Medical Branch-I

Sub: Guidelines for entering into up Arrangement for Provision of Super SpecialityServices to the ESI Beneficiaries.

System Division may please find enclosed herewith a photocopy of Guidelines alongwith draft arrangement on the subject cited above with the request to upload the same onESIC-website.

Encl: As above~ \\",

GUIDELINES FoR ENTERING INTO TIE UP ARRANGEMENT FORPROVISION OF SUPER SPECIALTY SERVlES TO THE ESI

BENEFICIARIES

1) Tie up arrangement should be made with all CGHS approved Hospitals

/ Institutions (whether public or private) in the State on the CGHS

rates and terms and conditions. For tie up consent may be obtained

from the empanelled centres and Memorandum of Agreement ( MoA)

may be signed.

2) Tie up arrangements already made by the State Govt. will continue on

the same terms and conditions and SSMC/SMCjMS/Director (Med.)•.~~

Delhi may adopt the same.

\) It may be ensured that all areas where IPs are concentrated are covered

and they are not required to unnecessary travel long distances and that

the facility is available at nearest possible location.

B) Tie up arrangement with hospitals / institutions ( public /private) not on CGHS panel.

In the State where there is no CGHS approved centres or the approved

centres are not available in the areas, where IPs are concentrated, new tie up

arrangements are to be made on theCGHS rates applicable in the State or of

the neighbouring State as per the following guidelines:-

I ) Offers may be invited from reputed hospitals / institutions

providing diagnostic services / super specialty I tertiary careservices for empanelment under ESIC on CGHS rates and terms

and conditions.

2) If the CGHS approved hospitals I institutions are not in their ina particular State, CGHS rates of nearby States may be adopted.

3) A Memorandum of Agreement may be signed with the hospital /

institutions, who agreed to provide the services on the h;::!sls of

CGHS rates.

4) While entering into tie up, it should be ensured that IPs are not

required to travel long distances.

1

Suitable earnest money / security deposit rnay be obtained fromthe centre with which tie up is being made.

The empanelment should be done initially for a period of 2 years

and the same can be extended with mutual consent.

A committee appointed by SSMC/SMC/Director (Med.) will

ensure that the centre empanelled has the requisite facility for

providing the facilities and also has trained, qualified

professional staff.

Empanelled centre will provide cashless service to the IPs and

their families.

9) Empanelled centre will honour all permissions issued by the

referring authority as indicated in the Memorandum - of~

Agreement.

10) While entering into the agreement, the payment schedule, the

referring authority schedule procedure for submission of bills,

authority for referral of cases to the empanelled centres may beclearly specified.

I 1) The empanelled centres will provide all the facilities included in

the package including medicines etc.

12) The empanelled centre will investigate I treat the ESIbeneficiaries only for the condition for which they have been

referred. However, in case of unforeseen emergencies of these

patients, life saving measures be taken and approval may be

taken from the competent authorities later.

J 3) It may be ensured that the empanelled centre has got valid

registration recognition and all statutory I mandatory licensesrequired.

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8)

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DRAFf AGREEME:NTBETWEEN ESIC

AND....................................... , NEW DELHI

This Agreement is made on the day of , 200~ betweenthe SSMCs/SMCs/DMD/ M.S.ESI Corporation, New Delhi having its office at ESICorporation, (hereinafter called ESIC, whichexpression shall, unless repugnant to the context or meaning thereof, be deemedto mean and include its successors and assigns) of the First Part

ANb4i

............................................... (Name of the Hospital with Address) ( herein aftercalled the empanelled centre) of the Second Part.

WHEREAS, the ESI Corporation is providing comprehensive medical carefacilities to the ESI Beneficiaries.AND WHEREAS, SSMCs/SMCs/DMD/ M:S. proposes to provide treatmentfacilities to the ESI Beneficiaries in the Private Recognized Hospitals.AND WHEREAS, (Name of the Hospital) offered to give the following treatmentI diagnostic facilities to the ESI Beneficiaries in the Hospital.............................. , .

NOW, THEREFORE, IT IS HEREBY AGREED between the Parties as follows:

1. Em panelled centre will provide all the facilities as per the package rates

agreed to for various procedures, investigations, etc. on the CGHS rate

and terms and conditions to ESIC beneficiaries.

2. Empanelled centre will provide all the services on cashless basis to ESI

beneficiaries.

3. The empanelled centre will provide treatment only to referred

beneficiaries by the competent authority as defined.

4. The empanelled Hospital shall provide services only for which it has

been empanelled by ESIC at rates fixed by CGHS from time to time and

shall be binding.

5. A copy of Discharge Slip incorporating brief history of the case, "'-diagnosis, details of procedure done, reports of investigation, andidentification stickers of implants treatment given and advised shall besubmitted by the hospital along with the ad~':l8Jmentbill.

6. The Hospital agrees that any liability arising due to any default ornegligence in providing or performance of the medical services shall beborne exclusively by the hospital who shall alone be responsible for theeffect and/or deficiencies in rendering such services.

7. The Hospital agrees that during the In-patient treatment of the ESI

beneficiary, the Hospital will not ask the beneficiary or his attendant topurchase separately the medicines / consumables / equipment oraccessories from outside and will provide the treatment within thepackage deal rate, fixed by the ESIC which includes the cost of all the

items. Appropriate action, including removing from ESICempanelment and / or termination of this Agreement, may be initiatedon the basis of a complaint, medical audit or inspections carried out byESI team.

8. The Hospital will honour permissions issued by the Referring

Authority i.e. Medical Superintendent to the ESI beneficiaries holding

ESI Medical Benefit Card. Treatment will be provided as per prevalent

/applicable,CGHS rates.9. In case of any natural disaster / epidemic, the hospital/diagnostic

hospital shall fully cooperate with the ESIC and will convey / reveal allthe required information, apart from providing treatment.

10. The procedure for submission / payment of bills will be as under.-

11. The hospital will investigate / treat the CGHS beneficiary patient onlyfor the condition for which they are referred with permission, and in

the specialty and / or purpose for which they are approved by ESIC. Incase of unforeseen emergencies of these patients during admission for

approved purpose / procedure. Necessary life saving measures be

taken and concerned authorities may be informed accordingly later

with justification.

1.2. The Hospital will not refer the patient to other specialist/ other hospital

without prior permission of ESIC authorities. '

13. The duration of indoor treatment for specialized and other procedures

will be as per CGHS terms and conditions.

14. DUTIES AND RESPONSIBILITIES OF EMPANELLED HOSPITALS /DIAGNOSTIC CENTERS

It shall be the duty and responsibility of the Hospital at all times, to obtain,

maintain and sustain the valid registration, recognition and high quality and

standard of its services and healthcare and to have all statutory / maadatorylicenses, permits or approvals of the concerned authorities under or as per the

existing laws".

15. HOSPITAL'S / DIAGNOSTIC CENTER'S INTEGRITY ANDOBLIGAlTONS DURING AGREEMENT PERIOD

The Hospital is responsible for and obliged to conduct all contracted activities

in accordance with the Agreement using state-of-the-art methods and economic

principles and exercising all means available to achieve the performance specified

in the Agreement. The Hospital is obliged to act within its own authority and

abide by the directives issued by the ESIC. The Hospital is responsible for

managing the activities of its personnel and will hold itself responsible for their

misdemeanors, negligence, misconduct or deficiency in services, if any.

16. LIQUIDATED DAMAGES

The Hospital shall provide the services as per the requirements specifiedby the ESIC in terms of the provisions of this Agreement. In case of initialviolation of the provisions of the Agreement by the recognized private Hospital,the amount equivalent to 15% of the amount of security deposit will be charged asagreed Liquidated Damages by the ESIC, however, the total amount of thesecurity deposit will be maintained intact being a revolving Guarantee.

17. In case of repeated defaults by the Hospital, the total amount of securitydeposit will be forfeited and action will be taken for removing the Hospitalfrom the empanelment of ESIC as well as termination of this Agreement.

IS. For over-billing and unnecessary procedures, the extra amount socharged will be deducted from the pending / future bills of the Hospital and '-the ESIC shall have the right to issue a written warning to the Hospital not todo so in future. The recurrence, if any, will lead to the stoppage of referral tothat Hospital.

19. TERMINATION FOR DEFAULT

19.1 The ESIC may, without prejudice to any other remedy for breach ofAgreement, by written notice of default sent to the Hospital terminate theAgreement in whole or part:

a. If the Hospital fails to provide any or all of the services for whichhas been recognized within the periodfs) specified in theAgreement, or within any extension thereof if granted by the ESICpursuant to Condition of Agreement or

b. If the Hospital fails to perform any other obligation(s) under thei\greement. ~

c. If the Hospital, in the judgment of the ESIC has engaged in corruptor fraudulent practices in competing for or in executing theAgreement.

19.2 If the hospital found to be involved in or associated with any unethicalillegal or unlawful activities, the Agreement will be summarily suspendedby ESIC without any notice and thereafter may terminate the Agreement,after giving a show cause notice and considering its reply if any, receivedwithin 10 days of the receipt of show cause notice.

20 INDEMNITY

The Hospital .shall at all times, indemnify and keep indemnified ESICagainst all actions, suits, claims and demands brought 'or made against itin respect of anything done or purported to be done by the Hospital inexecution of or in connection with the services under this Agreement andagainst any loss or damage to ESIC in consequence to any action or suitbeing brought against the ESIC, along with (or otherwise), Hospital as aParty for anything done or purported to be done in the course of theexecution of this Agreement. The Hospital will at all times abide by the jobsafety measures and other statutory requirements prevalent in India andwill keep free and indemnify the ESICfrom all demands or responsibilitiesarising from accidents or loss of life, the cause or result of which is theHospital negligence or misconduct.

The Hospital will pay all indemnities arising from such incidents withoutany extra cost to ESIC and will not hold the ESIC responsible or obligated.ESIC may at its discretion and shall always be entirely at the cost of the

Hospital defend such suit, either-jointly with the Hospital or singly in casethe latter chooses not to defend the case.

21 ARBITRATION

If any dispute or difference of any kind whatsoever (the decision whereofis not herein otherwise provided for) shall arise between the ESIC and theHospital upon or in relation to or in connection with or arising out of theAgreement, shall be . referred to for arbitration by theSSMCs/SMCs/D(M)D/M.S. who will give written award of his decision tothe Parties. The decision of the Arbitrator will be final and binding. Theprovisions of the Arbitration and Conciliation Act, 1996 shall apply to thearbitration proceedings. The venue of the arbitration proceedings sIwll beat Delhi / New Delhi.

22 MISCELLANEOUS

22.1 Nothing under this Agreement shall be construed as establishingor creating between the Parties any relationship of Master andServant or Principal and Agent between the ESIC and theHospital.

22.2 The Hospital shall not represent or hold itself out as agent of theESIC.

22.3 The ESIC will not be responsible in any way for any negligence ormisconduct of the Hospital and its employees for any accident,injury or damage sustained or suffered by any ESIC beneficiary orany third party resulting from or by any operation conducted byand on behalf of the Hospital or in the course of doing its work orperform their duties under this Agreement or otherwise.

22-4 their status and their shareholdings or that qf any Guarantor ofthe Hospital in particular where such change would have an impacton the performance of obligation under this Agreement.

22.5 This Agreement can be modified or altered only on writtenagreement signed by both the parties.

22.6 Should the hospital get wound up or partnership is dissolved, theESIC shall have the right to terminate the Agreement. Thetermination of Agreement shall not relieve the hospital or theirheirs and legal representatives from the liability in respect of theservices provided by the Hospital during the period when theAgreement was in force.

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22.8

The Hospital shall bear all expenses incidental to the preparation ~,and stamping of this agreement.A recognized private hospital whose rates for aprocedure/test/facility are lower than the approved CGHS ratesshall charge the ESI beneficiaries as per actuals.

23. NOTICES

23.1 Any notice given by one party to the other pursuant to this Agreementshall be sent to other party in writing by registered post or by facsimile andconfirmed by original copy by post to the other Party's address as below.

ESIC : SSMCs/SMCs/D(M)D/M.S. ESI Corporation

Hospital with address:( )

23.2 A notice shall be effective when served or on the notice's effective date,whichever is later. Registered communication shall be deemed to havebeen served even if it returned with remarks like refused, left, premiseslocked, etc.

IN WITNESSES WHEREOF, the parties have caused this Agreement to besigned and executed on the day, month and the year first abovementioned.

Signed by

SSMCs/SMCs/D(M)D/M.S.

In the Presence of(Witnesses)