[Name of the Network Provider SUNRISE MULT CpEcLALITY HospsTAL— 2S] 90-1) Srinivasa reget nerdy) ‘Adres ‘Sir/Madam, subjects Addendum to the Agreement entered between Family Health Plan Insurance TPA Umited and 1. family Health Plan Insurance TPA Umited (hereinafter referred to as TPA) and the ode jH1 (hereinafter referred to as the Network Provider) entered into an AgreeMnent dated [ragreement”) for providing the services to the members of various insurance companies under the insurance policies issued by such Insurance companies and being serviced by TPA. 2, pala Birla Health Insurance Co, Lited (hereinafter referred to as ABHICL) has tied up with the TPA vide an Agreement dated 29th September 2016 for servicing its members covered under various insurance policies issued/ to be issued by ABHCIL from time to time (hereinafter refered to 25 members”). 3. ‘The parties herein agree that the Network Provider shall provide the cash less facilities to the Members ‘which shall be serviced by the TPA. ‘The process for identification of Members/Policyholders of ABHICL who would be serviced under this ‘Agreement shal be laid down and intimated to the Network Provider through emall or letter from time to time by ABHICL or the TPA. 5, The cherges forthe cashless services rendered by the Network Provider to ABHICL shall be paid as per the rate provided under the Agreement between the TPA and the Network Provider or the Agreement between ABHICL and the Network Provider, whichever is lower. 6. As per Insurance Regulatory and Development Authority of India (Health Insurance) Regulations, js required to have a tripartite arrangement when services are provided through TPA. Fa addendum captures the terms and conditions of the Agreement and other conditions that would be 2016, Jpalicable on the parties with respect to Network Provider providing the cashless services fo the Members. 8 Claim processing: (i) The Network Provider will forward the claims to the TPA. {i) lois admission and assessment by the TPA shall be as per the claims uidline/SOP provided by ABHICL to the TPA. (li) Claims approval and rejection can be done by ABHICL only. Billing: | 1 Network Provider shal raise the bills as per the biling procedure in the Agreement, All claims #hat ae recessed by the TPA and approved for cashless faclity shall be paid directly by ABHICL to the Network Provider in terms ofthe IRDA (Healt insurance) Regulations 2016, 19.2 The rate charts and discounts as agreed under the Agreement shall apply. 9.3 TPA will perform a reconciliation Provider shall issue a quarterly certificate or confirms to the TF from ABHICL between the Network Provider and TPA of the Invoice on frequency agreed In the Agreement and Network A regarding there being ’No Due’ pending 40. opting out- the Network Provider may by gvinga notice of atleast 30 days opt out of network for reasons of inadequacy of service rendered elther by the TPA or by ABHICL, 11. OthersABHICL and/or TPA shall have a right to visit the ABIL an ight to vst the premises of Nework Provider and gather information or cry investigation ofthe records/detalls, etc pertaining othe members of ABHIC at the premises ote Nene Seca at any time without prior intimation and have. eal | ‘a. Access rights to the Network Provider's premises/records either on regular or on ad-hoe basis. "Network Provider will promptly share all documents related to Members. bb. Network Provider shall follow the Procedure for cashless facility asin specified under Schedule - ‘Ato the IRDAI Circular ref: IRDA/TPA/REG/CIR/059/03/2016 dated March 28, 2016 c. Network Provider shall follow the Procedure to furnish the standard Discharge summary as. specified under Schedule -C to the IRDAI Circular ref: IRDA/TPA/REG/CIR/059/03/2016 dated March 28, 2016 4. Network Provider shall provide the bls In the Standard Format as specified under Schedule - D to the IRDAI Circular ref: IRDA/TPA/REG/CIR/059/03/2016 dated March 28, 2016 fe. _ Network Provider shall follow the Code of Conduct prescribed by IRDA from time to time £ Network Provider shall abide by the Confidentiality obligations laid down by ABHICL from time to time. fg Parties shall resolved any disputed amongst them by mutual discussions. n case the parties fall ‘to reconcile, the matter may be referred to a sole arbitrator to be appointed jointly by the disputing patties on such terms as may be agreed between the parties for appointment of such arbitrator and in terms of Arbitration and Conciiation Act, 1996. 42, Captalised terms not defined herein shall have the meaning as provided in the Agreement. 13, We request you to provide a confirmation of the above terms and conditions by singing ths letter authorized hgnatoy. —_R-y- shyt — B.S -Shyenela Name: Designation: (on behalf of Family Health Plan Insurance TPA Limited (TPA) ‘Authorized signatory: Name: Designation: Con behalf of Ady Bey Heath Insurance Co. United ‘Authorized signatory: Name Designation: ‘Accepted on behalf of {Network Provider]