Common Deficiences
PHASE DISTRICTS COVERED Policy period
Phase-I (4th Renewal) - 938 Procedures Anathapur, Mahaboobnagar, Srikakulam, Medak, Karimnagar, Y.S.R., Prakasam & SPS Nellore 05.04.2011 to 04.04.2012
Common Deficiencies:
 
  1. Qualifying criteria:

  2. i. The declaration is incomplete, it excludes the portion dealing with incurred claim ratio of Government sponsored insurance schemes as per the latest IRDA circular and as requested in bid.
    ii. Submitted without any mention of half yearly periods but for the full policy periods as against the requirement shown in annexure. All the net claim ratios for two consecutive policy years are exceeding 90% claim percentage.
    iii. Policy documents not submitted under qualifying criteria in support of experience.
    iv. The declaration and pages of bid document are signed by other than the officer indicated in document and is marked as ‘for' without any name or designation

  3. Draft policy:
  4. i. Scope of cover mentioned under Clause No.2 is only for 352 procedures in 14 systems as against 938 procedures in 31 systems mentioned in the bid.
    ii. Sub limits of the medical expenses defined in clause No.1.9 is contradictory to the cashless packages of the scheme.
    iii. Clause No.1.9 & 1.10 are contradictory to each other.
    iv. Clause No.4 excludes all other procedures other than 352 from the scope of coverage.
    v. Part III of the Schedule have overriding clause incorporated with many conditions are not part of the scheme and MOU. vi. Termination clause (Clause 12 in schedule 3) is not in conformity with the termination clause No. 25 of MoU.