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SUPPLEMENTARY HOSPITAL AGREEMENT

This Supplementary Hospital Agreement ("Agreement'') made and entered into on this --------------day

of ................... at(................................................................................................................................... ], India,

licensed by the Insurance Regulatory and Development Authority under the IRDA (Third Party
Administrator Health Services) Regulation 2001 under license no. 35 having its Registered office at 11-C,
Corporate Park, Chem bur Mumbai- 400071 being a company specialized in rendering health services in
connection with health insurance business, (hereinafter referred to as the ''TPA" which expression shall,
unless repugnant to the context or meaning thereof, be deemed to mean and include its successors and
permitted assigns) of the SECOND PART.

AND
[.... L.-J'F G.. C/lA..E?..... 11.0 .'S P.J:Tll .L.............................................................................................
............. ), a unit of ............................ a company incorporated in India with its registered office at

(hereinafter referred as the "Hospitar' which expression shall, unless repugnant to the context or
meaning thereof, be deemed to mean and include its successors and permitted assigns) of the Third
Part. (The "TPA" and the "Hospital" are individually referred to as a "Party" and collectively as "Parties")

WHEREAS

1. The TPA and the Hospital have executed an agreement dated I................. ) ("Original Hospital
Agreement'') whereby the Hospital provides "in-patient" medical and/or surgical treatment to Approved
TPA Members and the TPA reimburses the charges of the Hospital for provision of such "in-patient''
medical and/or surgical treatment ("Services").

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2. The parties have now decided to supplement the Original Hospital Agreement wtth this Agreement to
record the understanding and agreement between the Parties with regard to Implementation of
Insurance Regulatory and Development Authority (Health Insurance) Regulations, 2013 l"Regulatlons").

NOW lllEREFORE IT IS AGREED as follows:

1. DERNITIONS & INTERPRETATION

1.1 Capitalized terms not specifically defined in the main body of the Agreement shall have the same
meaning set forth in the Original Hospital Agreement
1.2 Scope of Services provided by the Network Provider
1.3 The tariff applicable with respect to various kinds of healthcare services being
provided by the network provider.
1.4 A clause specifically requiring only the insurance company the power to deny a claim.
1.5 Turnaround times for each of the services rendered by the parties, the course
of action in case of default of services
1.6 The responsibilities and obligations of each of the parties to the agreement in
enforcing the agreement etc.

2. SCOPE AND EXTENT OF THE ADDENDUM

a. The Parties agree that the scope of Services, the fees payable and the terms and conditions relating
to the Services shall be as per the Original Hospital Agreement except to the extent the same is
inconsistent with the Regulations, the provisions of the Regulations shall prevail.

b. The TPA represents that it acts as a registered as a third party administrator in accordance with
applicable law and is duly authorized by the insurance companies listed out in Annexure I ("Insurers") to
act as a third party administrator in accordance with applicable law include but not limited to !RDA (Third
Party Administrator -Health Services) Regulation, 2001 and the Regulations. The Annexure I may be
modified or supplemented by the TPA at any time by providing a notice in writing to the Hospital.

c. The Parties agree that the TPA shall execute an agreement with each of the Insurer to ensure that
each such Insurer shall be bound by the terms and conditions of this Agreement. The Hospital
acknowledges and agrees that the Insurer by executing the agreement as stated above shall deemed to
be a party to this Agreement.
d. The Parties acknowledge and agree that by such deemed inclusion of the Insurer to this Agreement,
the Parties and the Insurer shall be eligible to exercise all rights and shall be bound by all obligations a~
prescribed under the Regulations.
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Hospital Auth Si~nature
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e. Notwithstanding anything to the contrary stated In payment clause of the Original Hospital
Agreement, the duty and liability to reimburse any settled claim shall solely be the responsibility of the
Insurer and the Insurer shall make the payments to the Hospital through the TPA or through such
mechanism as may be mutually agreed upon between the Insurer and the TPA herein in accordance
with Applicable Law.

f. All claims shall be repudiated by the Insurer and shall be intimated to the Hospital and claimants
through the TPA. It shall be clearly indicated in the repudiation letter that "As per the instructions of the
insurer <name of the insurer>, the claim is being denied for Rs. <amount> on account of

<specifics of treatment/ grounds of denial>. For further clarification, you may directly contact the
insurer".

IN WITNESS WHEREOF, the Parties have caused this Agreement to be executed by their duly
authorized representative/s in as of the date first hereinabove written.

SIGNED, SEALED and DELIVERED by the within named:

Authorized Signatory of the Hospital In the Authorized Signatory of the TPA In the
presence of presence of
1) (witnesses)
1) (witnesses) ~M(5 1-1
2)
2)
Authorized Signatory
Authorized Signatory : '
Designation:
Designation:

For LIFE~1~PITAt

Hospital ~~~ ~~ -

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Annexure 1

list of Insurers

Sr. No Name of the Insurance

1 The New India Assurance Co. Ltd.

2 The Oriental Insurance Co. Ltd.

3 National Insurance Co. Ltd.

4 United India Insurance Co. Ltd.

5 Liberty Videocon General Insurance Co. Ltd.

6 Universal Sompo General Insurance Co. Ltd

7 Care Health Insurance Limited

8 TATA AIG General Insurance Co. Ltd

9 ICICI Lombard General Insurance Co. Ltd

10 lffco Tokio General Insurance Company

11 Bajaj Allianz General Insurance Co. Ltd.

12 Magma HDI General Insurance

13 Royal Sundaram General Insurance Co. Ltd.

14 Aditya Birla Health Insurance Co. Limited.

15 Niva Bupa Health Insurance Company Limited.

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