GOVERNMENT OF INDIA
MINISTRY OF LABOUR & EMPLOYMENT
“National empanelment of audit agencies to
conduct financial, process and technology audits
for Rashtriya Swasthya Bima Yojana [RSBY]”
Request for Empanelment (RFE)
Ministry of Labour and Employment
30th October 2014
(MoLE reserves the right to cancel this request for empanelment (RFE) and / or invite afresh with or without
amendments to this request for empanelment, without liability or any obligation for such request for
empanelment and without assigning any reason. Information provided at this stage is indicative and MoLE
reserves the right to amend / add further details in the RFE document.)
Table of Contents
1. Fact Sheet ............................................................................................................................................................... 2
2. Request for Empanelment (RFE) ............................................................................................................................... 3
3. Part I – General information ..................................................................................................................................... 3
3.1.
Definitions ...................................................................................................................................................... 3
3.2.
Procedure for obtaining RFE document ............................................................................................................ 3
3.3.
Language of bid and correspondence .............................................................................................................. 3
3.4.
Forwarding of bids .......................................................................................................................................... 3
3.5.
Clarification regarding contents of the RFE ...................................................................................................... 3
3.6.
Modification and withdrawal of bids ................................................................................................................ 3
3.7.
Clarification regarding contents of bids ........................................................................................................... 4
3.8.
Submission of Bids ......................................................................................................................................... 4
3.9.
Price of RFE document .................................................................................................................................... 4
3.10.
Time and date for opening of Bids ................................................................................................................... 4
3.11.
Opening of RFE documents ............................................................................................................................. 4
3.12.
Place of opening of the Bids ............................................................................................................................ 4
3.13.
Rejection of bids ............................................................................................................................................. 5
3.14.
Validity of bids ................................................................................................................................................ 5
3.15.
Special instructions ........................................................................................................................................ 5
3.16.
Content of the bids ......................................................................................................................................... 5
3.17.
Amendments in RFE ........................................................................................................................................ 5
3.18.
Validity of empanelment ................................................................................................................................. 5
4. Part II: Essential details for empanelment ................................................................................................................. 6
4.1.
Genesis of Rashtriya Swasthya Bima Yojana (RBY) ........................................................................................... 6
4.2.
Benefits of Rashtriya Swasthya Bima Yojana (RBY)........................................................................................... 6
4.3.
Objective of the scheme .................................................................................................................................. 6
4.4.
Financing of the scheme ................................................................................................................................. 7
4.5.
Current status of the scheme ........................................................................................................................... 7
4.6.
Ecosystem of RSBY ......................................................................................................................................... 7
4.7.
Processes of RSBY .......................................................................................................................................... 8
4.8.
Current challenges within RSBY ....................................................................................................................... 9
4.9.
Need for audit within RSBY .............................................................................................................................. 9
4.10.
Objectives of third party audit ........................................................................................................................ 11
4.11.
Scope of Audit .............................................................................................................................................. 11
5. Part III – Standard Conditions of RFE ...................................................................................................................... 14
6. Part IV: Empanelment criteria and evaluation of bids .............................................................................................. 16
6.1.
Pre-conditions .............................................................................................................................................. 16
6.2.
Pre-qualification criteria ............................................................................................................................... 16
6.3.
Documents required ..................................................................................................................................... 17
6.4.
Validity of empanelment ............................................................................................................................... 17
6.5.
De-empanelment or termination of empanelment .......................................................................................... 17
6.6.
Effect of de-empanelment ............................................................................................................................. 17
Annexure 1: Format for pre-bid query ............................................................................................................................ 18
Annexure 2: Documents required to be submitted with bid ............................................................................................ 18
Annexure 3: Details of zone applied for and calculation of required turnover .................................................................. 19
Annexure 4: Organisational Profile ................................................................................................................................ 19
Annexure 5: Financial turnover of company in last 3 financial years ............................................................................... 20
Annexure 6: Experience of conducting audit involving field survey .................................................................................. 21
Annexure 7: Undertaking for qualification bid ............................................................................................................... 23
Page 1 of 26
REQUEST FOR EMPANELMENT (RFE) FORMAT
(Director General of Labour and Welfare, Ministry of Labour and Employment)
Invitation of bid for “National Empanelment of audit agencies to conduct financial, process and technology audit for
Rashtriya Swasthya Bima Yojana [RSBY]”
Request for Empanelment (RFE)
1. Fact Sheet
No.
Item
Information
1
Description of work
National empanelment of agencies by Ministry of Labour and Employment (MoLE),
Government of India to conduct audits for RSBY. The qualified agencies shall be eligible
to bid in respective zones (comprising of states) as and when notified by the respective
states or its authorised representatives.
2
Date of issue of RFE
30th October, 2014
3
Last date of submission of
RFE
21st November, 2014 by 1700 hrs
4
Submission of RFE
Every bid should be properly sealed and should be in accordance with instructions
given in Point 3.8 of Part I – General Information of this document.
5
Interactive Session
There will be an Interactive Session on 7th November, 2014 at 11:30 am at Mini
Conference Room at Shram Shakti Bhawan, New Delhi.
6
Clarifications/queries
regarding bid
Clarifications/queries, if any, can be sent to Assistant Director (RSBY- Monitoring) in
format provided in Annexure 1, by 7th November, 2014 before 5 pm. The queries can be
sent at following address:
Assistant Director (RSBY- Monitoring),
Office of Director General Labour and Welfare,
Ministry of Labour and Employment, Government of India, Jaisalmer House, 26, Man
Singh Road, New Delhi- 110001, Phone: 011- 2338 5241 e-mail:
suresh.singh25@nic.in
Interested bidders can raise their queries in advance in the prescribed format in
Annexure 1. MoLE shall publish the response to the queries on the RSBY website –
www.rsby.gov.in. Bidders are requested to check the published responses on a regular
basis.
7
Receipt of RFE – Last date
and time
21st November, 2014by 1700 hrs
8
Opening of bid
At 11am on 25th November, 2014 at Conference Room, Jaisalmer House, 26, Man
Singh Road, New Delhi- 110001
9
Designated Ministry for
execution of work
Ministry of Labour and Employment, Government of India
10
Terms & conditions of As per the RFP document which would be issued to empaneled agencies in that zone.
work
Page 2 of 26
2. Request for Empanelment (RFE)
This RFE is divided into four parts as follows:
a.
Part I – Contains general information and instructions for the bidders about the RFE, such as the time, place of
submission and opening of RFE, validity period of RFE etc.
b.
Part II – Contains essential details of the requirements for empanelment of audit agencies with MoLE.
c.
Part III – Contains standard conditions of RFE, which will form part of the contract with the successful bidder.
Some additional conditions will be communicated at RFP stage.
d.
Part IV – Contains evaluation criteria for “Empanelment of audit agencies”.
3. Part I – General information
3.1.
Definitions
Unless repugnant to the subject or context of usage, the following expressions used herein shall carry the
meaning hereunder respectively assigned to them, namely:

The expression “MoLE” occurring in the RFE document shall mean Ministry of Labour and
Employment, Shram Shakti Bhawan, Rafi Marg, New Delhi – 110001 (India) and shall include
Secretary, Labour and Employment, his /her successors and assigns.

The expression “Bidder or Agency” means an agency that submits the bid and shall include the
successors and permitted assigns. In context of this RFE, the terms “Bidder‟ and “Agency‟ have
been used, interchangeably.

“Empanelled audit agency” shall mean an agency declared qualified for empanelment by MoLE.
Qualified bidders shall be eligible to bid for RSBY audit request for proposals (RFPs) during the
empanelment validity period.

“PAN” shall mean Permanent Account Number allotted by Income Tax Department, Government of
India.

“RSBY” means “Rashtriya Swasthya Bima Yojana”.

“SNA” shall mean the State Nodal Agency, responsible for implementation of RSBY in the
respective State/UT.
3.2.
Procedure for obtaining RFE document
The RFE document can be downloaded from the RSBY website at www.rsby.gov.in.
3.3.
Language of bid and correspondence
The language of bid, documents exchanged and correspondence on any matter incidental thereto between
the bidder and MoLE shall be English.
3.4.
Forwarding of bids
Bids should be forwarded by bidders under their original memo on letter head. All pages of the response to
RFE submitted shall contain initials of the authorized signatory on behalf of the bidder.
3.5.
Clarification regarding contents of the RFE
A prospective bidder who requires clarification regarding the contents of the bidding documents shall notify
to MoLE in writing about the clarifications sought in the format provided in Annexure 1 through e-mail to
suresh.singh25@nic.in not later than 5 pm on 7th November 2014. Copies of the query and clarification by
MoLE will be made available to all bidders.
3.6.
Modification and withdrawal of bids
No bid shall be modified or withdrawn after the deadline for submission of bids.
Page 3 of 26
3.7.
Clarification regarding contents of bids
During evaluation of bids, MoLE may, at its discretion, ask the bidder for clarification on their bid. The
request for clarification will be given in writing and no change in substance of the bid will be sought, offered
or permitted. No post-bid clarification on the initiative of the bidder shall be entertained.
3.8.
Submission of Bids
The RFE documents must be submitted in a sealed envelope. On the cover of the envelope, following details
should be written:
“<Title of the RFE>
<Date of submission of response>
<Number and names of zones applied for>”.
in three clear and different lines.
For example – the last line can be written as “2 Zones – North and South”
The envelope should be addressed to:
Assistant Director (RSBY-Monitoring),
Office of Director General of Labour & Welfare,
Ministry of Labour and Employment,
Government of India,
Jaisalmer House, 26, Man Singh Road,
New Delhi- 110001
The sealed envelope should contain two sealed envelopes:1.
First sealed cover (marked as “C1 – Tender Fee”) – containing RFE document tender fee of
INR 1000/- as DD/Bankers Cheque addressed to “Pay & Accounts Officer (MS), Ministry of
Labour and Employment, New Delhi” along with letter as per Annexure 7.
2.
Second sealed cover (marked as “C2 – Response to RFE”) –Bid as per Annexure-2.
The response to the RFE should be put in RFE box at Reception Office, Office of DGLW, Jaisalmer House, 26,
Man Singh Road, New Delhi – 110001. Responses sent through courier/registered post or any other means
will not be entertained. One bidder should submit only one bid, even if it is bidding for more than 1 zone.
3.9.
Price of RFE document
RFE document price INR 1000/- as DD/Bankers Cheque of any bank drawn in favour of the “Pay & Accounts
Officer (MS), Ministry of Labour and Employment, New Delhi”, submitted along with letter as per Annexure 7.
RFE submitted without instrument of cost of RFE will not be entertained. No exemption shall be granted on
this account for any reason.
3.10.
Time and date for opening of Bids
At 11 am on 25th November, 2014 (If due to any exigency, the due date for opening of the bids is declared a
holiday, the bids will be opened on the next working day at the same time. If this is not feasible, then it will
be opened at any other day/time, as notified by MoLE).
3.11.
Opening of RFE documents
The envelopes containing the bids and cost of RFE will be opened on the day of opening of the RFE by a
designated officer/committee. Bidders or their representatives may be present at the time of opening of
bids. Bids that are not according to the RFE requirements will be returned in due course of time. The names
of all bidders and other such details will be read out / announced at the time of the opening of bids, at the
sole discretion of MoLE or as MoLE may consider appropriate.
3.12.
Place of opening of the Bids
Office of Director General of Labour and Welfare, Jaisalmer House, 26, Man Singh Road, New Delhi110001. The bidders may depute their representatives, duly authorized in writing, to attend the opening of
bids on the due date and time. This event will not be postponed due to non-presence of a representative
from any bidder.
Page 4 of 26
3.13.
Rejection of bids
Canvassing by the bidder in any form, unsolicited letter/communication and post-RFE submission
corrections may invoke summary rejection of bid. All conditional bids will be rejected.
3.14.
Validity of bids
The bids shall remain valid for 180 days from last date of submission of the bids.
3.15.
Special instructions
All communication including any changes in content of RFE, date of events, clarifications etc. shall only be
published on the RSBY website www.rsby.gov.in and may not be communicated separately to agencies
(prospective bidders).
3.16.
Content of the bids
The bid should not contain alterations, omissions or additions, unless such alterations, omissions or
additions are signed by the authorized signatory of the bidder. The bidder should attach clearly marked and
referenced continuation sheets if the space provided in the prescribed formats is insufficient. Alternatively,
the bidder may format the prescribed forms making due provision for incorporation of the requested
information, but without changing the contents of such prescribed formats.
3.17.
Amendments in RFE
MoLE at its discretion may amend the RFE and all such amendments shall become part of this RFE. No
interpretation, revision or communication regarding this RFE is valid, unless made in writing.
3.18.
Validity of empanelment
The validity of empanelment would be for 5 years from the date of empanelment.
Page 5 of 26
4. Part II: Essential details for empanelment
4.1. Genesis of Rashtriya Swasthya Bima Yojana (RBY)
Social security and healthcare for all has been the motto of Government of India, and it has taken various steps in this
regard.
One of the important policy milestones is the Unorganized Workers Social Security Act (2008) enacted by the central
government to provide for the social security and welfare of the unorganized workers. This act recommends that the
central government provide social security schemes to mitigate risks due to disability, health shocks, maternity, and old
age, which all unorganized workers get exposed to, and are likely to suffer from. A number of Central schemes are in
operation and have provided protection to the beneficiaries from the unorganized worker segment. Additionally, a large
number of labour welfare funds set up by both central and state governments on non-contributory basis provide social
security as well as financial assistance in some cases to the unorganized workers in certain occupations.
One such policy initiative in the health insurance space is RSBY that was launched in early 2008 and became
operational from 1st April 2008. RSBY was initially designed to target only the Below Poverty Line (BPL) households, but
has recently been expanded to cover a number of non-BPL categories of informal sector workers, including street
vendors, domestic workers, beedi workers, building and construction workers, and most importantly the workers who
have worked for more than 15 days under MGNREGS. Government of India and the State Governments are co-financing
the premium cost for enrolled beneficiaries. The program has the target to cover 70 million households by the end of the
Twelfth Five Year Plan (2012-17). Its service delivery model – demand financing, freedom of choice among accredited
government and private hospitals, and cashless service reimbursable to provider on a pre-determined package price
basis, could become a strong pillar for the universal health care system laid down by Government of India.
4.2. Benefits of Rashtriya Swasthya Bima Yojana (RBY)
RSBY has been launched by Ministry of Labour and Employment, Government of India to provide health insurance
coverage for Below Poverty Line (BPL) families. The objective of RSBY is to provide protection to BPL households from
financial liabilities arising out of health shocks that involve hospitalization. The beneficiaries under RSBY are entitled to
hospitalization coverage up to INR 30,000/- for most of the diseases that require hospitalization. The government has
even fixed the package rates for the hospitals for a large number of interventions. Pre-existing conditions are covered
from day one and there is no age limit. The coverage extends to five members of the family which includes the head of
household, spouse and up to three dependents. The beneficiaries need to pay only INR 30/- as registration fee while
Central and State Government pays the premium to the insurer selected by the State Government on the basis of a
competitive bidding.
4.3. Objective of the scheme
The main objective of RSBY scheme is to provide the enrolled beneficiaries from the unorganized sector with a health
insurance cover, thereby protecting them from the financial shocks arising out of an emergency medical situation. It aims
to reduce the out of pocket expenses of the target population for every visit to hospital.
Page 6 of 26
4.4. Financing of the scheme
RSBY being a centrally sponsored scheme, majority of the funding comes from central government, i.e. 75% of premium
is paid by central government, while remaining 25% of premium is paid by state government (number changes to 90% &
10% in case of north eastern states and Jammu and Kashmir). The beneficiary has to pay a one-time fee of INR 30/- at
the time of enrolment. Apart from this, the central government also pays 100% of the card cost. As of now the notional
cost of issuance of card is INR 60/-. The beneficiaries contribution of INR 30/- is used by the State Nodal Agency (SNA)
to meet their administrative expenses. In subsequent years at the time of renewal of policy INR 30/- will be adjusted from
the premiums.
4.5. Current status of the scheme
As of now the scheme is operational in 398 districts of 25 states. There are 10,116 hospitals empaneled across these
states out of which 5,941 are private sector hospitals and 4,175 are public sector hospitals. During FY 2013-14
approximately 3 crore families were in possession of active RSBY cards.
4.6. Ecosystem of RSBY
Note: Changes in roles and any policy decisions shall be communicated by MoLE / SNA
Page 7 of 26
4.7. Processes of RSBY
A brief of the various processes under RSBY is provided below:
a.
Data preparation and pre-enrolment: The benefits of RSBY scheme, which was launched for BPL families, have
been extended to various other categories viz. Beedi worker, MGNREGA worker, Porters/coolies, taxi drivers etc.
Government has identified different ministries/departments to identify the beneficiaries from these categories.
These ministries/departments provide the list of beneficiaries to State Nodal Agency (SNA) of respective state.
SNA, in turn, consolidates the data and passes it on to MoLE after validating and removing the duplicates. MoLE,
then generates URN (Unique relationship number), a unique number provided to each eligible family. The data is
then provided to enrolment agency to capture photographs and biometric details of identified family members.
b.
Enrolment: The enrolment agency downloads the data from the central database of MoLE using FTP and visits all
the assigned villages as per route plan approved by district authorities. It captures photographs and biometric
data of all family members. To identify the family head, and other family members, district authorities deploys a
Field Key Officer (FKO). FKO authenticates all the family with his biometric credentials. One smart card is
provided to every eligible family, with photograph of head of family on card and biometric details of 4 other
family members. Before delivering the card to the head of family, the enrolment operator checks the data written
on the card to ensure that the finger prints recorded are of acceptable quality for future authentication purposes.
Details of all the beneficiary cards issued during the day of enrolment are also available in the FKO card. The
enrolment agency is also required to carry out awareness exercise using IEC materials to improve the % of family
enrolled.
c.
Wellness check: One member from each enrolled family which has received the card is entitled to avail free
wellness check at identified public health facilities (PHFs). The basic health details of the member undergoing
wellness check are captured on the smart card and detailed wellness check data is retained with MoLE too in the
central database. The PHFs conducting wellness checks shall receive a payment of INR 100/- per card. The
insurance company is responsible for mobilizing the beneficiaries for wellness check at the PHFs. Failure to
mobilize beneficiary for wellness check will attract penalty for the insurance company.
d.
Premium payment: The insurance company will receive the premium for all the cards issued at a rate discovered
through open tender. To ascertain the number of cards issued, data received from FKO card will be taken in
account.
e.
Hospitalisation: Any member of the eligible family, which has received RSBY card can avail cashless medical
services upto INR 30,000/- from any RSBY empaneled hospital. All the hospitals with required facility can be
empaneled under RSBY scheme. After providing services to beneficiary, hospital reimburses a sum of INR 100/as transportation charges to beneficiary and raises a claim with insurance company for services provided.
Claims raised for a particular service should be as per approved package rates only.
f.
Claim settlement: The insurance company verifies the claims and makes the payment to hospital for services
provided to beneficiary.
g.
Kiosk management: A kiosk is set up at every district to provide different services to beneficiaries. The main
services offered at kiosk are issue of duplicate and split cards. A duplicate card is issued to a beneficiary in case
they have lost the card or the card has become non-functional. A split card is issued to a family, if some of its
members are migrating to other place and want to carry part of the insurance cover with them. The cover amount
is split between the two cards, as per request from head of family.
Page 8 of 26
h.
Complaint and grievance redressal management: Any stakeholder can log a complaint, using following channels
to be made available - web portal, email, SMS, phone call to call center. A unique ticket number will be provided
for every complaint logged, and every complaint will be tracked /escalated until resolved.
Note: The detailed process can be found in the operational manual published on the RSBY website at:
http://www.rsby.gov.in/Documents.aspx?ID=2
4.8. Current challenges within RSBY
The RSBY scheme involves multiple types and number of transactions for each type of process described above. Due to
a large number of stakeholders at the field, the scheme is faced with challenges at the implementation level. Some of
the key challenges encountered at the field level from the operational point of view are:
a.
The pre-enrolment data shared by state departments is in multiple formats and data structures irrespective of
standard formats provided. This leads to incomplete and sometimes inaccurate data being provided, indicating
that background checks at field level have not been conducted.
b.
The pre-enrolment data needs to be checked for correct category prioritization to ensure that the right premium is
assigned based on the categorization
c.
Low percentage of enrolments in comparison to the pre-enrolment data provided and non-distribution of
information brochures to beneficiaries at the time of enrolment.
d.
Enrolment process being stretched beyond the enrolment window.
e.
Non-delivery of cards to beneficiaries.
f.
Un-authorized usage of Field Key Officer (FKO) cards, leading to unintended people being enrolled and
discrepancies in the reconciliation of enrolment data.
g.
Use of sub-standard quality of cards which results in high number of manual over-ride at the hospitals.
h.
Lack of awareness amongst the beneficiaries on various RSBY channels such as call center, online complaint and
grievance redressal management system, non-availability of district and state level grievance committee
proceedings to the national grievance redressal committee.
i.
Non- compliance of stakeholders to the decisions of DGRC, SGRC and NGRC.
j.
Lack of standard operating procedures at kiosk leading to security vulnerabilities
k.
Non- functional hardware and software at kiosks
l.
Non- functional kiosks
m. Low level of awareness amongst the beneficiaries about the enrolment process, empaneled hospitals, deempaneled hospitals, and services offered through the kiosk etc.
n.
Non-compliance to the decisions of SGRC/ DGRC/ NGRC by various stakeholders.
4.9. Need for audit within RSBY
Page 9 of 26
Due to the multiple stakeholders and complexities involved in the operations, there is a need to monitor and keep
checks on the processes in a regular manner. To make the monitoring of the scheme effective, various types of audits
are being introduced. An illustrative depiction of the different categories of audits envisaged is listed in Table 1 below,
and further elaborated in the sections to follow.
Third party audit shall involve examination of transactions on a regular basis to ensure accuracy, authenticity and
compliance to procedures and guidelines. It is an ongoing appraisal of the health and functioning of the program to
determine whether the internal control mechanisms are effective. Audit inputs will also be used to identify areas of
improvement in the program.
Note: This RFE document lists down illustrative audit requirements only for the purpose of empanelment, so as to
provide an indication to the bidders on the nature of audit activity which is expected. The actual audit type, process,
activities, data details, timelines and related information would be defined at the RFP stage by the stakeholder (such
as an SNA) requesting for proposals from empaneled vendors.
Table 1: Categories of audit
Categories of audit
Purpose (indicative)
Initiator
Process audit
The detailed scope and focus will be decided by SNA and will be
part of RFP. The broad purpose of process audit will be ensure
conformance to laid guidelines for the following processes within
RSBY:
• Data preparation
• Pre-enrolment & enrolment process
• Wellness check
• Hospital empanelment & management
• Claim settlement
• Kiosk operations
• Complaints and grievance management
• Contact center operations
State Nodal
Agency (SNA)
The detailed scope and focus will be decided by SNA and will be
part of RFP. The broad purpose of process audit will be to conduct
audit the financial transactions conducted by various stakeholders
within the following processes of RSBY:
• Wellness check
• Hospital management & beneficiary transactions
• Claim settlement
• Kiosk operations
State Nodal
Agency (SNA)
The detailed scope and focus will be decided by SNA and will be
part of RFP. The broad purpose of process audit will be to conduct
system audit for the following processes / entities within RSBY:
• Enrolment systems
• Hospital systems
• Kiosk systems
• Contact center systems
• Systems at DGLW office
• Systems at MoLE (including card generation)
• Systems at SNA office
• Systems at DKM office
State Nodal
Agency/ MoLE
(will require extensive
field visit to meet with
beneficiaries and hospital
personal)
Financial audit
(will require access to
transactions data at
various entities involved
in RSBY)
Technology audit
(will involve audit of IT
systems and sub-systems
that support RSBY
operations across
stakeholders)
The illustrative details on the categories of audits required at different processes / entities are given in Figure 1 given
below:
Page 10 of 26
Figure 1: Processes of RSBY and types of audit required (Illustrative only)
4.10.
4.11.
Objectives of third party audit
The overall objective of the audit is to conduct timely assessment of the scheme with a view of obtaining
reasonable assurance of adherence to the defined operational procedures. In particular, the third party
auditors shall:
a)
Provide an independent opinion on the performance of the scheme on various parameters and report
any exceptions which are in violation to the agreed procedures and guidelines of RSBY.
b)
Provide an overall assessment of the operational and internal control systems that are in place, for the
management of the scheme, so that related processes and protocols are followed in accordance with
RSBY to achieve the stated objectives.
c)
Suggest areas of improvement based on the assessment conducted to achieve the goals of the scheme.
Scope of Audit
Some activities, identified so far, under different processes that are required to be audited are illustrated in
the following section. MoLE / SNA can change/ add additional audits, as well as modify the audit
parameters, activities, and periodicity based on the requirements and the status of the project/ issues
observed in operations.
Note:
a.
The audit categories, activities, sample type and periodicity are illustrative in nature and exact scope shall be
detailed in the RFP released by the State Nodal Agency (SNA).
The indicative audits to be conducted for RSBY are tabulated below:
Page 11 of 26
Sr.
No
Category of
audit
(indicative)
Activity/systems to be
audited (indicative)
Activities to be
performed
Sample type
(indicative)
Periodicity
(indicative & to
be finalized by
SNA)
Technology /
process
Setting up of and activities at
enrolment stations (time,
quality of equipment, IEC
activity, quality of cards, reverification of cards, presence
of FKO, extent of family data
updated)
Auditor will visit
randomly selected
enrolment stations on
the day of enrolment
to ascertain that all
laid down procedures
are being followed.
Randomly
selected system
generated records
from route plan
data provided by
the insurance
company
At least once a
week, during
open enrolment
window
System
generated
random sample
Concurrent
System
generated
random sample,
feedback from
beneficiary
through call
center/ CGRMS,
reports from
pensioners
Once a month
System generated
random sample /
field reports
Once in two
months
1
2
Process audit
Beneficiary enrolment, card
issuance and delivery of card
to beneficiary
Process /
financial audit
Audit to check whether the
beneficiary has been provided
with cash of Rs. 100 at the
time of discharge, towards
transportation allowance and
whether any out of pocket
expenses have been taken by
the hospital.
Process audit
Complaint and grievance
audit
3
4
Auditor will visit
randomly selected
households to
ascertain that the
beneficiary has
received the cards
and all other laid
down guidelines for
enrolment are being
followed.
Auditor will visit or
call
randomly
selected beneficiaries
to ascertain whether
they have received the
Rs. 100 and whether
any out of pocket
expenses have been
charged. (Will be
clubbed with other
field audit)
Auditor to check
closure of complaints
as per standard
procedures and
whether decisions
taken by various GRCs
have been
implemented/actions
have been taken.
5
Technology /
process audit
De-duplication process (pre
and post enrolment data)
Auditor will visit or
call beneficiaries from
the randomly selected
villages and carry out
intensive checking for
different
families
registered under the
same URN.
Accuracy and completeness
of data shared by
departments
Auditor verifies the
randomly
selected
beneficiaries
by
calling or meeting the
beneficiaries
in
person to ascertain
6
Technology /
process audit
Randomly
generated by
system from preenrolment data
submitted by
departments,
from area where
chances of
duplicates are
high as well as on
post enrolment
data.
Randomly
generated by
system from preenrolment data
submitted by
departments
Once at the time
of enrolment
data
preparation,
prior to
submitting the
data to MoLE
and on
completion of
enrolment.
Once at the time
of enrolment
data
preparation,
before
submitting the
Page 12 of 26
Sr.
No
Category of
audit
(indicative)
Activity/systems to be
audited (indicative)
Activities to be
performed
Sample type
(indicative)
accuracy
and
completeness of data.
7
Technology /
process audit
Accessibility and functioning
of kiosks
Technology/
software audit
Verify functioning of TMS
8
9
Technology
audit
10
An audit of all the IT systems
prevalent in SNA, hospitals,
ICs and MoLE
Process audit
Checking adequacy of
facilities of hospitals and
examining quality of
beneficiary access
Process audit
Checking of operations at
insurance company
11
Functioning of the
Kiosk in terms of
access to public,
efficiency
of
functioning
in
complaint processing,
post enrolment role,
generation
of
awareness,
functioning of IT
equipment in kiosks
etc.
Check state of usage
and functioning of
TMS and ascertain
mechanism
of
beneficiary
registration
and
treatment
(e.g.
blocking of correct
package).
Examine the efficacy
and
networking
enablement of the IT
systems with different
stakeholders.
Check for ease of
access
to
the
beneficiaries
and
observe
rejection
profile
Examine compliance
to procedures for
claims and other
obligations of IC.
Periodicity
(indicative & to
be finalized by
SNA)
data to MoLE
Kiosks to be
audited wherever
auditor goes for
beneficiary visits
Once a month
At all hospitals
selected during
sampling process
Once in two
months
All SNAs and all
hospitals visited
along with the ICs
in the region, with
validation at
MoLE server.
Once in six
months
To be carried out
at all hospitals in
the sample
district
Once in two
months
All the IC
branches / offices
in the districts as
per the sample
Once in two
months
Page 13 of 26
5. Part III – Standard Conditions of RFE
The bidder is required to give confirmation of their acceptance of the standard conditions of the Request for
Empanelment (RFE) mentioned below which will automatically be considered as part of the contract for
“empanelled audit agencies” selected and empanelled by MoLE. Failure to do so may result in rejection of the
bid submitted by the bidder.
5.1. Law: The contract shall be considered and made in accordance with the laws of the Republic of India. The
contract shall be governed by and interpreted in accordance with the laws of the Republic of India.
5.2. Effective date of the empanelment of agencies: The empanelment of agency as an “empaneled audit agency”
shall come into effect on the date of notification by MoLE or its assigns. The list shall also be put on website and
shall remain valid for a period and manner laid down in conditions of this RFE.
5.3. Arbitration: Any dispute, disagreement or question arising out of or relating to the status of agency as
“empanelled audit agency” which cannot be settled amicably, may be resolved through arbitration as per extant
laws in India. Location for any legal action/settlement would be New Delhi.
5.4. Penalty for use of undue influence: The bidder undertakes that he has not given, offered or promised to give,
directly or indirectly, any gift, consideration, reward, commission, fees, brokerage or inducement to any person
in service of MoLE or otherwise in procuring the contracts or forbearing to do or for having done or forborne to do
any act in relation to the obtaining or execution of the present contract or any other contract with the
Government of India for showing or forbearing to show favour or disfavour to any person in relation to the present
contract or any other contract with the Government of India. Any breach of the aforesaid undertaking by the
bidder or anyone employed by him or acting on his behalf (whether with or without the knowledge of the bidder)
or the commission of any offers by the bidder or anyone employed by him or acting on his behalf, as defined in
Chapter IX of the Indian Penal Code, 1860 or the Prevention of Corruption Act, 1986 or any other act enacted
for the prevention of corruption shall entitle MoLE to cancel the empanelment of agency and all or any other
contracts with the agency and recover from the agency the amount of any loss arising from such cancellation. A
decision of MoLE or his nominee to the effect that a breach of the undertaking had been committed shall be final
and binding on the bidder. Giving or offering of any gift, bribe or inducement or any attempt at any such act on
behalf of the bidder towards any officer/employee of MoLE or to any other person in a position to influence any
officer/employee of MoLE for showing any favour in relation to this or any other contract shall render the bidder
to such liability/ penalty as MoLE may deem proper, including but not limited to termination of the contract and
imposition of penal damages.
5.5. Access to books of accounts: In case it is found to the satisfaction of MoLE that the agency has engaged an
agent or paid commission or influenced any person to obtain the contract as described in clauses relating to
agents/agency commission and penalty for use of undue influence, the agency, on a specific request of MoLE,
shall provide necessary information and allow inspection of the relevant financial documents / information.
5.6. Non-disclosure of contract documents: Except with the written consent of MoLE/ bidder, other party shall not
disclose the contract or any other information it may come across during its status as “empanelled audit
agency” from MoLE, SNAs, information technology setup of RSBY or any other source thereof to any third party.
Failure to do so may result in disqualification for empanelment as “empaneled audit agency” for minimum 5
years or more at the sole discretion of MoLE.
5.7. Notices: Any notice required or permitted by the contract shall be written in English and may be delivered
personally or by registered pre-paid mail/airmail, addressed to the last known address of the party to whom it is
sent.
Page 14 of 26
5.8. Patents and other intellectual property rights: The prices stated in the contract resulting from an RFP under this
empanelment shall be deemed to include all amounts payable for the use of patents, copyrights, registered
charges, trademarks and payments for any other intellectual property rights. The bidder shall indemnify MoLE
against all claims from a third party at any time on account of the infringement of any or all the rights mentioned
in the previous paragraphs, whether such claims arise in respect of manufacture or use.
5.9. Amendments: MoLE at its discretion may amend the RFE and all such amendments shall become part of this
RFE. No interpretation, revision or communication regarding this RFE is valid, unless made in writing.
Page 15 of 26
6. Part IV: Empanelment criteria and evaluation of bids
6.1. Pre-conditions
a.
The third party audit agencies will be empaneled on a zonal basis. For the purpose of this RFE, all the States
and Union Territories have been divided into five zones and agencies will have to apply for empanelment
separately for each zone. The five zones are as follows:
Note: Not all states are operating the RSBY scheme. States have been included in the zonal list should they come
under the RSBY scheme in future.
Zones
States
North
Uttar Pradesh, Punjab, Himachal Pradesh, Jammu & Kashmir, Haryana, Uttarakhand,
Chandigarh, Delhi
West
Rajasthan, Gujarat, Madhya Pradesh, Maharashtra, Goa, Daman & Diu
East
West Bengal, Bihar, Jharkhand, Orissa, Chhattisgarh
South
Seemandhra, Telangana, Karnataka, Kerala, Pondicherry, Tamil Nadu, Andaman Nicobar &
Lakshadweep
North East
Assam, Manipur, Meghalaya, Nagaland, Mizoram, Tripura, Arunachal Pradesh, Sikkim
b.
The States shall invite/release the RFP for audit agencies empanelled for the zone.
c.
The bidder can bid for more than one zone provided they meet the criteria for each zone.
d.
Consortium bids are not allowed.
e.
No sub-contracting of work shall be allowed.
6.2. Pre-qualification criteria
There will be no marking for evaluation. All the agencies satisfying the following criteria will be empaneled for
conducting audit. Only the audit agencies which fulfil the below mentioned criteria should submit their bids.
a.
The bidder should be a registered private or public owned company incorporated under Companies Act
1956, in India or a Limited Liability Partnership Company under Limited Liability Partnership Act, 2008.
b.
The agency shall have a minimum annual turnover of INR 5 crores from audit services (process, financial
and system audit) for each of the last 3 financial years (FY 2013-14, 2012-13, 2011-12), for each zone. In
case the firm is applying for more than one zone, the annual turnover shall be a multiple of INR 5 crores for
the number of zones applied for.
c.
The firm must have at least one office in the zone they are applying for.
d.
The firm must have at least 50 full-time employees/ partners/ article trainee as on 30th June 2014 in the
zone.
e.
The firm must have conducted 5 process / IT / financial audits, each of value INR 25 lakhs, within the last 3
financial years.
Page 16 of 26
6.3. Documents required
The documents required to be submitted along with bid are listed in Annexure 2.
6.4. Validity of empanelment
The agency shall remain on the list of “empanelled audit agencies” for a period of five
years.
6.5. De-empanelment or termination of empanelment
MoLE shall have the right to terminate this empanelment in part or in full in any of the following cases:
a.
The delivery of the services, in the event of entering into contract with SNA, is not found appropriate as per
conditions which are not attributable to Force Majeure.
b.
The agency has been blacklisted by SNA.
c.
The agency is declared bankrupt or becomes insolvent.
d.
The agency is involved in corrupt practices, any collusion with RSBY stakeholders, or has used corrupt
means to appropriate any contract under this empanelment.
e.
As per decision of the Arbitration Tribunal.
6.6. Effect of de-empanelment
a. A de-empaneled audit agency shall not be eligible to participate in any of the RSBY audit RFP under this
empanelment by any SNA or other RSBY stakeholder in the zone for de-empanelment. SNA/MoLE would
decide whether the de-empanelment would be done for one zone or multiple zones. The de-empanelment
shall be effective for the period decided by SNA/MoLE based on severity of the default.
b.
If by the time of de-empanelment, it has already quoted for an RFP by an SNA and bids have not been
opened then it will not be considered as valid “empanelled audit agency” and its bid shall not be opened
for consideration by SNA. However, this will not affect its participation as valid bidder if the bids in such
cases have already been opened by SNA.
Page 17 of 26
Part V: Annexures
Annexure 1: Format for pre-bid query
No. RFE clause Para No Page No Statement of
clarification/deviations
Bidder suggestions
1
2
3
4
5
Annexure 2: Documents required to be submitted with bid
The bidder provide all the requisite documentation as per the annexure. Absence of any requisite document could lead to
non-qualification for empanelment.
No
Documents
Reference
section
Formats
Document(s) to be submitted
1
Organisation Profile
6.2. (a)
Annexure 4
a.
b.
c.
d.
Certificate of incorporation
PAN number
Service tax registration
certificate
Other details as in Annexure 4
2
Cover letter for instrument
(demand draft/banker’s cheque)
submitted towards cost of bid
document (on company letter
head)
Page 24
Annexure 7
Demand draft along with cover letter
on company letter head
3
Detail and number of zones
applied for
6.2. (c)
Annexure 3
Details of number of zone applied
for as per Annexure 3
6.2. (b)
Annexure 5
a.
4
Financial details
organisation
of
the
b.
5
Details of experience of
conducting
audits involving
field survey (including work
order / completion certificates)
6.2. (e)
Annexure 6
a.
b.
c.
Year wise details of turnover
along with undertaking from CA
in prescribed format and copies
of audited statements of last 3
financial years as per Annexure
5
Year wise details of turnover
from audit services (process,
financial, technology) for last 3
financial years as per Annexure
5
Copy of engagement letter /
work order
Copy of completion certificate
Copy of transmittal letter
Page 18 of 26
Annexure 3: Details of zone applied for and calculation of required turnover
The bidder must provide all the requisite documentation as per the annexure. Absence of any requisite document could
lead to non-qualification for empanelment.
Sr. No.
Zone name
1
North zone
2
West zone
3
East zone
4
South zone
5
North East zone
Applied (Yes/No)
Number of zones applied: …………………….. (In words ………………………………………………………………)
Annexure 4: Organisational Profile
The bidder must provide all the requisite documentation as per the annexure. Absence of any requisite document could
lead to non-qualification for empanelment.
No.
Parameter
1
Name of organization
2
Name and designation of contact person
3
Postal address of the organization (with PIN code)
4
Permanent address, if different from postal address (with PIN
code)
5
Telephone with STD Code
6
Fax No. with STD Code
7
Mobile No. of contact person
8
E-mail address of contact person
9
Establishment details
a.
b.
10
11
Year established
Regd. No., Name and place of registration Authority
Documents to be submitted
Certificate of incorporation
Certificate of incorporation
Statutory registration details
a.
PAN number
Copy of PAN
b.
Service Tax number
Copy of service tax registration certificate
Name of key zonal office contact, designation, email address and
phone number (Please indicate details in the same field using
Provide number of offices in the zone along with
address and key contact person details
comma separation)
Page 19 of 26
a.
North zone
b.
West zone
c.
East zone
d.
South zone
e.
North East zone
13
Number of audit staff in each zone (certification from human
resources)
Manpower details should be provided zone wise
and certification should be provided separately
for each zone
a.
b.
c.
d.
e.
Annexure 5: Financial turnover of company in last 3 financial years
The bidder must provide all the requisite documentation as per the annexure. Absence of any requisite document could
lead to non-qualification for empanelment.
No.
Financial year
1
2013-14
2
2012-13
3
2011-12
1
2013-14
2
2012-13
3
2011-12
1
2013-14
2
2012-13
3
2011-12
1
2013-14
Annual turnover of the
agency in INR Lakhs1
Annual turnover of the agency from audit
activities in INR lakhs from each zone2
Zone
North Zone
(please insert
name of zone)
West Zone
(please insert
name of zone)
East Zone
(please insert
name of zone)
South Zone
1 Please give annual turnover of the agency/organization as per audited statements of last three years
2 Please provide how much of the total annual turnover is from audit related activities for each zone
Page 20 of 26
No.
Financial year
2
2012-13
3
2011-12
1
2013-14
2
2012-13
3
2011-12
Annual turnover of the
agency in INR Lakhs1
Annual turnover of the agency from audit
activities in INR lakhs from each zone2
Zone
(please insert
name of zone)
North East
Zone
(please insert
name of zone)
Annexure 6: Experience of conducting audit involving field survey
The bidder must provide all the requisite documentation as per the annexure. Absence of any requisite document could
lead to non-qualification for empanelment.
No.
Title of
completed /
ongoing
audits
Name,
address, email
and phone
number of
client
Month & year
of initiation
of audit
Month & year of
completion of
audit
Contract
value &
work order
Number of
manmonths
Geographical
location/ states
where the audit was
conducted
Scope of work
North Zone
1
2
3
4
5
West Zone
1
2
3
4
5
East Zone
1
2
3
4
5
South Zone
1
2
3
4
Page 21 of 26
No.
Title of
completed /
ongoing
audits
Name,
address, email
and phone
number of
client
Month & year
of initiation
of audit
Month & year of
completion of
audit
Contract
value &
work order
Number of
manmonths
Geographical
location/ states
where the audit was
conducted
Scope of work
5
North East Zone
1
2
3
4
5
Page 22 of 26
Annexure 7: Undertaking for qualification bid
<To be printed on company letter head of bidder>
Date: <Date>
From:
[Name of bidder]
[Address of
bidder]
To:
_____________________
Assistant Director (RSBY-Monitoring)
Office of Director General Labour and Welfare,
Ministry of Labour and Employment
Jaisalmer House, 26, Mansingh Road, New Delhi- 110001
Dear Sir,
Sub: Qualification bid for “Empanelment of audit agencies” by MoLE.
With reference to your RFE No ___________ dated ________ we, [insert name of bidder], wish to submit our
qualification bid for the empanelment of our company for the audit of various operations under Rashtriya
Swasthya Bima Yojana in different States of India.
1. We hereby submit our empanelment bid, which is unconditional and unqualified. We have examined the RFE
documents issued by MoLE.
2. The price of RFE document __________________________ is attached along with this letter as Demand
Draft/ Bankers Cheque No. ………………., dated …………………….. of …………………………………….. (Name of Bank)
in favour of “The Pay & Accounts Officer (Main Secretariat), Ministry of Labour and Employment, New Delhi.”
payable at New Delhi.
3. We acknowledge that MoLE or its authorised representative will be relying on the information provided in the
qualification bid and the documents accompanying such qualification bid for empanelment of the eligible bidders
for implementing RSBY in states, and we certify that all information provided in the qualification bid is true and
correct. Nothing has been omitted / concealed which renders such information misleading and all documents
accompanying qualification bid are true copies of their respective originals.
4. We shall make available to MoLE, any clarification that it may find necessary or require to supplement or
authenticate the qualification bid.
5. We acknowledge the right of MoLE to reject our qualification bid or not to declare us as an empanelled agency,
without assigning any reason whatsoever and we hereby waive, to the fullest extent permitted by applicable law,
our right to challenge the same on any account whatsoever.
6. We undertake that: We satisfy/ do not satisfy the qualification criteria.
7. We agree and release MoLE and their employees, irrevocably, unconditionally, fully and finally from any and all
liability for claims, losses, damages, costs, expenses or liabilities in any way related to or arising from the RFE
documents and/or in connection with the bidding process, to the fullest extent permitted by applicable law and
Page 23 of 26
waive any and all rights and/or claims I/we may have in this respect, whether actual or contingent, whether
present or in future.
8. We undertake that none of the partners / members of the team of auditors of the firm face any disciplinary action
on account of frauds or collusion or any act which can be construed as moral turpitude, during the empanelment
process.
9. Our agency/organization/institution is not blacklisted or/ and reprimanded by any client from the Government/
PSU/ State Government / Urban/ Local bodies.
10. We represent and warrant that:
a.
We have examined and have no reservations to the RFE document, including all addenda issued by MoLE.
b.
We accept the terms and conditions including the special conditions laid down in the RFE Document, and
shall seek no material deviations from or otherwise seek to materially negotiate the terms of the draft
contract, if declared as the successful bidder and consequently empaneled as audit agency for RSBY.
c.
We have not and will not undertake any activity in any manner to influence or to try to influence the process
of selection of the successful bidder.
d.
The RFE document and all other documents and information that are provided to us shall remain the
property of MoLE and are provided to us solely for the purpose of preparation and the submission of this bid
in accordance with the RFE document. We undertake that we shall treat all information received from or on
behalf of MoLE as strictly confidential and we shall not use such information for any purpose other than for
preparation and submission of this bid.
e.
MoLE is not obliged to return the qualification bid or any part thereof or any information provided along with
the qualification bid.
f.
We have made a complete and careful examination of the RFE Document and all other information made
available by or on behalf of MoLE.
g.
We have satisfied ourselves about all things, matters and information, necessary and required for submitting
an informed bid.
h.
Our bid shall be valid for a period of 180 days from the bid opening date.
11. We are submitting with this letter all the documents that are listed in Annexure 2 of the bid. Absence of any
requisite document for all annexures could lead to non-qualification for empanelment.
12. We, hereby, irrevocably waive any right or remedy which we may have at any stage at law or howsoever arising to
challenge the criteria for evaluation of the qualification bid or question any decision taken by MoLE in connection
with the evaluation of the qualification bid, declaration of the eligible bidders, or in connection with the bidding
process itself.
13. We agree and undertake to abide by all the terms and conditions of the RFE documents, including all addenda,
annexures and appendices.
14. We categorically and specifically state that we understand that this RFE by MoLE aims only at empanelling audit
agencies based on criteria brought out in this document.
15. We confirm that there are no litigations or disputes against us, which materially affect our ability to fulfil our
obligations in this regard.
16. Capitalized terms which are not defined herein will have the same meaning ascribed to them in the RFE
documents.
17. In witness thereof, we submit this letter accompanying the qualification bid under and in accordance with the
terms of the RFE documents.
Page 24 of 26
18. The information given above is true to the best of my knowledge. The organization shall stand liable for any
information given above which is later found to be false.
Dated this [insert date] day of [insert month], 2014
[Authorized Signatory]
[Designation]
OR
Duly authorized to sign this bid for and on behalf of
[Name of Bidder]
[Signature]
In the capacity of__________
Page 25 of 26