu te MI with with Card Card iogenic Shock Inv - ECG, CPKMB, Troponin, 2D Echo, Coronary Angiography 2 wee wee ks st ay with with po st t reatment reatment evidence eviden ce of ECG, 2D Echo Echo , Lab Lab Inve Invest st igations Acute Acu te MI requiring requiring IABP IA BP Pum Pu mp Inv - ECG, CPKMB, Troponin, 2D ECHO, Coronary angiography 3 weeks weeks s tay with with po st treatment treatment evidence of ECG, 2D Echo, Lab Investigations Refractory Cardiac Failure Inv - ECG, CPKMB, Troponin, 2D Echo, Coronary Angiography 2 weeks weeks stay with with p ost treatment treatment evidence of ECG, 2D Echo, Lab Investigations Infective Endo carditis Inv - ECG, 2D Echo, cho , Blood C/S 5 days stay with with po st treatment treatment evidence o f ECG, 2D Echo, Lab Investigations Pulmonary Pulmonary Embolis Embolis m Inv - M RI/doppler 5 days stay with with p ost treatment treatment ev idence of ECG, 2D Echo, Lab Investigations Complex Arrhyth Ar rhyth mias Inv - ECG, Doppler, 3 days s tay with with pos t treatment treatment ev idence of ECG, 2D Echo, Lab Investigations Simp Simp le Arrhyth mias Inv - ECG dopp ler 3 days stay with with p ost treatment treatment ev idence of ECG, 2D Echo, Lab Investigations Pericardi Pericardiaa l Effus Effus ion Tamponade Inv - Doppler 1 week stay with pos t treatment evidence of ECG, 2D Echo, Lab Investigations Acute Acu te Renal Failure-(A RF) Inv - LFT, S. Protein, Calcium, Phos phate, uric acid, Electrolytes , Urine protein, US G, ECG, 2D Echo, HIV, H CD, HbSAg 10 days stay in MICU with po st treatment treatment evidence of RFT and other lab investigation Dialys Dialys is chart Nephrotic Nephrotic Syndro me Inv - LFT, Seru Seru m protein, Serum electrolytes, 24 hours urine, Urine protein, Chest X-Ray, Biopsy report, USG, ECG, HIV, HCG, HBSAg, ANA/dsDNA, BTCT 4 Days stay with with pos t treatment treatment evidence of RFT RFT and ot her lab inves inves tigation tigation Rapidly progress ive Renal Failure (RPRF) Inv - S. Renal Chemistry 10 days stay with with po st treatment treatment evidence of RFT and oth er lab lab inves tigation tigation

20000

Medical

30000

Medical

30000

Medical

50000

Medical

50000

Medical

25000

MEDICAL

30000

MEDICAL

95000

Cartoguided

70000

Focus Ablation

25000

Aspiration

20000

Dialys Dialysis is and supportive therapy

15000

Immunosuppre ssive RX

35000

Medicines, Steroids parenteral



Specialty

Indicativ e Rate &

SYSTEM

880

Nephrology

881

Nephrology

882

Neurology Neurology

883

Neurology Neurology

CIDP Inv - NCS, EM G, CSF analysis, Seru Seru m Protein Protein electropho electropho resis, Nerve Nerve Biopsy 10 days stay with with p ost treatment treatment ev idence of Clinica Clinica l and Lab Investigations

8000

884

Neurology Neurology

Haemorrhagi Haemorrhagicc Stro Stro ke/Strokes ke/Strokes Inv - CT Bra Bra in / MRI Brain / MRV / M RA, ECG, ECG, Echocardiography, Carotid and vertebral Doppler etc. special tests for Evaluation valuation o f cause, 4 -vessel cerebral angio if necessary (DSA), lipid profile 15 days s tay with with pos t treatment treatment ev idence of Clin Clin ical and Lab Investigations

25000

885

Neurology

Ischem Isch emic ic Strokes Inv - CT Bra Bra in / M RI Bra Bra in / MRV / MRA, ECG, Echocardiography, Carotid and v ertebral Doppler etc. special tests for Evaluation valuation of caus e, 4-ves 4-ves sel cerebral angio if necessary (DSA), lipid profile 15 days stay with post treatm t reatment ent ev idence of o f Clinica Clinica l and Lab Investigations

20000

~ 134 ~

Chronic Renal Failure Fai lure 1 (CRF ) Inv - LFT, S. Protein, S. Ca, Ca, S. Po4, Po 4, S. u ric ric acid, ac id, A lb/G lb/ Globulin lobul in ratio ratio S . electro electro lytes, 24 hrs. urine, urine, Spot Urine /Creatin /Creatin ine ratio, ratio, Chest X-ray, USG, EC G, HIV, HCV, HCV, Hb SAg, 2D Echo Echo 5 days s tay with with post treatment treatment evidence of RFT and oth er lab lab investigation Mainten ance Haemodia Haemodia lysis for CRF Inv - LFT, S. Protein, S. Ca, S. Po4, S. uric acid, Alb/Globulin ratio S. electrolytes, 24 hrs. urine, Spot Urine /Creatinine ratio, Chest X-ray, USG, ECG, ECG, HIV, HCV, HbSAg, 2D Echo 1 day stay per dialys dialys is with with post treatment treatment evidence of RFT and other lab inves tigation tigation ADEM ADEM or Re lapse in Multiple Multiple sclerosis Inv - M RI Brain & Spinal cord (3 sites) Pla Pla in and cont rast, CSF analysis, Evoked Potentials, CSF Monoclonal Bands , HIV HIV Profile Profile 15 days stay with with po st treatment evidence of Clinical and Lab Investigations


Initial treatment and Dialysis and supportive therapy

10000 month

Dialys Dialysis is and supportive therapy (M inimum of 8 dialysis)

20000

Inj. Methylprednis olone, supportive care, ventilatory support if necessary, antacids and vitamin supplementatio n, physiotherapy physiotherapy + Oral st eroids eroids for 4 weeks Oral steroids, azathioprine, vitamin supplementatio n, physiotherapy physiotherapy antihypertensiv e, antidiabetics, Antacids, M annitol annitol IV, IV fluids as necessary, Surgery if necessary Antihypertensi ve, Antidiabetics, Aspirin + Clopidogrel, Antacids, M annitol annitol IV, Heparanoids for 5 days, IV fluids as necessary, Surgery in some cases cases



Specialty

Indicativ e Rate &

SYSTEM


886

Neurology Neurology

Myop athies - Acquired NCS, NCS, Inv - EM G, Seru m CPK, Seru m Calcium, Calcium, Phosphat e and alkali alkaline ne phos phatase, end ocrine evaluat ion, Mus cle Biops Biopsy y 15 days stay with with po st treatment treatment evidence of Clin Clin ical and Lab Investigations

887

Neurology

NEUROINFECTIONS - Fungal Funga l Meningitis Men ingitis Inv CT brain, M RI brain s can, CSF analys analys is, cell count, A DA, culture, culture, CSF s erology erology for tuberculosis tuberculosis antigens, Fungal Fungal st udies udies M in 20 days - ICU, 40 days - ward st ay with with pos t treatment treatment evidence of Clin Clin ical and Lab Inves tigations tigations

40000

888

Neurolog y

NEUROINFECTIONS - Pyogenic Pyoge nic Meningitis Men ingitis Inv - CT brain, MRI b rain scan , CSF CSF analysis, cell count, ADA, culture Min Min 10 days - ICU, 7 days ward ward s tay with pos t treatment treatment ev idence of Clinica Clinica l and Lab Investigations

25000

889

Neurology

25000

890

Neurology Neurology

NEUROINFECTIONS - Viral Meningoencephalitis Meningoencephalitis (Including (Including Herpes Herpes encephalitis) encephalitis) Inv - CT brain, MRI brain scan, CSF analysis, cell count, A DA, culture, culture, CSF antibodies for HSV Min 10 days - ICU, ICU, 7 days - ward ward st ay with with p ost treatment treatment ev idence of Clinica Clinica l and Lab Investigations Neuro Neuro muscu lar (myas (myas thenia gravis) Inv - RNS / CT chest / CT abdo men, Neostigmine Neostigmine tes t, thyroid profile 15 day s stay with with po st treatment evidenc e of Clinica Clinica l and Lab Inves tigations tigations

891

Neurology Neurology

Neuropath Neuropath ies (GBS) (GBS) Inv - NCS / EM G (1000), Nerve Biops y (2000), CSF ana lysis 10 days - ICU 20 days - Ward stay with with po st treatment treatment evidence of Clinica Clinica l and Lab Inves tigations tigations

35000

892

Neurology Neurology

Optic Optic neuritis Inv - M RI Bra Bra in & Optic Optic nerves, VEPs, VEPs, CSF analysis 3 days stay with with po st treatment evidence of Clinical and Lab Investigations

10000

~ 135 ~

15000

Prednisolone + Azathioprine, Calcium supplementatio n, vitamin supplementatio n, Endocrine therapy. Antacids, M annitol annitol IV, steroids, Antifungal drugs, IV fluids as necessary Antacids, M annitol annitol IV, steroids, Higher Antibiotics, IV fluids as necessary, Surgery if necessary Antacids, M annitol annitol IV, methyl prednisolone, prednisolone, Acyclovir, IV fluids as necessary Prednisolone + Neostigmin Neostigminee + Calcium supplementatio ns, Azathioprine, (Surgery for thymoma), Ventilatory care if necessary Inj. Methylprednis olone, supportive care, ventilatory support if necessary, antacids and vitamin supplementatio n, physiotherapy physiotherapy

Inj. Methylpredni solone, antacids and vitamin supplementati



Specialty

Indicativ e Rate &

SYSTEM

Upper ceiling (Rs.) on + oral steroids steroids for 2 weeks 893

Neurology Neurology

Immunog Immunog lobulin lobulin Therapy - IV Investigations indicative indicative of diseas es 5 day s stay with with po st treatment evidence of Clinical and Lab Investigations

100000

894

Pulmonology Pulmonology

20000

895


Bronchiectasis requiring requiring hos pitalisation pitalisation Inv - HR CT - Chest, spirometry, FOB (Fiberoptic Bronchos copy), IgE, IgE, Sputum culture culture / drug susceptibility susceptibility 10 days stay with with p ost treatment treatment evidence of Clin Clin ical and Lab Inves tigations tigations Lung Abs cess, cess, non resolving resolving Inv - CT Scan Ches t, FOB, FOB, Pus C/S 1 0 days s tay with post treatment treatment evidence of Clin Clin ical and Lab Lab Investigations

896


897


898


899


900


901

Dermatology

~ 136 ~

In sev eral life life threatening diseases i.e. rapidly progress ive GBS, CIDP, Myasthenia, Multiple sclerosis, etc. According to International Guide lines

15000

Antibiotics, Bronchial toilet

Pneumothora Pneumothora x (Large/Recurrent) HRCT Inv - Chest , VATS 10 days s tay with with pos t treatment treatment ev idence of Clin Clin ical and Lab Inves Inves tigations tigations

35000

Interstitial Interstitial Lung diseases Inv - Spirometry, Spirometry, HRCT Ches t, Collagen Collagen Pro Pro file, file, Bronchos copy, 2D Echo Echo 10 days stay with with po st t reatment reatment evidence o f Clin Clin ical and Lab Investigations Pneumoconiosis Pneumoconiosis Inv - Spirometry, Spirometry, HRCT Chest, Collagen Profile, Bronchos copy, 2D 2D Echo 10 days stay with with p ost treatment treatment ev idence of Clinica Clinica l and Lab Investigations Acute Resp iratory iratory Failure Failure (without ventilator) ventilator) Inv - Seru m Electrolyte Electrolytes, s, ABG, ECG, 2D Echo, Bronchos copy, Sputum / Bronchial Wash ing / ET Suctions Suctions for Analysis Analysis 10 days s tay with with post treatment evidence of Clinical and Lab Investigations Acute Resp iratory iratory Failure Failure (with ventilator) ventilator) Inv Serum Electrolytes, ABG, ECG, 2D Echo, Bronchos copy, Sputum / Bronchial Wash ing / ET Suctions Suctions for Analysis Analysis 10 days s tay with with post treatment evidence of Clinical and Lab Investigations Pemphigus / Pemph Pemphigoid igoid Tzanck Tzanc k Inv - Smear Skin Biopsy HPE DIF DIF Clinical Protocol 15 days stay with with p ost treatment treatment ev idence of Clinica Clinica l and Lab Investigations

30000

Thoracostom y + o xygen + antimicrobial s, pleuredesis, MICU Steroids, antimicrobial, MICU

25000

Medical Management, MICU

25000

Oxygen, Antimicrobial s, Suppo rtive rtive therapy in MICU

50000

Oxygen, Antimicrobial s, Suppo rtive rtive therapy in MICU

25000

IV Fluids Fluids IV Antibiotics IV Steroids Pulse Pulse therapy



Specialty

902

Dermatology

903

Dermatology Dermatology

904

Rheu matolog y

905

Rheumatology Rheumatology

906


907


908


909

910

911

Indicativ e Rate &

SYSTEM

Toxic ep idermal necrolys is Inv - LFT, Bloo Blood dculture, urine Culture, Skin swab, USG abdomen Skin biopsy - HPE, Echo - Cardiogram 15 days stay with with p ost treatment treatment ev idence of Clinica Clinica l and Lab Investigations Stevens- Johnson Syndrome Syndrome Inv - LFT, LFT, Blood culture, urine Culture, Skin swab, USG abdomen Skin biopsy - HPE, Echo - Cardiogram 15 days stay with with po st treatment treatment evidence o f Clinical Clinical and Lab Investigations SLE (S YSTEM YSTEM IC LUPUS ERYTHEMATO SIS) Inv - dSDNA, ACL ANTIBODIES, A NA PROFILE, PROFILE, K IDNEY BIOPSY, HRCT, 24 Hrs URINARY PROTEIN, ENANTIGEN 10 days stay with post treatment treatment evidence of Clinical Clinical and Lab Investigations SLE with with Sepsis Inv - dSDNA, A CL Antibodies, ANA Profile, Kidney biops y, HRCT, HRCT, 24 Hrs urinary protein, ENAntigen, Blood culture / proof of seps is 4 weeks weeks stay with with po st treatment evidence of Clin Clin ical and Lab Inves tigations tigations


IV Fluids Fluids IV Antibiotics IV Steroids

20000

IV Fluids Fluids IV Antibiotics IV Steroids

15000

As per American College of Rheumatolog y Guidelines.

50000

As per American College of Rheumatolog y Guidelines.

SCLERODERMA SCLERODERMA Inv - Renal dopp ler, ler, 2D ECHO, ECHO, Skin biops y HPE Report, ANA ANA Profil Profilee 7 days s tay with with pos t treatment treatment ev idence of Clin Clin ical and Lab Inves Inves tigations tigations

15000

MCTD Mixed Connective Tiss Tiss ue Diso Diso rder Inv CPK, LDH, ENMG, MRI of muscles, MRI of hands, kidney kidney biopsy 24 Hrs Hrs u rinary rinary p rotein rotein 7 Days s tay with with p os t treatment treatment ev idence of Clin Clin ical and Lab Investigations PRIMARY PRIMARY SJOGREN'S SYNDROME SYNDROM E Inv Inv - 24 Hrs Urinary protein , AB G, USG Abdo men 7 Days s tay with with pos t treatment treatment evidence of Clin Clin ical and Lab Inves tigations tigations

15000

As per American College of Rheumatolog y Guidelines. As per American College of Rheumatolog y Guidelines. As per American College of Rheumatolog y Guidelines.


VA SCULITIS SCULITIS Inv - CANCA, CANCA, pANCA, ANA profile 10 day s stay with with po st treatment evidenc e of Clinica Clinica l and Lab Inves tigations tigations

10000

Endocrinology Uncontrolled Diabetes Diabetes Mellitus Mellitus With Infectious Infectious Emergencies Endocrinology Uncontrolled Diabetes Diabetes Mellitus Mellitus With Infectious Infectious Emergencies

Pyeloneph Pyeloneph ritis ritis Inv - Urine C/S, USG 10 days s tay with with p ost treatment treatment ev idence of Clinica Clinica l and Lab Investigations

20000

As per American College of Rheumatolog y Guidelines. IV fluids fluids

Lower Respiratory tract infection Inv - CXR, Sputum C/S 10 days stay with with po st treatment treatment evidence of Clin Clin ical and Lab Inves tigations tigations

20000

Insulin

~ 137 ~

15000



912

Specialty

Indicativ e Rate &

SYSTEM

Endocrinology Uncontrolled Diabetes Diabetes Mellitus Mellitus With Infectious Infectious Emergencies Endocrinology Uncontrolled Diabetes Diabetes Mellitus Mellitus With Infectious Infectious Emergencies Endocrinology Uncontrolled Diabetes Diabetes Mellitus Mellitus With Infectious Infectious Emergencies Endocrinology Uncontrolled Diabetes Diabetes Mellitus Mellitus With Infectious Infectious Emergencies Other Endo crinal disorders

Fungal sinusitis Inv - CT PNS 10 days stay with with post treatm t reatment ent ev idence of o f Clinica Clinica l and Lab Investigations

917

Other Endo crinal disorders

918


919


920

Gastroe nterolog y

913

914

915

916

~ 138 ~


IV & Ora Ora l antibiotics

Cholecystitis Inv - USG, CT Abd 10 day s stay with with p ost treatment treatment ev idence of Clinica Clinica l and Lab Investigations

25000

Antibiotics and Supportive Therapy

Cavernous sinus thrombos thrombos is Inv - M RI, Venogram, Twice 10 days stay with with po st treatment treatment evidence of Clin Clin ical and Lab Inves tigations tigations

40000

IV & Ora Ora l antibiotics

Rhinocerebral mucormycosis Inv - CT-Scan, (Brain (Brain PNS Chest, Abdo men) when neces sary 10 days s tay with with pos t treatment treatment ev idence of Clin Clin ical and Lab Investigations

40000

IV antifungals

Hypopitutarism Inv - T3 T4 TSH, basal cortisol post-act post -act cortiso l, GH st imulat imulat ion tes t, FSH, FSH, LH, Testosterone or Estradiol GH stimulation test 1 yr. needed MRI pic visu al field field water deprivation tes t 1 yr. needed 1 week stay with post treatment treatment evidence of Clin Clin ical and Lab Inves tigations tigations

100000

Hormone Therapy for three months

Pituitary Pituitary - Acro megaly Inv - Post glucose on assay, prolactin, prolactin, t3 t4 TSH, Basal cortiso cortiso l cost ACTH, FSH / LH, testosterone / estriol, water deprivation deprivation t est (if (if needed), M RI co lonoscopy if needed, Visual field, 2D ECHO 1 week stay with post treatm t reatment ent ev idence of o f Clinica Clinica l and Lab Investigations CUSHINGs CUSHINGs Syndrome Inv - Cortiso Cortiso l assay after dexamethaso dexamethaso ne, ACTH ass ay, DHEA DHEA S, MRI pituitary CTABD, CT Chest, Chest , Dexa Dexa of Hip H ip spine 1 week stay w ith pos t treatment treatment ev idence of Clinical Clinical and Lab Investigations

15000

Hormone Therapy for three months

30000

Delayed Delayed Puberty Hypog onadism (e (e x.Turners x.Turners s ynd, Kleinfelter Kleinfelter syn d) Inv - F SH, LH, tes tosterone, tosterone, estradiol, USG pelvis karyoty ping, T4 TSH S-ray bon e age, X-ray X-ray s kull, MRI brain DEXA 2D echo 5 days s tay with with pos t treatment treatment evidence o f Clin Clin ical and Lab Inves tigations tigations Corros Corros ive Oesophagea Oeso phageall injury injury Inv - Barium swallow swallow 7 days stay with with po st treatment treatment evidence of Ba Ba riu riu m swallow

12000

Diabetes mellitus drugs, Hypertension, Osteoporosis, infection with antibiotics + surgery Inj Testosterone 250mg / 3 wks., wks., oc p ills ills

20000

Endoscopic dilatation video / photo Medical treatment, MICU stay



Specialty

Indicativ e Rate &

SYSTEM

921

Gastroenterology

Oesophageal foreign foreign body Inv - X-Ray X-Ray one day stay with with po st treatment treatment evidence o f Endos Endos copic Photograph

922

Gastroenterology

923

Gastroenterology

924

Gastroenterology

925

Gastroenterology

926

Gastroenterology

927

Gastroe nterolog y

928

Gastroenterology

Oesophageal perforation perforation Inv - CT scan thorax, & abdomen, Ba Ba rium swallow swallow 7 d ays stay with post treatment treatment evidence o f CT Abdomen Achalasia cardia cardia Inv - UGI endos copy / Barium Barium swallow swallow o ne day stay with with po st treatment treatment evidence of Endos copic copic Photograph Oesophageal Varices, varicea varicea l banding Inv - UGI endoscopy one day stay with with post treatment treatment evidence of Endosco pic Photograph Oesophageal Varices, sclerotherapy Inv - UGI endoscopy o ne day stay with with po st treatment treatment evidence of Endosco pic Photograph Oesophageal Fistu Fistu la Inv - CT Thorax, Gastrograffi Gastrograffin n co ntrast picture 3 days stay with post treatm t reatment ent ev idence with pos t treatm treat ment evidence of Photograph o f stent in position position GA VE (Gastric Ant ral Vascu lar Ectas ia) Inv UGI Endos Endos copy 2 days stay with post t reatment reatment evidence of Endosco pic Photograph Gastric Gastric varices Inv - UGI Endos copy 3 days stay with with p ost treatment treatment ev idence of Endos copic Photograph

929

Gastroenterology

930

Gastroenterology

931

Gastroenterology

932

933

Acute pancreatiti pancreatitiss (Mild) (Mild) Inv - USG abdomen, S. Amylase, S. Electrolytes, Ranson's Scoring 1 week stay with pos t treatment treatment ev idence of USG, Lab Investigation Acute pancreatiti pancreatitiss (severe) Inv - CT Abdo men, S. Amylase, EUS, RFT, LFT S. Electrolytes, Rans on's Scoring, CXR, A BG 3 weeks s tay with post treatm t reatment ent ev idence of o f USG, USG, Lab Invest Inve stigation igation


25000

7000

10000

5000

30000

20000

15000

Up to 75000

Foreign Foreign body removal removal pho to of the proced ure Conservative, MICU stay Dilatation, Botulinum, Taxim Inj. Endoscopic variceal banding ban ding Endoscopic sclerotherapy injection Covered esophageal stent, MICU Medical Med ical + Argon Laser Coagulation MICU, Endoscopic Glue Injection MICU

Up to 150000

MICU

Acute pancreatiti pancreatitiss with with ps eudocyst (infected) (infected) Inv CT Scan abdomen, EUS, Post Procedure USG 3 weeks weeks stay with with p ost treatment treatment ev idence of USG, Lab Investigation

Up to 30000

Gastroenterology

Chronic pancreatitis with with sev ere pain Inv - EUS, EUS, CT Scan, Abdo men, ERCP / M RCP 7 days stay with with p ost treatment treatment ev idence of Lab Inves tigation

Up to 20000

Gastroenterology

Obscure GI beed Inv - BMFT, Capsule Endos copy, Enterosco Enterosco py b iopsy iopsy 1 week week stay w ith post treatm t reatment ent ev idence of o f Endos copic photograp h

50000

Endoscopy drainage, Percutaneous drainage, surgical drainage + MICU Conservative, ERCP + Stenting, ERCP, EUS guided, Celiac ganglion block, MICU MI CU Argon Laser Rx

~ 139 ~



Specialty

Indicativ e Rate &

SYSTEM


934

Gastroenterology

Cirrhosis Cirrhosis with Hepatic Hepatic Encephalopath y Inv - UGI Endos copy, Axc Axc itic itic fluid fluid analysis 11 days stay with with p ost treatment treatment ev idence of Lab Inves tigation tigation

935

Gastroenterology

Cirrhosis Cirrhosis with hepato renal sy ndrom ndromee Inv Reports of Seru Seru m Che Che mistry mistry 1 0 days stay with with post treatm t reatment ent ev idence of o f Lab Inv Inves estigation tigation

40000

936

Gastroenterology

50000

937

Gastroenterology

938

Gastroenterology

939

Interventional Radiology

940


941


942


943


944


945


946


947


Biliary Biliary structure 1) Post op stent Inv - EUS, EUS, MRCP, MRCP, ERCP, ERCP, PTBD 7 days stay with with po st treatment evidence of Radiological & endoscopic image Biliary Biliary structure 2) Post op leaks leaks Inv EUS, EUS, M RCP, RCP, ERCP, ERCP, PTBD 7 days stay with with po st treatment treatment ev idence of Radiolog adiolog ical & endos copic image Biliary Biliary structure 3) Scleros Scleros ing cholangitis cholangitis Inv - EUS, MRCP, ERCP, PTBD 7 days stay with post treatm t reatment ent ev idence of o f Rad Rad iological & endoscopic image image Embo Embo lizat lizat ion of A V malformat ion of per ipheral extre extre mity, mity, craniofascial and visceral per s itting itting Post p rocedure rocedure evidence o f Clinical Clinical phot ograph and Radiographic image Inferior Inferior vena cava s tenting single stent Pos Pos t proced ure evidence eviden ce of Clin Clinical ical photo ph oto graph an d Radiographic image Hepatic vein Stenting in Budd - Chiari Syndrome single stent Pos t p rocedure rocedure evidence of Clin Clin ical pho tograph and Radiograph ic image Acute stroke thrombolysis thrombolysis with rTPA Pos t proced ure evidence eviden ce of Clin Clinical ical photo ph oto graph an d Radiographic image Renal artery e mbolization with mu ltiple ltiple co ils and microcatheter microcatheter Post procedure ev idence of Clinical pho tograph and Radiograph ic image Cortica ortica l venous sinus th rombolysis rombolysis Post Post procedure evidence of Clin Clin ical photo graph and Radiographic image Deep venous th rombolys rombolys is for DVT DVT w ith IVC filter Post procedure evidence of Clinical pho tograph and Radiograph ic image Subclavian, Iliac, Superficial Femoral artery stenting each with with on e st ent Pos t procedure evidence of Clin Clin ical photog raph and Radiographic Radiographic image Tibial angioplasty in critical limb ischemia Post proced ure evidence eviden ce of Clin Clinical ical photo ph oto graph an d Radiographic image

948


~ 140 ~

Mesenteric Mesenteric artery angioplasty & s tenting in acute & chronic chronic mesen teric teric ischemia ischemia - S ingle ingle sten t Post proced ure evidence eviden ce of Clin Clinical ical photo ph oto graph an d Radiographic image

EVL-EST, MICU 10 days Medical, EVL-EST, MICU 10 days Medical, biliary sten t

75000

Medical, biliary sten t

75000

Medical, biliary sten t

90000

125000

125000

100000

100000

100000

125000

125000

120000

110000



Specialty

Indicativ e Rate &

SYSTEM

949


950


951


Radiofrequency Tumor Tumor Ablat ion Therapy Post proced ure evidence eviden ce of Clin Clinical ical photo ph oto graph an d Radiographic image

120000

952


100000

953


954


955


956


957


958


959


960


961


962


963


Embo Embo lizat lizat ion of po stoperative and post t raumatic raumatic bleeding Pos t proced ure evidence eviden ce of Clinical Clinical pho tograph and Radiograph ic image Inferior Vena Cava Filter placement Post proced ure evidence eviden ce of Clin Clinical ical photo ph oto graph an d Radiographic image Biliary Biliary drainage procedures - External External dra inage and stent placement placement - Single metallic metallic stent Pos t proced ure evidence eviden ce of Clin Clinical ical photo ph oto graph an d Radiographic image Nephros tomy tube tub e and neph roureteral stent place ment Pos t procedure proce dure evidence o f Clinica Clinica l pho tograph and Radiograph ic image Uterine Uterine a rtery rtery e mbolization in s evere Men orrhagia orrhagia secondary to PPH, PPH, uterine uterine f ibroids ibroids and AVM AVM Post proced ure evidence eviden ce of Clin Clinical ical photo ph oto graph an d Radiographic image Intra-arteri Intra-arterial al thro mbolysis for acute ischemic ischemic limbs limbs Post procedure evidence of Clin Clin ical pho tograph and Radiograph ic image Permanent Permanent tunn elled elled cath eter placement placement as substitute for AV Fistu Fistu la in in long term dialys dialys is Post proced ure evidence eviden ce of Clin Clinical ical photo ph oto graph an d Radiographic image Central Venous stenting for Central Central veno us occlusion ( Brachiocephalic, Brachiocephalic, s ubclavian vein and sup Vena cava) Single metallic metallic st ent Post proced ure evidence eviden ce of Clin Clinical ical photo ph oto graph an d Radiographic image Endov ascu lar intervention intervention for s alvaging alvaging hemodialysis hemodialysis AV fistu fistu la Pos Pos t procedu re evidence of Clinica Clinica l photog raph and Radiographic Radiographic image Ba lloon lloon Ret rograde Transvenous obliterati obliteration on of bleeding ga st ric ric varices ( BRTO) Pos t proced ure evidence of Clin Clin ical photo graph and Radiographic image Preoperative portal vein embolization for liver tumors tumors Pos t procedu re evidence of Clinica Clinica l pho tograph and Radiograph ic image Che mo e mbolization for liver tu mors us ing drug and PVA or DC beads Pos t procedure evidence evidence of Clin Clin ical photog raph raph and Radiographic Radiographic image image

~ 141 ~

Gastrointestinal visceral arterial embolization in upper an d lower gastrointestinal bleeding bleeding with microcatheter microcatheter Post procedure ev idence of Clinical pho tograph and Radiograph ic image Bronchial Artery Embolizat Embolizat ion in he mopty sis using PVA PVA and micro micro catheter Post p rocedure evidence of Clin Clin ical photog raph and Radiog Radiog raphic image


60000

100000

100000

60000

80000

100000

40000

125000

120000

100000

100000

100000



Specialty

964


965


966


967


968


969

970

971

972

Interventional Radiology Interventional Radiology Interventional Radiology Interventional Radiology

~ 142 ~

Indicativ e Rate &

SYSTEM

Percutaneo Percutaneo us v ertebro plasty/ cementoplasty cementoplasty (for (for each level) Post procedure evidence of Clinical pho tograph and Radiograph ic image Trans jugular intrahepatic portosystemic portosystemic shun t (TIPSS) (TIPSS) Post procedure evidence of Clinical Clinical pho tograph and Radiograph ic image Embo Embo lizat lizat ion of Pulmonary A V Ma lformation lformation Post p rocedure rocedure evidence o f Clinical Clinical phot ograph and Radiographic image Preoperative Preoperative Proph ylactic ylactic t umor umor e mbolization Post p rocedure rocedure evidence o f Clinical Clinical phot ograph and Radiographic image Embo Embo lizat lizat ion of A V malformation malformation of brain per sitting with with Ony x Pos Pos t procedure ev idence of Clin Clin ical photog raph raph and Radiographic image image Carotid arotid s tenting s ingle ingle s tent with with p rotection device Post p rocedure rocedure evidence o f Clinical Clinical phot ograph and Radiographic image Intracranial Intracranial arterial and ven ous s tenting tenting Post proced ure evidence eviden ce of Clin Clinical ical photo ph oto graph an d Radiographic image Peripheral Peripheral stent graft for peripheral aneurysms aneurysms and AV Fistulae Post procedure procedure evidence of Clinica Clinica l pho tograph and Radiograph ic image Embo Embo lizat lizat ion of Caratico-Cavernous aratico-Cavernous Fistu Fistu la Post proced ure evidence eviden ce of Clin Clinical ical photo ph oto graph an d Radiographic image


150000 100000

100000

150000

150000

150000

150000

150000


APPENDIX 1 B FOLLOW UP PACKAGE Sr. No.

System

Package Rs. Indicative and upper ceiling

First Instalment

Subsequent 3 Instalment

Rs. Indicative and upper ceiling


1 Total Thyroidectomy Thyroidecto my

3000

1200

600

2 Portocaval Portocaval Anastomosis Anastomosis Operat io n of Adrenal Operation o f Adrenal Adrenal

10000

4000

2000

3 Gla Gla nds bilateral bila teral

4000

1600

800

Splenorenal 4 Anastomos Anastomosis is

10000

4000

2000

5 Warren Warre n S hunt

10000

4000

2000

6 Splee Splee nectomy + Devasculari Devascular isati sat ion + Sple no Renal Shunt

10000

4000

2000

7 Lap - Pancreat Pancreatic ic Necrosectomy Necrosecto my

8000

3500

1500

8 Pancreat Pancreatic ic Necrosectomy Necrosecto my (ope n)

8000

3500

1500

9 Coronary Balloon Balloo n Angioplasty Angioplast y 10 Renal Angioplas ty

10000 10000

4000 4000

2000 2000

11 Peripheral Peripheral Angioplasty

10000

4000

2000

12 Vertebral Angioplas Angioplasty ty 13 Coronary Bypass S urger urgery y

10000 10000

4000 4000

2000 2000

14 Coronary Bypass S urgery rger y - post Angioplas ty

10000

4000

2000

15 CABG with wit h IABP IA BP Pump 16 CABG with wit h a ne uris mal repai repa ir

10000 10000

4000 4000

2000 2000

17 W ith prosthe pro sthetic tic Ring

10000

4000

2000

18 Without Without prosthetic prosthet ic Ring 19 Open P ulmo ulmo nary nar y Valv Va lvoto oto my

10000 10000

4000 4000

2000 2000

20 Closed mitral mitra l Valvotomy Valvoto my

10000

4000

2000

21 Mitra Mitra l Valvoto Valvotomy my (open) 22 Mitra Mitra l Valve Valve Replacement (with (w ith Valve)

10000 10000

4000 4000

2000 2000

23 Aortic Aortic Valv Va lvee Replace Replace ment (wi (w ith Valve)

10000

4000

2000

24 Tricuspid Tricuspid Valve Replacemen Replaceme nt 25 Double Double Valve Valve Replacement (with (w ith Valve)

10000 10000

4000 4000

2000 2000

26 Caroti Carot id Embolectomy Embolecto my

10000

4000

2000

27 Encephaloce le 28 Surgeri Surger ies O n adre adr e nal gland in c hildre n

4000

1600

800

29 Open p ylo ylo lithotomy lithoto my

2000

800

400

30 Open Nephro lithotomy 31 Open Cystolithoto Cysto lithotomy my

2000 2000

800 800

400 400

32 Laparoscop Laparoscopiic P ylolithotomy ylolithotomy

2000

800

400

33 Cystolithotripsy Cystolithotripsy 34 PCNL PCN L

2000 2000

800 800

400 400

~ 143 ~


Sr. No.

System


First Instalment




35 ESWL

2000

800

400

36 URS URS L 37 Endoscope Remova l o f S tone in Bladder Bladd er

2000 2000

800 800

400 400

38 Transurethra Transurethrall resection of prostate (TURP)

2000

800

400

39 TURP C yst lithotripsy lithotr ipsy 40 Open prostatecto pros tatecto my

2000 2000

800 800

400 400

41 Craniotomy Cranioto my a nd Evac uation at ion o f Hae ma toma Subdural

8000

3200

1600

42 Craniotomy Cranioto my a nd Evac uation at ion o f Hae ma toma Extradural

8000

3200

1600

43 Evacuat io n o f Brain Abscess -b urr hole

8000

3200

1600

44 Excisi Excis io n o f Lobe (Front (Fro ntaa l, Temporal Tempora l, Cerebellum etc.

8000

3200

1600

45 Excisi Excis io n o f Brain Tumour S upratentoria uprate ntoria l 46 Parasagittal

8000 8000

3200 3200

1600 1600

47 Basal

8000

3200

1600

48 Brain Stem Ste m 49 C P Angle Tumou Tumo ur

8000 8000

3200 3200

1600 1600

50 other tumors

8000

3200

1600

51 Excisi Excis io n o f Brain Tumour S ubtent ubte nto o rial 52 Ventric Ventricul uloatr oatrial/V ial/Vee ntriculope ntriculope ritoneal S hunt

8000 8000

3200 3200

1600 1600

53 Subdural Tapping

8000

3200

1600

54 Ventricular Ventric ular Tapping 55 Abscess Tapping

8000 8000

3200 3200

1600 1600

56 Vascular Malformation Malformatio ns

8000

3200

1600

57 Peri Per itoneal tonea l S hunt 58 Atria Atriall S hunt

8000 8000

3200 3200

1600 1600

59 Meningo Encephaloce Encephalocelle

8000

3200

1600

60 Meningo mye mye locele 61 Ventric Ventricul ulo-A o-Atrial trial S hunt hunt

8000 8000

3200 3200

1600 1600

62 Excision of Bra Bra in Abscess 63 Aneurysm Aneurysm C lipping lipping 64 Extern Exter na l Ventri Ventr ic ular Draina ge (EVD)

8000 8000 8000

3200 3200 3200

1600 1600 1600

65 Trans Trans Sphenoidal S urgery

8000

3200

1600

66 Trans Trans Oral Surgery Surger y 67 Endoscopy Proced Proc edur ures es

8000 8000

3200 3200

1600 1600

68 Intra-cereb Intra-ce rebral ral Hematom Hemato ma Evacuat io n

8000

3200

1600

69 Temporal Tempora l Lobecto my 70 Lesionectomy Lesionectomy Type Type -1

8000 8000

3200 3200

1600 1600

71 Lesionectomy Lesionectomy Type Type -2

8000

3200

1600

~ 144 ~


Sr. No.

System


First Instalment




72 Temporal Tempora l Lobecto my P lus Dept h Elec Electrodes trodes

8000

3200

1600

73 Stay in Gen Ge neral Ward @ Rs. Rs. 500day 74 Stay in Neu Ne uro ICU @ Rs. 4000day

8000 8000

3200 3200

1600 1600

75 Surgical Surgica l Treatment Treat ment (Up to)

8000

3200

1600

Sr. No.

Disease

FOLLOWUP PACKAGES - MEDICAL Package First Instalment


1 Acute Acute Severe Asthma with Acute Acute respirator respirator y failure

10000

4000

2000

2 COPD Respiratory Respiratory Failure (infect ive ive exacerbation)

10000

4000

2000

3 hyperte hyperten nsion sio n Ventilation Ventilatio n -HFO

6000

3000

1000

hyperbilir hyperbiliru ub inemia Clinical sepsis seps is 4 Term baby with se izures izures ve ntilated

5000

2000

1000

5 Acute Acute Severe Asthma with (Ven (Ve ntilated )

4000

1600

800

6 Infective Endocarditis Endocarditis 7 MeningoMeningo- encepha encepha litis (Non Ventilated)

10000 6500

4000 2000

2000 1500

8 MeningoMeningo- encepha encepha litis ( Ven Ve ntilated)

6500

2000

1500

9 Status Epileptic us 10 Intra Intra Cranial Crania l bleed

6500 6500

2000 2000

1500 1500

11 Congenita l heart d isease with wit h congest co ngestiv ivee cardiac failure

5000

2000

1000

12 Acquired Acquired heart heart disease with congestive congest ive cardiac failure

5000

2000

1000

13 Steroid Steroid Resistant Neph Nep hrotic syndrom syndro me Complicated Complicated or Resistant

5000

2000

1000

14 Anaemia o f unknown cause ca use

5000

2000

1000

15 Pyogenic me ningitis 16 Neuro Tuberculos is

5000 5000

2000 2000

1000 1 000 1000

17 Neuro Tuberculosis Tuberculos is with wit h ventilatio vent ilation n

5000

2000

1000

18 Convulsive Convulsive Disorders/Stat us Epileptic Epilepticu us (fits) 19 Encephalitis/Encep Encephalitis/Encep ha lopathy opat hy

5000

2000

1000

10000

4000

2000

20 Acute Acute Myocardial Myocard ial infarct infarct ion

10000

4000

2000

21 Infective Endocarditis Endocarditis 22 Comple Complex x Arrythmias

10000 10000

4000 4000

2000 2000

23 Nephrotic Nephrotic S yndrome yndrome

5000

2000

1000

24 ADEM ADEM or Relapse in Multiple- sclerosis 25 CIDP

5000 5000

2000 2000

1000 1000

26 Haemorr Haemorrh ha gic Stroke/Strokes Stroke/Strokes

5000

2000

1000

Term baby with pers istent pulmonary

~ 145 ~


Sr. No.

System


First Instalment




27 Ischemic Strokes

5000

2000

1000

28 NEUROINFECT NEUROINF ECTION IONS S -fungal -funga l me ningitis 29 NEUROINFECTIONS NEUROINFECTIONS - pyogenic pyogenic meningitis 30 Meningoencephalitis Meningoencephalitis (Including (Including Herpes encephalitis)

5000 5000

2000 2000

1000 1000

5000

2000

1000

31 Neuromusc Neuromuscul ular ar (myasthenia gravis) 32 Interst Interstiti itial al lung diseases

4000 10000

1600 4000

800 2000

33 Pneumoco Pneumoconi niosis osis

3500

1400

700

34 Pemphigus/Pe Pemphigus/Pe mphigoi phigo id 35 SLE (SYSTEMIC (SYST EMIC LUP LUP US ERYTHEMATOSIS)

6000 6000

2400 2400

1200 1200

36 SCLERODERMA SCLERODERMA

6000

2400

1200

37 MCTD MIXED MIX ED CONN CO NNECT ECTIVE IVE TISSUE 38 MCTD M IXED CONN CO NNECT ECTIVE IVE TISSUE

6000 6000

2400 2400

1200 1200

39 VASULITIS

6000

2400

1200

40 Hypopitutarism Hypopitutar ism 41 pituitary – pituitary – Acromegaly Acromegaly

8000 6500

3500 2000

1500 1500

42 Delayed P uberty be rty Hypogonadism Hypogonad ism (ex. (e x. Turne Turne rs synd, synd, kie nfelter nfelter s ynd) ynd)

7000

2500

1500

43 Gastric Varices 44 Chronic Chronic Pan Pa ncreatiti creat itiss with severe pain

7000 7000

2500 2500

1500 1500

45 Cirrh Cirr hosis os is with wit h Hepatic Encephalopat hy

7000

2500

1500

46 Cirr Cirrh hosis with Hepato Hepato renal syndrome

7000

2500

1500

~ 146 ~


APPENDIX APPENDIX II WORKING PATTE PA TTERN RN Health Camps

Rural /Sub /Sub d istrict /District/Women /District/Women

Accident sites

Hospital and Primary Health Centre

Direct to Hospital

Preliminary Verification & Diagnosis Online preauthorization by Insurance and Society doctors of call center through Arogyamitra of network hospital on same Admission and Treatment Treat ment

Discharge & follow up Billing Claim Process Pro cessing ing

Online payment within 7 working days of discharge

Social Audit

~ 147 ~


APPENDIX APPENDIX -III AAROGYAMITHRA

Aarogyamithra is Friend of Health; Aarogyamithra is a concept unique to Rajiv Gandhi Jeevandayee Yojana. Aarogyamithras act as facilitators for the patients. In fact they form face of this this insu ins ura nce scheme. Aarogyamithras are to be selected by the stakeholders of Self Help Group (SHG) movement / Loca Loca l bodies bodies i.e. Gram Pan Pa nchayat, Munici Munic ipality, Munici M unicipal pal Corporation/Government Hospital in order to ensure performance efficiency and acceptability among local communities. The following qualifications are prescribed. Graduate 1. Native & Reside Residen nt of the same PHC area 2. 3. Good communication skills 4. Prefers to move around the villages 5. Functional knowledge of computers Help of local bodies and NGOs may be taken by the insurer to hire the services of local persons in eac h PHC / Rural Rural / Sub district / Genera Genera l / District Hospital Hosp ital.. The working working of the Aarogyamithras will be monitored on a daily basis by the regional coordinators and district coordinators of the Insurance Company in coordination with the Gram Panchayat, Municipality, Municipal Corporation, Civil Surgeon, District Administration, etc. All the Aarogyamithras are to be provided with cell phones (CUG connection) by the Insurance Company fo fo r ins ins tant communicat co mmunicatiio n a nd network ing. ing. The Ins Ins ura ura nce Com Co mpany pa ny shall sha ll a lso provide provide uniforms (Aprons compulsor compulsorily) ily) for for a ll Aa Aa rogyamithras. rogyamithras. The following table shows the indicative number of PHC‟s / Government Hospitals where Aarogyamithras are to be placed: Districts

Population

Mumbai City Mumbai Suburban Dhule Raigad Nanded Nanded Solapur Amravati Gadchiro li

Total

3338031

Approx.no of Beneficiary Families

482073

No. of PHCs

No. of RH

H. posts posts 182, Disp Disp = 162

0

SDH 100

SDH 50

0

GH

0

WH

DH

0

Other Hosp. (Corporation/ra ilway/ Defense)

Medical College Hospitals

Hospitals -18

Medical Colleges4, Dental=3, Specialist Hospitals =5

8640419

1340828

1707947

2607160

398000 398000 570000 545000 831000 560000

41 55 64 77 56

7 11 12 16 12

1 1 1 1 1

1 2 2 2 2

0 0 0 0 0

0 0 0 0 1

0 1 0 0 1

0 0 0 0 0

1 0 1 1 0

970294

183000

45

10

0

3

0

0

1

0

0

4909901

682

68

5

12

0

1

3

18

15

2207929 2876259 3849543

26197582

Total

374 51 70 80 97 73 59 804

In addition to the above the Insurance Company has to select and post at least three Aarogyamithras in each Network Hospitals for round the clock monitoring of the patients. The total number will depend up on the exact number of the Network Hospitals. The insura insura nce Co C o mpany shall follow fo llow the the instructions of Raj iv Gandhi Gandhi Jeevandayee Aro gya gya Yojana Society in this regard. Training Training of Aarogyamitras Training Training for Aarogyamitras Aarogyamitras shall be done by t he Insuran Insura nce Com Co mpa ny on the instru instr uction ctio ns of th t he society.

~ 148 ~


Role of Aarogyamitras in PHC / CHC / Government/ District Hospitals 1. ROLE OF PHC AROGYAMITHRAS a) IN THE PHC / HOSPITAL  Publicity and awareness.  Maintain Maintain helpdesk at hospital.  Receive the beneficiary.  Verify the Beneficiary criteria. (Eligibility Criteria) co nsultation sultatio n with Doctor Doctor (P HC Doctor Doctor / Nearest N earest Govt. Govt. Hospital  Facilitate con Doctor)  Fill up up th t he referral card.  Guide the patient to the next center. co unsel the patients pa tients who w ho ma ma y req re q uire uire any a ny o ne o f the the listed surg s urger eries. ies.  To counsel  To facilitate either to a Government Hospital for further tests or to Network Hospital depending upon the advi ad vice ce of t he doctor.  To guide the patient to Network Hospital.  Follow-up the referred cases. effec t to ac ac t as, a guide and friend friend for the prospectiv prospect ivee be neficiary efic iary families families  In effect under Rajiv Gandhi Jeevandayee Yojana.  Any work assigned by Rajiv Gandhi Jeevandayee Arogya Yojana Society from time to time. b) OUTSIDE THE PHC / HOSPITAL  To send daily MIS of the patients. spread the awareness of th t he scheme in the villages.  To spread  To spread spread th t he awar a wareness eness abo ut th t he scheduled camps ca mps by network network hospital hosp italss in the villages.  To coordinate with network hospitals and help conduct camps. the pati pat ients for ca mps.  Mobilize the up the patients patie nts ide identified ntified in the camp ca mp to report to network network hosp ita l.  Follow up  Coordinate Coordinate with Civil C ivil S urgeons, Medi Med ical S uperintendents, Gra m Pan Pa nchayat, Municipalities, Municipalities, Corporations, Corporat ions, ANMs, Women Health Volun Vo lunteers teers an a nd Self Se lf-- Help Groups Groups for effective impleme implemen ntati tat ion of the sche me. Move around a round the the villages and encourage patients to come to a va il the the benefits  Move of the scheme.  Educate Educate villagers villagers about th t he scheme and distribute brochures and other other material. ater ial.  Keep in touch with the District Coordinator. up th t he Beneficiar Beneficiar y families families before be fore and after Sur gery.  Follow up  Any work work ass igned by the Rajiv Ga ndhi Jeeva ndayee Arogy Aro gyaa Yojan Yoja na Society Soc iety from time to time. 2. ROLE OF DISTRICT HOSPITAL AAROGYAMITHRAS Apart Apart from the duti dut ies enlisted above t he Aarogyamithras Aarogyamithras in Distr ict Hospitals will  Facilitate the Patient for specialist consultation and tests. up th t he referral card (part- B) properly proper ly..  Fill up  Counsel the patient.  Any work work ass igned by the Rajiv Ga ndhi Jeeva ndayee Arogy Aro gyaa Yojan Yoja na Society Soc iety from time to time. 3. ROLE OF AAROGYAMITHRAS AT NETWORK HOSPITAL  Maintain Maintain Help Desk at Reception of the Hospital.  Receive the pati pat ie nt referred from (PHC (PHC or Network).  Work round round the clock in shift to to cater c ater to the needs of o f e merge merge nc ies.  Verify the documents of the patients.  Obtain digital photograph of the patient.  Facilitate the Patient for cons ultat ultatiion a nd admission.

~ 149 ~


                

~ 150 ~

Liaiso Liaison n with with coordinator / administrati administrat ion of the hospital. Counsel Counsel th t he pat ient reg re garding treatmen treatme nt / surgery surger y. Facilitate early evaluation a nd posting post ing for for surgery s urgery.. Facilitate hospital send proper pre-authorization. FollowFollow- up preauthorization procedure procedure a nd facilitate approval. Follow-up recovery of patient. Facilitate payment of tran tra nsport charges as per the guidelines. Facilitate cashless transaction at hospital. Facilitate dischar dischar ge of th t he patient. Obtain feedback feedback from the pati pat ie nt. Counsel Counsel th t he patient pa tient regarding regarding follow-up. ollo w-up. Coordinate with PHC / Government Hospital Aarogyamithras for follow up of bene bene ficiary. FollowFollow- up the pati pat ient referr re ferred ed by t he hospital d uring t he camps. Coordinate Coordinate with w ith the the head-O ffice ffice a nd Medical officers for any a ny c lar ificat ificatiio ns. Send Send daily da ily MIS. Facilitate Network Hospital Hospital in conducting conduct ing Healt Health h Cam Ca mps as sch sc heduled. Any work assigned by the Rajiv Gandhi Jeevandayee Arogya Yojana Society from time to time.


APPENDIXAPPENDIX- IV

PROCEDURE FOR ENROLLMENT OF HOSPITAL HOSPIT ALS S The Public and Private Hospitals will be jointly empanelled within the State of Maharashtra by Rajiv Gandhi Jee va ndayee Arogya A rogya Yojan Yoja na Soc iety a nd I nsurance Company Company following ollo wing the e mpanelment procedure lay la y dow down n by Rajiv Ga Ga ndhi Jee vanda yee Arogy Aro gyaa Yojana Yojana Society. The hospitals having minimum of 50 inpatient hospital beds with adequate facilities and offering the services as stipulated below shall be empanelled after being scrutinized and recommended by the Empanelment and Disciplinary Committee. Empanelment and Disciplinary Committee will constitute four doctors. Two doctors will be nominated by Insurance Insurance Com Co mpa ny a nd two by b y Rajiv Gandhi Jeevandayee Soci Soc iet y. The minimum number number o f inpatient beds criteria will not be revised from 50. It would be the responsibility of the Insurer for enrolment of Network Hospitals in the State of Maharashtra to give adequate fac ilities ilities for th t he treatment of th t he patien patie nts wh w he n they present present th t he mselves. PROCEDURAL STEPS FOR ENROLLMENT OF HOSPITALS/NURSING HOME: i. Advertise for seeking seek ing o n line e xpre xpre ssi ss io n o f interest from the p ub lic and priv pr ivaa te hospitals ii. Preparation of the short list of the hospitals qualifying eligib eligib ility criteria iii. Inspections by joint joint pan pa nel o f 4 Phy P hysic sicians ians to to the eligi e ligible ble hospitals for confirmation confirma tion of eligibility and capacity. iv. iv. Joint panel of o f 4 Physici Physic ia ns to recommend the eligible for hospital for specifi spec ificc package package s v. RGJA RGJAY Y / Selected I nsurer would approve t he recommendati recommendat ions vi. vi. Send Send invitat invitatiion to th t he adminis trator trator o f selected hospital for signing MoU. Signing Signing of MoU between Network Hospitals a nd Insurer. ( Please vii. Pleas e refer Appendix Appendix ) (It is worth noting that th t he procedure of o f e mpanelment of hospitals would would be b e ongoing.) ongoing.) Hospital / Nursing Home: means any institution in Maharashtra established for indoor medical care and treatment of disease and injuries and should be registered under Bombay Nursing Nursing Home Registration Am A me ndmen dme nt (2005) (2005) Act an a nd Public Hospitals. A. Infras Infrastru tructure cture and an d Manpowe Manpowe r (General): (General): a. Should have at least 50 inpatient medical beds with adequate spacing of 65 sq. feet per bed with qualified qualified an a nd registered paramedical staff sta ff.. Should have Separate Male Ma le and Female General Wards. b. Should c. Hospital should be fully equipped and engaged in providing Medical and Surgical fac ilities ilities for the spec ialty alt y for which it is to be empanelled. d. In-house round the clock basic diagnostic facilities. (May also have link facilities for high end tests like MRI, CT Scan etc.) e. Fully equipped Operation Theatre of its own wherever surgical operations are carried out out with w ith qualified qualified a nd registered nurs nursing ing staff sta ff under its employment round th t he clock. c lock. f. Post-op ward ward with ventilator and other other required req uired facilities. g. ICU facility with requisite staff. h. Fully qualified doctors of modern medicine should be physically in charge round the clock. i. Casualty with Duty doctor and nursing staff. j. j. Availability of trained / Qualified / registered paramedics. k. Round Round the clock availability of specia lists lists in the co ncerned specialties of s upport fields fields within short notice. l. Shall be able to facilitate round the clock advanced diagnostic facilities either inHouse or with wit h Tie-up with a nearby Diagnostic Center. m. Shall be able to facilitate round the clock Blood Bank facilities either In-house or with TieTie- up with a nearby nearb y Blood Bank.

~ 151 ~


n. Shall be able to facilitate round the clock Ambulance facilities either own or with Tieup with a nearby Service Provider. o. Maintaining complete record as required on day-to-day basis and is able to provide necessary records of the insured patient to the Insurer or his representative as and when required. p. Having sufficient sufficie nt experience in the specific ident ified ified fiel fie ld. Shall have all necessary infrastructu infrast ructure re required req uired fo fo r preauthorization preauthorization ro und und the clock. q. Shall r. Should have at least 50 inpatient medical beds with adequate spacing and supporting staff as per norms. 25% beds should be reserved for beneficiary families under Rajiv Gandhi Jeevandayee Arogya Yojana exclusively apart from legal provisions. (At least 12 beds or 25% of total beds whichever is more) In case of charitable hospitals 10 % beds s hould be b e res erved for indige indige nt a nd 10% for economically weaker sections. sect ions. O ut of remaining 80% beds 25% beds should be reserved for beneficiary families under Rajiv Gandhi Gandhi Jee va ndayee Arogya Yojana exclusiv exclus ivee ly. s. Shall have round the clock laboratory facilities either In-house or with Tie-up with a nearb y laboratory laboratory with wit h qualified qualified pathologi patholo gist st e ither in-house or with t ie up. o ut in fo llowing llowing proforma. t. Hospital should have line list of procedures carried ou 1) Name of patient 2) Age 3) Sex 4) Address 5) Diagnosis 6) Name of surgery / Treat Treatm ment.7) Date of admis ad missio sion n 8) Date of disc ha rge. B. Infras Infrastru tructure cture and Manpowe Manpowe r (Sp (Spee cific): a. For Empanelment of Cancer Therapy  Services of fully qualified Medical Oncologist, Radiation Oncologist and Surgical Oncologist - all or either and equipment for Cobalt therapy, Linear accelerator and Brach therapy – therapy – all all or either to be empanelled for Cancer Surgeries and Chemo and Radio-Therapies.  Hospital should have qualified and registered oncologist, oncosurgeon and Radiotherapists. Tumour board comprising of qualified and registered oncologist, oncosurgeon and Radiotherapists will decide comprehensive treatment plan of patient. If hospital has no Radioth Radiot herapy eq uipme uipmen nt a nd Radi Rad ioth ot herapist it should should have tie up with nearest Radiotherapy center. Note: A combination of both prof pro fess ional and the equipm equip ment is essential. b. For Empanelment of Poly Trauma 

c)

d)

~ 152 ~

Shall have Emergency Room Setup with round the clock dedicated duty doctors doctors of o f Modern Medicine. Shall have round th t he clock c lock anesthetist services  Shall  Shall be able to provide round the clock services of Neurosurgeon, Orthopedic Surgeon, CT Surgeon and General Surgeon, Vascular Surgeon and other support support specialties. spec ialties.  Shall have dedicated round the clock Emergency operation theatre, Surgical ICU, Post-Op Setup with qualified and registered staff.  Shall be able to provide necessary cashless diagnostic support round the clock including specialized investigations such as CT, MRI, Emergency biochemical investigations. For Empanelment of Pediatric Congenital Malformations and Post-Burns Contractures  Shall have Services of qualified specialists in the field Viz. Pediatric Surgeon, Plast Plastic ic Surgeon with dedica dedicated ted theatre theatres, s, post-operat ive ive setup s etup and staff. For Empanelment of Prostheses (Artificial limbs) Shall have full time services ser vices of Orthopedic Orthopedic S urgeon an a nd Prosthetic and orthoti orthot ic  Shall Engineer or technician to be empanelled to provide prostheses package under the scheme. Signature & s tam tam p of Insurance Insurance Agency



e)

~ 153 ~

Shall facilitate supply, fitting of appropriate prosthesis and gait training of patient by physiotherapist physiotherapist / Occu Occ upational therapist. Shall en e nsure that a n appropriate appropriate prosthesis pros thesis is prescri prescr ibed based on o n occ upation of  Shall the person and standard prosthesis is supplied as per quality norms of BIS (Burea (Burea u of Indian Standards).  Shall also facilitate free replacement of leather parts and ensure total replacement of Prosthesis in case of damage during guarantee period of 3 years. And Hospital Hospital sh s hall provide provide followi follo wing ng ame ame nities for the the ben beneficia eficiarry families: familie s: 1. Provide space and separate Rajiv Gandhi Jeevandayee counter/ kiosk as per the design for Aarogyamitras Aarogyamitras (Health (Hea lth Coordinators) Coordinators) 2. Provide Computer with networking (dedicated broadband with minimum 1 mbps speed), pr inter, inter, sca nner, nner, bio bio metric reader and digita l ca mera. 3. Provide free food for the patient including includes morning tea, breakfast, lunch, afternoon tea at 4 PM and dinner. Type of diet should be according to guidance of concerned treating specialist and qualified dietician. 4. Provide one time transport / transportation charges for patient equivalent to State Transport fare or ordinary class of Railway fare from network hospital to taluka headquarter. 5. Free OPD consultation. 6. Free diagnostic tests and medical treatment required for beneficiary families irrespective of surgery. 7. Provide the the round the the c lock servi ser vices ces o f a dedica ted Medical Officer to work as as Rajiv Gandhi Gandhi Jeev Jee va nda yee Medical Medica l Coordinator (MCO) for th t he scheme an a nd he will be responsible to Rajiv Gandhi Jeevandayee Arogya Yojana Society and the Insurer for doing various activities under the scheme including Health Camps, Follow-up of referred patients form camps, diagnosis, outpatient details, E-Preauth E- Preauthorizatio orization n, Su S urger ies, Feedback o n the patient‟s co ndition and services offered by the hospital during hospital stay of the patients, discharges, deaths if any, follow-up free consultation of the patients and distribution of medicines after discharge etc. The Insurance Company shall provide provide CUG (Closed User Groups) Connection to a ll MCOs. Sel Se lecti ect ion of hospital for treatment will be according to choice of patient subject to availability of beds in that selected hospital. ultation n diagnost diagnostiic s an a nd medic ines. ines. 8. Provide follow-up with free cons ultatio 9. Minimum one free Health Camp in village in a fortnight for the screening of the Beneficiary families patient suffering from the identified ailments. Hospital may have a mobile team with diagnostic equipment and team of doctors as specified by the Rajiv Gandhi Jeevandayee Arogya Yojana Society for this purpose. Villages shall be identified by the society in consultation with district administration and communicated to the hospitals / insurance company. Hospital shall provide services of Rajiv Gandhi Jeevandayee medical Camp Coordinator (MCCO) for organization of health camps. The Hospital shall follow the camp policy of the society. The Insurance Company sha sha ll provide CUG Connection to to all MCCO s.


APPENDIX- V ACTIVITY CHART FOR INSURANCE COMPANY Activ Activ ity Number of days re quired to complete the activity from the award date date Identifying Identifying the Project O fficer fficer Tasks Tasks will be compl comp leted within within 7 days of awarding contract Setting up up of Project O ffice ffice with infrastr ucture in Tasks will be completed within 30 MCGM limits days of awarding contract Appointme Appointmen nt of Medical Medica l O fficers fficers Tasks Tasks will be compl comp leted before comme comme ncemen ceme nt of sc he me i.e. 2 October 2011 Estab Establishm lishmee nt of other staff sta ff Tasks Tasks will be compl comp leted before comme comme ncemen ceme nt of sc he me i.e. 2 October 2011 Preparator Preparator y meeting eet ing with hospitals Tasks Tasks will be compl comp leted bef be fore comme comme ncemen ceme nt of sc he me i.e. 2 October 2011 Inspection of hospitals hospitals vis-à-vi vis-à- viss sche me req uireme uiremen nts, Tasks Tasks will be completed before ide ntificati tificat ion of Raj iv Ga Ga ndhi Jeevandayee Medi Med ical commencement of scheme i.e. 2 Coordinator(RJMCCO Coordinator(RJMCCO), ), signi s igning ng of MOU an a nd October 2011 Empanelment Empanelment of o f Hosp Hosp itals Issue of CUG connecti connect ions to RJMCOs RJMCOs a nd RJCCOs Tasks Tasks will be compl comp leted before comme comme ncemen ceme nt of sc he me i.e. 2 October 2011 Insta Insta llation of kiosk, computer a nd accessor ies and 1 Tasks Tasks will be completed be fore mbps connectivity commencement of scheme Printing & distr ibution of publicity publicit y material Tasks Tasks will be compl comp leted before comme comme ncemen ceme nt of sc he me i.e. 2 October 2011 Printing & distribution of stationery re lated to work work Tasks Tasks will be completed before flow of the scheme. comme comme ncemen ceme nt of sc he me i.e. 2 October 2011 Appointme Appointmen nt of o f Aaro gya gya mithras Tasks Tasks will be completed before comme comme ncemen ceme nt of sc he me i.e. 2  In PHCs / Govt. Hospitals October 2011  In Network Hospitals Tra Tra ining ining of o f Aarogyamithras, d istributi str ibution on of o f Apron Apro ns Tasks Tasks will be completed before and and CUG mobiles commencement of scheme Tra Tra ining ining of Doctors Tasks Tasks will be compl comp leted before commencement of scheme Tra Tra ining ining of oth ot her staff Tasks Tasks will be compl comp leted before comme comme ncemen ceme nt of sc he me i.e. 2 October 2011 IT enabling Immediate Immediate Estab Establishm lishmee nt of 24 Hrs. Hrs. Call Ca ll Cen Ce nter Tasks Tasks will be compl comp leted before comme comme ncemen ceme nt of sc he me i.e. 2 October 2011 Estab Establishm lishmee nt of other infrastr infrastru uc ture Tasks Tasks will be compl comp leted before comme comme ncemen ceme nt of sc he me i.e. 2 October 2011 Estab Establishm lishmee nt of infrastr infrastructure ucture in the d istricts Tasks Tasks will be compl comp leted before

~ 154 ~


Activ Activ ity

Preparatory meetings and trainings at district level for inaugura inaugura l mega-camps Handing over o f adequate adequate space for office of Rajiv Ra jiv Gandhi Jee vandayee Society in the jurisdiction of Municipal Municipal corporation corporat ion of Greater Bombay.

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Number of days re quired to complete the activity from the award date date comme comme ncemen ceme nt of sc he me i.e. 2 October 2011 Tasks will be completed 20 days before before commen co mmenceme cemen nt of scheme i.e. 2 October 2011 Tasks Tasks will be completed before comme comme ncemen ceme nt of sc he me i.e. 2 October 2011


APPENDIX VI HEALTH HEALTH CAMP C AMP POLICY

Health camps are main source of mobilizing beneficiary families under the scheme. Effective conduct conduct of o f healt health h camps is key to to s uccess of scheme. Activities 1. IEC IEC Activities Act ivities by ne ne twork twork hospital hosp italss through Pamphlets, posters, banners. Public address system. Drumbeating. Audiovisual media – media – TV, TV, Local cable. SHG, Village meetings. Exhibitions.      

2. Facilities in camp Shade in form of shamiyana. Pedestal fans. Sitting arra arra ngement ngement in for for m of c ha irs. Snacks Snacks and dr inking inking water.    

3. Treatment of minor ailments List of common drugs. No 1

Category Anti-inflammatory/ Antipyretic/Analgesic

2

Antialler Antiallerg g ic

3 4 5

Antiamoebic Antiamoebic Antihelminthi Antihelminthicc Antibiotic Antibiotic

6 7 8

H1 Antag onist onist Antacid Vita Vita min min and supplement

9

For Children

iron iron

Sr No 1 2 3

Form Tab Tab Tab

Drug Ibuprofen Paraceta Paraceta mol Aspirin Aspirin

4 5

Tab Tab

6 7 8 9 10 11 12 13 14 15 16 17 18

Tab Tab Tab Tab Cap Tab Tab Tab Tab Tab Tab Cap Syrup

Dic Dic lofenac lofenac Sodium Chlorphenera Chlorphenera mine mine maleate Metronidazole Metronidazole Albendazole Albendazole Noflo Noflo xacin xacin Ciproflo Ciproflo xacin Ampicillin Ranit Ranit idine idine Antacid Multivitamin Multivitamin Iron+Foli Iron+Folicc acid B-Co B-Co mp lex Vit – Vit – C Vit Vit A and D Paraceta Paraceta mol

19

Syrup

Ampicillin

20

Syrup

Antitussive Antitussive

Strength 400 mg 500 mg 300/500 300/500 mg 100 mg 4mg

Min Qty 500 1000 500

400 mg 400mg 400mg 400 mg 500 mg 250 mg 150 mg

800 100 1000 5000 500 1000 1000 2000 2000 2000 1000 1000 2000 20

500 mg 125mg/5 125mg/5 ml 125mg/5 ml

1000 5000

10 20

4. Other Activities 1) Provide treatment for common ailments and common drugs in the camps and prevent spread of o f communicabl communicab le diseases. diseas es. Provide free consultation for ailments other than those covered under the scheme. Provide common drugs for ge ge neral nera l a ilment ilme ntss as indicated in the lis lis t below. be low. Hospital shall carry at least 10 types of drugs from the above list and should have at least on o ne dr ug fro from m each ca ca tegory. tegory. 



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Distr Distriibuti but ion of a ll drugs drugs for childr c hildren en ( Category C ategory 9) is mandatory. Stock of above above drugs must must be ca rried rried to the cam ca mp, howev howe ver hosp itals itals are free to distrib distribu ute more number of dr ugs. ugs. Minimum Rs 1500 worth medicines must be carried to the camp. Hospitals may carry generic drugs instead of proprietary preparations to keep cost of medicines low. 2) Network hospitals to provide professional incentives to Government Doctors partic partic ipating in t he ca mp to e ncourage their act ive partici partic ipati pat ion a nd coope ration. Each Medical officer has to be given incentives of Rs 250. At least two Medical officers from one network hospital or four medical officers if camp is organized by two network hospitals should attend the camp. Each network hospital shall pay incentive for two t wo medica medica l officers. 5. Allocations In order to encourage the above activities in the camps by network hospitals, Government has decided to provide financial support to the hospitals through RGJAY society to the tune of Rs 5000 for each eac h ca ca mp and activity act ivity wise wise allocat ion of sa sa id amount is a s listed below. Sr Activity Amount Amount allocated No in Rs 1 IEC IEC Activity 1500 2 Basic necess ities ities to patient pat ientss such as shamiyana, c ha irs, water, water, fa ns, 1500 snacks etc. 3 Providing common dr ugs ugs to pat ients as indica indica ted in the list 1500 4 Inc Inc entive to Government Medical Medica l officers off icers 500 Total 5000  

 

6. Confirmation of camps, indenting, approval, organizing, claiming and reimbursement of amount. The entire process of intimation, confirmation, indenting, details of camp organization and c laiming of money will be through health camp module in the RGJAY society website. The RGJAY society will communicate the schedule of camps well in advance and same will be available availab le o nline in the lo lo gin o f hospital for confirmat con firmatiio n. Confirmation and indenting – The The details of Doctors and paramedics and equipment to be carried attending camp shall also be indicated online. The indent for each camp should be put put up by each hospital online as under. under. Details Details of IEC I EC activities activities with w ith specific proposa ls and estimat est imated ed amoun amo unt. t. o Details Details of facilities acil ities to be pro vided. vided. o o Details Details of o f common drugs drugs to be d istributed. istributed. Incentives to be given to Government Medical officers with names of o Medical officers tied for camp. Approval – Approval – Based Based on indent RGJAY society will approve amount subject to 5000 rupees per hospital per camp. The approval status sta tus can ca n be viewed o nline. nline. Approved a mount can be denied in case o f resc heduling camp a fter confirmati co nfirmation. on. Organizing the camp – The ho ho spi sp ita l shall sha ll conduct co nduct cam ca mp as per sched ule. ule. Hosp ita l s ho uld uld ensure that an Arogyawardhini Medical Camp Coordinator (MCCO) is earmarked for the purpose purpose a nd se nt to campsite camps ite to undertake undertake camp IEC activities and arrang arra ngee for facilities provided provided for the camp. Documentat Documentation ion for ca mp  Each patient is given OPD card. The diagnosis and treatment is mentioned on card.  Medicines are given as per prescription and details mentioned in drug dispensing register. register. 









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 



 

 

The signature and thumb impression of patients in Annexure B is scanned and uploaded at t he time of c laiming ca mp amoun amo unt. t. The referral card is given to patients to patients who are referred under the scheme with details of hospital referred, name of consultant, mobile number of network arogyamithra in Annexure C. The details of outpatients referred and patients will be recorded, a copy of same is signed by Government Medical officer, Medical officer of network hospital and and Arogyamithra of network hospital an a nd same is scann sca nned ed and uploaded online at the the t ime of claimi cla iming ng camp amount. Incentives given to Government Medical officer is obtained in acquaintance in Annexure E. MCCO of network hospital shall also take declaration as to successful conduct of camp camp s igned igned b y MO PHC, Arogyamitra of concer ned PHC. Network hospital shall shall also a lso upload upload it for claim. cla im. Annexure F. Utilizat Utilizat ion certificate certif icate shall be claimed online Ann A nnexure exure G. Reimbursement – RGJAY RGJAY society based on uploaded and submitted documents will reimburse the amount once in a month.

7. Role of District District Administration Administration in conductin co nducting g th t he camps.

1. Spreading awareness of camp. 2. Camp inaugurated by Local MLA and all Public representatives are informed regarding camp. 3. Drinking Drinking water to be arrang arra nged ed by panchayat. 4. Snacks for doctors and staff to be arranged by arogyamitras or Medical officers. Cost will be borne borne by net work work hospital. ospita l. 5. Two MOs from Government and two from network hospital should be deputed for camp. 6. DMHOs DMHOs shall take necessary ecessar y steps to distr distribut ibutee common medicines. 7. The patients referred from camps are followed to report to network hospital by Arogya Arogya mithras of PHC a nd Network hospital. 8. District coordinator of RGJAY society and insurance company should speak to AMCCO of ne ne twork twork hospital and e nsure that all activities are taking place.

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APPENDIX APPENDIX VII DRAFT MOU BETWEEN INSURER AND NETWORK NETWORK HOSPITAL MEMORANDUM MEMORANDUM OF UNDERSTAND UNDERSTANDING ING RGJAY – RGJAY – PHASE PHASE I This Agreements is made at Mumbai on this ______ the day of ___ 2011 between ____________________ ____________________ INSURANCE COMPANY LTD., a Com Co mpany incorporated incorporated under under the Companies Act 1956 and having its Registered & Corporate Office at ______________________ ________________________repres __represented ented by _____________________ _________________________here ____here ina ina fter referred to as “Insurer” which expression shall unless it be repugnant to the context or meaning thereof shall deem to mean and include its successors and assignees of the ONE PART AND ______________________ _________________________________ _____________________ ______________ ____ rep by Mana Mana ging Superintendent Superintendent / Director / Propri Propr ietor an a nd having its Regi Re gistered stered Offic O fficee at _____________________ ________________________________ ______________________ ______________________ _____________________ _____________________ ___________ _____________________ ________________________________ ______________________ __________________________ ___________________ ____ here inafter inafter referred to as PROVIDER which expression shall unless it be repugnant to the context or meaning thereof be deemed to mean and include its successors and assignees of the OTHER PART. WHEREAS, Insurer is an insurance company licensed under IRDA to transact Health, Accident and Overseas Medical Insurance, Providing Healthcare insurance coverage to its Insu Ins ured / Bene fic fic iary families having got got the ma ndate from the Gover nme nme nt o f Mah Ma harashtra aras htra to cover yellow ration card holders (“B PL ”) and Orange card holdersne ( APL) belonging to 8 (eight) districts namely, Mumbai city, Mumbai Suburban District, Dhule, Raigad, Solapur, Nanded, Nanded, Amravati Amravat i, and Gadchiroli, of the State of Maharashtra (“Beneficiary families ”) against specified surgical / Therapeutic procedures (972 procedures and 121 follow up procedures) procedures) for which purpose Insurer has has created crea ted a network network of service Providers . _____________________ ________________________________ ______________________ ________________ _____ desires desires to jo in the the sa id network of of Providers and is willing to extend cashless medical facilities for the surgical / Therapeutic procedures procedures as per “RGJAY Manua l on S urgical rgica l & Medical Medica l Treat Treat me nts for Cashless Cas hless Treat Treatm ment of BP BP L and APL Population of RGJAY RGJAY soc soc iet y to members of Be Be low Poverty Povert y Line (BPL and APL ) families identified either by RGJAY Health Card or yellow / orange Ration Card and referred to them by the Insurer under the RGJAY Health Insurance Scheme of the Gover Gover nment nment o f Ma harashtra. Now this t his agreeme agreemen nt witn w itnesses esses as under. under. Article Article 1: Defin De finitions itions 1.1 „RGJAY society‟: RGJAY Health Care RGJAY society. 1.2 „IRDA‟: Insurance Regulatory and Development Authority. Authority. 1.3 „Hospital‟: Hospital Registered under Bombay Nursing Home Act with minimum 50 beds. HOSPITAL HOSPITAL / NURSING HOME: H OME: Means any Government institut institut ion or Private ins titution titution in Maharashtra Maharas htra established for indoor medical care and treatment of disease and injuries and should be registered under Bombay Nursing Home Registration ( Amendment 2005) Act and PNDT Act (Wherever Applicable). II. Infrastructure Infrastructure and Manp M anpowe owerr (Ge (Ge ne ral): a) Should have at least 50 inpatient medical beds with adequate spacing and support supporting ing staff staff as per norms. b) Should Should ha ve Separate Male an a nd Femal Fema le Gen Ge neral Wards c) Fully equipped and engaged in providing Medical and Surgical facilities for the respective specialties

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d) In-house round the clock basic diagnostic facilities for biochemical, Pathological and radiology tests such as Calorimeter/ Auto analyzer, Microscope, X-ray, E.C.G, USG.etc. e) Fully equipped Operation Theatre of its own wherever surgical operations are carried carried out with wit h qua qua lified nursing staff under under its empl emp loymen oyme nt roun ro und d the clock. f) Post-op Post-op ward with wit h ve ve ntilator and other other required req uired facil facilities ities g) ICU facility with w ith requis requisite ite staff h) Fully qualified doctor(s) of modern medicine should be physically in charge round the clock. i) Casualty/dut Casualty/duty y doctor/Appropriate nursing staff j) Availabil Availability ity of Qualified/trained paramedics paramed ics k) Round the clock availability of specialists in the concerned specialties and support fields within short notice. l) Shall be able to facilitate round the clock advanced diagnostic facilities either InHouse or Tie-up facility with a nearby Diagnostic Center m) Shall be able to facilitate round the clock Blood Bank facilities either In-House or Tie-up Tie- up fac facilit ility y with with a nearby Blood Ba Ba nk n) Shall be able to facilitate round the clock Ambulance facilities either own or Tie-up fac ility ility with a nearby Ser vice vice Pro vider vider o) Maintaining complete record as required on day-to-day basis and is able to provide necessary records of the insured patient to the Insurer or his representative as and when required. p) Ha Ha ving sufficient sufficient experience in the specifi spec ificc iden ide ntified field q) Shall Shall ha ve a ll necessar necessary y infrastr infrastru ucture required for preauthorization preauthorizatio n round the clock clock r) Shall have round the clock laboratory facilities either In-house or with Tie-up with a nearb y laboratory laboratory with wit h qualified qualified pathologi patholo gist st e ither in-house or with t ie up. s) Hospital Hospital s hould have line list list of procedures carried car ried out in following prof pro forma. 1) Name of patient 2) Age 3) Sex 4) Address 5) Diagnosis 6) Name of surgery / Treat Treatm ment.7) Date of admis ad missio sion n 8) Date of disc ha rge. III. Infrast Infrastru ructure cture and Manp M anpowe owerr (Specific) (Specific) For Empanelment of Cancer Therapy Services of fully qualified Medical Oncologist, Radiation Oncologist and Surgical Oncologist – all or either and equipment for Cobalt therapy, Linear accelerator and Brachy therapy – therapy – all all or either to be empanelled for Cancer Surgeries and Chemo and Radio-Therapies. Hospital should have qualified and registered oncologist, oncosurgeon and Radiotherapists. Tumour board comprising of qualified and registered oncologist, oncosurgeon and Radiotherapists will decide comprehensive treatment plan of patient. If hospital has no Radiotherapy equipment and Radiotherapist it should have tie up with nearest Radiotherapy center. Note : A combination of both bot h professio nal and th t he equipment is esse ntial tia l. b. For Empanelment of Poly Trauma 1. Shall have Emergency Room Setup with round the clock dedicated duty doctors of Modern Medicine. 2. Shall Shall have round the clock anesth anest hetist services 3. Shall be able to provide round the clock services of Neurosurgeon, Orthopedic Surgeon, CT Surgeon and General Surgeon, Vascular Surgeon and other support specialties. 4. Shall have dedicated round the clock Emergency theatre, Surgical ICU, Post-Op Setup Setup with w ith qualified staff. 5. Shall be able to provide necessary cashless diagnostic support round the clock including specialized investigations such as CT, MRI, emergency biochemical investigations.

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c. For Empanelment of Pediatric Congenital Malformations and Post-Burns Contractures Shall have services of qualified specialists in the field Viz., Pediatric Surgeon, Plastic Surgeon Surgeon with wit h dedicated t heatres, postop setup and and sta ff. ff. d. For Empanelment of Prostheses (Artificial limbs) 1. Shall have full time services of Orthopedic Surgeon to be empanelled to provide prostheses prostheses packag packa ge under the sche me. 2. Shall facilitate supply, fitting of appropriate prosthesis and gait training of patient by physiotherapi physiotherap ist. 3. Shall ensure that an appropriate prosthesis is prescribed based on occupation of the person a nd standard prosthe prosthe sis is supplied as per quality norms of BIS BIS (Bu (B ureau o f India Indian n Standards). Standards). 4. Shall also facilitate free replacement of leather parts and ensure total replacement of Prosthesis Prosthesis in case o f damag dama ge du d uring guarantee guarantee period o f 3 years. and IV. Hosp Hospital ital shall provide provi de follo follo wing additional benefit to the BPL (Yellow (Ye llow ration card holder) and APL (orange ration card holders with Annual income < Rs. 100000) beneficiary beneficiary families related to identified identified systems: s ystems: a. Provide space and separate RGJAY counter/kiosk as per the design for Aarogyamithras. b. Provide Com Co mputer with with networking (dedicated broadban broadba nd with minimum minimum 1mbps speed), printer, printer, scann sca nner, er, bar code reader and digital digita l camera. c. Provide Provide free food for the patient d. Provide Provide tran tra nsport/transportati sport/transportat io n char ges for patien patie nt. e. Free OPD consultation. f. Free diagnostic tests and medical treatment required for beneficiary families irrespective of surgery. g. Provide the services of a dedicated Medical Officer to work as Rajiv Gandhi Jeevandayee Medica Medica l Coordinator Coordinator (MCO) for the sc heme an a nd he will be respons ible to the Society and the Insurer for doing various activities under the scheme including Health Camps, Follow-up of referred patients from camps, diagnosis, outpatient details, E-preau E-prea uthorization, Surgeries, Feedback o n the patie the patien nt‟s condition t‟s condition and services offered by the hospital during hospital stay of the patients, discharges, deaths if any, follow-up free consultation of the patients and distribution of medicines after discharge etc. The Insurance Company shall provide CUG (Closed User Groups) Connection to all MCOs. h. Provide follow-up free consultation diagnostics and medicines under follow-up packages packages for 121 identified identified proced ures a nnexed nnexed at provi pro vided ded under under the scheme, the package package a mount will be directly reimbursed to the hosp hosp ital by t he Soc iet y. i. Minimum one free Health Camp in village in a week for the screening of the BPL patient suffering s uffering from t he identifie identifie d a ilme ilme nts. Hospital may ha ve a mobile team with w ith diagnostic equipment and team of doctors as specified by the Society for this purpose. Villages shall be identified by the Society in consultation with district administration and communicated to the hospitals/insurance company. Hospital shall provide services of Medical Camp Coordinator (MCCO) for organization of health camps. The Hospital shall follow the camp policy of the Society. The Insurance Company shall provide provide CUG Conne Conne ction to all MCCOs. „Ne two o rk Hospi Hos pital‟ tal‟ / NWH: N WH: Hosp ital e mpanelled 1.4 „Netw mpane lled under RGJAY. 1.5 „MOU‟: Memorandum of Understanding between bet ween the the I nsurance & Empa Empa ne lled Hospital. 1.6 „Surgery / Surgeries‟: means cutting abrading, suturing, laser or otherwise physically changing changing body tissues and org or gans by qualified medical medical doctor wh w ho is author author ized ized to do so

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1.7 „Therapy / Therapies‟: Standard way of medical treatment to the patient as per the medical medical protoco ls of o f Allopathic medicine. 1.8 „Treatment‟: Medical Medica l manageme managemen nt by qualified Doctor in the Network Network Hospital. 1.9 „Aarogyamitra‟: F irst contact person for RGJAY RGJAY patient pat ient at Network Hospital. Hospital. 1.10 MCOs (RGJAY Medical Coordinator) - Medical Coordinator from the Network Hospital with with minimum M BBS BBS qu q ualification ali fication to coordinate with w ith RGJAY RGJAY soc ie ty / Insu Ins urer 1.11 „MCCOs‟ an a n Officer Officer des ignated ignated as RGJAY R GJAY Medical Cam Ca mp Coordinator for the sc he me to coordin coord inaa te with RGJAY RGJ AY society soc iety / Insurer Insu rer through Arogyamitra. 1.12 „IEC‟: Information, Education Education & Comm Co mmunication. unication. 1.13 „TAT‟: Turn Around Time. „Per- Authorization‟: Pre-Authorization is a process by which an Insured Person obtains 1.14 „Perwritten approval for certain medical procedures or treatments, from RGJAY society / Insurance. 1.15 „EDC‟: Em E mpanelment & Disc iplinary Committee. Article Article 1a: Effective Effective Date 1a. This This agree agree ment will be in force force for for a per iod of one year year from 02.10.2011 to 01.10.2012 for Phase I. Renewal or unit otherwise terminated as provided for in this MOU an shall be extended by mutual consent under same and conditions. 1b. In case of Renewal intimation of Scheme by the insurer, the Provider agrees to extend services to beneficiary families of RGJAY Scheme beyond the effective date until otherwise terminated and all the services rendered by the Provider shall be considered for subsequent ren re ne wal peri per iod. Article Article 2: General General Provis Provision ionss 2.1 General Undertaking: Provider warrants that it has all the required facilities for performing the enlisted surgeries / procedures procedures / therapi therap ies as specifi spec ifiee d in clause. No. 3 2.2 Min M inimum imum Bed Strength and Specialty Wise Bed Capacity Capacity Provider declares that the hospital has the required number of bed capacity (50) under the scheme scheme an a nd will w ill declare the specia lty wise allocati allocat ion o f beds in the the Performa su s ubmitted below and uploaded in RGJAY society portal. Total Be d Stre Stre ngth Code

Specialty

S1

General Surgery

S2 S3

ENT Ophthalmology

S4

Gyneco Gynecollogy & Obstetrics

S5 S6

Orthopedics Surgical Gastroenterology

S7

Cardio Thoracic Surgery

S8 S9

Pedi Pe diatric atric Surgery Genito Urinary Surgery

S10

Neuro Surgery

S11 S12

Surgical Oncology Medica Medicall Oncology

S13

Radio Oncol Onco logy

S14 S15

Plastic Surgery Polytrauma Polytrauma

S17

Prosthesis

M1 M2

Critical Care General Medic Medic ine

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Total No. of Be ds


Total Be d Stre Stre ngth Code

Specialty

M3

Infecti Infec tious ous Diseases Disease s

M4.1 M4.2

Pedi Pe diatric atric Intensive Intensive Care Neonatal Intensive Intensive Care Car e

M4.3

Pedi Pe diatric atric General

M5 M6

Cardiology Nephrology

M7

Neurology

M8 M9

Pulmonology Dermatology

M10

Rheumatology

M11 M12

Endocrinology Gastroenterology

M 13


Total No. of Be ds

2.3 Allocating minimum 25% of beds in network hospital for RGJAY patients: Provider agrees to provide at least 25 % of their bed capacity available for occupation by RGJAY patients for treatment under each specialty available in the hospital and under which the procedures are covered in the RGJAY Scheme. 2.4 Conduct of OP services: 2.4.1 Provider agrees provide separate OP facilities for RGJAY patients. To be manned by “Medical Medica l Coordina Coordina tor” of the hospital (MCO) ( MCO) and Aarogyamitra(s). 2.4.2 Provider agrees to do general counseling for all OP patients to ascertain their eligibility under RGJAY to avoid later conversion of cash patients at a later date. 2.5 Conve Conve rsion o f cash patients into RGJAY: Provider agrees to take a declaration from patient at the time of admission itself on the appli app licab cabilit ility y or otherwise other wise of RGJAY in his/ her case. In e merg er ge ncy / trauma cases, patients may be allowed allowed 48 hours a fter admiss ion to c laim RGJAY bene bene fit. fit. 2.6 Online Updating of Bed Occupancy: Provider agrees to upload the bed occupancy under each specialty for which hospital is e mpanelled as and wh w he n required. 2.7 The The first first po int of contact for all th t he patien patie nts (ou (o ut patients pat ients and and in pat ients) coming under th t he Scheme Scheme will be the Aarogyamitra positioned at Network Network Hospital. Hospita l. 2.8 The Provider agrees to follow ALL the guidelines in rendering the services to RGJAY patient annexed annexed hereto as part & parce l of this MOU. MO U. The The Provider Provider a lso agrees to follow and and adhere to the guide guideline line issued by the RGJ RGJ AY society societ y / Insu Ins urer re r fro fro m time to. 2.9 The Provider agrees to follow & adhere to the ON-LINE workflow of the RGJAY community Insura Insura nce Sch Sc he me in provi pro viding ding services ser vices to RGJAY pat ie nts. 2.10 Eligibility Criteria: The provider agrees to follow the guidelines on eligibility criteria for admission of patients under RGJAY Health Scheme as mentioned here under and the Following guidelines are reemphasized by the RGJAY society to be followed by Network hospital in cases where c larificati arificat ions are so ught. No

1

Situa Situation tion

No Health Ca rd with beneficiary beneficiary

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Requirement for ben efit Valid Valid Yellow Yellow or Orange Ration Ration Card cou pled with Aadhaar number and in in cas e Aad haar number not taken any Photo ID card issued by Govt. Govt. agen cies ( Driving license, election election identity card with pho tograph) to correlate correlate the patient name & pho tograph. tograph . (In (In instan ce of emergenc emergency y ad mission, iss ion, provision al preaut horization horization may be given g iven subject s ubject to c onfi on firmation rmation of it against sub mission of p hoto identity before discharge.) Signature & s tam tam p of Insurance Insurance Agency

2

Children born after iss ue of card i.e. na me and p hoto not available available on card or valid yellow/Orange yellow/Orange ration card

3

Name is the re in in Yellow or Orange Ration Card and matches with name in phot o identity. identity. But the card is invalid invalid as it does not match with the digitized list.

Photograph of child with either parent along with Health card/ valid Ye Ye llow or Orange ration card of either parent and Birth Birth certificate certificate issu ed by hospital hospital or other aut horized horized en tities Not eligible fo r benefit package (The yellow /Orange ration card is cancelled after verification by department d epartment bu t still still the fa mily is is ho lding it)

Satisfactory Performance Certificates from the clients of institutions must be submitted with no adverse reports. These certificates shall be from the clients/end users where diet services were provided. Article Article 3: Specialty Specialty / S pecialties Empan Empanelled elled for 3.1 Provider Provider hereb hereb y decl dec la res that the hospital has has req uisite uisite infrastructure infrastructure a s per RGJAY guidelines in relation to specialty services for which empanelment is done and agrees to provide provide quality diagnostic and treatment services as per t he standard protocols. protocols. 3.2 Provider hereb hereby y declares dec lares that hosp hospital ital d id not e xclude a ny other othe r speci spec ia lty service se rvice deliberately from the scheme inspire of having such facility and agrees to empanel for the specia specia lties for which adequate adequate infrastr infrastru uct ure is available. 3.3 The Hospital Hospita l hereby hereb y declares dec lares that the the bed capac cap acity ity o f the hospital hospita l is more more than 50 with wit h adequate infrastructure and manpower as per standard guidelines and agrees to provide separate separate male an a nd femal ema le wards wards with w ith toile toilett and other other bas ic amenities. 3.4 The The Hospital declares tha tha t it has a well-eq uipped uipped ICU to meet meet th t he emergency requirements of the patients belonging to all categories empanelled for and agrees to facilitate round clock diagnostic and specialist services as per the requirement mentioned in clause 4. 3.5 Specialties Provider agrees not not to refuse refuse admission admissio n of RGJAY RGJAY patient in in any spec spec ialty alt y where it has has consultants co nsultants and equipment equipme nt.. A minimum o f 25% 25 % o f o verall vera ll bed capacit y a nd of beds in each specialty have to be made available to RGJAY patients in network hospital. 3.6 Provider a grees to follow follow the the guidelines guidelines issu iss ued by the RGJAY society / Insurer Insurer on specific specialties ann a nnee xed herewith (Refer Annexure V, V, XXVII) Article Article 4: Empanel Empanelm ment Infrastru tructure cture and a nd Manpowe Manpowe r (General): (General): 4.1 Infras  Well-equipped theatre  Casua Casua lty / 24 hrs. duty doctor / Appropriate nursing staff  Availability of trained paramedics ward with ventilator and other other required req uired facilities.  Post-op ward  ICU with concerned specialty specia lty  Round the c lock lab lab and a nd image lo lo gy s upport spec ialists in support fiel fie lds.  Availability of specialists Facilitie s for Interventional Radiolo Radiology gy and availability of concerned spe spe cialist.  Facilitie Infrastructure and Manpowe Manpowe r (Specific): (Specific) : 4.2 Infrastructure  Provider agree to provide to provide the services the services of fully qualified Medical Oncologist, Radiation Oncologist and Surgical Oncologist – and and equipment for Cobalt therapy, Linear Accelerator and Brach therapy – to be empanelled for Cancer Surgeries and Ch C he mo an a nd Radio-Th Radio-T herapies. Note: A combination of bot h profession professio nal a nd th t he equipm equip ment is essential. If equi eq uipme pmen nt for Radiotherapy are not available, there should be tie up with nearest Radiotherapy center.  Chemotherapy and Radiotherapy should be administered only by professionals well versed in dealing with w ith the si s ide-effects de- effects th t hat th t he treatmen treatme nt can cau ca use.

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

Patients with Hematologic malignancies (Ex Leukemia, Lymphomas and Multiple Myeloma) and Pediatric malignancies (Any patient < 14 years of age) should be treated by qualified qualified by medical medica l oncologi oncolo gist. st.  Chemot Chemot herapy has to be administered to the patient as in-pat ient treatment only. only.  Provider agrees to provide the services as per the packages and adhere to the treatment protocols protocols (Ref ( Refer er Annexure-IV) Annexure- IV)  The Service Provider will agree to quote batch no. of the drugs and attach empty vials and ampoules with labels intact along with the bills.  The Provider will agree to give patients feedback through Multimedia having webcam and mike. The provision for live viewing of the patient will be provided in the RGJAY society portal. 4.4 For Empanelment of Poly Trauma :  The Provider will have Emergency Room Setup with round the clock dedicated duty doctor.  Provider Provider will w ill ha ha ve ro und und the clock anesthetist services.  Provider will be able to provider round the clock services of Neuron-surgeon, Orthopedic Surgeon, CT Surgeon and General Surgeon, Vascular Surgeon and other support support specialties. spec ialties.  Provider will have dedicated round the clock Emergency theatre, Surgical ICU, PostOp Setup Setup wi w ith qualif qua lified ied staff.  Provider will be able to provide necessary cashless diagnostic support round the clock including including speci spec ia lized su s uc h as CT, C T, MRI, MRI, emerg emer gency bioch bioc hemical invest igat igatiions. Provider s hould put all necessary infrastr ucture required for prea uthorizati thorizat io n round the  Provider clock. 4.5 For Empanelment of Pediatric Congenital Malformations and Post-Burns Contractures: Provider will have services of qualified specialists in the field Viz., Pediatric Surgeon with dedicated theatres, post-op setup and staff. 4.6 For Empanelment of Prostheses (Artificial limbs)  The hospital hospital s hall have full t ime services services of o f Orthopedic Surgeon to be e mpanelled to provide provide prostheses package under the scheme. facilitate supply, supply, fitting of appropriate prosth prost hesis a nd gait tra ining of  Hospital sha ll facilitate patient by physiotherapist. physiotherapist.  Hospital sha ll ensure ensure th t hat an appropriate prosthes is is prescribed based on occupation of the person and standard standard prost hesis is supplied as per quality norms of BIS (Bureau of Indian Indian Stan Sta ndards).  Hospital sha ll also also facili fac ilitate tate free replacement of leather parts and ens ure total replacement of Prosthesis in case of da mage d uring guarantee period of o f 3 years. 5.7. For empanelment empanelment of laborator y services, services, t he signat s ignatory ory s hould essentially be a qualified pathologist 5.8. For empanelment empanelment of Ca ncer treat me nt, the the facility should have have tumour board whic whic h dec dec ides comprehensive treatmen treatme nt pla n of pa pa tient. Tumour board should consist consist of q ualified on o ncologists, on o ncosurgeon. cosurgeon. Linkage to Referral Re ferral facility for radiotherap radiotherapy y would would be permiss ible. Article 5: Specialties for which empanelment is done No.

1.

Specialty Sp ecialty Service

Available Available / Not Available

Specialist Name

Qualification

SURGICAL SPECIALTIES General Gener al S urgery urgery Qualified General Surgeon with post

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No.

1a.

2.

3.

4.

5.

6.

7.


graduate degree in General General Su S urgery rger y Well Equipped theatre facility with trained staff Post-op with Ve Ve ntilator S upport SICU Facility Availability of s upport specia lty of General Medicine, Pediatrics. For Lapa Lapa roscopic S urgeri urge riee s Surgeon Surgeon having requisite req uisite training tra ining and having perf per for med a t least 100 procedu proced ures for laparoscopic aparoscop ic su s urgery rger y (doc (doc umentary umentary evidence to be produced) Orthopedic S urgery Qualified Qualified Ort O rth hopedic Surgeon S urgeon Well-equipped Well-equipped theatre with C- Arm facility Trained paramedics Well-equipped Well-equipped Post-op Pos t-op facili fac ility ty with w ith Ventilator Support Round the clock lab support with CT,MRI Gynecology Gynecology and Obstetrics Qualified Gynecologist Expertise trained in laparoscopic procedure procedure wi w ith minimum 100 performances Post-op ventilator ventilator & Pediatric reconstruction facilities. Support services of Pediatrician Ophthalmology Qualified Ophthalmologist , trained vireo Retinal and orthot ics Surgeon S urgeon Optometry facility Well-equipped theatre facility ENT Qualified Qualified EN T Surgeon Surgeon Well-equipped Well-equipped theatre Post-op with with ventilator support Audiology Audiology su s upport Cardio-thoraci Cardio-t horacicc surge ry CT Surgeon CT theatre Cath – Cath – lab lab Cardiologist Cardiologist support Post-op with with ventilator support ICCU Other Other card iac infrastructure Plastic S urgery

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Specialist Name

Qualification

Well Equipped theatre


No.

8.

9.

10.

11.

B. 1.

2.

3.



Specialist Name

Qualification

Qualified Plastic Surgeon with MCh in plastic surger surger y or oth ot her equivalent degree recognized recognized by b y MCI MCI Well Equipped Theatre SICU Post-op rehab rehab / Physio-therapy support Neurosurgery Qualified Qualified Neuro-S N euro-S urgeon (M.Ch ( M.Ch.. Neurosur Neurosur gery or equivalent Well Equipped Theatre with qualified paramedica paramedica l staff sta ff Neuro Neuro ICU facility Post-op with with ventilator support Step down fac fac ility ility Facilitation for round the clock MRI, CT and and other o ther support support b io-c hemical emica l investigations Urology Qualified urologist Well-equipped Well-equipped t heatre with C-ARM Endoscopes Endoscopes investigation su s upport Post-op with ventilator s upport Sew lithotripsy equipment Pediatr Pediat ric S urgery Qualified Qualified ped iatri atr ic s urgeon Well-equipped Well-equipped theatre Pediatric and Neonatal ICU support Post-op with vent ventilat ilator or a nd pediatric resuscitator facility Support Support services o f pediatric Surgical Sur gical Gastroente Gastroenterrology Qualified Qualified Surgical S urgical Gastro- Enterologist Enterologist Well Equipped Theatre Endoscope equipment Post – Post – op op with ventilator support Centre Must have done at least 100 Endoscope Endoscope S urgeri rger ie s SICU MEDICAL MEDICAL SPECIAL SP ECIALTIES TIES General Gener al Me dicine icine Qualified Qualified Gen Ge nera l Physici Physic ia n with post graduate degree in General Medicine, Or Equal General Gener al Me dicine icine Qualified Qualified General Physician with w ith post graduate degree in General Medicine , Or Equal General Gener al Me dicine icine

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No.

4.

5.

5a.

6.

7.

8.

9.



Specialist Name

Qualification

Qualified Qualified General Physician with w ith post graduate degree in General General Medicin Med icine, e, or or Equal Pediatric Qualified Qualified p ediatrician NICU & PICU PICU fully equipped Round Round th t he clock c lock Pediatric / Emergency Emergency service room with Pediatrician Pediatric resuscitation faculty Cardiology Qualified Qualified Cardiol Ca rdiolog ogist ist with DM or Equivalent Degree ICU Facility with cardiac monitoring and ventilator support Hospital should should facilitate acil itate Round Round the clock cardiologist services Availability of s upport specia lty of General General P hysicia hysician n & Pediatrician Pediat rician Cardiac Interventions and Procedures Qualified Qualified Cardiol Ca rdiologis ogistt with experi exper ience in interventions and procedures Fully equipped Cath lab Unit with qualified and trained Paramedics Must have Backup CT Surgery Unit to perform Cardiac Cardiac Sur geries. Centre Must have done at least 100 interventions Nephrology Qualified Qualified Nep hrologist rolo gistss with DM or Equivalent Degree Hemodialysis facility AMC and Physician Support Medical-Gastro Medical-Gastro Ent Entomology omology Qualified Gastro Enterologist with DM or Equivalent Degree. Endoscopy facility AMC and Physician S upport Centre Must have done at least 100 Endoscopic procedures Endocrinology Qualified Endocrinologist with DM or Equivalent Degree AMC with ventila ventila tor and Phys ic ian Support. Neurology Qualified Qualified Ne urologist rolo gist with DM or Equivalent Degree. EEG, ENMG, Angio-CT facility of

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No.

10.

11.

12

C 1.



Specialist Name

Qualification

Neurological Neurological study Neuro Neuro ICU Facili Fac ility ty with wit h vent ventilat ilator or support Physic Physiciia n Support Support Dermatology Qualified Qualified Dermatologist w ith MD or or Equivalent Degree. AMC and Physician Support. Pulmonology Qualified Qualified Pulmonologi Pulmonolo gist st RICU facility Spirometry and bronchoscope facility Physic Physiciia n Support Support Rheumatology Qualified Pulmonologist MICU Facility Physic Physiciia n and and Or thopedic thopedic Su S upport Physiot Physioth herap y Support COMMINED COMM INED SERVICES SERVICES FOR CANCER CANCER THERAPY Cancer Services of q ualified Medical Oncologist Services of qu q ualified Surgi Sur gical cal On O ncolo gist Services of qu q ualified Radiatio n Oncologist if inin- house Rad Radiio therapy therap y equipment. Fully equipped equipped Radioth Rad iotherap erapy y Unit SICU or tie up with nearest Radiotherapy center. Intervent Interventiional Radi Rad iology Availability of DSA DS A equipme equipmen nt Qualified Qualified a nd trained intervent intervent ional radiologists

Article 6: Cashless Services under Package 6.1 The The Provider Provider ag a grees to to provide total tota l cashless transacti transact ion to the Beneficiary right from from his report reporting ing to disc disc harge under the sche me. 6.2 Provider Provider agrees to provide provide treatm treat me nt as per the packages packages worked out by the RGJAY RGJAY society the package includes consultation, medicine, diagnostics, implants, food, cost of transportatio transportation n, hospital charges etc. In other other words the package package should cover the entire cost of patient from date of reporting to his discharge from hospital 10 days after surgery, making the transaction truly cashless to the patient. And under no circumsta circumsta nces s hall ch c harge a ny money money extra within the treatment peri per iod of packag packa ge. 6.3 The The Provider Provider ag a grees to iss iss ue a test requis requisiti ition on s lip to to the patient which will empower the patie patie nt to to approach approac h the con co ncerned di d iagnosti agnost ic/test c/te st centers within the hospi hosp ita l or oth ot herwise erw ise and do the tests tes ts without wit hout any cash cas h transactio transac tion. n. The details deta ils o f the Tes Tests ts don do ne and their results will be uploaded in the portal b y the MCO of the Pro Pro vider. vider.

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6.4

Provider Provider agrees to keep a ll the RGJAY RGJAY patients admitted till 10 days of postoperative or till patient recovered satisfactorily in a ll those those cases where where operation operat ion was was per for med. 6.5 The The hospital agrees to the package to be a uthoriz thor ized ed even for those patients who who were were admitted as non-RGJAY out of ignorance but subsequently identified as RGJAY benefic beneficiary iary during the course of his/her stat in the hospital. In the mea nwhile ant payment received from the patien patie nt shall be refun re funded ded immediate immediately ly a fter getting ett ing preauthorization approval and before discharge of the patient from the hospital duly obtaining a receipt from the patient. 6.6 Hospital shall a ssist and fa fa cilitate the patient pat ient to to proc ure compat compat ible blood for for th t he surgeries and therapies. The Hospital shall provide blood from their own blood bank subject to availability within the package. In case of non-availability the hospital shall make efforts to procure from other blood banks, Red Cross, Voluntary Organizations, etc. The Hospital Hospital sh s hall also a lso iss iss ue a copy of the request request letter to the patient. Article Article 7: Package Package Rates R ates 7.1 The The Packa ge rates are give give n in the Booklet Booklet (RGJAY Manual on S urgical rgica l & Medical Medical Treatments for Cashless Treatment of beneficiary Population) will form a part and parcel of the MOU and which will be the basis and binding for the treatment cost of various procedures and as per the package rates. 7.2 The The Package Package rates are the ma ma ximum ximum rate indicated for for each sur gical gical procedure However, However, the settlement of the claims will be made on the basis of actual bill submitted by the provider. provider. 7.3 Provider has agreed to the continuation of the agreed tariff for the period of this agreement. 7.4 In the e vent o f more than o ne procedu proced ure is being be ing unde undertaken rtaken in o ne s itting o ther than those those o f routine/sta routine/stan ndard components of t he surgical procedure, t he package pa ckage amount will be dec ided b y th t he technical committee in co nsolatio n with w ith treating doctor a nd d ecision of this committee will be final and binding on the hospital. 7.5 Provider under any circumstances will not refuse to undertake procedure on the ground of insufficient package. 7.6 In all other disputes related to package rates and technical approvals of preauthorizatio preauthorization n‟s the matter will be referred to a technical committee committee of the RGJAY society a nd decision d ecision of t he commi co mmittee ttee is binding on the provi pro vider. der. Article Article 8: Cost of evaluation evaluation of patients patients 8.1 The The cost of various various treat treatment ment/tests /tests conducted on the the ben be ne ficia ficia ry family family members members who who are evaluated but ultimately do not undergo Surgery or Therapies will be borne by the Provider themselves and the Provider will not charge any fee for consultation and investigation from from the Beneficiary Beneficiar y. Article Article 9: Quality Quality of Ser Se rvices 9.1 Provider Provider agrees agrees to provide separate separate and Free OPD consultat consultat ion. However there there will not not be any discrimination to RGJAY patien patie nts vis-a-vi vis-a- viss other paying pati pat ie nts in regard to quality of services. 9.2 Provider shall a gree gree to provide pro vide free free diagnostic dia gnostic tests and med mediical ca l treat ment for for benefic beneficiary iary familie familie s irrespect irrespective ive of surgery / Therap Therap y required a ccording to good business business practices. pract ices. 9.3 The Provi Pro vide derr will treat RGJAY RGJA Y Benefic iary fa fa milies in a courteous co urteous ma ma nner and and according to good good busine busine ss practices. 9.4 The The Provider Provider will e xte nd admissio admission n facilities facilities to the Be Be neficiary families round the the clock. clock. 9.5 The The Pro vider vider will ha ha ve themselves covered by proper indemnity policy including including errors, omission and professional indemnity insurance and agrees to keep such policies in force during during e ntire tenure of the agree me nt.

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9.6

Provider Provider will e nsure that the the best an a nd compl comp le te diagn dia gnostic, ostic, therapeut therapeutiic and follow follow -up services based on standard medical practices / recommendations are extended to the Beneficiary. 9.7 The The provider agrees to pro vide vide qua lity servi ser vice ce to the the beneficiary benefic iary by following fol lowing stan sta ndard protocols protocols for d iagnosis a nd treatme tre atmen nt. It I t is a lso mandator mandator y for the provider pro vider to assess the appropriate appropriate need and subject the beneficiary for treatment / Procedure. 9.8 The The provider provider agrees to to provide quality medic medic ine ine s, stan sta ndard prosth prost he ses. I mpla mpla nts and disposables disposables while treat ing the the ben be ne ficiar ficiar y fa fa milies. 9.9 The The P rovider rovider agrees to a ssist and cooperate with the medica medicall auditing team team from the RGJAY society / Insurer as and when required. 9.10 The Provider agrees to provide video recorded evidence of patient counseling before surgery in order to avoid legal complications / any adverse reaction by patients or Patient‟s Patient‟s relatives re latives or b y public public in the event of unacceptab unacceptablle outcom o utcome. e. 9.11 The hospitals Morbidity and Mortality cases will be subject to scrutiny by the RGJAY society / Insurer. (Refer ANNEXURE – ANNEXURE – V & XIV) 9.12 The provider agrees to take sole responsibility in submitting the patient details online and if any discrepancy is found in this regard the Provider agrees to abide by decisions of EDC. Article 10: Services of Medical Coordinator Provider will have a Medical Officer / Medical Officers designated as RGJAY Medical Coordinator/s (MCO) for the scheme to coordinate with society through Arogyamitra. The provider agrees to submit the details of appointed MCO ‟s as per the ANNEXURE ANNEXURE XXII The provider should promptly inform the insurer about change if ant in the MCO designated designated the tenu te nure re of th t he ag a gree me nt. The following will be the responsibility of MCOs (RGJAY Med Me dical Coordinator): Coordinator): 1. He / S he will ens ure that all required evaluation in inc luding diagn dia gnostic ostic tests are done free of cost for all beneficiary families and the details of the same along with reports are captured in the RGJAY society portal. 2. He / S he will up lo ad the OP/IP stat us o f the patie nt. nt. 3. He / S he will guid guid e the patient pa tient in a ll a spects a nd s ign the inve inve stigat io n request. 4. He / S he have to cross c heck whether d ia gnosis is covered co vered in the sche sc hem me. If doubtful do ubtful about the plan of management then should coordinate with treating specialist along with Package list as specified in the Rajiv RGJAY Medical on Surgical & Medical Treat Treatm ments for Cashless C ashless Treatment of BPL Pop ulation – ulation – 3rd 3rd edition. 5. He / She should facilitate acil itate the admiss ion process of Patien Patie nt without a ny delay. 6. After admission ad mission He / She will wil l collect co llect a ll the necessary necessar y investigat ion reports repor ts bef be fore sending for approval. 7. He / S he will up lo ad the admiss ad missiio n notes a nd preoperative preop erative c linica l no tes o f the patient. pat ient. 8. He / She will ensure that prea uthoriz thor izat at ion request is is sent only for for those who a re on bed (IP) 9. He / She will ens ure before sending Preauthorization that all documen docume nts like health ealt h card or valid ration card (yellow/orange) coupled with aadhar number, Patient photo and also necessary reports like CT Films, X-Ray films, Angio CD etc. are uploaded in the system. 10. He / She will will coordinate with insurance insurance a nd RGJAY society doctors doctor s as need need arises. 11. Preauthorizatio Preauthorization n kept pending from from Insuran Insura nce and RGJAY RGJAY society will be verified verified on a regular basis a nd necessary necessar y correctio correctio ns to be done b y MCO. 12. He / She will furnish furnish daily c linical linical notes notes (Per Operat ive ive and Post-operative). Post -operative).

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13.

He / S he will upload 3 P hotog oto graphs of the the Patien Patie nt taken taken preoperative preopera tive beds ide, immediat immediatee post-operativ post-operat ivee showing show ing operation op eration wound wound and at th t he time of dischar ge. 14. He / S he will will update surgery surger y and discharge deta ils a nd ha ha nd over signed signed copy of the summar summar y along along with follow-up advice in preprinted prepr inted stationar stationar y supplied. supplied. 15. He / S he will e nsur ns uree free fo llow – up up consultations, routine investigations and distrib distribu ution tio n of drugs to to be su s upplied by the Pro vider vider to the the be neficiary efic iary families. families. And also refer ANNEXURE – ANNEXURE – VI VI 16. He / S he will e nsure to to update update the deta ils of on bed statu stat us of pati pat ients time to to time as per the for ma t (Refer ANNEXURE-XX) on the display disp lay board placed a t the Arogya Arogya mithra Kiosk Kiosk / reception recep tion desk. desk. 17. The Provider will will have a Data Data Entr Entry y Operator and each each data e ntry operator will be linked to the respective MCO and the final responsibility of the data fed by the data entry operator will be vested on MCO of the Hospital. The provider agrees to submit the details of Data En E ntry Operator as per the ANNEXURE ANNEXURE XXV. Article 10.1 Mode of communication 10.1 (i) The Provider a gree greess to use the Closed User Grou Gro up (CUG) mobile ob ile pho ne give give n by insurer to MCOs & MCCOs exclusively for the purpose official communications related to RGJAY Scheme. Any mis-utilization of CUG by the MCOs & MCCOs the insurer insurer reserves rese rves the the right to initiate action against the service Provider. (ii) The Provider agrees to use only RGJAY Messaging Services provided on the Web Portal for for any a ny kind of official communicat communications ions rela rela ted to RGJAY RGJAY scheme. The The EmailEma ilIds of MCOs & MCCOs provided by the RGJAY society/ Insurance will be used as their communication me thod. Article Article 11 Documentation Documentation and a nd MIS 11.1 The provi pro vider der will ensure ensure that that documentat documentat ion of RGJAY patie patien nts are done using standard formats supplied / available online such as admission card, referral card, investigation slip, discharge summary etc. 11.2(i) RGJAY society Insurer reserves the right to visit the Beneficiary and check his medical data with or without intimation as and when required. (ii) The provider will allow a llow the the Gen Ge neral Managers / Deput Deput y General General Managers / Field staff / Doctors. Vigilance officials and other officials from the RGJAY society and Insurance Company to inspect the hospitals without obstruction and co-ordinate with them during Surprise Surprise a nd Regular Inspection Inspectio ns. 11.3 Provider will furnish periodical reports to RGJAY society / insurer on the progress of the scheme as per the for for mats prescr ibed for t his his purpose. 11.4 Provider will wil l not give any document doc ument to fac facilita ilitate te the RGJAY patient pat ient to obtain obta in a ny other relief like like CMRF CMRF etc. P rovider rovider will not cla im a ny other re re lief for for t he proced ures covered under the scheme. Any deviation in this regard may attract Delisting of the hospital. 11.5 The Provider agrees to keep printouts of all online documents in the case sheet and make available as and when required for verification by field staff / doctors of the RGJA RGJAY Y socie socie ty / I nsurance. Article 12: Display of Boards & Banners 12.1 Provider Provider agrees agrees to display disp lay their stat stat us of preferred Provider of RGJAY RGJAY Community Community Health Insura Insura nce Scheme at th t heir recepti recept ion / admis ad mission sion desks. 12.2 Provider Provider agrees to display disp lay their statu stat us of specialti specia lties es em e mpanelled in RGJAY Community Community Health Ins urance Sche me at th t heir recepti rec eption on / ad missio mission n desks. desks. 12.3 Provider Provider agrees to d ispla ispla y a vailability of beds in the hospital hospital and a lso displ disp lay specialt specialty y wise bed occupancy under RGJAY Community Health Scheme at their reception / admissio admission n desks. (Ref ( Refer er ANNEXURE-XX)

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12.4

Provider Provider agrees agrees to displa display y the process flo flo w of RGJAY RGJAY within the hospital hospital at the RGJA RGJAY Y kiosk. 12.5 Provider Provider agrees to to make a va ilable o f the list list of diseases disease s with packa ge rates covered covered under RGJAY community Health Insurance scheme in the form of Booklet supplied by the RGJAY society/ Insu Ins urer at their reception receptio n / admissi admiss ion desks. 12.6 Provider Provider a grees to display other mater materiials supplied by RGJAY society /In /I nsurer for for the ease of Beneficiary families. Article 13: RGJAY Kiosk and Aarogyamithra Services 13.1 The Provider will will allow RGJAY Assistance Counter Counter / K iosk to be be established at the reception of the Provider free of cost. (Photograph of the space annexed herewith (Refer ANNEXUR-1)) 13.2 The Provider will provide following infrastructure and network facility to the counter. P.C., Printer, Scanner, Digital Camera, Webcam, Barcode reader, Mike, Speakers, Stationary etc. (Refer ANNEXURE - XVII) The System and other peripherals should be provided provided exclusively exclusive ly for for th t he use of Aarogy Aaro gyamithra amithra who can ca n use use t he reso urces at any point of time. t ime. 13.3 The Provider will provide a dedicated 2MB broadband connectivity to the Computer to be exclusively used by the Aarogyamithra to access the web for online MIS. e preauthorizatio preauthorization n etc. 13.4 The Provider will allow Aarogyamithra access to the wards and patients data to fac ilitate ilitate onward transmission to the Company for e-pre-aut h, claims, correct MIS etc. 13.5 The Provider will update the date of surg sur gery, d ischarge ischarge / death deat h of the beneficiary benefic iary in in the RGJAY society portal. 13.6 The Provider will intimate Aarogyamithta and MCO regarding emergency admissions of the Beneficiary during non office hours. Article 14 Preference to Beneficiary families 14.1 The Provider agrees not to deny admission for for the be ne fic fic iary for for want o f preauthorizatio preauthorization n approval. 14.2 The provider agrees to provide a separate ward for RGJAY Benefic iar y fa fa milies. 14.3 The provider agrees to provide separate Operation Theatre and weekly schedules for the surger surger ies / therap ies to be per formed for the Beneficiar Beneficiar y families. families. Article 15 Capacity for Surgeries 15.1 The provi pro vide derr agrees to handl ha ndlee a minimu minimu m number o f cases in each eac h speci spec ia lly includ including ing trauma trauma cases based ba sed on their their av a va ilable infrastru infrastr uc ture as as under: under : CATEGORY SPECIALTY Capa Capa city to a dmit dmit number number of patients /Day (Bed Strengt Strength h) A MEDICAL MEDICAL S PECIALTIES PECIALTIES General Medicine Critical Care General Medicine Infectious Diseases Pediatrics Neonatal Neonatal Intensiv I ntensivee Care Ca re Pediatric Intensive Care Pediatrics (General) Cardiology (Medical Management) Nephrology Nephrology Neurology Neurology Endocrinology Medical Gastroenterology

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CATEGORY

SPECIALTY

Capa Capa city to a dmit dmit number number of patients /Day (Bed Strengt Strength h)

Dermatology Rheumatology Pulmonology B SURGICAL SURGICAL SPECIALTIES SPECIALTIES Genera Genera l Surgery Orthopedics ENT Ophthalmology Gyneco Gyneco logy and Obstetrics Obs tetrics Cardiac Interventions Cardiothoracic Surgery Surgica Surgicall Gastroenterology Gastroenterology Genitourinar Genitourinar y Surgery Surgery Neuro Neuro Surgery Pediatric Surgery Plastic Surgery C SPECIAL SPECIAL S ERVIC ERVICES ES Cancer Medical Oncology Surgical Oncology Radia Radia tion On O ncology* 15.2 The Provider agrees to submit the vacancy level in pre-operative words, ICU, PostOperative wards and also upload the same in the RGJAY society portal on a daily basis. Article 16 Medical Camps 16.1 The Provider will conduct free medical camps at least once a week at the place specified by the RGJAY society to identify the members of the BPL families who may require surgeries covered under the scheme as per the schedule given by the RGJAY society/for such surgeries. The camp policy as given in Annexure II will be scrupulously scrupulously followed. ollo wed. 16.2 The Provider will carry necessary diagnostic equipment such as ECG, Echo Ultraso Ultrasoun und d etc. to th t hese free medical medical cam ca mps. 16.3 The Provider will will provi pro vide de servi ser vices ces of concern concer ned spec ialists name namely ly Cardiol Cardio logists, CT Surgeon, Neurosurgeons, Urologists, Oncologists, Gynecologists. Plastic Surgeon, Pediatric Surgeon, Surgeon, Gen Ge nera l P hysic hysiciians to the ca mp to facilitate proper e va luat luat ion of th t he patients. 16.4 The Provider will submit the camp confirmation and indent (Annexure-III) online as given in camp policy in the prescribed format to RGJAY society/ Insurance at least one one week in adva nce of the stipulated date. 16.5 The Provider will inform all the stakeholders such as district Administration, concerned public representatives, PHC / AH / DH staff etc. well in advance for successful conduct of the camp. 16.6 The Provider will spread awareness about the camp through Publicity in coordination with with Dist D istrict rict Coordinator. Coordina tor. Regional Regional coordinator, PHC staff a nd Aarogyamithras. Aarogyamithras. 16.7 The Provi Pro vide derr will provi pro vid d e pati pat ie nt data to RGJAY RGJ AY society soc iety / Insura Insu ran nce in the prescribed presc ribed form at the end of the camp. 16.8 The Provider will enter the details of the patients screened and referred at the camps on the RGJAY society website on the same day of the camp.

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16.9

The Provider will coordinate constantly with the Medical camps cell of the RGJAY society in all matte matters rs related to Medical cam ca mps. 16.10 The patients referred from the camp will be followed up and transported to the Hospital within 10 days of the camp unle unle ss the patient is not willing, in which whic h case th t he same should be recorded and updated updated in the Website. 16.11 Provider will have an Officer designated as RAJIV GANDHI JEEVANDAI Medical Camp Coordinator (MCCOs) for the scheme to coordinate with RGJAY society / Insurance through Aarogyamithra The provider agrees to submit the details of appointed MCCO‟s as per the ANNEXURE XXIV. The provider agrees to inform the insurer & RGJAY society about the change in the MCCO designated designated if any, d uring the tenure of t he ag a greemen reeme nt. The Provider will give the full time services of RGJAY Medical Camp Coordinator (MCCO) to coordinate all activities related to camps and patient follow up from camps. The following will be the responsibilities of RGJAY Medical Camp Coordinator (MCCOs) Confirma Confirma tion of camps online online and indenting online. Carrying out the IEC activities within wit hin camp camp area at least leas t 7 days before the ca mp date. Providing facilities facilities like s hamianas, chairs, screening enclosures. Providing common medi med ic ines in the camps. Arra Arra nge nge for distribution d istribution of incentives incentives to the medical officers. Coordinating and and en e nsuring participation participatio n of specialists. Arra Arra nging the diagn dia gnost ostiic eq uipme uipme nt Coordinate with PHC doctors / government Doctors. Public Representatives, SHG groups an a nd Local Administrat ion. Raising Raising c laims online for th t he camps ca mps conduc conduc ted. Follow – Follow – up up of patients referred from Camps as per clause 16.10 And other responsibilities mentioned in ANNEXURE – XV. XV. Article 17: Admission of Beneficiary 17.1 Request for examination and if necessary hospitalization for surgical procedures on beha beha lf of o f the Beneficiary will made by the “RGJAY Help Desk” at PHC/ Government Hospital or b y the the “RGJAY Assistance Counter / Kiosk” at Network Hospital.        

  

17.2

Aarogyamithras at RGJAY Assistance Counter / Kiosk at the Network Hospital will coordinate with the Provider from the time of admission till discharge after the surgical surgical procedure. Article Article 18: e-Pr e -Pree- Authorization Authorization 18.1 Pre-author Pre-author iza iza tion request will be sent only after admiss ion and the pati pat ient will be there there in the hospital as inpatient till final decision on the Preauthorization is made. 18.2 The Provider will submit the e-pre-authorization, after admitting the patient as in patient, o n th t he RGJAY Website complete in a ll aspects a spects including including the signed copy of consent of the patient. All relevant test reports along with Digital photograph of the Beneficiar Beneficiar y taken taken in the the hospital hospital s hould also also be uploaded. uploaded. Catheterizatio n C D, MRI films, X-rays, biopsy reports will be uploaded, cytology and biopsy reports / slides should be submitted. 18.2a Insurer undertake undertake to appro appro ve the Preau Prea uthorizatio n in cons ultatio ultation n with the RGJAY RGJAY society indicating the relevant package rates within 12 working hours of the receipt of the request for pre-authorization form as well as the required data and information online. 18.2b the Provider agrees to update the surgery online immediately after performing the Surger Surgery y. However, However, th t he validity per iod o f the pre-a pre- a uthoriz thor izaa tion is is 14 days days from the the date of approval. appro val. The Provi Pro vide derr agrees to update c linical no no tes of ALL cases (both Pre

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18.2c

18.2d

18.2e

18.2f

18.3

18.4

18.5

18.6

& Post pre-authorization notes) in the Website on daily basis. If the surgery / therapy is not update within 14 days after approval of pre authorization will automatically get cancelled cancelled in the RGJAY Portal Porta l. The The provide provide r should obtain fres fres h approv appro val for the the cancelled pre-authorization by mentioning valid reasons and the Insurer / RGJAY society reserves the the r ight to approve approve t he req uest of pre-a uthorization. After Approval of pre-authorization, if the patient is not found on bed at the time of routine check by officials of RGJAY society Insurer and in case the provider unable to present the patie nt d uring the routin ro utinee check by offici o fficiaa ls of RGJAY soc iety et y/Insu /Ins urer, the RGJAY society/ Insurer reserves the right to cancel the Preauthorization immediately without without any a ny intimatio intimation n. If the provider is is not able to conduct co nduct the operation opera tion within wit hin a reason reaso nable ab le time for a ny reason other than medical such as non availability of beds or specialists, the Provider will arrange for the operation to be conducted at any other appropriate Network Hospitals Hospitals in con co nsultat ion with w ith Insurer. Insurer. The provider agrees that the approval of Pre-authorization by RGJAY society / Insurance is mere approval for eligibility of case for Assistance under scheme and should not be construed as approval of choice of the treatment & outcome conseque conseque nces thereof which is sole responsibility of treating Doctor. Doctor. Any deficiency in documentation & ONLINE updation of data and protocols by the provider provider which may lead to pending o f Pre- authorization approval, approval, the responsibil responsibility ity for such delay leading to delay in treatment & outcome is solely responsible of the Provider. The provider agrees that any Rejection of Pre-authorization shall not be construes as denial of treatment to the patient and outcome thereof, it is a mere rejection of assistance under under the scheme scheme guide guide lines. lines. The provider provider ag a grees to exercise best of his his judgme judgmen nt and counse l the pati pat ient about the a lternate ways of pro viding viding such care including the option of referring the patient to Govt. Institution where such facility exists. Preauthorization preferably will be given to the network hospital whichever does the preliminar preliminar y screening scree ning eith eit her at the Medical camp or at the hospital. Second Se cond preauthorization for the same patient from different network hospital will not be entertained for the same proced ure unless medically med ically wa wa rranted or su s urgical rgica l p rocedure rocedure is unduly delayed by the first hospital without proper medical grounds. Insurer reserves the right to disallow the claim if the Surgery / Therapy is performed before before a ny approval from the Insurer / RGJAY society and pre-authorization preauthorization is obtained at a later date keeping the insurance / RGJAY society in dark about the surgery /t herapy. The provider agrees to send the enhancement requests before the discharge of the patient through E-ma E-ma il or by fax and follow the enhanceme enhanceme nt guidelines (ANNEXURE-XXI) (ANNEXURE-XXI) an a nd enhance ment module module manu ma nual al in the the book let (RGJAY ( RGJAY manual for Surgical and Medical treatments for Cashless Treatment of BPL Population- 3rd edition.) The Provider agrees to abide by the decision of Technical Committee and shall shall extend e xtend cashless facility to t he patien patie nt. The provider provider agrees a grees to obtain e merge nc y Telephonic Telephonic Appro va l for for e mer gency cases only. only. The The Insurer / RGJAY society reserves t he right to ca ncel th t he Emergen Emerge ncy telephonic telephonic approval, if the the provider fa ils to to update the pre-aut pre -auth horization orizatio n online online within 72 ho ho urs of Eme Eme rgency rge ncy telepho te lephoni nicc approv appro va l. The p rovi ro vide derr a lso agr a grees ees to perform per form the surgery / therapy obtained through telephonic intimation within 24 hours form the date and time o f telep honic approval. The P rovi ro vide derr a lso agr a grees ees to update update the s urgery/ therapy done for telephonic instructions online mentioning the date & time along with specific remarks and photo photog graphic evi e vide de nces whil w hilee updating the online preauthorization, authorization, starting sta rting from the the te lephonic intimations. intimations. (Refer Annexure- XXVII).

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Article 19: Transport of Patients 19.1 The Provider agrees to transport of bear the cost of transport transport charges (To & fro) incurred by the beneficiary and agrees to arrange the same at time of discharge and obtain obta in acknowledgme ack nowledgme nt from the patient pat ient accordingly. accord ingly. The Provider Pro vider a gree greess to obtain obta in signature of beneficiary on the acknowledgment sheet generated from the portal and upload the sca nned nned copy to RGJAY Web portal. Article 20: Free food to patients 20.1 The Provider agrees to provide free food to the patients as envisaged in the package rates either through in-house pantry or by making alternate arrangements like supplying supplying from nearby canteen. Article Article 21: Discharge Discharge and Follow up 21.1 Intimation Intimat ion o f the impe impending nding d ischarge ischar ge o f the Benefici Benefic ia ry need to to be advised to RGJA RGJAY Y Ass Ass istan sta nce Coun Co unter ter at least one day before the discharge o f the patient. pat ient. 21.2 The discharge has to be done in the presence of MCO and Aarogyamithra concerned and and update the details ONLINE. 21.3 At the time of Discharge the transportation cost to and fro has to be reimbursed to the Pati Pat ie nt, nt, if the Hospital Hospita l has has not provi pro vided ded the t he transporta tion. The acknowledgme ack nowledgme nt o f receiving the amount for transportation has to be generated from the RGJAY society portal a nd th t he signed copy has to be uploaded. uploaded. 21.4 Discharge summary will be generated from the RGJAY society portal in a pre-printed stationary to to be be su s upplied. The The Disch Disc harge summary will will consist consist of all the treatmen treatme nt details of the Patient at the Hospital and the follow up regime for the Patient including consultat consultat ion and medicat medicatiio n. 21.5 All the patients must be provided with follow-up medicines after discharge by the provider provider as part of the packag packa ge. 21.6 If the same Patient is coming back to the Hospital, the follow up derails have to be uploaded in the RGJAY society portal. 21.7 Satisfaction letter of the Patients has to be generated from the RGJAY society portal and the signed copy has to be uploaded. 21.8 The MCO & Aarogyamithra should counsel the patient for all the precautions to be taken for for th t he post-operativ post- operativee care. 21.9 All patients who requite follow-up medicines will be advised by the provider to come back on 11 t h day of discharge for first follow0up mandatory. The date of first followup will be generated generated by b y the RGJAY society portal along alo ng with th t he discharge summar y. 21.10 The subsequent follow-ups for the above cases will be as per the follow-up guidelines (Re (Re fer ANNEXURE-VI) 21.11 The Provider will agree to provide follow-up services for a period of ONE YEAR under under th t he Scheme. 21.12 The provider will provide provide free post- transpla transplan nt immunosuppress immunosuppressive ive therapy therap y for for a per iod st th of six months from date of surgery (1 to 6 month), irrespective of agreement period for all cases of renal transplant within package. The provider will do cashless posttransplant immunosuppressive therapy for the remaining period of six months (7 t h to 12th month) under RGJAY II. 21.13 The provider will agree to provide free post-surgical physiotherapy services, wherever required required for the a greemen reeme nt peri per iod. Article 22: Billing B illing Procedure / Checklist for fo r the the Pr P rovide r at the the time of Patien Patient‟s t‟s discharge 22.1 It is is admitted and a greed that that the the Provider Provider is aware that this this MOU ha ha s arisen arise n for for the the purpose purpose of imple implem mentatio n of the RGJAY Commu Co mmunity nity Health Insurance Scheme (RGJAY I & II) intended for Below Poverty Line families in specified Districts of Maharashtra and accordingly the Provider will in no circumstance charge or seek any payment from the the Beneficiar Beneficiar y families families but b ut will look look only to for indemnity, and that that too

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only to the limits/ schedule of fees in respect of procedures referred to earlier and agreed agreed to under under this t his MOU. MOU. 22.2 Signature or the LTI of the patient / Beneficiary will be obtained on final hospital bills and the discharge form. 22.3 The provider will submit the following to Original discharge summary, original investigation reports. All original prescriptions, Procedure CD‟s MRI films, X-rays, X -rays, Post-Operative slides with Biopsy report, 3 Photographs of the patient taken preoperative preoperative bedside, immediate immediate postoperative showing operation operat ion wound and at the time of discharge, Case Sheet with Operation Notes Breakup of the bills (Room Rent, Investigations, Procedure charges & pharmacy receipt) etc. These are to be made available to for Claim payment, while submitting the bill. The copies of the discharge summary signed by the Beneficiary will be uploaded in the web. A summary of the bills bills ra ised will also also be uploaded. 22.4 Letter of satisfaction from the patient should also be obtained and sent along with the bills bills to in presc ribed for for mat. 22.5 Provider Provider should ensure that C hemo Therap Therap y Drug Dr ugss are physically physically administered to to the Patients. Provider should produce bills by coating batch no. and attaching empty vials & ampoules ampoules with intact labels. 22.6 The Provider will have-an Officer designated as Billing Head in order to follow the process the online work work flow. flow. The The provider agrees to submit the deta ils of Billing Head as per the ANNEXUR XXIII. Article 23: Pay Paym me nt Te Te rms rms and Conditions Conditio ns 23.1 Insurer a grees to pay all the e ligible ligible bills within 7 working days. Subjec Subjec t to submiss ion of all supporting documents including post-operative investigations and reports as required online and the photocopies of daily progress report and ICU charts should be sent by courier. 23.1a The paymen payme nts to the the provider are made the the Insurer after deducting deducting Taxes (TDS) (TDS) as per prevailing IT Rules, R ules, an a nd accordingl accord ingly y I nsurer will issue the Form No. 16A t th t he e nd o f Financial Year. Provider hereby agrees to comply all the formalities required in fulfilling regulations of Income Tax Dept. (Refer ANNEXURE-XXVI) 23.2 The provider pro vider a gree greess to submit sub mit the core banking ba nking number IFSC code to the in ins urer to facilitate electronic fund transfer for settling the claims. (Refer ANNEXURE-XIX) 23.3 The Provider agrees to submit all the claims for the surgeries / Treatments performed within within 60 day da ys from the date of disch disc harge of patie nt. 23.4 The provider agrees to perform Surgeries / Treatment within 30 days from the date of expiry of this agreement for all the Pre-authorizations obtained during the period and submits the claim as per clause 23.3 above. Article Article 24: Limitations Limitations of liabili lia bility ty and i nd ndee mnity mnity 24.1 The Provi Pro vide derr will be respon respo ns ible fo fo r a ll commiss co mmissiio ns a nd o missions in trea ting the patients referred under under the scheme and and will also be responsible responsible for all legal conseque conseque nces that may arise. Insu Ins urer /RGJAY societ society y will will not be he he ld responsib responsiblle for the choice choice o f treatmen treatme nt a nd outcome of the treatment or quality of the care pro vid vid ed by the provider and should any legal complications arise and is called upon to answer the provider provider will w ill pay all le gal expen expe nses and consequent compen compe nsati sat io n, if any a ny.. 24.2 The Provider admits and agrees that if any claim arises out of alleged deficiency in service service on th t heir part pa rt of on the part of t he ir men or ag a gents, then it will be th t he d uty of the provider provider to answer such claim. In the unlike unlike ly event of Insure Insure r being proceeded against for such cause of action and any liability was imposed on them, only by virtue of its relationship with the provider and then the provider will step in and meet such liability on their own. 24.3 Notwithstanding Notwithstanding anything anyt hing to the the contrary contra ry in in this Agreeme Agreemen nt, neither Party will be liable by reason of failure or delay in the performance of its duties and obligations

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under this Agreement if such failure or delay is caused by acts of God, Strikes, lockouts, embargoes, war, riots civil commotion, any orders of Governmental, QuasiGovernmental or local authorities, or any other similar cause beyond its control and without its fault of negligence. 24.4 The Provider undertake for applicability of terms and conditions mentioned and in all the MOUs MOUs executed for all a ll the the phases inin- lieu of thi t hiss MOU. Article 25: Confidentiality 25.1 All the stakeholders undertake to protect the secrecy of all the data of Beneficiary families and trade or business secrets of and will not share the same with any una una uthorized person person for any a ny reason reaso n whatsoe whatsoev ve r within or wi w ithout or cons iderati derat ion. 25.2 The provider a grees to protect p rotect the confidentiality under this agree ment a nd e nsures not to recruit ex-employees of insurer anytime during this agreement and also for a further period of one year from fro m the date of ex e xpiry of this t his an agree agree me nt. Article Article 26: Termination Termination 26.1 Any defi de ficc iency ienc y in servi ser vicc e by the e mpanelled pa nelled hosp hospitals itals (Provi (Pro vid d er) or no no ncomp ncomp liance o f the provisions of MOU will be scrutinized by the Empanelment & Disciplinary Committee (EDC) comprising of representative from the RGJAY society and Insurer and make deliberations to sus pend / de de -list / stop pay paym ments or any other appropriate action based on the nature of the complaint against the Provider. The Provider shall abide by the deliberations made by the EDC and RGJAY society. Article Article 27: Jurisdiction Jurisdiction 27.1 Any dispute arising of this MOU will be subject to arbitration as per Arbitration Act and and subject to th t he jurisdiction of Mah Ma ha rashtra courts only. 27.2 Any a me ndme ndme nts in the c la uses o f the Agree me nts can ca n e ffec ffected ted as an adden adde nd um, um, a fter the writte writte n approval from fro m both the parti part ies. Article Article 28: Non-exclusivity Non-exclusivity 28.1

Insurer reserves the right to appoint other Provider/s for implementing the packages envisaged herein and provider will have no objection for the same and vice-versa.

In witness thereof this agreement executed by or on behalf of the parties on the day and year mentioned above. Signed Signed a nd delivered by: Provider: Through its Managing Director / by Sri/Smt. ______________________________________ Sign _______________________________ In presence of o f Sri/ Sr i/ Smt. ______________________________ ____________________________________ ______ Sign S ign ____________ _______________ ___ _____________________ ________________________________ ______________________ ______________________ _____________________ ______________ ____ Through Through its Chief Operating O fficer fficer Sri / Smt. _______________________________ ___________________________________ ____ Sign ___________________________________ In presence of o f Sri Sr i / S mt ___________________ ______________________________ _________________Sign ______Sign ______________ ______________

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“Rider “R ider A” A” 1

2

Resolution of dispute: In the event of any question, dispute or differences in respect of contract or terms and conditions of the contract or interpretation of the terms and conditions or part of the terms and conditions of the contract arises, the parties may mutually settle the dispute amicably. Arbitration:

If any dispute arises between the parties hereto during the subsistence of this Agreement of thereafter, in connection with the validity Interpretation implementation or alleged breach of any provision of this Agreement, the parties shall refer such dispute to their respective chairmen/CEO‟s for resolution. In the event that the chairmen/CEO‟s are unable to resolve res olve the dispute within 30 days of it be ing re ferred to them, them, then either Party may ma y refer the d ispute for resolution reso lution to a sol so le arbitrat a rbitrator or wh w ho will be Addi Add ition tio nal C hief hief Se cretary / Princi Princ ipal Secretary Se cretary P ublic Health Hea lth and Fa mily mily We lfare lfare Department Government of Maharashtra, or, in the event that the parties are unable to agree on the person to act as the sole arbitrator within 30 days after any party has claimed for an arbitrators in written form, by three arbitrators, one to be appointed by each party part y with power to th t he two arbitrators so appointed, appo inted, to to appoint a t hird arbitrator. arbitrator.

3 4

5

6

7

The arbitration proceedings shall be carried out as per the Indian Arbitration and Concillation Act, 1996 and the rules made thereunder. Governin Gove rning g Language: English language version of the contract shall govern its interpretation. Applicable Laws Laws : The contract shall be governed in accordance with the law prevailing in India, Act, Rules, Amendments and orders made theron from time to time. Indemnification: The contractor c ontractor shall indemnify indemnify the purchase purchaserr agai a gainst nst all actions, suit, claims and demand or in respect of anything done or omitted to be done by contractor in connection with the contract and against any losses or damages to the purchaser in consequence of any action or suit being brought brought against against the the contractor for anythi anything ng done done or omitted omitted to be done done by the the contractor contractor in the execution of the contract. Jurisdiction All the suits arising out of the contract shall be instituted in the court of competent jurisdiction situated in Mumbai only and not elsewhere. Saving clause clause No suits, suits, prosecutio prosecution n or any legal legal proceedings proceedings shall lie lie against against the Joint Joint Director of of Health Health Services (Procurement Cell), Mumbai or any person for anything that is done in good faith or intended to be done in pursuance of RFP.

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Detail of Rajiv Gandhi Jeevandayee Arogya Yojana Maharashtra

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