Tamil Nadu Pudhu Vaazhvu Project - TNPVP (Tamil Nadu Empowerment and Poverty Reduction Project) Terms of reference for engaging for insurance companies for insurance coverage to SHG women and their households Preamble: The Tamil Nadu Pudhu Vaazhvu Project (TNPVP) is an initiative of the Government of Tamil Nadu supported by the World Bank to address livelihoods and empowerment issues in the State. It is an empowerment and poverty alleviation project implemented by the Rural Development and Panchayat Raj department of Government of Tamil Nadu with World Bank assistance. The project is implemented over a 6 year period extended up to September 2014. The core objective of the TNPVP is to bring about a sustainable improvement in the livelihoods of the poor, the ultra-poor, the differently abled, tribals and the vulnerable through building pro-poor local institutions; enhancing skills and capacities of the poor; and financing productive demand-driven business plans related to livelihoods for the target poor. This will be done through targeted assistance for productive livelihood activities, in a more enabling village environment, using the Community Driven Development approach. There is a strong sense of ownership of the project among the community members. 1
Project Activities: Social Mobilization, Institutional Building, Capacity Building, Focus on Disabled and Tribal development, Livelihood promotion and youth development, Developing Social capital, promoting social accountability and good governance, Community based insurance and human resource management are some of the project activities undertaken through SHGs. Objectives The overall objective of the project is to empower the Community Based Organizations (CBOs) to play an active role in the implementation of social security and livelihood interventions to reduce vulnerabilities of very poor and tribal households. In order to poverty proof the target households, Social security is one of the key components which is being taken up for intensive implementation under the project. Need for insurance: Community based insurance is one of major activities undertaken by the project for providing social security to the community members. The need for providing a comprehensive package of insurance has become a necessity. Risk mitigation cover for life, health and asset are some of the insurance services needed by the community. The proposed insurance cover would eventually benefit all SHGs formed so far which amounts to a total of 80 lakh Households. Total SHGs functioning in the project area is around 1 lakh with 13 lakhs households under its fold. The proposed insurance package is to be provided for all the SHG Household members and their families. 2
Insurance Schemes & Benefits required: Life Insurance renewable on yearly or once in 3yrs: All women in the households and their spouse and family members in the project area have to be covered. The package shall minimum include Life cover for natural and accidental death, permanent disability and partial disability. Additional benefits such as scholarships to students (9th to 12th standard) of all eligible families. The sum assured for the risk of Natural Death shall be Rs 50,000/- Accidental death - Rs 1,00,000/- Permanent disability - Rs 75,000/- Partial disability - Rs 50,000/- Additional benefits required Rs. 1200 for per student. (9 th to 12 th Std - Per family maximum 2 children). General Insurance: Health Insurance: Approximately 13 lakh members & their families have to be covered under the health insurance. Primary care & Secondary care with wage loss compensation for the earning member shall be provided. 1 lakh floater with an Individual limit of Rs.50,000 per family for treatment. 30 days @ Rs.120/-per day for wage loss. Apart from hospitalisation expenses out patient (OP) charges coverage should also be part of the package. Live Stock: Approximately 2 to 3 lakh animals have to be covered under the live stock insurance for the period of three years. The entire value of the animal to be insured. The required benefits of natural and accidental death coverage including transit. 100% of the value of the animal as per Bank 3
statement or veterinary surgeon s certificate shall be provided in case of death. Hut Insurance: Approximately 40,000 dwelling huts have to be covered under the Hut insurance. Thatched Hut and household articles shall also be covered. Natural disasters and accidents including theft to be covered. Required benefits 75% of the value of the property. Internal Loan Insurance: Approximately 1,00,000 loans have to be covered per year. The members receiving loan from PLFs / CBOs to be insured. All internal lending of SHG/PLF should be covered. The loan size is generally upto Rs.50,000/-. The entire loan amount to be insured, for the entire loan period. (Minimum 3 years). In case of death before completion of repayment of loan the entire loan amount has to be repaid to the PLFs / CBOs. Youth insurance: Every year the project churns out trained youth who also happen to operate in hazardous conditions predominant among it being driving. The package for these youth shall cover accident and health cover during the entire period of training till one year. The insurance policy with a sum assured for Rs.1 lakh should cover death due to natural causes or accident, hospitalisation expenses, partial and permanent disability compensation. 4
Overseas Insurance: The project has trained and sent approximately 200-400 youth aboard for employment after imparting skills. The members will be in the age group of 20 to 40. The package shall include Life cover with natural and accidental death coverage with permanent disability and partial disability benefits. The benefits for the risk of Natural Death shall be sum assured of Rs 2,50,000/- Accidental death - Rs 5, 00,000/- Permanent disability - Rs 1,50,000/- Partial disability - Rs 1,00,000/- Differently abled There shall be a special package for the Differently abled community including the Mentally Ill and Mentally retarded for health coverage. It is envisaged to provide affordable Health Insurance to persons with Autism, Cerebral Palsy, Mental Retardation & Multiple Disabilities, to encourage health services seeking behaviour among persons with developmental disability and also to improve the general health condition & quality of life of persons with developmental disability. Have a single premium across age band Provide same coverage irrespective of the type of disability Insurance cover up to Rs.1.0 lakh. All persons with developmental disabilities will be eligible and included and there will be no selection. There shall be No exclusion of Pre-existing condition 5
Same cover as that for other persons Services ranging from regular Medical Check up to Hospitalization, Therapy to Corrective Surgery, transportation. Conditions requiring repetitive medical intervention as an in-patient. Pre & Post hospitalization expenses, subject to limits. No pre-insurance medical tests. Reimbursement of claims in case of OPD services and treatment through non-empanelled hospitals. Treatment can be taken from any hospital from anywhere. The overall limit of coverage for a person can be Rs. 1, 00,000/- Pension scheme A scheme to provide pension for SHG women reaching 60 years age to till death. The entry age group may be from 18 to 55 years. The minimum pension payable shall be Rs.1000/- Per month. Policy coverage period Life insurance to be covered for a period of 3 years. However quote premium rate for a year, for two years and for 3 years. Health insurance to be covered for a period of 3 years. However quote premium rate for a year, for two years and for 3 years. Livestock insurance to be covered for a period of 3 years. However quote premium rate for a year, for a two years and for 3 years. Hut insurance to be covered for a period of 3 years. However quote premium rate for a year, for a two years and for 3 years. Loan insurance to be covered for 3 years of entire repayment period. 6
Policy combinations The agency if competent can combine various products as a single package, however break up should be given such as individual / family, CBOs, Livestock Hut, insurance for candidate sent for overseas employment through the project. There shall be a special package in the quote including the Mentally Ill and mentally retarded especially for health coverage. Insurance implementation plan: We have community based organizations from panchayat level to district level. The Panchayat Level Federation (PLF) will facilitate insurance Community Insurance agents and will act as the insurance unit at village Panchayat level and offer services through the Community Professionals identified by the PLF and appointed by the district level Mavatta Magamai. Mavatta Magamai is the district level CBO who will be the third party administrator and will appoint insurance CPs at the panchayat level, who shall be trained by the insurance company on various insurance products. This CPs/CRPs (Insurance) will market the insurance product in the entire implementation area. For ease of operations, the Block Magamai will aggregate and consolidate the activities at Block level. The Insurance Company shall have tie up with various hospitals / health care providers who are very near to villages. The agents shall assist the clients in claim settlement and all other services. The company shall set up 24 X 7 call centers at Magamai of each district which shall accept the call and point out the causes and proceed for settlement of claims. This facility can also be located at Magamai on 7
agreement over the services. The claim documents shall be submitted by the Mavatta Magamai. After getting the claim documents the insurance company shall provide the claim settlement within 7 days. Role of CBO: PLF through its Community Insurance Agents will facilitate Premium collection from members Maintain data, file claims, follow up of Claims with individual policy holders Follow up of renewal of policy Maintaining policy documents Mavatta magamai Issuance of TPA photo ID cards Identification of hospitals and facilities for health insurance with concurrence of insurance companies. Monitor agency commission. Process claims and to check for timely settlement. Resolve the problems related to service provided by hospitals and insurance companies. Prior intimation of admission and treatment in case of health insurance. Function as a call center 24 hrs and to support Grievance redressal facilities. 8
Audit all transaction through SAC and also through regular internal audit. Role of TNPVP Liaise with the service provider and CBOs and filed support for implementation of the programme. Monitor the implementation at filed level and review the activities on a regular basis for smooth operation in a manner fulfilling the objectives of the project. Role of Insurance Company Train the CBOs on various insurance products and customer relations. Communication materials to be shared with TNPVP and CBOs Creation of necessary software for community usage. Support at filed level through their local offices. Liaise with CBOs and TNPVP for quicker processing of policies and claims. Liaise hospital for ensuring smooth admission and faster processing of Claims. The Insurance Company should have the following minimum qualifications: At least 5 years of existence as a reliable insurance provider. The company should be registered with IRDA. The company should have branches of all the districts of Tamil Nadu. 9
The company should have handled a minimum 10 lakh policies a year & have experience in all categories. The company should have a minimum turnover of 50 crore in a year for last 3 years. Should not be blacklisted or penalised by any Government agencies. Selection method: The insurance company will be selected based on Quality and Cost Based Selection (QCBS). Mode of submission of bid: The main single cover super-scribed as EOI for engaging of Insurance companies to provide different social security insurance products for SHG members and their households under TNPVP, should contain two separate sealed covers super- scribed, 1. Technical Bid for Engaging for insurance coverage to SHG women and their households under TNPVP. 2. Financial Bid for Engaging for insurance coverage to SHG women and their households under TNPVP. Documents to be submitted by the Insurance Company: Covering letter on official letter head indicating the total amount of premium along with list of documents to be attached with the bid. Detailed address of Company s registered office and office receiving the correspondence. Detail of branches/sub offices across the State. Relevant documents to prove experience in the relevant field. Name of authorized person for dealing with TNPVP and making correspondence on behalf of company. 10
Detail of claims to whom the similar facilities / services are being provided and their contact numbers for verifications. Sales tax and Income tax certificates for the last three years. Affidavit that the firm / company have never been blacklisted from any Govt, semi Govt. & Autonomous Body. Having documented evidence of 1000 cases of expeditious and unencumbered settlement of substantive claims with in 7 to 15 Days. The company should be registered with IRDA. (Copy of registration certificate to be attached). Quoted premium amount must be inclusive of all taxes plus operational cost if any. Details of category wise break up of premium amount may also be provided. Experience in handling in similar products and its quantum. Give the product details in the enclosed format in annexure A Following detail should be provided in the bid:- Method of premium payment (Eg: Quarterly, Half Yearly, Yearly and full three years). Low claims Bonus. Details of operational cost /administrative charges if any to be charged. Commission payable details. For insurance claim services 6% of the premium fee shall be provided and procurement cost 5% to 17% shall be provided by the company. Commission provided for pension scheme to be specified by the service provider. 11
Rejection of the proposal: TNPVP reserves the right to accept or reject any or all proposals, to waive any defect or infirmity thereon or minor deviations which do not affect the substance and validity of any or all of the proposals, or to annul the selection process and reject at any time prior to award, without thereby incurring any liability to the affected proponents. TNPVP reserves the right to reject the proposal of any proponent who: a. Does not offer the required services as provided for in this TOR. b. is discovered to have suppressed, disclosed or falsified information or c. Failed to satisfactorily perform / complete any contract previously taken. Project Director Tamil Nadu Pudhu Vaazhvu Project 12