Terms of Reference

Medical and Accidental Insurance of PIN Staff

Introduction

People in Need (PIN) is a non-governmental, non-profit, international organization founded in the Czech Republic in 1992, and currently active in 22 countries globally. PIN arrived in Nepal as part of a humanitarian response to the April 25, 2015 earthquake. Since its inception in Nepal, PIN has had a strong role in designing, facilitating and advocating for systemic solutions that address the needs of vulnerable populations, including person categories who live in geographically remote areas of the country, historically marginalized ethnic groups, and those marginalized because of their age and/or gender identity. Currently, PIN Nepal is implementing programmes under three strategic pillars 1) Emergency response and recovery, 2) Climate resilience, and 3) Civil society and inclusive governance. To achieve these, PIN Nepal team works in and promotes strong partnerships with civil society, Government of Nepal, networks, academia, private sector, media and other key stakeholders in Nepal. Together with them, PIN Nepal has been one of the pioneer organizations advancing programmes such as multi-hazard disaster preparedness and anticipatory action, durable local solutions, inclusive education and GBV prevention, community climate resilience modelling for more inclusive and efficient local decision-making, urban resilience or waste management and circular economy approaches. PIN is strongly committed for safeguarding of children and vulnerable adults, including persons with disabilities, in line with its safeguarding framework and child protection policy.

Objectives

The primary objective is to secure a comprehensive insurance plan for PIN-Nepal’s staff members. The selected insurance service provider will deliver medical and accidental insurance coverage for approximately 100 team members (current: 56 staff, anticipated: 74+) and their dependents for a minimum duration of one year, at an approved rate.

Insurance Coverage Specifications

1. Medical Insurance Coverage:

• Family floater medical insurance: Coverage amount of NPR 5,00,000 annually.
• Medical services include inpatient and outpatient care, surgeries, emergency ambulance, pharmaceuticals, dental and vision care, maternity, pediatric care, chronic disease management, laboratory and diagnostic tests, physiotherapy, mental health care, and alternative treatments (homeopathy and ayurvedic).
• Add-on coverage of critical illness for staff members only

2. Accidental Insurance Coverage:

• Coverage amounts of NPR 30,00,000 per person annually.

3. Dependents Coverage:

• Married Staff: Spouse and up to 2 children under the age of 21 (maximum 4 persons).
• Unmarried Staff: Father and Mother (under the age of 75) (maximum 3 persons)

4. Underwriting:

• No pre-existing condition exclusions
• No waiting periods

5. Premium Rate:

• Annually, Quarterly, Monthly premium rate. Staff can be added and removed according to actual employment dates - any pre-paid premium will be reimbursed accordingly.
• Options for short term coverage for short-term staff

6. Deductibles and excess: No deductibles or excess

Service Provider Responsibilities

1. Enrollment and Documentation:

• Submit insurance policy documentation for enrolled staff within 7 days of agreement.
• Enroll new staff and their dependents immediately upon notification.

2. Claims and Reimbursements:

• Efficiently collect and reimburse medical claims as per agreed terms.
• Handle queries and issues promptly and effectively.
• Provide a 90-day window for claim submission and a maximum of 30 days for claim settlement.

3. Coverage and Network:

• Provide coverage for both Nepal and India.
• Detail provider network including hospitals, physicians, and clinics.
• Outline out-of-network coverage policies and emergency services network.

4. Review and Communication:

• Conduct quarterly review meetings to discuss service performance and necessary adjustments.
• Offer a cashless treatment option at network clinics and hospitals.
• Designate a primary contact person for all queries and issue resolutions.

5. Policy and Procedures:

• Prepaid premiums will be reimbursed according to policy terms.
• Attach detailed company information and list of services provided, including previous experience with international NGOs.

Policy Coverage Requirements

The insurance policy must cover the following:

• Inpatient Services: Semi-private or private hospitalization.
• Outpatient Services: Day-clinic and home visits.
• Surgery: Inpatient and outpatient.
• Emergency Services: Ambulance.
• Medicines: Coverage for pharmaceuticals.
• Dental and Vision: Regular care.
• Maternity: Pre- and post-natal care.
• Pediatrics: Pediatric care.
• Chronic Diseases: Management and treatment.
• Diagnostic Tests: Laboratory tests and scans (e.g., MRI, CT, x-ray).
• Physiotherapy and Alternative Medicine: Acupuncture, homeopathy, and ayurvedic treatments.
• Mental Health: Psychiatric and psychological care.
• Preventative Health: Annual checkups and preventative care

Evaluation Criteria:

A. Price (60%)

Evaluation result of this criterion equals to the following formula: Price A/Price B

* criteria weight.

Price A = lowest price from all submitted offers; Price B = actual price offered by the tenderer.

B. Quality (40%)

The bids will be evaluated by a procurement committee considering the following criteria for technical proposal. The total marks of the technical evaluation will be 50 whereas weightage is given as below-

Evaluation result of this criterion equals to following formula: Points B/Points A * criteria weight. Points A = highest points score from all; Points B = actual points score received from committee.

Main requirements:

Required Documents:

• Up to date Firm/Company Registration Certificate.
• VAT/PAN Registration Certificate.
• Latest Tax clearance document.
• Detailed Price Proposal with comprehensive breakdown.
• Detailed Company profile, including organizational structure and expertise
• Three reference letters from previous clients

Interested individuals/firms are requested to send their application by 14th September 2026 to [email protected] 

People in Need is committed to preventing any type of unwanted behavior at work including sexual harassment, exploitation and abuse, lack of integrity and financial misconduct and is committed to promoting the welfare of children and adults with whom People in Need involves. People in Need expects all staff to perform job duties and responsibilities in accordance with People in Need code of conduct and key policies (available at: https://www.peopleinneed.net/key-policies-4142gp). People in Need Staff will undertake the appropriate level of training. All offers of employment will be subject to satisfactory references and appropriate screening checks, which can include criminal records and terrorism finance checks.

We are committed to ensuring diversity and gender equality within our organization and encourage applicants from diverse backgrounds to apply.