1
Company Background
• Pioneer & time proven Managed Care Organisation (MCO) in Malaysia
• Third Party Administrator (TPA)
• Established on 15th Nov’2001 • Specialist- dedicated core business activity (not a side business)
• Managed by insurance experts and supported by full time medical doctors
2
Company’s Goal
– To be Malaysia’s leading Health Care organization. – To be recognized for Excellence. – To be respected for integrity, initiative and involvement. – To be a caring organization. – To Practice the Highest Degree of Professionalism.
3
4
BOARD OF DIRECTORS
Abdul Aziz Nor
(LLB Hons Essex University, London)
Chairman
S.Gopinath
Group Executive Director
Dr. Madhavan Nair
Director Medical
Dr. Avtar Singh
Director Medical (Penang)
5
6
Our Responsibilities, Your Advantages
We : • • • • • • • • • • • • Compare and choose a health plan to your needs. Understand your managed care benefits. Resolve claims problems and billing disputes. Select Doctors, Hospitals and Clinics. Tackle Doctor/Patient communications issues. Give reports every month to the Employer on the Date of Visit, Clinic visited, Illness, No. of MC Days and Amount spent. Give reports on Pattern Of Illness and Eligibility Vs Usage. Verify / Validate Clinic Bills. Issue Cheques to the multiple clinics. Issue Guarantee Letters (24 Hours) Educate the Employees. Communicate in Medical language. Reduce Cost without fixed rates. Wellness Program Save your valuable Time and Headaches.
7
Functions & Operations
• 24- hour helpdesk line • Roadshow for issuance of cards • Appoint and select panel clinics • Administrating claims • Monitoring claims • Generating management reports based on clinic claims • Review of Clinic Bills
8
How the cost will be reduced ?
• Review of Medical Bills • Monitoring of Clinic Bills • Querying the Clinics/Doctors • Supplying the medicines for Long term Illness. • Wellness Program
• Monitoring the frequent visits report.
• Reduce the hidden cost of the client.
9
PRODUCT
10
OUTPATIENT (CLINICAL) SCHEME
11
Managing Outpatient Scheme on Fixed Cost Basis
12
EMPLOYEES
ABC BERHAD
Outpatient Benefits
Present Rakyat OP card and get treatment
Monthly Payment
Submit Reports
Managed by P.C.S.Rakyat Sdn Bhd
Panel Clinics/ Specialist Submit Claim Forms & Bills
Pay Clinic Bills
P.C.S. RAKYAT OUT-PATIENT SCHEME
Plan Individual Plan Family Plan Single Parent
OUTPATIENT CARE BENEFITS GP Clinic Service for Outpatient Consultation including
Drugs Basic Diagnostic tests including Lab Tests/X-Ray/ECG Childhood Immunisations
Covered NIL
Covered Child : up to 21 yrs old
URGENT/EMERGENCY CARE
Nationwide Emergency Health Coverage Provided by GP or Specialist on an Outpatient Basis According to Benefits Limit Covered 24 hours Covered 24 hours Covered 24 hours
Specialist Visit (referred by Panel Clinic)
Specialist Care & Diagnostic Services Covered in Full Covered in Full Covered in Full
Specialist Consultations, Diagnostics Procedures & Recommended Drugs via Specialist Consultant
OUT PATIENT SCHEME
EXCLUSION CLAUSES
The exclusion of the Rakyat Out Patient Programme are as follows: • • • • • • • • • Pregnancy and abortion Family planning services, sterilization procedures and work-up or treatment of infertility Treatment, examination and lab tests not ordered by Medical Practitioner Traditional and alternatives therapy such as Acupuncture, Homeopathy, Bomoh or Sinseh Treatment Injuries due to insanity or self-inflicted AIDS (Acquired Immune Deficiency Syndrome) & HIV related Diseases Travel & Adult immunization including Hepatitis Direct sales nutritional products Treatment to improve the psychological, mental or emotional well-being
15
EXCLUSION CLAUSES
• •
•
• • • • •
•
Cosmetic Surgery for purpose of beautification or plastic surgery including sex change surgery Dietary supplements, appetite, suppressants, anabolic steroids and cosmetics products Expenses which should be claim under SOCSO / Workmen’s Compensation Scheme Medical examination, required by third party such as Pre-employment examination, Vehicle licensing examination & regular screening profiles Telephone, fax charges, private nursing, lodger fee, administrative registration fee & nonmedical personal items Treatment for recuperative purpose as a result of mental fatigue, rest cures or sanatorium care, drugs addiction or alcoholism, communicable diseases requiring by law isolation or quarantine in the event of an epidemic Sonotron Therapy, Heart scan & new investigative modalities non approve by Ministry of Health Malaysia, Academic, Medical Institutions, or renowned medical authorities such as FDA of the USA. Maximum supply of Medication is up to 1 month & if a member needs medication more than the said periods, he / she has to consult P.C.S Rakyat who will make the necessary arrangement for him / her. Vitamin / food supplement / Orthopaedic appliances / Medical equipment.
Any changes can be discussed
16
17
Sample Report
Date of Visit
01/04/04
Monthly Clinic Claim Report-April’2004
Name Empl No.
12048
Branch
Dept
R’Ship
Clinic
Doctor
Diagnosis
Fever/Cough/ Cold
MC days
2
Charges
C.Sivarajan Hamidon Buang Norhayati Sulaiman Bin Alimon Tong Fei Loong Rita Mohd Idris Abd Kadir Md Elai Bin Fadzil
P.Klang
HR
Principal
Klinik Ravi
Dr. Azhar
30.00
02/04/04
02/04/04 03/04/04 05/04/04 06-04-05 07-04-04 08-04-04 10/04/04
65032
Johor
AD
Principal
Spouse Klinik Deepa Klinik Famili Klinik Public Dr. Usha Dr. Joe Dr. Chuah Dr. Amar Dr. Aisah Dr. Tan Dr. Sasi Tonsilitis Diarrhoea Rashes Eye Infection Migraine Bronchitis Back Ache/Body Ache 1 1 1 1 40.00 35.00 45.00 55.00 65.00 45.00 30.00
76800 80963 87600 17821 62145 23456
Penang KL KL Johor Penang Johor
AD GN AC AD HR HR
Principal Principal
Principal Principal Principal Principal
Klinik Amar
Klinik Nik Isa Mediviron Klinik Segara
HR- Human Resource AD - Administration GN- General
TOTAL 345.00
Sample Report
Date of Visit Name
Monthly Employee Claim Report-April’2004
Empl No. Branch Dept R’Ship Clinic Doctor Diagnosis MC days Charges
01/04/04
C.Sivarajan
12048
P.Klang
HR
Principal
Klinik Ravi
Dr. Azhar
Fever/Cough/ Cold Fever
2
30.00
02/04/04
C.Sivarajan
12048
P.Klang
HR
Principal
Klinik Ravi Klinik Famili Klinik Public Klinik Amar Klinik Nik Isa Mediviron
Dr. Azhar
30.00
08/04/04
C.Sivarajan
12048
P.Klang
HR
Principal
Dr. Joe
Diarrhoea
1
35.00
12/04/04
C.Sivarajan
12048
P.Klang
HR
Principal
Dr. Chuah
Rashes
1
45.00
15-04-05
C.Sivarajan
12048
P.Klang
HR
Principal
Dr. Amar
Eye Infection
1
55.00
25-04-04
C.Sivarajan
12048
P.Klang
HR
Principal
Dr. Aisah
Migraine
65.00
30-04-04
C.Sivarajan
12048
P.Klang
HR
Principal
Dr. Tan
Bronchitis
1
45.00
HR- Human Resource AD - Administration GN- General
TOTAL 305.00
Sample Report
Usage Vs Eligibility Report for the period
of April’2004 – June’2004
Name
Empl No.
Branch
Dept
R’Ship
Eligibility
Usage
Balance
Amount
Rita Md. Idris Kadir Tan Foo Siti Ravi Afandi 87600 17821 62145 31361 1234 4567 3456 KL Johor Penang KL KL PJ Johor AC AD HR AD AC HR GN Principal Principal Principal Principal Principal Principal Child 1500.00 1500.00 1500.00 1500.00 1500.00 1500.00 1500.00
Amount
300.00 600.00 1200.00 800.00 900.00 800.00 1200.00
Amount
1200.00 900.00 300.00 700.00 600.00 700.00 300.00
AC- Accounts
HR- Human Resource GN-General
20
Sample Report Most Active Treatment for the period April’04 – June’04 Quarterly Report
Diagnosis AC
Fever/Cough/Cold Back Ache/Body Ache/ Joint Ache Diarrohea/Vomiting/Food Poisoning Diabetes Mellitus Vertigo / Migraine Gastrisitis 25 15 10 08 06 03
Department GN
18 10 08 07 07 05
Total HR
32 10 06 04 05 08
No.
75 35 24 19 18 16
Percentage
40 % 18 % 13 % 10 % 9.6 % 8.5 %
AC- Accounts GN- General HR- Human Resource 21
Quarterly Report on MC's issued for the period April'04 - June'04
35
33
30
28
28
25
No. of MC's
20
19
15
15
10
10
5
0 Klinik Ravi Poliklinik Dr. Siti Klinik Medifom Klinik Klinik Dr. Azhar Klinik 24 Jam Klinik Mediviron
22
Sample Report Amount (RM)
Most Active Clinics
5000 4500 4000 3500 3000 2500 2000 1500 1000 500 0 April'04 May'04
Month
Klinik Public Klinik Ravi Klinik Dr. Siti Klinik Joe Poliklinik Azhar
June'04
July'04
23
Sample Report
Pattern of Disease for April'04 - June'04 - Outpatient
250 213 200
No. of Patients
150
100
50 34 31 22 17 14 12 12 11 10 5 5
0 Diagnosis
FEVER/URTI/COUGH/COLD DIABETES MELLITUS GASTRITIS TONSILITIS/PHARYNGITIS BACKACHE/BODYACHE/JOINTACHE RASHES / URTICARIA ECZEMA/DERMATITIS EAR INFECTION DIARRHOE/VOMITING/FOOD POISONING VERTIGO/MIGRAINE HYPERTENSION ASTHMA
24
OUTPATIENT PROCEDURES AND FLOWCHART
25
RAKYAT OUTPATIENT CLAIMS PROCEDURE For PANEL CLINIC
Patient visits Rakyat Panel Clinic and produces Rakyat Health Card. Nurses have to make sure that the patient brings his/her own Rakyat card and IC. However, Dependants have to bring their parents IC and Rakyat card. The Rakyat GP Claim Form to be filled in full by the Patient, Nurse and the Doctor.
Patient proceeds to seek consultation / treatment Patient proceeds to the Dispensing / Billing counter for Medication. ( No Payment to be made by the patient). Patient’s details and Medication Details to be entered in the Software provided by PCS Rakyat.
GP Claim Forms fully filled to be sent to Rakyat Ofiice for Verification/Validation and Reimbursement.. 26
RAKYAT OUTPATIENT CLAIMS PROCEDURE For PANEL CLINIC
Patient Forgets Rakyat Card
Process Flow If the patient forgets to bring Rakyat Card in case of Emergency / Accident / Lost Card.
Contact our Call Centre :
Hotline : 03 – 7726 5229 (24 Hours) H/P: 017-320 0048
27
RAKYAT OUTPATIENT CLAIMS PROCEDURE For NON PANEL CLINIC
In case of Emergency patient visits a Non-Panel Clinic.
Patient seeks Consultation / Treatment
Patient proceeds to the Dispensing/Billing counter for Medication and Pays the Bill.
Patient handover the Bill to the concerned Department (HR) of the Employer within 7 days..
Employer after verification send the Bill to Rakyat Office for payment within 14 days. Rakyat after Verification reimburse the payment to the Employee within 30 Days.
28
Panel Clinics in Malaysia
4 10 65 20 90 90 300 3
Miri Kudat
5 2
10
1
Labuan
Semporna Pulau Sipadan Tawau
20
15 20 22 500 1 Total Panel Clinics in Malaysia : 1400 60
Sarikei
1
3 3 2
Bandar Sri Aman
29
SAMPLE RAKYAT OUT PATIENT CARD
30
31
•
P.C.S. Rakyat is well equipped with all the latest Computers, Printers and Scanners. 10 Personal Computers – Pentium IV – All PC’s are interconnected via Local Area Netwrok (LAN) and 24 Hours connected to Internet. 4 Printers - Colour HP Scanner
1. 2. 3.
Software System :
P.C.S.Rakyat is having a Claim Management System - A Software developed by J.D.Systems to monitor all the Claims and Monthly Reports. The Software is also installed at the major Rakyat GP Panel Clinics to get the data online thru Internet and is working very well.
32
PROPOSED DATA FLOW DATA PROCESSING -
CLINICS CLINICS CLINICS
CLINICS CLINICS CLINICS
CLINICS CLINICS CLINICS
P.C.S RAKYAT CONTROL P.C.S RAKYAT / /CONTROL CENTRE CENTRE
A. Data transfer from Clinics: either by: ~Internet ~Diskettes B. Optional ~from PCS to clinics via Internet.
ABC Berhad
Server
RakyatGroup Server
Offline Reports Monitoring Purpose only
33
34
•
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23.
MAJOR ACCCOUNTS UNDER RAKYAT PLAN FOR OUTPATIENT (GP) –
INTEGRATED LOGISTICS BERHAD SURIA BUSINESS SOLUTIONS (Subsidiary of Scomi Berhad) PICSEL TECHNOLOGIES MALAYSIA (UK Based) KOPERASI PERDANAJAYA SDN BHD TRONOH CONSOLIDATED BERHAD ZELAN CONSTRUCTION SDN BHD ZELAN HOLDINGS (M) SDN BHD ZELAN ENTERPRISES SDN BHD ZELAN CORPORATION SDN BHD ZELAN DEVELOPMENT SDN BHD PANDUAN PELANGI SDN BHD EUROPEAN PROFILES (M) SDN BHD MALAYSIAN BAR COUNCIL INFRASOFT TECHNOLOGIES LTD. KOLEJ SAINS KESIHATAN BERSEKUTU GAYA BINA CONTRUCTION SDN BHD SILVER RIDGE HOLDINGS BERHAD WOODLANDOR HOLDINGS BERAHD SPECIFIC RESOURCES SDN BHD JVC MANUFACTURING MALAYSIA MISC INTEGRATED LOGISITICS SDN BHD EDARAN OTOMOBIL NASIONAL BERHAD (EON) EPE SWITCHGEAR SDN BHD
35
36
Name of Client
Types of Service
Malaysian Bar Council Suria Business Solutions Sdn Bhd ( Subsidiary of Scomi Berhad) Picsel Technologies (UK based)
Bumi Gajah Agencies Sdn Bhd
SilverRidge Holdings Berahd Bumihighway
Koperasi Perdanajaya
Securiforce K-Card Technologies Mechanalysis Sdn Bhd Koshin Kitamula (M) Sdn BHd ABM Metal Sdn BHd
Hospital & Surgical Group Personal Accident Outpatient Hospital & Surgical Group Term Life Outpatient Hospital & Surgical Group Personal Accident Outpatient Hospital & Surgical Marine Insurance Contractors All Risk Foreign Workers Compensation Group Personal Accident Erection All Risk - General Foreign Workers Compensation Fire Burglary Property Outpatient Hospital & Surgical Annual Medical Health Screening Hospital & Surgical Group Personal Accident Group Personal Accident Hospital & Surgical Group Personal Accident Fire
37
WELLNESS PROGRAM
1.
Free Health & Wellness talks for Employees and their Dependants (Twice in a year)
Medical Advice (2nd Opinion)
2.
3.
Legal Assistance on Medical Matters
All the above services will be Free of Cost
38
Hospital & Surgical Scheme Underwritten by MCIS Zurich Insurance Berhad
39
IN-Patient Admission / Hospitalisation CLAIMS PROCEDURE for Panel Hospital
Patient visits Hospital along with the reference letter from the Rakyat Panel GP Clinic and produce the In-Patient Card (issued by the Insurance Company)
Patient needs to Fill the Hospital Admission Form . The Hospital will fax the form to the Insurance Company for Verification and Eligibility of the patient.
A Guarantee Letter is forwarded to the Hospital from the Insurance Company within 30 mins (approx.) and the patient is admitted for the treatment if found eligible.
Delay may be caused in getting Guarantee letter in few cases, but need to have patience. (Terms and Conditions apply). A Pre Discharge Billing Assessment is done to identify the Payable claims by the Patient and the Insurance Company. The Bill is forwarded to the Insurance Company for the final settlement/payment. The patient is discharged.
40
SAMPLE IN PATIENT CARD
Note : The Hotline Number Managed by Asia Assistance Network (M) Sdn Bhd. (24 Hours) P.C.S.RAKYAT HOTLINE NUMBER : 03 – 7726 5229 (24 HOURS)
41
LIST OF PANEL HOSPITALS
KL/Selangor 1. 2. 3. 4. 5. 6. 7. 8. 9. AMPANG PUTERI SPECIALIST HOSPITAL ANDALAS MEDICAL CENTRE APOLLO TTDI MEDICAL CENTRE ARUNAMARI SPECIALIST HOSPITAL ASSUNTA HOSPITAL DAMAI SERVICE HOSPITAL DAMANSARA SPECIALIST CENTRE DARUL EHSAN MEDICAL CENTRE GLENEAGLES INTAN MEDICAL CENTRE 03-4270 2500 03-3324 1000 03-7726 6911 03-3324 3288 03-7780 6197 03-4043 4900 03-7722 2692 03-5880 8868 03-4257 1300 03-2617 8200 03-8736 0631 03-2693 1007 03-7805 2111 03-7803 1212 03-9132 2022 03-3372 5222 03-2296 0888 03-4023 3599 03-4041 4922 03-5543 1111 03-4043 7166 03-3373 3636 03-5634 1212 03-5632 7688 03-7982 6500 03-2072 1655 03-7950 2650 03-4289 2828 03-7956 1511 03-2078 2055
10. INSTITUT JANTUNG NEGARA 11. KAJANG MEDICAL CENTRE 12. KAMPONG BARU MEDICAL CENTRE 13. KELANA JAYA MEDICAL CENTRE 14. MEGAH MEDICAL SPECIALIST 15. PANTAI CHERAS MEDICAL CENTRE 16. PANTAI KLANG SPECIALIST MEDICAL CENTRE 17. PANTAI MEDICAL CENTRE 18. PUSAT PAKAR TAWAKAL 19. PUSAT RAWATAN ISLAM 20. SELANGOR MEDICAL CENTRE 21. SENTOSA MEDICAL CENTRE 22. SRI KOTA MEDICAL CENTRE 23. SUBANG JAYA MEDICAL CENTRE 24. SUNWAY MEDICAL CENTRE 25. TAMAN DESA MEDICAL CENTRE 26. TUNG SHIN HOSPITAL 27. UNIVERSITI MALAYA SPECIALIST CENTRE 28. HOSPITAL PANTAI INDAH 29. THE TUN HUSSEIN ONN EYE HOSPITAL 30. CMH MEDICAL CENTRE
42
Penang
BAGAN SPECIALIST CENTRE BUKIT MERTAJAM SPECIALIST CENTRE GLENEAGLES MEDICAL CENTRE HOPE CHILDREN HOSPITAL HOSPITAL PANTAI MUTIARA LAM WAH EE HOSPITAL LOH GUAN LYE SPECIALIST CENTRE PENANG ADVENTIST HOSPITAL PUBLIC SPECIALIST HOSPITAL TANJUNG MEDICAL CENTRE ISLAND HOSPITAL 04-332 2800 04-538 7577 04-227 6111 04-228 6557 04-643 3888 04-657 1888 04-228 8501 04-226 1133 04-226 6699 04-226 2323 04-228 8222
Kedah
METRO SPECIALIST HOSPITAL KEDAH MEDICAL CENTRE PUTRA MEDICAL CENTRE STRAND HOSPITAL 04-423 8888 04-730 8878 04-734 2888 04-442 8888 06-284 8222 06-231 9999 06-283 5888 06-601 1988 06-762 2104 06-6477 588 06-767 7800 07-331 1722 07-252 1800 07-223 7811 07-224 3888 07-223 3377 07-413 3333 07-771 8999
Melaka
MAHKOTA MEDICAL CENTRE PANTAI AYER KEROH THE SOUTHERN HOSPITAL, MELAKA
Negri Sembilan
COLUMBIA HOSPITAL N. SEMBILAN CHINESE MATERNITY HOSPITAL PUSAT PAKAR PD SEREMBAN SPECIALIST HOSPITAL
Johor
CENTURY MEDICAL CENTRE HOSPITAL PENAWAR JOHOR SPECIALIST CENTRE MEDICAL SPECIALIST CENTRE PUTERI SPECIALIST HOSPITAL THE SOUTHERN HOSPITAL, BATU PAHAT PUSAT PAKAR KLUANG UTAMA
43
Pahang
70. KUANTAN MEDICAL CENTRE 71. KUANTAN SPECIALIST HOSPITAL 09-514 2828 09-567 8588 09-743 3399 09-745 8000 088-222 922 088-424 333 089-221 007 088-780 670 082-440 055 084-330 733 085-437 755 082-234 466 082-365 777
Kelantan
72. KOTA BAHRU MEDICAL CENTRE 73. HOSPITAL PAKAR PERDANA
Sabah/Labuan
74. DAMAI SPECIALIST CENTRE 75. SABAH MEDICAL CENTRE 76. SANDAKAN SPECIALIST CLINIC 77. RAFFLESIA MEDICAL CENTRE
Sarawak
78. NORMAH MEDICAL CENTRE 79. REJANG MEDICAL CENTRE 80. COLUMBIA ASIA MEDICAL CENTER, MIRI 81. TIMBERLAND MEDICAL CENTRE 82. KUCHING SPECIALIST HOSPITAL
Perak
APOLLO MEDICAL CENTRE HOSPITAL FATIMAH IPOH SPECIALIST CENTRE KINTA MEDICAL CENTRE LARUT MEDICAL CENTRE PANTAI PUTRI HOSPITAL PERAK COMMUNITY SPECIALIST HOSPITAL TAIPING MEDICAL CENTRE 05-805 6000 05-545 5777 05-241 8777 05-254 2125 05-806 7817 05-548 4333 05-254 5594 05-807 1049
44
WHY YOU SHOULD CHOOSE P.C.S.RAKYAT ?
1. P.C.S. Rakyat is headed by Professionals who are having hands on experience of Insurance and Health Industry. 2. Board Members consist of Insurance Adjustors, Underwriters, HR Directors and Medical Directors. 3. Local Company Incorporated in Malaysia. 4. Committed to Customer Service. 5. Believe in Long Term Business relations. 6. Reasonable Pricing 7. Fixed Cost for the year 8. Understand Customer Needs (patience). 9. Simplified procedures. 10. Committed Staff 11. Successful Track record of serving Large Organizations like Matsushita Group of Companies (5000 Staff). 12. Good Networking. 13. Easy accessibility to the Top Management. 14. Give and Take Policies. 15. Well equipped with all the necessary Softwares and Hardwares. 16. Customized Reporting.
45
Contact Us
Office : 79 M, Jalan SS 21/1A, Damansara Utama 47400 Petaling Jaya, Selangor
Tel: 03- 7726 5229, 03 – 7726 4858
Fax: 03- 7726 4858 Web : www.rakyatgroup.com Contact Person: Chairman
Executive Director Manager Operations Asst. Manager Finance & Admin Customer Service General Enquiries
:
: : : ; :
aziz@rakyatgroup.com
gspl22@hotmail.com, gopi@rakyatgroup.com prakash@rakyatgroup.com vani@rakyatgroup.com karishma@rakyatgroup.com info@rakyatgroup,.com
46
Location Map
47