Documents for EOI for empanelment of hospitals / Page No.- 1 -
BHARAT SANCHAR NIGAM LTD
(A Government of India Enterprise)
Office of the
Principal General Manager Telecom,
Admin Section, Telephone Bhavan, Kala Talav ,
Kalyan (W).
To,
--------------------------------------------------------------------------------------------NO. KYN/ADMIN/HE/10-11/ 17
DATED AT KALYAN THE 15/10/2010
SUB: EXPRESSION OF INTEREST FOR EMPANELMENT OF HOSPITALS FOR
PROVIDING INDOOR TREATMENT TO BSNL SERVING/RETIRED EMPLOYEES &
THEIR DEPENDENTS
The Asstt. General Manager (Admin), Kalyan Telecom District invites Expression of
interest on behalf of BSNL, Kalyan for the Empanelment of Hospitals for giving indoor
treatment to BSNL Serving/Retired Employees/Voluntary retired & their dependent family
members from the hospitals run by Government/Private/semi private/Charity/Trust or any
other hospitals.
The documents containing terms and conditions shall be obtained from the Sub
Divisional Engineer (Admin-II) O/o PGMT, BSNL Kala Talav, Kalyan for free of cost or can be
downloaded from maharashtra.bsnl.co.in/ssa/kalyan
Other details are as under
Period of issue of forms
On all working days from 06/11/2010 to 27/11/2010
between 10.30 hrs. To 16.30 hrs.
Time & Date of submission of EOI
documents
Up to 15.00 hrs of 29/11/2010.
by hand, register post , Speed post or by courier
Date of opening
At 15.30 hrs. of 29/11/2010.
The Principal General Manage, BSNL, Kalyan reserves the right to accept or reject any or all
the expression of interest(s) without assigning any reasons whatsoever.
Asstt. General Manager (Admin)
O/o PGMT, BSNL, Kalyan 421301.
Signature of in-charge of the hospital with seal :-
Documents for EOI for empanelment of hospitals / Page No.- 2 -
BHARAT SANCHAR NIGAM LTD
(A Government of India Enterprise)
Office of the
Principal General Manager Telecom,
Admin section, Telephone Bhavan, Kala Talav ,
Kalyan (W).
Terms, Conditions & Specifications for empanelment of hospital
NO. KYN/ADMIN/HE/10-11/ 17
DATED AT KALYAN THE 15/10/2010
This Document Contains:
Part-I
: Definitions, General Terms & Conditions for empanelment of
Hospitals
Part-II
: Scope of work and specifications
Part-III
Part-IV
: Quotation for rates
: Agreement
( ANNEXURE A to be submitted after approval)
Sd/-
Asstt. General Manager (Admin& MIS)
O/o PGMT Kalyan-421 301
NOTE: Please ensure before sending documents by register post / by speed post or by
courier that:
1. The required documents are kept in envelope super-scribed as “Expression of interest
for empanelment of hospitals” vide Offer NO. KYN/ADMIN/EH/10-11/17 Dated at
Kalyan the 15/10/2010”.
2. The signature with stamp of hospital in-charge should be available on all pages of
EXPRESSION OF INTEREST DOCUMENTS.
3. All the contents enclosed with this documents shall be attested.
Signature of in-charge of the hospital with seal :-
Documents for EOI for empanelment of hospitals / Page No.- 3 -
BHARAT SANCHAR NIGAM LTD
(A Government of India Enterprise)
Office of the
Principal General Manager Telecom,
Admin Section, Telephone Bhavan, Kala Talav ,
Kalyan (W).
NO. KYN/ADMIN/HE/10-11/ 17
DATED AT KALYAN THE 15/10/2010
EXPRESSION OF INTEREST FOR EMPANELMENT OF
HOSPITALS FOR PROVIDING INDOOR TREATMENT TO
BSNL SERVING/RETIRED EMPLOYEES & THEIR
DEPENDENTS
Particulars of Issue of Document.
Name and address of the
Hospital/Dr.
Sd/-
Asstt. Geberal Manager(Admin&MIS)
% PGMT,BSNL, Kalyan 421 301.
O/O Principal General Manager Telecom,
Admin Section, Telephone Bhavan ,
Kala Talav, Kalyan (W)– 421 301.
Signature of in-charge of the hospital with seal :-
Documents for EOI for empanelment of hospitals / Page No.- 4 -
PART-I
DEFINITIONS AND GENERAL TERMS & CONDITIONS OF THIS DOCUMENTS.
A. DEFINITIONS
1.
The BSNL means the Bharat Sanchar Nigam Ltd. and its successors.
2.
The PGMT means the Principal General Manager Telecom, Kalyan and his
successors.
3.
The AGM (Admin) means Assistant General Manager (Admin.), office of the Principal
General Manager Telecom., Bharat Sanchar Nigam Limited, Telephone Bhavan,
Kalyan and his successors.
4.
Nodal officer/Representative of PGMT means officers and staff for the time being in
Kalyan Telecom District deputed by the PGMT for verifying the genuineness of
beneficiary in all indoor treatment.
B. GENERALTERMS & CONDITIONS FOR EMPANELMENT OF HOSPITAL.
1. All BSNL serving/retired employees who have opted for BSNL MRS & their
dependents (including voluntarily retired) will be eligible for this scheme.
2.
Empanelled hospitals are entitled to get reimbursement of expenses incurred towards
the medical expenses of all BSNL serving/retired/voluntarily retired employees and
their dependents, at the CGHS approved rates prevailing at the time of admission of
patient at hospitals recognized from time to time by the management. Entitlement
under this clause will be separate and distinct from the ceiling amount prescribed for
domiciliary out door treatment.
3. Medical card having photo of eligible family members of an employee shall be given
to all the eligible employees by Asstt. General Manager (Admin & MIS).
4. Before admission employee has to apply for an Authorization letter along with the
recommendation of any registered medical practitioner for indoor treatment, to the
competent authority, O/o PGMT, BSNL, Kalyan, through proper channel, for getting
indoor treatment from empanelled hospital.
5. Competent authority of BSNL shall issue “Authorization letter “ in Annexure- F to
the employee.
6.
Employee has to produce the Authorization letter to the hospital concern where he
wants to take indoor treatment. Hospital shall entertain only all such patient who
produces Authorization letter issued by Competent authority of BSNL. No patient has
to be treated without such letter under BSNL MRS.
7. In case of emergency or on holidays hospital can admit the patient by verifying their
Medical Card issued by Competent authority of BSNL, Kalyan. In such cases hospital
authority should intimate to Competent authority of BSNL, Kalyan in writing the
reason for admission of the patient and should insist the employee to produce
Authorization letter on next working day.
8. No refund of medical expenses will be made to the hospitals without complying to the
conditions of 6 or 7 above and the treatment done will be at the risk and cost of the
hospitals.
9. Authorization letter issuing authority of BSNL, Kalyan shall depute one Nodal Officer
to verify the genuineness of beneficiary in all indoor treatment.
10. Nodal Officer will issue “Verification certificate” as per Annexure-V
11. After discharge of the patient, hospital has to raise the bill as per conditions stipulated
in the agreement duly executed between the BSNL and the Hospital concerned.
12. Hospital shall attach “Certificate for hospitalization” in Annexure D-1 along with
the bill.
Signature of in-charge of the hospital with seal :-
Documents for EOI for empanelment of hospitals / Page No.- 5 -
B. GENERAL TERMS & CONDITIONS FOR EMPANELMENT OF HOSPITAL.
1. The BSNL desires to empanel hospitals for giving indoor treatment to their employees
& their dependent family members. The specifications and the scope of work are
mentioned in part-II.
2. Schedule for procurement & submission of the EXPRESSION OF INTEREST
form.
Issue of form document
From
Up to
10.30 Hrs.
16.30 Hrs.
Of
Of
06/11/2010
27/11/2010
Address for getting the form
AGM(Admin) O/o the PGMT, Kala Talav, Kalyan (W)
Submission of form
BY hand, register post, speed post or by courier so as to
reach on or Before 15.00 H`rs. Of 29/11/ 2010
Date of opening
15.30 hours of 29/11/2010
3.
Documents to be submitted along with the EXPRESSION OF INTEREST
a. Registration Certificate for hospital.
b. Opinion Certificate from Civil Surgeon/Health Officer of Municipal Authorities as
per Annexure-O
C .Letter for agreeing to CGHS rates Mumbai. ( format attached)
d. Hospital brochure along with existing rate list of hospitals
e. Annexure G
4. Filling the form: The interested hospitals shall fill up Annexure –G, The hospital
should give their details of services provided by them for indoor treatment (i.e
Emergency & Trauma services, Specialized services, facilities of clinical investigation
available with them. The facilities available with them like No. of special/private/semi
private/general wards, No of beds, Amenities provided. The diagnostic facilities like
pathological, Radiological, availability of Medical shops, etc. List of Doctors available
& their bio data.
5. Information Regarding Submission Of Documents: The documents super scribed
on the envelope as “Documents for Expression of Interest form vide NIT NO.
KYN/ADMIN/HE/10-11/17 Dated at Kalyan the 15/10/2010” are to be addressed to
Asstt General Manager (Admn&MIS),
Office of the Principal General Manager Telecom,
Administration Section, Kala Talav,
Kalyan (W)– 421 301
so as to reach on or before 15.00 hrs. of 29/11/2010 by Hand/ Registered Post/
Speed Post or by courier,
6. TERMINATION FOR DEFAULT :
The BSNL, Kalyan can terminate the contract of any hospital by issuing written
notice in whole or in part, for the following reasons, without prejudice to any other
remedy for breach of contract.
a. If the hospital fails to give treatment to the patient whom authorization letter is issued
by the competent authority of BSNL.
b. If the contract is abandoned by the hospital for any reason, it will be de-listed from
the panel of BSNL and can be black listed.
c. If the hospital refuses to give treatment.
d. For poor treatment or for the bad act of the hospital.
Signature of in-charge of the hospital with seal :-
Documents for EOI for empanelment of hospitals / Page No.- 6 -
7. Procedure to Open & Evaluating of the Expression of Interest.
a. An “EOI” opening committee shall be constituted for opening of Expression of
Interest documents and shall submit them to evaluation committee along with their
report.
b. An “Evaluation Committee” shall be constituted for evaluation of the Expression of
Interest.
c. The evaluation committee will examine the documents submitted. If required original
copies of documents submitted along with the Expression of Interest will be verified
by committee.
d. The evaluation of document will be done as per the offer submitted by the hospital.
However BSNL Kalyan reserves the rights not to accept the higher rates.
e. The BSNL Kalyan reserves the right to refuse consideration of any Expression of
Interest deficient or incomplete in any of the requisite matters, particulars or
formalities or for any reason which shall not be disclosed to the hospitals.
f. Incomplete G form shall be rejected out rightly & no correspondence shall be
entertained in this regard.
g. The offer with extraneous conditions or conditional offer will not be accepted.
Hospitals with such conditions are liable for rejection.
h. The decision of the PGMT, BSNL, Kalyan on the recommendation of the “Expression
of Interest Evaluation Committee” shall be final.
i. The rates quoted should be as per CGHS approved rates only.
8. Validity of the offer: The rates approved under this contract will be valid, normally,
for a period of two year from the date of Agreement. No increase in the approved
rates will be allowed due to any reason except the change if any in the rates of
CGHS Mumbai during the period of agreement shall be accepted from the date of
change in rates of CGHS, Mumbai.
9. Payments: The bills shall be submitted in duplicate to the BSNL within one month
from the date of discharge of the patient. The hospital shall be responsible to submit
the bills, which are prepared accurately, and giving all details to facilitate, treatment,
medicines supplied by them to the patient..
10. The decision of the PGMT, BSNL, Kalyan shall be final & binding on the hospitals.
11. The offer of black listed hospitals will not be entertained and the same will be
excluded from consideration
12. In case of default, the BSNL will have right to discontinue the hospital from panel.
13. The PGMT, BSNL, Kalyan may terminate the contract at his option at any time giving
30 days (Thirty days) notice and that without assigning any reason in the case of any
unethical medical practices.
14. Submission of documents by the hospital shall be taken to signify the acceptance of
the stipulated terms and conditions. Any failure on the part of the hospital to observe
the prescribed procedure or any attempt to canvass for the work will prejudice the
hospital and make it liable for exclusion from consideration.
15. The PGMT, Kalyan reserves the rights to accept or reject any hospital or all hospitals
and reserves the right to recall the offer without assigning any reason whatsoever.
16. The PGMT, BSNL, Kalyan reserves the right of recommending one or more hospitals
in the area as he may think fit for approval.
Signature of in-charge of the hospital with seal :-
Documents for EOI for empanelment of hospitals / Page No.- 7 -
17. Late submission of offer form: The offer received after due date & time, will not be
accepted.
18. The offer form is available on web site
http://www.maharashtra.bsnl.co.in/ssa/kalyan
19. The successful bidder has to undergo an agreement as per Annexure-A
20. ARBITRATION
20.1 In the event of any question, dispute or difference arising under the agreement or in
connection with (except as to the matters, the decision to which specifically provided
under the agreement), the same shall be referred to the sole arbitration of the CGM,
BSNL, MUMBAI or in case his designation is changed or his office is abolished, then
in such cases to the sole arbitration of the officer for the time being entrusted
(whether in addition to his own duties or otherwise) with the functions of the CGM,
BSNL, MUMBAI or by whatever designation such an officer may be called
(hereinafter referred to as the said officer), and if the CGM or the said officer is
unable or unwilling to act as such, then to the sole arbitration of some other person
appointed by the CGM, BSNL, MUMBAI or the said officer. The agreement to
appoint an arbitrator will be in accordance with the Arbitration and conciliation Act
1996. There will be no objection to any such appointment on the ground that the
arbitrator is a Government Servant or that he has to deal with the matter to which the
agreement relates or that in the course of his duties as a Government Servant he
has expressed his views on all or any of the matters in dispute. The award of the
arbitrator shall be final and binding on both the parties to the agreement. In the
event of such an arbitrator to whom the matter is originally referred, being transferred
or vacating his office or being unable to act for any reason whatsoever, the CGM,
BSNL, MUMBAI or the said officer shall appoint another person to act as an
arbitrator in accordance with terms of the agreement and the person so appointed
shall be entitled to proceed from the stage at which it was left out by his
predecessors.
20.2 The arbitrator may from time to time with the consent of both the parties enlarge the
time frame for making and publishing the award. Subject to the aforesaid, Arbitration
and Conciliation Act, 1996 and the rules made there under, any modification thereof
for the time being in force shall be deemed to apply to the arbitration proceeding
under this clause.
20.3 The venue of the arbitration proceeding shall be the office of the CGM,
BSNL, Mumbai or such other place as the arbitrator may decide.
END OF PART-I
Signature of in-charge of the hospital with seal :-
Documents for EOI for empanelment of hospitals / Page No.- 8 -
PART II
Scope of Work & Specifications
A.
Scope of Work:
The BSNL Kalyan desires to empanel the hospitals for giving indoor treatment to BSNL
employees & their dependent family members.
The hospital should entertain the patient on production of Authorization letter issued by
Competent authority, O/o PGMT, BSNL, Kalyan and immediate medical treatment
should be given without insisting for any advance payment.
Admission sought by the patients on Saturdays, Sundays, General Holidays & in case
of Emergency may be permitted on the basis of Identity Card provisionally. Hospital
shall insist to produce authorization letter on next working day. In such cases the
hospital may issue a certificate about the emergency condition of the patient and send
the same along with the monthly bill.
The rates quoted for treatment are at par with approved rates of CGHS Mumbai. The
change if any in the rates of CGHS Mumbai during the period of agreement shall be
accepted from the date of change in rates of CGHS, Mumbai.
The hospital should supply all medicines/clinical material and any other material
required for treatment of the patient.
“During indoor treatment of the BSNL persons covered under the BSNL MR scheme,
the hospital shall not ask the eligible person to purchase medicines from outside, but
will have to be arranged and provided by the Hospital itself as a package deal, at the
approved rate by the CGHS vide G.O.I. Ministry of Health & Family Welfare, New Delhi
in their letter No. F.No.S.11011/28/2006-CGHS-Desk.II/CGHS(P) dated. 04.12.2007
which includes the cost of drugs, surgical instruments and other medicines etc.
“During in-patient treatment “Any liability on account of default or negligence on the part
of the Hospital in providing or performing the medical services, arises, the Hospital shall
be fully responsible for such deficiency of service and the BSNL will no way be
responsible for the same.
The agreement shall remain in force for a period of one/two years from the date of
execution by both parties or finalization of new panel which ever is earlier.
The agreement shall be extendable on its expiry by consent of both the parties.
The rate sheet (Part-III) should be filled in at the time of submitting the documents
keeping in view the terms and conditions and specifications stipulated here in.
B: PROCEDURE FOR INDOOR TREATMENT
1)
2)
3)
4)
5)
All the serving, retired and voluntary retired employee registered under BSNLMRS and
his/her dependents are eligible for treatment in recognized hospitals/nursing homes at
the approved rates at all hospitals recognized from time to time by the management.
Medical card shall be issued to all the serving and retired and voluntary retired
employee registered under BSNLMRS.
The BSNL empanelled hospital shall entertain the patient provisionally on production of
Medical card/Authorization letter issued by BSNL
An employee should intimate regarding his/her serious illness needing hospitalization
to the section dealing with medical policy implementation. A letter of Authorization shall
be issued to the hospital concerned by the Competent authority.
Copy of the Authorization letter issued by competent authority shall be given to the
nodal officer appointed by BSNL for verification of genuineness
Signature of in-charge of the hospital with seal :-
Documents for EOI for empanelment of hospitals / Page No.- 9 -
6)
After completion of treatment and discharge of patient, hospital shall send the bill to
concern Account Officer(Claim) of BSNL for payment.
Following documents are necessary along with the bill submitted for payment.
a) Admission/ Discharge letter/Card in which date and time of admission and
Discharge of patient should be clearly mentioned.
b) Original Authorization letter issued by BSNL.
c) Bill showing complete details of treatment given, Pathological charges, details of
medicine and their prices.
d) Form D-I duly signed by concern doctor.
e) Verification certificate issued by nodal officer of BSNL.
f) Xerox copy of Medical Card issued by BSNL with encircle to the photo of patient
availed indoor treatment.
7)
Admission sought by patient on Sundays, Holidays or in case of emergency may be
permitted by the hospital on the basis of Identity Card/Medical Card issued by BSNL. In
such cases patient should produce Authorization Certificate on next working day.
END OF PART-II
Signature of in-charge of the hospital with seal :-
Documents for EOI for empanelment of hospitals / Page No.- 10 -
PART – III
SCHEDULE FOR QUOTING RATES
NO. KYN/ADMIN/HE/10-11/ 17
DATED AT KALYAN THE 15/10/2010
(Please Read Part-I and Part-II Carefully before Quoting the Rates in Part-III)
The opinion of hospital should be as follows.
Agreed as per CGHS schedule rates approved by Government of India, Ministry of
Health and Family Welfare, New Delhi in their letter No F.No.S.11011/28/2006-CGHS Desk.
II/CGHS(P) dt. 04.12.2007.issued from time to time for CGHS, Mumbai.
At present CGHS SCHEDULE OF RATES are available as given below.
Approved by G.O.I., Ministry of Health & Family Welfare, New Delhi in their letter No.
F.No.S.11011/28/2006-CGHS Desk. II/CGHS(P) dated. 04.12.2007.issued from time to time
for CGHS, Mumbai
F.No.S.11011/28/2006-CGHS D.II(Pt.2)/Mumbai dt 04-12-2007
S.No.
NAME OF INVESTIGATION / TREATMENT PROCEDURE
1
Consultation
2
Consultation- Revisit or each subsequent visit
30
3
Consultation First Visit - Private, if any
50
50
5
Consultation Revisit or each subsequent visit Private -if
any
First Consultation by Medical Officer / Resident Doctor
6
Subsequent Consultation by Medical Officer / Resident Doctor
30
7
First Visit by Specialists
60
8
Revisit by Specialists or each subsequent visit
60
9
Injections - SC
10
10
Injection - IM
10
11
Injection - IV
15
12
Dressings Small
40
13
Dressings Medium
45
14
Dressings Large
90
15
Suturing without local anesthesia
90
16
Suturing
195
17
Removal of Benign Tumor
780
18
Aspiration Plural Effusion - Diagnostic
140
19
Aspiration Plural Effusion - Therapeutic
140
20
Abdominal Aspiration - Diagnostic
250
21
Abdominal Aspiration - Therapeutic
470
22
Pericardial Aspiration
300
23
Bone Marrow Aspiration
275
24
Joints Aspiration
230
25
Biopsy Skin except Hensens
200
4
First Visit
CGHS Rates,
CGHS rates
Mumbai (Rs) agree/diasagree
30
of wounds with local anesthesia
Signature of in-charge of the hospital with seal :-
40
Documents for EOI for empanelment of hospitals / Page No.- 11 26
Biopsy Lymphnode
400
27
Biopsy Liver
570
28
Strapping
65
29
Removal of Stitches
30
30
Venesection
90
31
Phimosis Under LA
970
32
Lumber puncture
150
33
Sternal puncture
150
34
Injection for Haemorrhoids
300
35
Injection for
300
36
Catheterisation
60
37
Dilatation of Urethra
420
38
Incision & Drainage
390
39
Intercostal Drainage
650
40
Lung function test
400
41
E.C.G.
75
42
E.E.G.
400
43
Stress test (TMT)
810
Peritoneal dialysis
1220
44
Varicose Veins
Skin
45
Excision of Moles
280
46
Excision of Warts
410
47
Excision of Molluscumcontagiosum
400
48
Excision of Veneral Warts
210
49
Excision of Corns
210
50
I/D Injection Keloid of Acne
70
51
Chemical Cautery (per sitting)
80
E.N.T.
52
Pure Tone Audiogram
130
53
Impedence & other tests
210
54
SISI, Tone Decay & Difference times
130
55
Multiple hearing assessment test.
130
56
Hearing Aid Selection
130
57
Hearing Aid Analysis
100
58
Speech Discrimination Score
65
59
Speech Assessment
100
60
Speech therapy per session of 30-40 minutes
95
61
Cold Calorie Test for Vestibular function
130
62
Removal of foreign body From Nose
250
63
Removal of foreign body From Ear
250
64
Syringing (Ear)
120
65
Polyp removal under LA
450
66
Peritonsillar abscess drainage under LA
1050
Ear
67
Ear Piercing
Signature of in-charge of the hospital with seal :-
150
Documents for EOI for empanelment of hospitals / Page No.- 12 68
Myringoplasty
8000
69
Staepedectomy
9600
70
Myringotomy
3500
71
Grommet Insertion
4500
72
Tympanotomy
7050
73
Paracentesis
2400
74
Tympanoplasty
10800
75
Mastoidectomy
11900
76
Otoplasty
12250
77
Labyrinthectomy
10650
78
Skull Base surgery
20400
79
Facial Nerve Decompression
15200
Nose
80
Septoplasty
6800
81
Submucous Resection
5300
82
Septo-rhinoplasty
12350
83
Rhinoplasty
12100
84
Fracture Reduction
4800
85
Intra Nasal Diathermy
1760
86
Turbinectomy
4400
87
Endoscopic DCR
9600
88
Endoscopic Surgery
10000
89
Septal Perf. Repair
10000
90
Antrum Puncture
700
91
Lateral Rhinotomy
880
92
Cranio-facial resection
21900
93
Ethamoidectomy
11300
94
Caldwell Luc Surgery
7700
95
Angiofibroma Excision
15200
96
Endoscopic Hypophysectomy
25000
97
Endoscopic Optic Nerve Decompression
24950
98
Decompression of Optic Nerve
20000
Throat
99
Ranula Excision
5750
100
Tongue Tie excision
1800
101
Sub Mandibular Duct Lithotomy
4000
102
Adenoidectomy
4700
103
Palatopharyngoplasty
13600
104
Cleft Palate repair
12600
105
Pharyngoplasty
12800
106
Styloidectomy
9600
Eye
107
Cauterisation of ulcer/subconjuctival injection - One eye
50
108
Cauterisation of ulcer/subconjuctival injection - Both eyes
100
109
Retrobular Injection - One Eye
50
110
Retrobular Injection - Both Eyes
100
Signature of in-charge of the hospital with seal :-
Documents for EOI for empanelment of hospitals / Page No.- 13 111
Syringing of Lacrimal Sac -For One eye
50
112
Syringing of Lacrimal Sac - For both eyes
100
113
Paracentesis
200
114
Foreign body removal
130
115
Refraction/Fundoscopy
30
116
Ortho-optic check up
50
117
Ortho-optic exercises
50
118
Plepoptic Exercises
50
119
Perimetry/field test
100
120
Chalazion operation - One Eye
300
121
Chalazion operation - Both Eyes
320
122
Dressing (Eye)
65
123
Clinical Photography
150
124
Pterygium Excision
830
125
Orbitotomy
12000
126
Ptosis correction
4640
127
Ectropion Correction
3600
128
Xenon Arc Laser
1000
129
D C R (Dacryocystorhinostony)
7000
130
ECCE/ICCE
6600
131
Epicantuhus correction
3850
132
Dacryocystectomy(DCT)
7000
133
Squint Correction
6000
134
Keratoplasty
12000
135
Trabeculotomy
6700
136
Trabeculectomy
7200
137
Iridectomy
1000
138
Goniotomy
4000
139
Scalaral Bukling (Retinal Detachment Surgery)
11000
140
ERG
575
141
Flourescein Angioraphy
800
142
A-Scan
150
143
Tono Graphy
100
144
VER
800
145
Goldmen Perimetry
400
146
Specular microscopy
280
147
Vitrectomy
8800
148
Enucleation
3600
149
Eviseration
3600
150
Entropion correction
1000
151
Indo cyaningreen Angiography of Retina
1200
152
Indo cyaningreen Angiography
560
153
Automated Perimetry
810
154
Corneal endothelial cell count
240
155
Corneal topography
240
Signature of in-charge of the hospital with seal :-
- IRIS
Documents for EOI for empanelment of hospitals / Page No.- 14 156
Corneal pachymetry
220
157
Retinal nerve film analyzer studies
80
158
Auto Refrectemetry
30
159
Biometry
55
160
Ultrasound studies ---- A Scan
150
161
Ultrasound studies ---- B Scan
240
162
Retinal/Meter function studies
140
163
PAN ACUITY METER ---
1300
164
Laser inter ferometry ---
1300
165
EKG, EOG ---
750
166
Dacryocystography (DGC)
1200
167
Orbital Angio studies
1300
168
Cateract with IOL
7500
(Cost of lens extra)
Orthopaedic & Plaster Work
169
Fingers (post, slab)
195
170
Fingers full plaster
195
171
Colles Fracture - Below elbow
890
172
Colles Fracture -
720
173
Colles fracture Ant. Or post. slab
720
174
Above elbow full plaster
810
175
Above Knee post-slab
520
176
Below Knee full plaster
750
177
Below Knee post-slab
520
178
Tube Plaster (or plaster cylinder)
750
179
Above knee full plaster
1500
180
Above knee full slab
1800
181
Minerva Jacket
2000
182
Plaster Jacket
1700
183
Shoulder spica
1600
184
Single Hip spica
1700
185
Double Hip spica
2100
Full plaster
Strapping
186
Strapping of Finger
130
187
Strapping of
Toes
130
188
Strapping of
Wrist
190
189
Strapping of
Elbow
190
190
Strapping of Knee
260
191
Strapping of
260
192
Strapping of Chest
380
193
Strapping of Shoulder
390
194
Nasal bone fracture
390
195
Figure of 8 bandage
390
196
Colar and cuff sling
300
197
Ball bandage
380
Ankle
Physiotheraphy
198
Ultrasonic therapy
Signature of in-charge of the hospital with seal :-
57
Documents for EOI for empanelment of hospitals / Page No.- 15 199
S.W. Diathermy
57
200
Electrical stimulation (therapeutic)
57
201
Muscle testing and diagnostic
57
202
Infra red
50
203
U.V. Therapeutic dose
57
204
Electric vibrator
57
205
Vibrator belt massage
57
206
Intra Lumbar Traction
57
207
Intermittent Cervical traction
57
208
Combined Lumbar & Cervical
57
209
Wax bath
57
210
Hot pack
57
211
Whirl pool bath
57
212
Obesity Exercises
57
213
Breathing Exercises & Postural Drainage
57
214
Cerebral Palsy – Massage
57
215
Post–polio exercise
57
traction
Dental
216
Extraction of tooth including LA
81
217
Complicated Ext. per Tooth including LA
165
218
Flap Operation per Tooth
300
219
Gingivectomy per tooth
195
220
Cyst under LA (small)
195
221
Cyst under LA (large)
325
222
Impacted Molar including LA
545
223
Apisectomy including LA
520
224
Fracture wiring including LA
650
225
Intra oral X-ray
50
Others
226
Upper G.I. Endoscopy
1200
227
Upper G.I. Endoscopy with Biopsy
1450
228
Esophageal scierotherapy for varices First sitting
1650
229
Esophageal sclerotherapy for varices Subsequent sitting
1300
230
Sigmoidoscopy (rigid)
900
231
Sigmoidoscopy (flexible)
900
232
Oesophagoscopy
970
233
Colonoscopy
1600
234
Fibroptic bronchoscopy
1700
X-Ray
235
Fluroscopy chest
80
236
Dental
50
237
Occlusal
60
238
Abdomen AP or Erect (one film)
100
239
Abdomen Lateral view (one film)
100
240
Abdomen for Pregnancy
100
241
Chest PA view (one film)
100
Signature of in-charge of the hospital with seal :-
Documents for EOI for empanelment of hospitals / Page No.- 16 242
Chest Oblique or Lateral (One film)
100
243
Mastoids
100
244
Extremities, bones & Joints (one film)
100
245
Pelvis (One film)
100
246
Paranasal sinuses (One film)
100
247
T.M. Joints (One film)
100
248
Abdomen & pelvis for K.U.B.
104
249
Skull A.P. & Lateral
160
250
Spine A.P. & Lateral
160
251
Barium Swallow
565
252
Sinography/ Sialography
500
253
Cystography/ Urethrography
650
254
Hystero-Salpaingography
702
255
Arthrography
565
256
Retrograde Pyelography
650
257
Oral or I.V. Cholecystography
625
258
Barium Enema
770
259
Barium Meal Upper or Lower
800
260
Bronchography
875
261
I.V. Urography
940
262
Myelography
936
263
Pneumo Encephalography
750
264
Barium meal Complete
1100
265
Cerebral/Femoral Angiography
1125
Ultrasound Investigations
0
266
Obstetric First Scan
250
267
Obstetric Follow up (2nd visit)
250
268
Upper abdomen First Scan
350
269
Upper abdomen Follow up (2nd visit)
300
270
Quick look check-up for IUCD failure/Foetus.
250
271
Total Abdominal survey or Multiple organ
350
272
Special procedures & Aspiration etc.
500
273
Image Intensifiers
1090
Clinical Pathology
0
274
Urine routine
30
275
Quantitative Albumin/Sugar
15
276
Urine Bile Pigment and Salt
20
277
Urine Urobilinogen
30
278
Urine Ketones
30
279
Urine Occult Blood
30
280
Urine total proteins
30
281
Urine Sodium
60
282
Urine Chloride
60
283
Bence Jones protein
50
284
Stool routine
30
Signature of in-charge of the hospital with seal :-
study
Documents for EOI for empanelment of hospitals / Page No.- 17 285
Stool occult blood
24
286
Post coital smear examination
40
287
Smear analysis
50
288
Body fluid (CSF/Ascitic Fluid etc.) Chemistry, Sugar,
Protein etc.
75
289
Body fluid for Malignant cells
80
Haematology
290
Haemoglobin (Hb)
24
291
Total Leucocytic Count (TLC)
24
292
Differential Leucocytic Count (DLC)
25
293
E.S.R.
24
294
Total Red Cell count
30
295
Platelet count
30
296
Reticulocyte count
30
297
Absolute Eosinophil count
30
298
Packed Cell Volume (PCV)
25
299
Peripheral Smear Examination
32
300
Smear for Malaria parasite
30
301
Bleeding & Clotting Time
30
302
Clot Retraction Time
30
303
R.B.C. Fragility Test
30
304
L.E. Cell
60
305
Foetal Haemoglobin (Hb-F)
50
306
Prothrombin Time (P.T.)
96
307
Complete Haemogram
60
308
Bone Marrow Smear Exmination
150
309
Partial Thromboplastin
130
310
Glucose Phosphate Dehydrogenase (G, 6PD)
130
Blood Bank
311
Blood Group & RHO Type
40
312
Cross match
30
313
Packed cell preparation
30
314
Coomb’s Test Direct
97
315
Coomb’s Test Indirect
97
316
Australia Antigen
100
317
RHO, Antibody titer
60
Bio-Chemistry
318
Glucose
30
319
Blood Urea Nitrogen
50
320
Serum Creatinine
57
321
Serum Uric Acid
55
322
Serum Bilirubin total & direct
50
323
Serum Iron
80
324
Serum Cholesterol
60
325
Total Iron Binding Capacity
100
326
Glucose (Fasting & PP)
50
Signature of in-charge of the hospital with seal :-
Documents for EOI for empanelment of hospitals / Page No.- 18 327
Serum Calcium
60
328
Serum Phosphorus
60
329
Total Protein Alb/Glo Ratio
50
330
S.G.P.T.
60
331
S.G.O.T.
60
332
Serum amylase
100
333
Serum Electrolyte
64
334
Triglyceride
100
335
Glucose Tolerance Test (GTT)
100
336
C.P.K.
120
337
L.D.H.
120
338
Alkaline Phosphatase
60
339
Acid Phosphatase
80
340
CK MB
100
341
T3, T4, TSH
200
342
HDL Cholestrol
75
343
LH
150
344
FSH
270
345
Prolactin
270
346
Blood gas analysis
230
347
Blood gas analysis with electrolytes
295
348
Cortisol
270
Histopathology
349
Pap Smear
100
350
Histopathology
150
351
Frozen section & Paraffin section
150
352
Vaginal Cytology for Hormonal evaluation
100
Bactriology & Serology
353
Smear gram-strain examination
48
354
Sputum smear A.F.B. stain
48
355
Vaginal Smear Examination
48
356
V.D.R.L.
60
357
Widal test
56
358
Rheumatoid Factor test
80
359
Culture & Sensitivity (other specimens)
96
360
Urine pregnancy test
80
361
C.R.P.
115
362
ASO Titer
100
363
Quantitative H.C.G.
145
364
Blood culture & sensitivity
120
365
Vibro cholera culture
100
ICU/CCU CHARGES (Special Care Cases)
366
367
368
Coronary Care with Cardiac Monitoring including ECG & Diet
1250
Respirator & Compressed air / piped oxygen (Ventilator
charges)
Post operative care (ICU) with Diet
800
Signature of in-charge of the hospital with seal :-
1150
Documents for EOI for empanelment of hospitals / Page No.- 19 369
Paediatric care for New born
- per day(7 to 12 days)
370
General Nursery Care (per day)
250
371
Incubator charges (Per day)
300
372
Intensive care in Nursery (Per day)
1050
373
Phototherapy
160
374
Resuscitation
250
375
Resuscitation with Incubator attended by Specialist
600
376
Exchange Transfusion
810
377
O.T. Charges for Exchange transfusion
230
378
Pneupack ventilator in Nursery (Per day)
560
190
Oxygen Charges
379
Operation theatre(including supply of Nitrous Oxide)
650
380
Casuality ICU
30
381
General Ward
30
382
Semi-private wards
30
Burn Dressing
385
upto 30% Burns 1st Dressing
110
384
upto 30%
90
385
30% to 50% Burns 1st Dressing
140
386
30% to 50%
110
387
Extensive Burn above 50% Frist Dressing
200
388
Extensive Burn above 50% Subsequent dressing
140
Burns Subsequent Dressing
Burns Subsequent Dressing
Obstetric Cases
389
Normal delivery or with Episiotomy & P. repair
6500
390
Low Forceps
7300
391
Low midcavity forceps
7300
392
Cesarean Section
12000
393
Cesarean Hysterectomy
13750
394
Rupture Uterus, closure & repair with Tubal Ligation
13750
395
Perforation of Uterus after D/E Laparotomy & Closure
9700
396
Laparotomy for Ectopic Rupture
9700
397
Laparotomy-peritonitis Lavage and Drainage
8100
398
Laparotomy-failed laparoscopy to explore
4050
399
Salphingectomy
7760
400
Salphingo-Oophorectomy
10000
401
Ovarean Cystectomy
10000
402
Oopherctomy
8900
403
Broad Ligment Haemotoma Drainage
5000
404
Exploration of perineal Haematoma & Resuturing of Episiotomy
6500
8900
406
Exploration of abdominal Haematoma (after laparotomy +
LUCS)
Internal podalic version and extraction
407
Manual Removal of Placenta
2500
408
3rd stage Complication MRP for outside delivery etc
3000
409
Examination under anaesthesia
1650
410
Burst-abdomen Repair
8100
405
Signature of in-charge of the hospital with seal :-
3000
Documents for EOI for empanelment of hospitals / Page No.- 20 411
Gaping Pareneal Wound Secondary Suturing
1200
412
Gaping abdominal wound Secondary Suturing
2500
413
Complete perineal tear-repair
1650
414
Exploration of PPH-tear repair
2800
415
Destructive Operation
7300
416
Suction evacuation vesicular mole, Missed abortion D/E
3900
417
Colpotomy-drainage P/V needling EUA
2800
418
2800
419
Repair of post-coital tear, perineal injury
Excision of urethral caruncle
420
Laparoscopy (Gynae)
4050
Shirodhkar, Mc. Donalds stich.
2500
2500
421
General Surgery
422
Drainage of Abscess
1200
423
Dressing under G.A.
1500
424
Aspiration of cold Abscess of Lymphnode
1400
425
Aspiration of Empyema
1650
426
Aspiration of Liver Abscess
1200
427
Open Drainage of Liver Abscess
6500
428
Drainage of Pelvic Abscess
6500
429
Drainage of Ischiorectal Abscess
4400
430
Drainage of Subdiaphragmatic Abscess
8100
431
Open Drainage of Perinepheric Abscess
8100
432
Drainage of Perigastric Abscess
6500
433
Drainage of Perotid Abscess
4400
434
Drainage of Retropharyngeal Abscess
4400
435
Open Drainage of Psoas Abscess
4400
436
Open Drainage of Perivertebral Abscess
6000
Injury Of Superficial Soft Tissues
437
Suturing of small wounds
195
438
Secondary suture of wounds
300
439
Delayed primary suture
1150
440
Debridement of wounds
300
Removal Of Foreign Bodies
441
Removal of F.B. Superficial
200
442
Removal of F.B. Deep
1650
Biopsies
443
Cervical Lymph Node
1300
444
Auxillary Lymph Node
1650
445
Inguinal Lymph Node
1650
446
Excision/Biopsy of Large Lumph Nodes
1650
447
Excision Biopsy of Ulcers
2500
448
Excision Biopsy of Superficial Lumps
2500
449
Incision Biopsy of Growths/Ulcers
1300
450
Trucut Needle Biopsy
1300
Signature of in-charge of the hospital with seal :-
Documents for EOI for empanelment of hospitals / Page No.- 21 451
kidney biopsy
1500
452
Percutaneous Kidney Biopsy
1300
453
Spleen Aspiration
1300
454
Marrow Biopsy (Open)
1300
455
Muscle Biopsy
1300
456
Scalene Node Biopsy
970
Excision Of Cyst / Small Tumours
457
Excision of Sebaceous Cysts
900
458
Excision of Superficial Liipoma
1400
459
Excision of Superficial Neurofibroma
1950
460
Excision of Dermoid Cysts
1650
461
Haemorrhoids
1950
462
Keloids
3600
463
Superficial Veriscosity
3250
Head & Neck
464
Ear Lobe Repair one side
410
465
Excision of Pinna for Growth (Squamous/Basal/ Injuries) Skin
Only
3000
466
Excision of Pinna for Growth (Squamous/Basal/ Injuries) Skin
and Cartilage
3900
467
Partial Amputation of Pinna
4700
468
Total Amputation of Pinna
5500
469
Total Amputation & Excision of External Auditory Meatus
7300
470
Excision of Cystic Hygroma Minor
3900
471
Excision of Cystic Hygroma Major
5400
472
Excision of Cystic Hygroma Extensive
8750
473
Excision of Branchial Cyst
9000
474
Excision of Branchial Sinus
8000
475
Excision of Pharyngeal Diverticulum
8100
476
Excision of Carotid Body-Tumours
24300
477
Operation for Cervical Rib
15500
478
Block Dissection of Cervical Lymph Nodes
16200
479
Pharyngectomy & Reconstruction
25100
480
Operation for Carcinoma Lip - Wedge-Excision
6000
481
Operation for Carcinoma Lip - Vermilionectomy
6000
7000
483
Operation for Carcinoma Lip - Wedge Excision and
Vermilonectomy
Estlander Operation
484
Abbe Operation
9000
485
Cheek Advancement
7300
486
Excision of the Maxilla
15600
487
Excision of the Mandible Segmental
12200
488
Hemimandibulectomy
18250
489
Partial
4050
490
Hemiglossectomy
9100
491
Total Glossectomy
18250
492
Commondo Operation
18250
482
Glossectomy
Signature of in-charge of the hospital with seal :-
5700
Documents for EOI for empanelment of hospitals / Page No.- 22 493
Parotidectomy - Superficial
14000
494
Parotidectomy -
Conservative
8450
495
Parotidectomy -
Radical Total
18250
496
Repair of Parotid Duct
12900
497
Removal of Submandibular Salivary gland
6650
498
Hemithyroidectomy
9750
499
Partial Thyroidectomy
9100
500
Subtotal Thyroidectomy (Toxic Goitre)
12500
501
Total Thyroidectomy (Cancer)
15900
502
Resection Enucleation of Adenoma
8410
503
Isthmectomy
8410
504
Total Thyroidectomy and Block Dissection
21900
505
Excision of Lingual Thyroid
18100
506
Excision of Thyroglossal Cyst/Fistula
10000
507
Excision of Parathyroid Adenoma/Carcinoma
17800
508
Laryngectomy
25600
509
Laryngo Pharyngectomy
30000
510
Sinus & Fistula repair
6000
511
Lymph Node Excision
3600
512
Hyoid Suspension
7850
513
Genioplasty
15000
514
Direct Laryngoscopy
3900
515
Phonosurgery
11300
516
Fibroptic Laryngoscopy
2600
517
Microlaryngeal Surgery
7600
518
Laryngofissure
13800
519
Stenosis Excision
16300
Head & Neck Cancer
520
Excisional Biopsies
3000
521
Benign Tumour Excisions
8900
522
Temporal Bone resection
16500
523
Radical Neck Dissection
20160
524
Carotid Body Excision
28500
525
Total Laryngectomy
26400
526
Flap Reconstructive Surgery
24000
527
Parapharyngeal Tumour Excision
24000
Breast
528
Drainage of Abscess
4850
529
Excision of Lumps
7300
530
Local Mastectomy (Simple)
9900
531
Radical Mastectomy (Formal or Modified)
24000
532
Excision of Mammary Fistula
12120
533
Segment Resection of Breast
12000
Cardio Respiratory Procedures
534
Direct Laryngoscopy
4000
535
Bronchoscopy
1950
Signature of in-charge of the hospital with seal :-
Documents for EOI for empanelment of hospitals / Page No.- 23 536
Mediastinoscopy
1970
537
Pleural Biopsy
2250
538
Thoracoscopy
4900
539
Tracheostomy
2500
540
Thoracotomy (Penetrating Wounds)
11650
541
Intercostal Drainage of empyema
3800
542
Decortication (Pleurectomy)
19100
543
Thoracoplasty
27200
544
Pneumonectomy
22300
545
Lobectomy(lung)
19900
546
Segmental Resection
19900
547
Hydatid Cyst
19900
548
Pulmonary function test BMR
475
549
Spirometry
475
550
Spirometry with Helium Dilution
1100
551
Spirometry with a Helium Dilution with diffusion capacity
studies
750
552
Pulmonery exercise testing
600
553
Open Lung Biopsy
11960
554
Anterior mediastinotomy
26000
555
Mediastinoscopy(cervical)
24000
556
Video-assisted thoracoscopy (VATS)
17900
557
Video-assisted thoracoscopic lung Surgeries
39480
558
Lung volume reduction surgery
38000
559
Thoracoscopic Decortication
35962
560
Thoracoscopic Pneumonectomy
42000
561
Thoracoscopic Lobectomy
35962
562
Thoracoscopic Segmental Resection
35962
563
Thoracoscopic Hydatid Cyst excision
35962
564
Thoracoscopic Sympathectomy
29500
Cardiac / Cardio Thoracic Procedures
565
Coronary Bypass Surgery
127500
566
Coronary Bypass Surgery-post Angioplasty
127500
567
Coronary Baloon Angioplasty
75000
568
Balloon angioplasty with Valvotomy
93750
569
Open Heart Procedures
127500
570
Total Correction of Tetralogy of Fallot
120000
571
RSUV Correction
112500
572
TAPVC Correction
112500
573
Open ASD VSD
123750
574
Open Pulmonary Valvotomy
123750
575
Open Aortic Valvotomy
123750
576
Balock Taussig Operation
97500
577
Mitral Valvotomy
55000
578
Mitral Valve Replacement (cost of valve extra)
130000
579
Aortic ValveReplacement (cost of valve extra)
130000
Signature of in-charge of the hospital with seal :-
Documents for EOI for empanelment of hospitals / Page No.- 24 580
Double Valve Replacement.(cost of valve extra)
120000
581
Closed Valvotomy
75000
582
Coarctation-Arota Repair of Block Taussig Shunt
97500
583
Patent Ductus Arteriousus
73200
584
Mitral Valvotomy (Open)
110000
585
Pericardiostomy
90000
586
Pericardiectomy
90000
587
Pericardio Centrosis
1000
588
Permanent Pacemaker Implantation
13000
589
Temporary Pacemaker Implantation
9000
590
Test of Pacemaker
485
591
Embolectomy
17300
592
Aneurysm Resection & Grafting
30000
593
Thoracocentesis
1600
594
Thorachostomy
12000
595
Exploratory Thorocotomy
14900
596
Aorta-Femoral Bypass
48750
597
Removal of Foreign Body from Trachea or Oesophagus
3000
598
Rib Resection & Drainage
8100
599
Mediastinal Tumour
24300
600
Thymectomy
20300
601
Partial Pericardectomy
14600
602
Removal Tumours of Chest Wall
15500
Oesophagus
603
Atresia of Oesophagus and Tracheo Oesophageal Fistula
24000
604
Operations for Replacement of Oesophagus by Colon
20400
605
Oesophagectomy for Carcinoma Easophagus
20400
606
Oesophageal Intubation (Mausseau Barbin Tube)
10000
607
Achalasia Carida Transthoracic
9700
608
Achalasia Carida Abdominal
12000
609
Oesophago Gastrectomy for mid 1/3 lesion
20300
610
Heller’s Operation
16200
611
Colon-Inter position or Replacement of Oesophagus
18600
612
Oesophago Gastrectomy – Lower Corringers procedure
16160
Abdomen
613
Gastroscopy
1300
614
Gastric & Duodenal Biopsy (Endoscopic)
1616
615
Pyleromyotomy
2424
616
Gastrostomy
6868
617
Simple Closure of Perforated peptic Ulcer
8100
616
Vagotomy Pyleroplasty / Gastro Jejunostomy
10100
617
Duodenojejunostomy
15200
618
Partial/Subtotal Gastrectomy for Carcinoma
17500
619
Partial/Subtotal Gastrectomy for Ulcer
17500
620
Operation for Bleeding Peptic Ulcer
15200
621
Gastrojejunostomy & Vagotomy
15200
Signature of in-charge of the hospital with seal :-
Documents for EOI for empanelment of hospitals / Page No.- 25 622
Operation for Gastrojejunal Ulcer
15200
623
Total Gastrectomy for Cancer
22300
624
Highly Selective Vagotomy
15200
625
Selective Vagotomy & Drainage
14652
626
Congenital Diaphragmatic Hernia
14500
627
Hiatus Hernia Repair Abdominal
16200
628
Hiatus Hernia Repair Transthoracic
12500
629
Exploratory Laparotomy
8900
630
Epigastric Hernia Repair
8450
631
Umbilical Hernia Repair
8450
632
Ventral and Scar Hernia
633
Inguinal Hernia
634
Inguinal Hernia - Hernioplasty
13500
635
Femoral Hernia Repair
15400
636
Rare Hernias Repair (Spigalion, Obturator, Lumbar, Sciatic)
14000
637
Splenectomy - For Trauma
15850
638
Splenectomy - For Hypersplenism
15850
639
Splenorenal Anastomosis
19000
640
Portocaval Anastomosis
25900
641
Direct Operation on Oesophagus for Portal Hypertension
18800
642
Mesentericocaval Anastomosis
24300
643
Warren Shunt
24300
644
Pancerato-duodenectomy
24300
645
By Pass Procedure for Inoperable Carcinoma of Pancreas
17800
646
Cystojejunostomy or Cystogastrostomy
15000
647
Cholecystectomy
10200
648
Cholecystectomy & Exploration of CBD
13300
649
Repair of CBD(Common Bile Duct)
13300
650
Operation for Hydatid Cyst of Liver
14220
651
Cholecystostomy
10400
652
Hepatic Resections (Lobectomy Hepatectomy)
16200
653
Operation on Adrenal Glands - Bilateral
22700
654
Operation on Adrenal Glands - Unilateral for Tumour
12000
655
Appendicectomy for Acute Appendicitis
12000
656
Appendicectomy for
12000
657
Appendicular Abscess – Drainage
7500
658
Mesenteric Cyst- Excision
9700
659
Peritonioscopy/Laparoscopy
3560
660
Jejunostomy
10400
661
Ileostomy
15514
662
Congenital Atresia & Stenosis of Small Intestine
15850
663
Muconium ileus
13300
664
Mal-rotation & Volvulus of the Midgut
13300
665
Resection & Anastomosis of Small Intestine
15600
666
Excision of Meckle’s Deverticulum
15600
Repair
Herniorraphy
Chronic/recurrent Appendicitis
Signature of in-charge of the hospital with seal :-
10500
12000
Documents for EOI for empanelment of hospitals / Page No.- 26 667
Duodenal Diverticulum
15600
668
Operation for Intestinal Obstruction
14300
669
Operation for Intestinal perforation
14300
670
Benign Tumours of Small Intestine
14300
671
Excision of Small Intestine Fistual
14300
672
Operations for Haemorrhage of the Small Intestines
16200
673
Operations of the Duplication of the Intestines
18800
674
Operations for Recurrent Intestinal Obstruction (Noble
Plication & Other Operations for the Adhesions)
18800
675
Ilieosigmoidostomy
14600
676
Ilieotransverse Colostomy
14600
677
Caecostomy
2828
678
Loop Colostomy Transverse Sigmoid
11400
679
Terminal Colostomy
14000
680
Closure of Colostomy
14300
681
Right Hemi-Colectomy
14300
682
Left Hemi-Colectomy
14300
683
Total Colectomy
18200
684
Operations for Volvulus of Large Bowel
18200
685
Operations for Sigmoid Diverticulitis
14600
686
Fissure in Ano - Dilatation
4550
687
Fissure in Ano - Fissurectomy
10000
688
Rectal Polyp-Excision
4100
689
Operation of Haemorrhoids -Lords procedure
5000
690
Fistula in Ano
12160
691
Fistula in Ano - Low Fistulectomy
7150
692
Imperforat Anus -
10550
693
Imperforate Anus
694
Prolapse Rectum - Theirch Wiring
7700
695
Prolapse Rectum - Rectopexy
5700
696
Prolapse Rectum -
Grahams Operation
14600
697
Operations for Hirschsprungs Disease
11200
698
Excision of Pilonidal Sinus
9400
699
Abdomino-Perineal Excision of Rectum
17800
700
Anterior Resection of rectum
17800
701
Pull Through Abdominal Resection
14600
702
Operations for Neuroblastoma
14600
- High Fistulectomy
Colostomy
- Pull Through Operation
10109
Nephrology / Genitourinary
703
Partial Nephrectomy
14100
704
Nephrolithomy
14100
705
Pyelolithotomy
13000
706
Operations for Hydronephrosis
14100
707
Open Drainage of Perinephric Abscess
8100
708
Cavernostomy
11550
709
Operations for Cyst of the Kidney
10400
Signature of in-charge of the hospital with seal :-
Documents for EOI for empanelment of hospitals / Page No.- 27 710
Ureterolithotomy
9700
711
Nephroureterectomy
9700
712
Operations for Ureter for -Double Ureters
16200
713
Operations for Ureter -for Ectopia of Single Ureter
18100
714
Operations for Vesico- ureteric Reflux
20000
715
Ureterostomy - Cutaneous
13000
716
Uretero-Colic anastomosis
13000
717
Formation of an Ileal Conduit
13000
718
Ureteric Catheterisation
4250
719
Dormia Extraction of Calculus
6565
720
Biopsy of Bladder (Cystoscopic)
4550
721
Diathermy Destruction of Bladder Neoplasm
7110
722
Litholapexy
8450
723
Operations for Injuries of the Bladder
13900
724
Suprapubic Drainage (Cystostomy)
8000
725
Total Cystectomy
18600
726
Diverticulectomy
18000
727
Open Resection of the Bladder Neck
15600
728
Y-V Plasty of the Bladder Neck
15600
729
Cystoplasty
18600
730
Operations for Extrophy of the Bladder
16160
731
Repair of Ureterocoel
10400
732
Suprapubic Prostatectomy
16200
733
Retropubic Prostatectomy
15900
734
Transurethral Resection of Prostate (TURP)
16200
735
Urethroscopy
3500
736
Operations for Injury to Urethra
24000
737
Internal urethrotomy
8000
738
Urethral Reconstruction
16900
739
Operation for Congenital Valves of Urethra
9050
740
Operations for Incontinence of Urine - Male
14200
741
Operations for Incontinence of Urine - Female
14200
742
Reduction of Paraphimosis
1700
743
Circumcision
2950
744
Meatotomy
1700
745
Meatoplasty
2500
746
Operations for Hypospadias - Chordee Correction
9100
18000
748
Operations for Hypospadias - Second Stage or One Stage
Repair
Operations for Epispadias
749
Partial Amputation of the Penis
7800
750
Total amputation of the Penis
12000
751
Orchidectomy
8500
752
Epididymectomy
8500
753
Adreneclectomy Unilateral/Bilateral for Tumour/For Carcinoma
13500
747
Signature of in-charge of the hospital with seal :-
9696
Documents for EOI for empanelment of hospitals / Page No.- 28 754
Operations for Hydrocele - Unilateral
4250
755
Operations for Hydrocele - Bilateral
6200
756
Vasectomy (Should be free for Family Welfare)
FREE
757
Operation for Torsion of Testis
8500
758
Vasovasostomy
11700
759
Operations for Varicocele
7300
760
Block Dissection of Inguinal Nodes - One Side
16200
761
Block Dissection of Inguinal Nodes - Both Sides
20200
762
Excision of Filarial Scrotum
10400
763
Emergency Dialysis Femoral Puncture
810
764
Emergency Dialysis Subclavian Puncture
1010
765
Fistula/Shunt
4040
766
Dialysis Femoral Catheterisation Bilateral
1000
767
Haemo Dialysis
960
768
Double Lumen Sub Clavian Catheter
1400
769
Continuous Arterio Venus Dialysis (CAVD)
12200
770
Subclavian Access
1300
771
Femoral Access
900
772
Plasma Exchange
1200
773
Donor Nephrectomy
25200
774
Renal Transplantation
148000
775
Ureteric Reimplant
11475
776
Lymphocoel
12000
777
Transplant Nephrectomy
17000
778
Bilateral Nephrouretectomy (Native)
17000
779
Vascular Prosthetic Graft
20000
780
CAPD
6000
781
PCNL - Unilateral
16160
782
PCNL - Bilateral
24300
783
Palomo’s Unilateral
4850
784
Palomo’s Bilateral
9700
785
Endoscopic Teflon Inject
4000
786
Testicular Biopsy
3000
787
Gil-Verner’s Extended Pyelolithotomy
14400
788
Nephrectomy Complicated Tumour or Adhesions
16160
789
Anderson Hynes Pyeloroplasty
13000
790
Vasico Vaginal Fistula
13000
791
Radical Cystectomy
19400
792
Caeco Cystoplasty
10000
793
Nephrectomy Simple
12000
794
Nephrostomy
7300
795
Ureteric Reimplant
7300
796
Partial Cystectomy
10000
797
TURP & TUR Bladder Tumour
16160
798
TURP Cystolithotripsy
15600
Repair
Signature of in-charge of the hospital with seal :-
Documents for EOI for empanelment of hospitals / Page No.- 29 799
Open Prostatectomy
16000
800
Closure of Urethral Fistula
8100
801
Orchidopexy - Unilateral
7150
802
Orchidopexy - Bilateral
8900
803
Cystolithotomy -Suprapubic
7950
804
Endoscopic Removal of Stone in Bladder
2500
805
Resection Bladder Neck Endoscopic
8450
806
Ureteroscopic Removal
10550
807
Cystoscopic Basketing of Urethra
8100
808
Urethroplasty 1st Stage
8100
809
Optical Urethrotomy
7800
810
Exploratory Scrototomy
6200
811
Perineal Urethrostomy
4900
812
Dilatation of Stricture Urethra under G.A.
2050
813
Dilatation of Stricture Urethra without Anesthesia
1500
814
Retroperitoneoscopy Nephrectomy
22500
815
Retroperitoneoscopy partial Nephrectomy
22500
816
Retroperitoneoscopic nephrolithotomy
22500
817
Retroperitoneoscopic pyelolithotomy
22500
818
Retroperitoneoscopic operation for Hyderonephrosis
22500
819
Retroperitoneoscopic surgery for
19700
820
Retroperitoneoscopic ureterolithotomy
22500
821
Retroperitoneoscopic Nephroureteroectomy
22500
822
Laproscopy aassisted orchidopexy
17500
823
Laproscopic operation for varicocele
14500
824
Lithotripsy
18000
Renal cyst
Plastic Surgery
825
Primary Suture of Wound
2600
826
Injection of Keloids - Ganglion
2000
827
Injection of Keloids - Haemangioma
4100
828
Free Grafts - Wolfe Grafts
5200
829
Free Grafts - Theirech-
5700
830
Free Grafts -
831
Free Grafts - Very Large Area 20%
8300
832
Skin Flaps - Rotation Flaps
7000
833
Skin Flaps -
Advancement Flaps
9500
834
Skin Flaps -
Direct- cross Leg Flaps- Cross Arm Flap
10400
835
Skin Flaps -
Cross Finger
10400
836
Skin Flaps -
Abdominal
10400
837
Skin Flaps -
Thoracic
10400
838
Skin Flaps -
Arm Etc.
12000
839
Subcutaneous Pedicle Flaps Raising
5200
840
Subcutaneous Pedicle Flaps Delay
5700
841
Subcutaneous Pedicle Flaps Transfer
6500
842
Cartilage Grafting
6500
Small Area 5%
Large Area 10%
Signature of in-charge of the hospital with seal :-
6700
Documents for EOI for empanelment of hospitals / Page No.- 30 843
Reduction of Facial Fractures of Nose
8000
844
Reduction of Facial Fractures of Maxilla
10000
Reduction of Fractures of Mandible & Maxilla - EyeLet
Splinting
Reduction of Fractures of Mandible & Maxilla - Cast Netal
Splints
5700
6000
848
Reduction of Fractures of Mandible & Maxilla - Gumming
Splints
Internal Wire Fixation of Mandible & Maxilla
849
Cleft Lip - repair.
9700
850
Cleft Palate Repair Severe Degree
9700
851
Primary Bone Grafting of Cleft Lip Palate
8500
852
Secondary Surgery for Cleft Lip Deformity
8100
853
Secondary Surgery for Cleft Palate
10000
854
Reconstruction of Eyelid Defects - Minor
5900
855
Reconstruction of Eyelid Defects - Major
8100
856
Plastic Surgery of Different Regions of the Ear - Minor
5900
857
Plastic Surgery of Different Regions of the Ear - Major
8100
858
Plastic Surgery of the Nose - Minor
5900
859
Plastic Surgery of the Nose - Major
8100
15100
861
Plastic Surgery for Facial Paralysis (Support with
Reanimation)
Pendulous Breast - Mammoplasty
862
Underdeveloped Breast
13300
863
After Mastectomy (Reconstruction)
864
Syndactyly Repair
13300
Dermabrasion Face
10700
845
846
847
860
Mammoplasty
Mammoplasty
5200
9100
15100
13300
865
Orthopaedic Surgery Procedure
866
Application of P.O.P Casts for Upper & Lower Limbs
850
867
Application of Functional Cast Brace
1150
868
Application of Skin Traction
800
869
Application of Skeletal Tractions
1500
870
Bandage & Strappings for Fractures
400
871
Aspiration & Intra Articular Injections
500
872
Application of P.O.P Spices & Jackets
2450
873
Close Reduction of Fractures of Limb & P.O.P
2000
874
Reduction of Compound Fractures
2000
875
Open Reduction & Internal Fixation of Fingurs & Toes
4000
876
Open Reduction offracture of Long Bones of Upper / Lower
Limb -Nailing & External Fixation
7000
877
Open Reduction of fracture of Long Bones of Upper / Lower
Limb -AO Procedures
7000
878
Tension Band Wirings
4100
879
Bone Grafting
6000
880
Excision of Bone Tumours -Superficial
8000
881
Excision of Bone Tumours -Deep
12000
882
Excision or other Operations for Scaphoid Fractures
5000
Signature of in-charge of the hospital with seal :-
Documents for EOI for empanelment of hospitals / Page No.- 31 883
Sequestrectomy & Saucerisation - Superficial
5000
884
Sequestrectomy & Saucerizations - Deep
7000
885
Sequestrectomy & Saucerizations - Arthrotomy
8000
886
S.P.Nailing for Fracture Neck Femur
9000
887
Multiple Pinning Fracture Neck Femur
10000
888
Nail Plate Fixations for Fracture Neck Femur
12000
889
A.O.Compression Procedures for Fracture Neck Femur
12000
890
Open Reduction of Fracture Neck Femur Muscle Pedicle Graft
and Internal Fixations
15000
891
Close Reduction of Dislocations
2300
892
Open Reduction of Dislocations -
Superficial
4660
893
Open Reduction of Dislocations -
Deep
15400
894
Open Reduction of Fracture Dislocation & Internal Fixation
10000
895
Neurolysis/Nerve Suture
10100
896
Nerve Repair with Grafting
15000
897
Tendon with Transplant or Graft
8000
898
Tendon Lengthening/Tendon Sutures
6000
899
Tendon Transfer
8000
900
Laminectomy, Excision Disc and Tumours
15000
901
Spinal Ostectomy and Internal Fixations
20000
902
Anterolateral Clearance for tuberculosis
18000
903
Antereolateral Decompression and Spinal Fusion
20000
904
Costo Transversectomy
15000
905
Corrective Ostectomy & Internal Fixation -
Minor
10000
906
Corrective Ostectomy & Internal Fixation -
Major
8000
907
Arthrodisis of -
Minor Joints
8000
908
Arthrodisis of -
Major Joints
8000
909
Soft Tissue Operations for C.T.E.V.
6000
910
Soft Tissue Operations for Polio
5000
911
Partial Hip Replacement
14000
912
Operations for Brachial Plexus & Cervical Rib
19800
913
Amputations -
Below Knee
5000
914
Amputations -
Below Elbow
5000
915
Amputations -
Above Knee
8000
916
Amputations -
Above Elbow
8000
917
Amputations -
Forequarter
12000
918
Amputations -Hind Quarter and Hemipelvectomy
15000
919
Disarticulations -
Major
16500
920
Disarticulations -
Minor
10100
921
Arthrography & Osteomedullography
7150
922
Arthroscopy -
Diagnostic
7450
923
Arthroscopy -
Operative
12000
924
Soft Tissue Operation on Knee
12000
925
Myocutaneous and Fasciocutaneous Flat Procedures for Limbs
15000
926
Removal of Nails, Wires & Screw
4600
927
Removal of Plates
3000
Signature of in-charge of the hospital with seal :-
Documents for EOI for empanelment of hospitals / Page No.- 32 928
Total Hip Replacement
75000
929
Total Ankle Joint Replacement
110000
930
Total Knee Joint Replacement
100000
931
Total Shoulder Joint Replacement
100000
932
Total Elbow Joint Replacement
89100
933
Total Wrist Joint Replacement
89000
Neuro-Surgery
934
Craniotomy and Evacuation of Haematoma -Subdural
31500
935
Craniotomy and Evacuation of Haematoma -Extradural
35280
936
Evacuation of Brain Abscess
36540
937
Excision of Lobe (Frontal, Temporal, Cerebelium etc.)
40000
938
Excision of Brain Tumours -Supratentotial
40000
939
Excision of Brain Tumours -Subtentorial
40000
940
Surgery of Cord Tumours
40000
941
Ventriculoatrial /Ventriculoperitoneal Shunt
20000
942
Excision of Cervical Inter-Vertebral Discs
24000
943
Sympathetectomy -
Lumbar
11400
944
Sympathetectomy -
Cervical
2500
945
Twist Drill Craniostomy
16240
946
Subdural Tapping
1780
947
Ventricular Tapping
2150
948
Abscess Tapping
2150
949
Placement of ICP Monitor -
2000
950
Urokinase Therepy for ICH -
1000
951
Skull Traction Application
3500
952
Lumber Pressure Monitoring
4900
953
Vascular Malformations
17800
954
Peritoneal Shunt
9700
955
Atrial Shunt
9700
956
Meningo Encephalocoel
26082
957
Meningomyelocoel
30240
958
C.S.F. Rhinorrhaea
32000
959
Cranioplasty
19400
960
Posterior Cervical Dissectomy
16160
961
Anterior Cervical Dissectomy
16160
962
Brachial Plexus Exploration Microsuturing
11400
963
Median Nerve Decompression
11000
964
Peripheral Neurectomy (Tirgeminal)
11000
965
Trigeminal Rhiotomy
11400
966
Cranial Nerve Anastomosis
8800
967
Meningocoele Excision
10000
968
Peripheral Nerve Surgery – Major
14000
969
Peripheral Nerve Surgery
6000
970
Ventriculo-Atrial Shunt (Exclud. Cost of valve)
9700
971
Nerve Biopsy
5500
Minor
Signature of in-charge of the hospital with seal :-
Documents for EOI for empanelment of hospitals / Page No.- 33 972
Brain Biopsy
16968
973
Anterior Cervical Spine Surgery with fusion
24300
974
Anterior Lateral Decompression
21600
975
Brain Mapping
2900
976
Cervical or Dorsal Laminectomy
18600
977
Combined Trans-oral Surgery & CV Junction Fusion
34200
978
C.V. Junction Fusion
24300
979
Depressed Fracture
22700
980
Discectomy
21600
981
Endarterectomy
16700
982
R.F. Lesion for Trigeminal Neuralgia -
4848
983
Spasticity Surgery -
31200
984
Spinal Fusion Procedure
25300
985
Spinal Intra Medullary Tumours
25300
986
Spinal Bifida Surgery Major
13900
987
Spina Bifida Surgery Minor
13900
988
Stereotaxic Procedures
17000
989
Trans Sphenoidal Surgery
31000
990
Trans Oral Surgery
30000
991
Trans Cranial Doppler
2500
Vascular Surgery
992
Patch Graft Angioplasty
20250
993
Femoropopliteal by pass procedure
24300
994
Thrombendarterectomy
20300
995
Surgery for Arterial Aneursysm -Distal Abdominal Aorta
28000
996
Surgery for Arterial Aneursysm -Upper Abdominal Aorta
30000
997
Surgery for Arterial Aneursysm -Vertebral
30000
28000
999
Intrathoracic Aneurysm -Aneurysm not Requiring Bypass
Techniques
Intrathoracic Aneurysm -Requiring Bypass Techniques
1000
Dissecting Aneurysms
35000
1001
Stripping of Short or Long Sephenous Veins
12200
1002
Ligation of Ankle Perforators
13500
1003
Excision and Skin Graft of Venous Ulcer
12500
1004
Venous Thrombectomy
19000
1005
Lymphatics Excision of Subcutaneous Tissues In Lymphoedema
19400
1006
Vascular Procedure – Major -
27750
1007
Vascular Procedure – Minor
18000
1008
Surgery for Arterial Aneurysm Spleen Artery
20000
1009
Surgery for Arterial Aneurysm Renal Artery
20000
1010
Surgery for Arterial Aneurysm Carotid
22000
1011
Surgery for Arterial Aneurysm Main Arteries of the Limb
20000
1012
Operations for Acquired Arteriovenous Fistual
23000
1013
Congenital Arterio Venous Fistula
18938
1014
Operations for Stenosis of Renal Arteries
20200
998
Signature of in-charge of the hospital with seal :-
32500
Documents for EOI for empanelment of hospitals / Page No.- 34 1015
Trendelenburg Operations
8400
Paediatric Surgery
1016
Excision of thyroglossal Duct/Cyst
12700
1017
Diaphragmatic Hernia Repair (Thoracic or Abdominal Approach)
12600
1018
Tracheo Oesophageal Fistula (Correction Surgery)
20150
1019
Colon Replacement of Oesophagus
18880
1020
Omphalo Mesenteric Cyst Excision
13900
1021
Omphalo Mesenteric Duct-
12650
1022
Meckels Diverticulectomy
12650
1023
Omphalocele 1st Stage (Hernia Repair)
11350
1024
Omphalocele 2nd Stge (Hernia Repair)
12650
1025
Gastrochisis Repair
12650
1026
Inguinal Herniotomy
9100
1027
Congenital Hydrocele
9100
1028
Hydrocele of Cord
9100
1029
Torsion Testis Operation
11700
1030
Congenital Pyloric Stenosis- operation
10100
1031
Duodenal-
11350
1032
Pancreatic Ring Operation
23500
1033
Meconium Ileus Operation
13000
1034
Malrotation of Intestines Operation
13900
1035
Rectal Biopsy (Megacolon)
3030
1036
Colostomy Transverse
13000
1037
Colostomy Left Iliac
13000
1038
Abdominal Perineal Pull Through (Hirschaprugis Disease)
16200
1039
Imperforate Anus Low Anomaly -Cut Back Operation
7800
1040
Imperforate Anus Low Anomaly -
10400
1041
Inperforate Anus High Anomaly -Sacroabdomino Perineal Pull
Through
16200
1042
Inperforate Anus High Anomaly -
6500
1043
Intususception Operation
13840
1044
Choledochoduodenostomy for Atresia of Extra Hepatic Billiary
Duct
16200
1045
Operation of Choledochal Cyst
16200
1046
Nephrectomy for -Pyonephrosis
16200
1047
Nephrectomy for -
16200
1048
Nephrectomy for -Wilms Tumour
16200
1049
Paraortic Lymphadenoctomy with Nephrectomy for Wilms Tumour
18800
1050
Sacro-
13900
1051
Neuroblastoma
1052
Neuroblastoma Total Excision
Excision
Atresia Operation
Perineal Anoplasty
Closure of Colostomy
Hydronephrosis
Coccygeal Teratoma Excision
Debulking
Signature of in-charge of the hospital with seal :-
13900
16200
Documents for EOI for empanelment of hospitals / Page No.- 35 1053
Rhabdomyosarcoma wide Excision
18800
Gynae, Operation Charges
1054
Abdominal Hysterectomy
13000
1055
Vaginal Hysterectomy
13000
1056
Myomectomy
11400
1057
Vaginoplasty
12700
1058
Laparotomy (Ectopic Pregnancy)
11400
1059
Vulvectomy (Simple/Radical)
16200
1060
RVF
16200
1061
Other Major Operations
16000
1062
Manchester Operations
13000
1063
Perineorrhaphy
11400
1064
Colporraphy
11400
1065
Modified Gilliam
10000
1066
Shirodkar’s Operation
7500
1067
Diagnostic Curettage
1800
1068
Fractional Curettage
2000
1069
D & C and Cervical Biopsy
2300
1070
Polypectomy
1100
1071
Other-Minor Operation
2600
1072
Excision Vaginal Cyst/Bartholin Cyst
2600
1073
Excision Vaginal Septum
3500
1074
Laparoscopy - Diagnostic
4040
1075
Laparoscopy Sterilisation
4300
1076
Laparoscopy Operative
12000
1077
Laparoscopy LAVH
22000
1078
Drilling of Overy
11700
1079
Myomectomy
10500
1080
Ectopic pregnancy
13400
1081
Hysteroscopy TCRE
11500
1082
Hysteroscopy Removal of IUCD
5250
1083
Hysteroscopy Removal of Septum
8250
1084
Hysteroscopy - Diagnostic
5700
1085
Werthimas Hysterectomy for Cancer cervix
21000
1086
Sterilisation Post Pertum
3000
1087
Sterilisation Intravaginal
2900
1088
Abortion- D & C
3000
1089
Abortion- Evacuation
2200
1090
MTP- 1st Trimester
2200
1091
MTP - 2nd Trimester
3500
Repair
Laproscopic Operations In Gen. Surgery / Gastrohepatic
/ Nephro1092
Laproscopic Pyloromyotomy
16000
1093
Laproscopic Gastrostomy
15200
Signature of in-charge of the hospital with seal :-
Documents for EOI for empanelment of hospitals / Page No.- 36 1094
Laproscopic Closure of Perforated peptic ulcer
19900
1095
Laproscopic Vagotomy Pyleroplasty/ gastro jejunostomy
21000
1096
Laproscopic umbilical hernia repair
21000
1097
Laproscopic ventral hernia repair
21000
1098
Laproscopic cystogastrostomy
20500
1099
Lap. Cholecystectomy & CBD exploration
22000
1100
Lap. Hydatid of liver surgery
21000
1101
Lap. Hepatic resection
22000
1102
Lap. Assisted small bowel resection
15000
1103
Lap. For intestinal obstruction
20000
1104
Lap. For intestinal perforation
20800
1105
Lap. Assisted Right Hemicolectomy
22000
1107
Lap. Assisted left Hemicolectomy
22000
1108
Lap. Assisted Total Colectomy
22000
1109
Laproscopic Rectopexy
19500
1110
Lap. Asisted Abdominoperineal Resection of rectum
25000
1111
Lap. Assisted anterior resection
22500
1112
Laproscopic Cholecystectomy
12500
1113
Laproscopic Appendicectomy
12500
1114
Laaproscopic Hernia Repair
12500
1115
Laproscopic Hiatus Hernia Repair
12500
1116
Laproscopic Adrenalectomy
12500
1117
Laproscopic Thyroidectomy
12500
1118
Laproscopic Spleenectomy
12500
1119
Laproscopic Colectomy
12500
1120
Laproscopic donor Nephroctomy
15000
1121
Infra red coagulation in Haemeroohoids
4500
1122
Laproscopic Pyelolithotomy
15000
1123
Laproscopic ureterolithotomy
15000
Specialised Procedures / Investigations
1124
Cat Scan (C.T.) Head/ Brain - Without Contrast
900
1125
Cat Scan (C.T.) Head / Brain - with Contrast
1400
1126
C.T. Head Scan Involv. Spl. Investigation - Without Contrast
1400
1127
C.T. Head Involv. Spl. Investigation -with Contrast
1900
1128
C.T. Chest (HRCT)
1700
1129
C.T. Chest (HRCT) - with Contrast
2140
1130
C.T. Spine (Cervical,Dorsal,Lumbar,Sacral) -Without Contrast
1440
1131
C.T. Spine (Cervical,Dorsal,Lumbar,Sacral) - with Contrast
2300
1132
C.T. Cervical C.T. 3D Reconstruction only --
2945
1133
C.T. Guided Biopsy
1000
1134
C.T. Guided percutaneous cath drainage
1200
1135
C.T. Myelogram (Cervical Spine) - Without Contrast
1800
1136
C.T. Myelogram (Cervical Spine)
2558
1137
C.T. Myelogram (Lumbar Spine or D/S) - Without Contrast
2000
1138
C.T. Myelogram (Lumbar Spine or D/S)- with Contrast
2558
- Without Contrast
Signature of in-charge of the hospital with seal :-
- with Contrast
Documents for EOI for empanelment of hospitals / Page No.- 37 1139
C.T. Scan Chest - Without Contrast
1400
1140
C.T. Scan Chest
2325
1141
C.T. Scan Upper Abdomen - Without Contrast
1300
1142
C.T. Scan Upper Abdomen - with Contrast
2092
1143
C.T. Scan Lower Abdomen - Without Contrast
1680
1144
C.T. Scan Lower Abdomen - with Contrast
2092
1145
C.T. Scan Whole Abdomen - Without Contrast
2092
1146
C.T. Scan Whole Abdomen - with Contrast
3400
1147
C.T. Scan Neck (Thyroid Soft Tissue) - Without Contrast
1560
1148
C.T. Scan Neck (Thyroid Soft Tissue) - with Contrast
1940
1149
C.T. Scan Orbits - Without Contrast
1200
1150
C.T. Scan Orbits - with contract
1750
1151
C.T. Scan Limbs
1700
1152
C.T. Scan Limbs - with Contrast
2300
1153
C.T. Scan Whole Body - Without Contrast
6000
1154
C.T. Scan Whole Body - with Contrast
7000
1155
C.T. Scan of Para Nasal Sinus - Without Contrast
1520
1156
C.T. Scan of Para Nasal Sinus - with Constrast
1860
- with Contrast
- Without Contrast
MRI
1157
MRI Head
- Without Contrast
1158
MRI Head - with Contrast
3500
1159
MRI Orbits - without Contrast
1700
1160
MRI Orbits - with Contrast
5000
1161
MRI Nasopharynx and PNS - Without Contrast
2500
1162
MRI Nasopharynx and PNS - with Constrast
5000
1163
MRI Neck - Without Contrast
2500
1164
MRI Neck - with Contrast
5000
1165
MRI Shoulder - Without Contrast
2500
1166
MRI Shoulder - with Contrast
5000
1167
MRI Shoulder both Joint - Without Contrast
2500
1168
MRI Shoulder both Joint - with Contrast
5000
1169
MRI Wrist Single Joint - Without Contrast
2500
1170
MRI Wrist Single Joint - with Contrast
5000
1171
MRI Wrist both Joint - Without Contrast
1000
1172
MRI Wrist both Joint - with Contrast
5000
1173
MRI Knee Single Joint - Without Contrast
2500
1174
MRI Knee Single Joint - with Contrast
5000
1175
MRI Knee both Joint - Without Contrast
2500
1176
MRI Knee both Joint - with Contrast
5000
1177
MRI Ankle Single - Without Contrast
2500
1178
MRI Ankle Single - with Contrast
5000
1179
MRI Ankle Both - Without Contrast
2500
1180
MRI Ankle Both - with Contrast
5000
1181
MRI Hip - Without Contrast
2500
1182
MRI Hip - with Contrast
5000
Signature of in-charge of the hospital with seal :-
2500
Documents for EOI for empanelment of hospitals / Page No.- 38 1183
MRI Pelvis - Without Contrast
2500
1184
MRI Pelvis - with Contrast
5000
1185
MRI Extremities - Without Contrast
2500
1186
MRI Extremities - with Contrast
5000
1187
MRI Temporomandibular Single Joint - Without Contrast
2500
1188
MRI Temporomandibular Single Joint - with Contrast
5000
1189
MRI Temporomandibular Double Joints - Without Contrast
2500
1190
MRI Temporomandibular Double Joints - with contrast
5000
1191
MRI Abdomen - Without Contrast
2500
1192
MRI Abdomen - with Contrast
5000
1193
MRI Breast - Without Contrast
2500
1194
MRI Breast - with Contrast
5000
1195
MRI Spine Screening - Without Contrast
1000
1196
MRI Spine Screening
4000
1197
MRI Chest - Without Contrast
2500
1198
MRI Chest - with Contrast
5000
1199
MRI Cervical Spine - Without Contrast
1000
1200
MRI Cervical Spine - with Contrast
5000
1201
MRI Lumber Spine
2500
1202
MRI Lumber Spine - with Contrast
5000
1203
MRI Screening - Without Contrast
1000
1204
MRI Screening - with Contrast
4000
1205
MRI Angiography - Without Contrast
1200
1206
MRI Angiography - with Contrast
5000
1207
Mammography (Single side)
450
1208
Mammography (Both sides)
540
1209
Bone Densitometry Single site
800
1210
Bone Densitometry Two sites
1000
1211
Bone Densitometry Three sites ( Spine , Hip & one extremity)
2000
1212
Bone Densitometry Whole body
1650
1213
2 D Echo with colour Doppler
1100
1214
Trans Oesophaedral Echo (TEE)
1300
1215
Holter Analysis
800
1216
Fluoroscopic Screening
120
1217
Holter Report (with Prd. Specification)
1200
1218
Test of Pacemaker
485
1219
Oxygen Saturation
250
1220
Cardiac Cath Angiography (W/o Coronary Angio)
11350
1221
Aortogram
3250
1222
Pulmonary function test
430
1223
Test for Pacemaker
325
1224
Package charges for Cardiovascular investigation
500
1225
Fibroptic Bronchoscopy with Washing/Biopsy
2300
1226
Uroflow Study (Micturometry)
400
1227
Urodynamic Study (Cystometry)
400
- with Contrast
- Without Contrast
Signature of in-charge of the hospital with seal :-
Documents for EOI for empanelment of hospitals / Page No.- 39 1228
Cystoscopy with Retrograde Catheter -Unilateral
3300
1229
Cystoscopy with Retrograde Catheter - Bilateral
4050
1230
Cystoscopy Diagnostic
1950
1231
Cystoscopy with Bladder Biopsy
2450
1232
Voiding-cysto-urethrogram
300
1233
Renal Transplant Evaluation
700
1234
Whole body scan
1616
1235
Spect bone Scan
2200
1236
Bone Marrow Scan
1500
1237
Scan (Spect)
2404
1238
Stress Thallium
3000
1239
Muga (Resting)
2200
1240
Muga (Stress)
2800
1241
A.V. Fistula
4000
1242
Coronary Angiography
10000
Cobalt 60 Therapy
1243
Radical Treatment
20100
1244
Palliative Treatment
10100
1245
Adjustment Therapy
16150
Linear Accelerators
1246
Radical Radiotherapy Linear
25240
1247
Palliative Radiotherapy Linear
25000
Brachy Therapy
1248
Intracavitary
1000
Interestical (Implant)
1249
Head & Neck
8100
1250
Breast
9700
1251
Soft Tissue Sarcome
12110
Chemotherapy Charges
1252
Single Drug Therapy per day
400
1253
Multiple Drug Therapy per day
650
1254
Infusional Chemotherapy
750
The rates indicated above are for semi-private ward
category. There will be 15% increase in package rates
for treatment in private ward & 10% decrease in
package rates for treatment in General ward. Rates for
all other procedures and investigations will be same
for all categories.Cost of implants will be extra,as
per ceiling rates.
Note:
1) Package rate is defined as lump sum cost of inpatient treatment or diagnostic procedure
for which a patient has been referred by competent authority or CGHS to Hospital or
Diagnostic centre. This include all charges pertaining to a particular treatment/procedure
including admission charges, Accommodation charges, ICU/ICCU charges, monitoring
charges, operation charges, anesthesia charges, operation theatre charges, procedural
charges/surgeon’s fee, cost of disposable, surgical charges and cost of medicine used
during hospitalization, related routine investigations, physiotherapy charges etc.
Signature of in-charge of the hospital with seal :-
Documents for EOI for empanelment of hospitals / Page No.- 40 -
2) The package rate does not include diet, telephone charges, T.V. charges and cost of
cosmetics, toiletry, tonics and medicines advertised in mass media. Cost of these, if
offered, on request of patient will be realized from the individual patient and are not to be
included in package charges.
3) The recognized hospitals/diagnostic centre will not charge more than the package rate
from the beneficiary.
-
12 days for specialised procedure.
7- 8 day for other procedures.
3 days for laproscopic surgery.
1 days for day care/minor procedures (OPD)
No additional charge on account of extended period of stay shall be allowed if
the extension is due to infection on the consequences of surgical procedure or due to
any improper procedure and is not justified.
In case, there are no CGHS prescribed rates for any test/procedure then AIIMS
rates are applicable. If there are no AIIMS rates then reimbursement is to be arrived at by
calculating admissible amount item-wise (e.g. room rent, investigations, cost of medicine,
procedure charges etc.) as per approved rates/actual, in case of investigations.
However if the beneficiary has to stay in the hospital for his/her recovery for
more than the period covered in the package rate, the additional reimbursement shall be
limited to room rent as per entitlement, cost of the prescribed medicines and
investigations, Doctors visit (not more than 2 times a day) for additional stay.
4) a) The entitlement for indoor treatment would be as under:
i)
Group DGeneral Ward.
Ii)
Group CSemi Pvt. Ward.
iii)
Group B & Gr A ( Upto STS)
Private Ward ( Non A.C.)
iv)
Group A JAG and above
Private Ward with A.C.
V)
CMD & Board Directors ( Full Time)
Deluxe room with A.C.
b) Package rate offered to CGHS for treatment in Semi Pvt. Ward is mentioned and
indicated in the rate list at Annexure-C
c) It has further been decided that the CGHS beneficiaries taking treatment in the above
mentioned hospitals with the prior permission of the CGHS will be entitled for
reimbursement as per the package rates given in the Annexure-C.( PART III schedule
for quoting rates). The rates for indoor treatment mentioned in attached Annexure are
for Semi Private Category. For private Ward there will be an increase of 15% and for
General Ward there will be a decrease of 10%.
d) The implant shall be reimbursed as per actual except for the items where ceiling is
defined.
5) A Private Hospital/Diagnostic centre whose rates for a procedure/test/facility are lower
than the approved rates shall charge the beneficiaries as per actual
6). a. The maximum room rent for different categories would be
.
General
Rs. 500/- per day
Semi Private
Rs. 1000/- per day
Private
Rs.1500/- per day
Day care(6-8 hours admission)
Rs. 500 per day (Same for all categories)
b..Room rent is applicable only for treatment procedures for which there is no CHGS
prescribed package rates.
c. Normally the treatment in higher category of accommodation than the entitle category is
not permissible. However, in case of emergency when the entitle category
Signature of in-charge of the hospital with seal :-
Documents for EOI for empanelment of hospitals / Page No.- 41 -
7
accommodation is not available, admission in the immediate higher category may be
allowed till the entitle category accommodation becomes available . however, if a
particular hospital does not have the ward as per entitlement of the beneficiary, then the
hospital can only bill as per entitlement of the beneficiary even though the treatment
was given in higher type of ward.
The beneficiary will have the option of availing specialized treatment/diagnostic tests at
BSNL panel Hospital/Diagnostic Centre of Kalyan SSA of his/her choice after the
Specialist of panel Hospital Medical Officer recommends the procedure/test.
8.
In case of an emergency the recognized private hospital shall not refuse admission or
demand advance from the beneficiary and shall provide credit facilities to the concerned
patient on the production of valid BSNLMRS Card. The recognized Hospital/Diagnostic
Centre shall submit the bill for reimbursement subject to the ceilng of approved rate to the
BSNL.
9.
The recognized hospitals/diagnostic centres will provide necessary medicines and all
disposable sundries of standard quality and will not get them purchased through CGHS
beneficiaries.
10. If one or more treatment procedures form part of the major treatment procedure package
charges would be made against the major procedures and only one half of approved
charges quoted for the other procedures would be added to the package charges of the
first major procedure.
11. Treatment taken in branches of the recognized hospitals will not be admissible for the
reimbursement.
12. Any legal liability coming out of such services shall be dealt by the hospital diagnostic
centre and it shall be responsible alone.
I/We have read this tender documents carefully before quoting the aforesaid rates, and
undertake to abide all terms and conditions enunciated therein.
Signature:
Name of the Authorized person:
Capacity in which signed above:
Name & Address of the Hospital:
Telephone No. (O):
(R):
Fax:
END OF PART –III
Signature of in-charge of the hospital with seal :-
Documents for EOI for empanelment of hospitals / Page No.- 42 -
PART IV
ANNEXURE-A
AGREEMENT
(To be executed on stamp paper of Rs. 100=00)
For providing medical facilities to BSNL employees & their Dependants
This agreement made at Kalyan on _____ day of ___________ 200
BETWEEN:
M/S. BHARAT SANCHAR NIGAM LTD. a Govt. of India Enterprise, having its
registered office at B148, Statesman house, Barakhamba road, New Delhi-110001 & SSA
Head Quarters at The Principal General Manager Telecom, Telephone Bhavan, Kala Talav,
Kalyan (West)-421 301 (hereinafter referred to as “the BSNL” for short, which expression shall
where the context so admits, include its succession and assigns) of the ONE PART.
AND
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
a hospital registered and approved by the local authority (hereinafter referred to as ‘the
hospital’ for short, which expression shall, where the context so admits, include its
Successors & Assigns) of the OTHER PART.
WHEREAS ‘the BSNL’ is in desire of formulating a ‘Scheme of providing medical
facilities to its existing and retired Employees so also to their Dependent family
members, keeping in view of the Health & Welfare of its Employees’ during the course of
their employment and even after their retirement, for that matter.
AND WHEREAS the BSNL, was on the look out for having a tie-up arrangement with a
Hospital, which could undertake to provide medical treatment facilities, to its Employees
regularly and for the said purpose, approached with a concrete proposal, the aforesaid
Hospital.
AND WHEREAS the hospital has accepted the proposal given by the BSNL and
agreed to provide medical treatment facilities to BSNL Employees and to their family
Dependents, covered under the ‘Scheme’ formulated by the BSNL.
AND WHEREAS the BSNL & the Hospital, herein mentioned have agreed to enter into
this Formal Agreement, recording the terms and conditions on which the aforesaid tie-up
arrangement is to be worked out and implemented.
NOW IT IS AGREED BETWEEN THE PARTIES HERETO AS FOLLOWS :
1)
It is agreed that the BSNL, will issue “Medical Cards” to all its eligible persons for
availing the medical facilities provided in the said hospital covered under the Scheme
2)
The Hospital will entertain the patients provisionally on producing Medical cards issued
by the BSNL and immediate Medical treatment will be given without insisting for any
advance payment. However, the Hospital can forward the bill immediately to the BSNL
for reimbursement, as per the scheme hereby agreed.
Signature of in-charge of the hospital with seal :-
Documents for EOI for empanelment of hospitals / Page No.- 43 -
3)
The hospital shall treat all cases involving indoor treatment referred to it by BSNL.
4)
The nominated nodal officer of BSNL shall verify the genuineness of beneficiary in all
indoor treatment(s). He will issue certificate after verification.
5)
The hospital will charge the BSNL serving & retired employees & their dependent
family members within the ceiling limits as described & contained in the schedule of
CGHS approved charges which are detailed (as approved by G.O.I., Ministry of Health
& Family Welfare, New Delhi in their letter No. F.No.S.11011/28/2006-CGHS Desk.
II/CGHS(P) dt. 04.12.2007).issued from time to time or the Charges quoted in the offer
submitted in expression of willingness whichever is less.
6)
All the charges to the working or retired employees of BSNL shall be at the schedule
rates fixed by CGHS vide G.O.I. Ministry of Health & Family Welfare, New Delhi in their
letter No. F.NO.S. 11011/28/2006-CGHS Desk. II/CGHS(P) dt. 04.12.2007) and if any
charges are made other than the schedule rates, it has to be done generally with prior
written consent of BSNL
7)
----------------------------------------------------------Hospital will send the bills directly to BSNL
in duplicate to the concerned Drawing & Disbursing Officers (DDOs) of the office which
has issued the authorization letters. The bills should contain the copy of authorization
letter, verification certificate issued by Nodal officer.
8)
Payment of the bills shall be made after due scrutiny & certificate of BSNL within one
month from the date of receipt of the bill.
9)
The authorization letters are to be sent in original by BSNL (required detailed
clarification).
10)
Where due to surgical procedure or for any other reason stay in the hospital beyond
schedule is necessitated the hospital shall inform BSNL in advance.
11)
The schedule of rates as per rates quoted by you or CGHS rates whichever are lowest
shall form an integral part of this agreement.
12)
Admission sought by the patients on Saturdays, Sundays, General Holidays & in case
of Emergency may be permitted on the basis of Medical Card/Identity Card
provisionally. The authorization letters are produced on next working day. In such
cases the hospital may issue a certificate about the emergency condition of the patient
and send the same along with the monthly bill.
13)
The Hospital shall also provide reports in the prescribed format to the BSNL Office in
respect of the beneficiaries treated on monthly basis by the 10 th day of the succeeding
calendar month in proforma enclosed.
14)
“During in-patient treatment of the “Any liability on account of default or negligence on
the part of the Hospital in providing or performing the medical services, arises, the
Hospital shall alone be responsible for such deficiency of service and the BSNL will no
way be responsible for the same.
15) “In case of charging excess amount or any discrepancy found in the bill amount, the
BSNL is entitled to make factual enquiry pertaining to the case against which the bill is
raised and the decision taken by the BSNL shall be final, in respect of its payment.
Signature of in-charge of the hospital with seal :-
Documents for EOI for empanelment of hospitals / Page No.- 44 -
16) “During in patient treatment of the BSNL persons covered under the scheme, the hospital
shall not ask the eligible person to purchase medicines from outside, but will have to be
arranged and provided by the Hospital itself as a package deal, at the approved rate by
the CGHS vide G.O.I. Ministry of Health & Family Welfare, New Delhi in their letter No.
F.No.S.11011/28/2006-CGHS-Desk.II/CGHS(P) dt. 04.12.2007) which includes the cost
of drugs, surgical instruments and other medicines etc.
17) “This agreement shall, remain in force for a period of ONE/TWO YEARS from the date of
execution by both parties or finalisation of new panel whichever is earlier”.
18) “In case of any breach of the terms of this agreement, either party by giving one month
Notice (clear 30 days to be counted from the receipt of the Notice) in writing to the other,
can terminate this contract. Such Notice will have to be sent by Registered A.D. on the
specific address of the parties given as under.
(a) The Principal General Manager Telecom, Telephone Bhavan, Kala Talav,
Kalyan-421 301 (West). BHARAT SANCHAR NIGAM LTD.
(b) (Name of the hospital)
_________________________________________________________
_________________________________________________________
19) The BSNL shall have a lien and also reserve the right to retain and set off against any
sum which may, from time to time be due to and payable to the hospital hereunder, any
claim which the BSNL may have against the hospital under this or any other agreement.
20) The Hospital shall pay all legal expenses incidental to the preparation and stamping of
this agreement.
21) “All questions, disputes or difference arising out of this agreement, relating to the
interpretation of this agreement or concerning or relating to the rights, duties or liabilities
of the parties (whether during the continuance of the agreement or after its completion
and whether before or after the determination or breach of the contract), shall be referred
to the decision of a Sole Arbitrator who shall be Nominee of the BSNL. This reference
shall be deemed to be a reference to arbitration within the meaning of the Arbitration &
Conciliation Act 1996.
22) The original copy of this agreement shall be kept at the office of The Principal General
Manager Telecom, Telephone Bhavan, Kala Talav, Kalyan(West)-421 301 and a true
copy shall be retained in the office of the hospital.
23) “The Hospital shall provide access to the financial and medical records to BSNL, for the
purpose of enquiry, assessment and review of any case, as and when required by BSNL
on its specific request in writing.
Signature of in-charge of the hospital with seal :-
Documents for EOI for empanelment of hospitals / Page No.- 45 -
IN WITNESS WHEREOF the parties hereunto have put their respective hands on the
day and year first hereinabove written.
DATED this ______ day of ________________ 2010.
SIGNED & DELIVERED BY THE
WITHINNAMED
BHARAT SANCHAR NIGAM LTD.
The party of the ONE PART, through
The Asstt. General Manager (Admn)
O/o PGMT,BSNL, Kalyan
_____________________________
In the presence of
_____________________________
SIGNED & DELIVERED by the
Within named hospital
_____________________________
the party of the OTHER PART
through its :
Chief Medical Officer
_____________________________
In the presence of
____________________________
Signature of in-charge of the hospital with seal :-
)
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Documents for EOI for empanelment of hospitals / Page No.- 46 -
Annexure-O
OPINION CERTIFICATE
ON LETTER HEAD OF ISSUING AUTHORITY
Certified that -------------------------------------hospital having its address-------------------------------------------------------------------------------------------------------------was
examined on ------------------- and found that the information submitted by Dr ----------------------------------------in Annexure G of BSNL is correct and there are basic
facilities for treatment of common illness and -------------------- specialist.
Dr ---------------------------------------is senior doctor and is capable of treating
emergencies also.
Medical Officer Health.
Seal
Signature of in-charge of the hospital with seal :-
Documents for EOI for empanelment of hospitals / Page No.- 47 -
ANNEXURE -D1
CERTIFICATE OF HOSPITALISATION
(to be completed in the case of patients who are admitted to hospital for treatment)
Certificate granted to Mrs./Mr./Miss …………………………………..………..
husband/wife/son/daughter/mother/father of Mrs./Mr. …………………………….
Employed in the office ………………………………..…., BSNL.
PART-‘A’
I, Dr. ……………………………………………….. hereby certify:
(a) that the patient was admitted to hospital on ………………………….
(b) that the patient has been under treatment at ………………………. And that
the under mentioned medicines prescribed by me in this connection were
essential for the recovery/prevention of serious deterioration in the condition
of the patient.
(c) that the patient is/was suffering from …………………. and is/was under
treatment from………………..….. to …………………..
(d) that the X-ray, laboratory tests, etc. for which an expenditure of Rs. …………
was incurred were necessary and were undertaken on my advice at
………………… ………………… (name of hospital or laboratory)
Signature and Designation of the
Medical Officer-In-Charge of the
Case at the hospital
Signature of in-charge of the hospital with seal :-
Documents for EOI for empanelment of hospitals / Page No.- 48 -
ANNEXURE-V
CERTIFICATE OF VISIT BY BSNL NODAL OFFICER
Proforma attached with Order No. BSNL/Admn.I/15-2/05 (Pt.) Dt. 8th August 2005
As per the instructions of …………………………………………………….…,
I visited the…………………………………………………. hospital at ……………...
AM/PM on……………………(date) and found that ………………… ………………
(name of the patient) is undergoing treatment/was undergone treatment under
Dr. …………………………., under Registration No.…………………….… in ward
No. …………..……….. and observed/verified from the hospital record the
following particulars of the patient.
Date of admission: ………………………………..
Name of Disease: ………………………………..
Name of employee ………………………………
Relationship with the employee …………………………
BSNLMRS Card No. ……………………………………..
The patient/the employee is satisfied with the treatment being given. As
per the documents available with him/her, he/she is found to be the authorized
beneficiary to take treatment under the BSNLMRS.
Signature
Name of the Officer
Date: ……………………
Place: …………………..
To
AO(Claims)
O/O PGMT, Telephone Bhavan,
Kala talav, Kalyan,421301
Signature of in-charge of the hospital with seal :-
Documents for EOI for empanelment of hospitals / Page No.- 49 -
Annexure-F
BHARAT SANCHAR NIGAM LTD
(A Government of India Enterprise)
Office of the
Principal General Manager Telecom,
Administration Section,Telephone Bhavan, Kala Talav ,
Kalyan (W).
No. …………………………………………………………… Dated………………..
Authorization Letter for Treatments in Hospital
This is to certify that Shri/Smt. ……………………………………….. (Name
of the patient),Age ……………………… is the Husband/Wife/Son/Daughter/
Mother / Father of Shri/Smt.………………………………………., an employee of
BSNL. He/She may be admitted in (Hospital’s Name) …………………………
……………………………….. as per his/her room entitlement, i.e., ………………
…………..
He/She may be charged as per agreed rates with BSNL.
Bills as per agreed rates may be sent to AO (Claims),O/O PGMT,
Telephone Bhavan, Kala talav, Kalyan for payment.
( Signature & Stamp of the Competent Authority)
Signature of in-charge of the hospital with seal :-
Documents for EOI for empanelment of hospitals / Page No.- 50 -
Annexure-G
RELEVANT INFORMATION FOR PROCESSING CASE FOR
EMPANELMENT OF HOSPITALS
1.Name of the Hosital
:
Whether the hospital is recognized by the State Government for treatment of its
employee and if so, a copy of the order thereof.
2. Location/Address of the Hospital
:
Map of the city/town showing the excat location of the hospital to be attached.
3. (I) Names of Govt hospital(s) recognized hospital(s) within a radius of 4 kms.
(II) Clinical facilities available in the above hospitals.
4. Indoor facilities :
( I) No of beds in the hospital – specially wise.
(II)
Gneral Wards
- Number
- Size
- No of beds in each size
- Amenities provided
- Rates
(III) Semi private wards
- Number
- Size
- No of beds in each size
- Amenities provided
- Rates
(IV) Private wards
- Number
- Size
- No of beds in each size
- Amenities provided
- Rates
(V) Operation theatre
- Number
- Size
- Equipment
- Rates
Signature of in-charge of the hospital with seal :-
Documents for EOI for empanelment of hospitals / Page No.- 51 -
(VI) Diagnostic facilities
- Pathological
- Radiological
- Others
- Rates
(VII) Details of the blood bank
(VIII) ICU & ICCU
5. Emergency and Trauma services
I)
No of ambulances available.
II)
No of Doctors available with particular reference to emergency and
Trauma services.
6. Specialised services
I)
Nature of specialized service
II)
Name of specialists with qualifications and field of specialization.
III) Facilities of clinical investigation.
7. Facilities for family planning services.
8. Doctors.
I)
II)
III)
IV)
List of Doctors available and their biodata.
Terms and conditions of the employment of doctors with particular
reference to
-pay
-duration of the appointment whether part time or full time.
Private practice whether allowed or not
The names of hospitals or clinical centers the said doctors are associated
with
9. Paramedical Staff
I)
Condition of employment of paramedical personnel
- Full time/part time
- Pay
- Duration for which appointed
10. Average OPD attendance during last one year.
11. Schedule of charges (schedule of charges of nearby Govt. hospitals and one nearby
recognized hospital are to be furnished for comparison purpose)
12.Particulars of casualty services in the hospitals
13. Percentage of free treatment in OPD and also reserved beds for poor patients
Signature of in-charge of the hospital with seal :-
Documents for EOI for empanelment of hospitals / Page No.- 52 -
14.Inventory equipments
15.Residential Physicians and residential Surgeons
16.
I)
II)
III)
IV)
Doctors-patient ratio
Doctors – Nurses ratio
Nurses – patients ratio
Bed Occupancy rate at presen
Signature of in-charge of the Hospital with seal
Signature of in-charge of the hospital with seal :-
Documents for EOI for empanelment of hospitals / Page No.- 53 -
LETTER FOR AGREEING CGHS RATES ON HOSPITAL LETTER HEAD.
No ----------------------------------------------------------------------------------------To,
The Asstt. General Manager (Admn),
O/o PGMT,BSNL, Kalyan 421001.
Sub- Agreeing of CGHS Rates for empanelment of Hospital.
Sir,
I, Dr.--------------------------------------------------- , Name of Hospital--------------------------------------------------------- gone through the CGHS Rates and agree for the
same.
Thanking you,
DatePlace-
Signature of in-charge of the hospital with seal :-
Signature
Name
Name of Hospital with seal.