Expression of Interest (EOI) for Group Health Insurance Coverage

Invitation for Quotation for Group Health Insurance Coverage

Date: 27th August 2026

Background

Centre for Mental Health & Counselling – Nepal (CMC-Nepal) is a national non-governmental organization working in the areas of mental health promotion, prevention, treatment, psychosocial support, and community-based mental health services in Nepal.

CMC-Nepal intends to procure Group Health Insurance Coverage for its employees and eligible dependents for a period of one year. In this regard, CMC-Nepal invites interested and eligible insurance companies to submit their competitive technical and financial proposals for providing comprehensive group health insurance services.

Objective

The objective of this EOI is to identify a qualified and reliable insurance company that can provide comprehensive, affordable, and responsive Group Health Insurance Coverage to CMC-Nepal's employees and eligible dependents.

Scope of Insurance Coverage

The proposed Group Health Insurance policy is expected to include, but not necessarily be limited to, the following:

A. In-Patient / Hospitalization Coverage

Coverage for eligible medical expenses arising from hospitalization, including:

• Room, boarding and operation theatre charges;

• Surgeon, anesthetist, specialist and nursing fees;

• Diagnostic tests;

• Medicines, blood, oxygen and other medically necessary expenses;

• Hospitalization arising from illness and covered accidental cases.

The policy should clearly state the minimum hospitalization period and applicable conditions for eligibility.

B. Day-Care Treatment

Coverage for eligible day-care procedures and treatments that do not require 24-hour hospitalization, subject to the insurer's approved list of day-care procedures.

The insurer is requested to provide the complete list of covered day-care procedures along with the quotation.

C. Pre- and Post-Hospitalization Expenses

The quotation should provide coverage for:

• Medical expenses incurred during the 30 days prior to hospitalization; and

• Medical expenses incurred during the 60 days following hospitalization,

subject to the terms and conditions of the policy.

D. Critical Illness Coverage

The quotation should clearly indicate the critical illnesses covered under this policy, applicable limits, eligibility conditions, and claim requirements.

E. Maternity Coverage

F. Accidental Dental and Optical Coverage

G. Geographic Coverage

The proposal should clearly specify the geographic area of coverage. 

H. Cashless Treatment Facility

The insurer should provide a cashless treatment facility through an adequate network of hospitals and healthcare facilities.

The quotation should include:

• Number of cashless hospitals in Nepal;

• Major hospitals covered in Kathmandu Valley and outside Kathmandu;

• Cashless hospital network in India or other country, if applicable;

• Procedure for obtaining cashless treatment; and

• Emergency assistance/contact mechanism.

The previous proposal indicated cashless treatment availability through a network of hospitals in Nepal and India.

Proposed Coverage Structure

• The insurer is requested to provide quotations for of Rs. 5 lakh per person
• The insurer may also propose any other suitable coverage options for consideration by CMC-Nepal.
• The premium should preferably be provided on a per-life basis, with age-wise premium details.

Eligibility and Family Coverage

The insurer should provide details regarding:

• the proposal should have coverage for an employee, spouse and up to three children, (for married).

  • the proposal should have coverage for an employee, parents (for unmarried).

Addition and Deletion of Staff

The insurer should provide flexibility for:

• Addition of new employees during the policy period;

• Deletion of employees who leave the organization;

• Addition of eligible dependents due to marriage or birth; and

• Pro-rata adjustment/refund of premium, where applicable.

The applicable terms and conditions for mid-term additions/deletions should be clearly stated in the quotation.

Claims Management and Third-Party Administrator

The bidder should provide details of its claim management mechanism, including:

• Name of the Third-Party Administrator (TPA), if applicable;

• Claims submission process;

• Cashless claim process;

• Reimbursement claim process;

• Required documents;

• Claim settlement timeline;

• Online claim tracking facility, if available; and

• Dedicated focal person/customer service support.

Policy Exclusions

The bidder must provide a complete and clearly defined list of exclusions, limitations, sub-limits, non-covered treatments and conditions applicable under the proposed policy.

Any exclusions or limitations should be clearly highlighted in the financial/technical proposal and not be implied.

Required Information from the Bidder

Interested insurance companies are requested to submit the following information in a sealed envelope to the address provided below within 10th September 2026:

1. Company profile and valid license/registration details;

      - Company Registration alongwith Company Renewal Certificate

     - VAT/PAN Registration Certificate

     - Recent Tax Clearance Certificate

2. Experience in providing group health insurance services to organizations/NGOs;

3. Details of proposed health insurance coverage

Financial Proposal

The financial proposal should clearly provide:

• Premium per employee/life;

• Premium for dependents, if applicable;

• Premium according to different age bands;

• Premium for each proposed Sum Insured;

• maternity coverage;

• Additional premium for any other riders;

• Applicable taxes;

• Discounts, if any; and

• Total estimated annual premium.

All costs should be quoted in Nepalese Rupees (NPR) and should be inclusive/exclusive of applicable taxes as clearly indicated.

 Validity of Quotation

The quotation should remain valid for a minimum of 60 days from the submission deadline.

CMC-Nepal reserves the right to seek clarification from bidders during the evaluation process.

Submission of Proposal

Interested and eligible insurance companies are requested to submit their technical and financial proposals in a sealed envelope , as specified below:

Centre for Mental Health & Counselling – Nepal (CMC-Nepal)
Thapathali, Kathmandu, Nepal

The subject line should be: “Expression of Interest – Group Health Insurance Coverage”

Disclaimer

Issuance of this EOI does not constitute a commitment by CMC-Nepal to award the contract. CMC-Nepal reserves the right to accept or reject any or all proposals, seek clarification, negotiate with selected bidder(s), or cancel the procurement process in accordance with its policies and procedures.

CMC-Nepal also reserves the right to finalize the insurance package based on organizational requirements, available budget, and the overall value offered by the selected insurance provider.