HEALTH CARE TPA LTD.

Corp. Office: Alankit House, 2E/21 Jhandewalan Extn., New Delhi 110 055
NS-ENISO9001:2008/ISO9001:2008

Phone: 42541256-60, Fax: 42541266-67, E-mail: health@alankit.com

REQUIREMENT FROM HOSPITAL FOR EMPANELMENT ANNEXURE-I

1. Hospital Profile a. No. of Beds with details including I.C.U., N.I.C.U., etc. b. Detailed list of OT Equipments . c. RMOs Qualification. d. No. of Nurses with their Qualification. e. OT size. f. Laboratory facilities available In house & Name of the Pathologist & his qualification g. X-ray facility available In house & Name of the Radiologist & his qualification h. Pharmacy Facility In-house i. Ambulance Facilities. 2. List of Consultant with their Qualification (necessary) & Certificate of Qualification (if possible). 3. Soft & Hard copy of Detailed Tariff List which contains details of room rent including (nursing care charges, RMOs charges), Package rates of all Operation/Treatments in the prescribe format as shown below (MANDATORY). ROOM RENT CHARGES CATEGORY OF ROOM RENT TYPE ROOM RENT, NURSING CARE CHARGES/DAY, RMOS CHARGES/DAY CONSULTANT FEE/VISIT SPECIALIST CONSULTANT FEE/VISIT SUPER SPECIALIST PACKAGE TA RIFF RATES S.NO PACKAGES 1 PACKAGE 1 2 PACKAGE 2

GEN/CUB/ WARD

SHARING ROOM

PRIVATE ROOM

A/C ROOM

GEN-WARD

SHARING ROOM

SINGLE ROOM

PACKAGE TARIFF PERCENTAGE INCREASE S.NO PACKAGES GENSHARING WARD(BASE) ROOM(% INCREASE) 1 PACKAGE 1 2 PACKAGE 2 *% Increase is with respect to the General Ward

SINGLE ROOM(% INCREASE)

Package rates of treatment/Operation should include a. Room rent, Nursing care charges. b. Investigation charges. c. Surgeon charges, Asst. surgeon charges, Anaesthesist charges.

HEALTH CARE TPA LTD.

Corp. Office: Alankit House, 2E/21 Jhandewalan Extn., New Delhi 110 055
NS-ENISO9001:2008/ISO9001:2008

Phone: 42541256-60, Fax: 42541266-67, E-mail: health@alankit.com

4. 5. 6. 7. 8. 9.

d. OT charges, OT consumbales. e. Medicine charges. Copy of PAN of the hospital (Mandatory). Copy of Registraion Certificate of Hospital. Proof of Excemption Certificate if possessed by Hospital, otherwise TDS will be deducted on final bill (as per income tax rules). E-mail ID of the hospital. Name of the Grievance officer with mobile no. Bank Account No. of the hospital (mandatory)

Note: Please mention for how many years the above agreed tariff would be available (with mutual consent) ON RECEIPT OF ABOVE AND AFTER APPROVAL, FURTHER PROCESS OF EMPANELMENT WOULD START IN WHICH WE SEND THE BELOW MENTIONED DOCUMENT TO HOSPITALS. 1. 2 copies of MOU. 2. Hospital Information Sheet. 3. ECS form. Hospitals are required to complete these document, duly signed and stamped from authorized signatory and send back to us for final processing. POINT TO BE NOTED

1. Reusable items are not payable like. a. C-ARM. b. REUSABLE EQUIPMENT CHARGES. c. PULSE OXYMETER. d. MONITOR CHARGES. e. LAPROSCOPIC INSTRUMENTS, ETC. f. NO DIET CHARGES. g. NO ADMISSION/ REGISTRATION CHARGES, FILES CHARGES, ETC. h. NO SEPARATE P HACO CHARGES. i. ROOM RENT ARE NOT PAYABLE IN DAYCARE EYE SURGERIES. j. SERVICE CHARGES AND ANY TYPE OF TAXES ARE NOT PAYABLE.
Payments related to above mentioned and similar items should be charged directly from patients before discharge. 2. Disposable items are payable, if used. The Tariff rates given by the hospital would be applicable for 3 years from signing the agreement and would not change during the period.