ABC COMPANY. P.C.S. RAKYAT SDN. BHD. Web: Hotline :

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1 Hospital & Surgical Scheme and Out-Patient (Clinical) Proposal for ABC COMPANY Managed By P.C.S. RAKYAT SDN. BHD. Web: info@rakyatgroup.com Hotline :

2 Table of Contents Company Profile Board of Directors Company Background Functions & Operations Hospital & Surgical Scheme Benefits Exclusions Sample In-patient Card Panel Hospital / Clinics Track Record

3 Company Profile Incorporation Kuala Lumpur, Malaysia Registration U Date of Incorporation 15th November 2001 Corporate Address 79M, Jalan SS21/1A Damansara Utama Petaling Jaya Branch Office No. 1, Jalan Relau, Bayan Baru Penang. Telephone Numbers / Facsimile Number info@rakyatgroup.com Web Authorised Capital RM 1,000, Paid up Capital RM 1,000, Bankers RHB Company Secretary ASEN & ASSOCIATE Kuala Lumpur Legal Advisor Nazri & Sugunan Advocate & Solicitor

5 BOARD OF DIRECTORS Abdul Aziz Nor ( LLB Hons Essex University, London ) Chairman Dato S.Gopinath Group Executive Director Prashanth Marketing Director Dr. Madhavan Nair Director Medical

6 Company Background Pioneer & time proven Managed Care Organisation (MCO) in Malaysia Third Party Administrator (TPA) Established on 15 th Nov 2001 Specialist- dedicated core business activity (not a side business) Managed by insurance experts and supported by full time medical doctors Registered MCO with Ministry of Health.

7 Functions and Operations 24 hours 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 Hospital & Surgical Scheme Underwritten by AXA/PACIFIC Insurance

9 ABC COMPANY HOSPITAL & SURGICAL SCHEME SUPPLEMENTARY BENEFITS Funeral Expenses - Due to accident only TABLE OF BENEFITS Plan A Plan B Plan C Plan D Room & Board (daily max up to 120 days) Intensive Care Unit (up to 30 days) Hospital Miscellenous Surgical Fees Anaesthetics Fees Operation Theatre Fees In-Hospital Physician's Visit (daily up to120 days) AMBULATORY CARE Pre-Surgical/Medical Diagnosis Services ( Max. upto31 days prior to Hospitalization or Daycare Procedure ) Pre-Surgical/Medical Diagnosis Consultation ( Max. upto 31 days prior to Hospitalization or Daycare Procedure ) Second Surgical Opinion Post Hospitalization procedure Follow-up AS CHARGED treatment ( Up to 31 days maximum per disability following discharge from Hospital or upon undergoing Daycare procedure ) AS CHARGED Outpatient Accidental Treatment ( Maximum per dissability within 24 Hours after the accident & follow up treatment upto 60 days ) Daycare Procedure - ( Surgical / medical ) - Inclusive of all incidental costs pre and post day care visits upto 31Days ) Ambulance Fees Emergency Outpatient Treatment ( Max. per dissability from p.m. to 6 a.m. ) Daily Cash Allowance in Govt. Hospital ( Max. upto 90 Days ) Medical Report Fees Reimbursement ( Max. per dissability applicable for In-Hospital Care and Ambulatory Care ) Hospital Service Tax 50 6% 50 6% 50 6% 50 6% ANNUAL LIMIT PER MEMBER 120,000 96,000 70,000 44,000

10 Type of Quotation : Group Hospital & Surgical Policy Insured Name : ABC Period of cover : ONE YEAR Insured Benefits : As per Schedule attached Terms & Conditions: Age Limit : up to 64 years old Compulsory participation of All employees Applicable to standard lives only 30 days Waiting Period except for accidental causes (for new members only) Exclusion of Pre-existing illnesses or conditions (for new members only) Exclusion of Specified Illnesses (for first 120 days) as defined below: (for new members only) Hypertension, diabetes mellitus and cardiovascular disease. All tumors, cancers, cysts, nodules, polyps, stones of the urinary system and biliary system All ear, nose (including sinuses) and throat conditions Hernias, hemorrhoids, fistulae, hydrocele, varicocele Endometriosis including disease of the Reproduction System Vertebra-spinal disorders (including disc) knee conditions Policy wordings will be based on new PIAM GHS policy wordings

IN-Patient Admission / Hospitalization CLAIMS PROCEDURE for Panel Hospital Patient visits Hospital and produce the In-Patient Card (issued by the Insurance Company) Patient needs to Fill the Hospital

11 IN-Patient Admission / Hospitalization CLAIMS PROCEDURE for Panel Hospital Patient visits Hospital 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.

12 SAMPLE IN PATIENT CARD Note : The Hotline Number Managed by Asia Assistance Network (M) Sdn Bhd. (24 Hours) P.C.S. RAKYAT HOTLINE NUMBER : (24 Hours)

13 Common Non-Medical Related Items not covered, but not limiting to: Laundry for patient s clothes / gown Tissues, Toilet rolls Telephone/ Fax Charges Vitamins (unless medically necessary) CDs (patient s copy) Electricity charges Rental of Television / Radio Newspapers Sanitary pads / towels (unless utilized for related medical condition) Shaving blades (unless utilized for surgery purposes) Sarongs (unless utilized in Operating Theater) Discharge Pack Purchase of appliances such as crutches, wheelchairs and etc. Lodging Fees/Lodger Extra meals

14 LIST OF HOSPITALS

15 LIST OF PANEL HOSPITALS KL / Selangor 1. 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 INSTITUT JANTUNG NEGARA KAJANG MEDICAL CENTRE KAMPONG BARU MEDICAL CENTRE KELANA JAYA MEDICAL CENTRE MEGAH MEDICAL SPECIALIST PANTAI CHERAS MEDICAL CENTRE PANTAI KLANG SPECIALIST MEDICAL CENTRE PANTAI MEDICAL CENTRE PUSAT PAKAR TAWAKAL PUSAT RAWATAN ISLAM SELANGOR MEDICAL CENTRE SENTOSA MEDICAL CENTRE SRI KOTA MEDICAL CENTRE SUBANG JAYA MEDICAL CENTRE SUNWAY MEDICAL CENTRE TAMAN DESA MEDICAL CENTRE TUNG SHIN HOSPITAL UNIVERSITI MALAYA SPECIALIST CENTRE HOSPITAL PANTAI INDAH THE TUN HUSSEIN ONN EYE HOSPITAL CMH MEDICAL CENTRE

16 Penang 31. 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 Kedah 42. METRO SPECIALIST HOSPITAL KEDAH MEDICAL CENTRE PUTRA MEDICAL CENTRE STRAND HOSPITAL Melaka 46. MAHKOTA MEDICAL CENTRE PANTAI AYER KEROH THE SOUTHERN HOSPITAL, MELAKA Negeri Sembilan 49. COLUMBIA HOSPITAL N. SEMBILAN CHINESE MATERNITY HOSPITAL PUSAT PAKAR PD SEREMBAN SPECIALIST HOSPITAL Johor 53. CENTURY MEDICAL CENTRE HOSPITAL PENAWAR JOHOR SPECIALIST CENTRE MEDICAL SPECIALIST CENTRE PUTERI SPECIALIST HOSPITAL THE SOUTHERN HOSPITAL, BATU PAHAT PUSAT PAKAR KLUANG UTAMA

17 Pahang 60. KUANTAN MEDICAL CENTRE KUANTAN SPECIALIST HOSPITAL Kelantan 62. KOTA BAHRU MEDICAL CENTRE HOSPITAL PAKAR PERDANA Sabah / Labuan 64. DAMAI SPECIALIST CENTRE SABAH MEDICAL CENTRE SANDAKAN SPECIALIST CLINIC RAFFLESIA MEDICAL CENTRE Sarawak 68. NORMAH MEDICAL CENTRE REJANG MEDICAL CENTRE COLUMBIA ASIA MEDICAL CENTER, MIRI TIMBERLAND MEDICAL CENTRE KUCHING SPECIALIST HOSPITAL Perak 73. APOLLO MEDICAL CENTRE HOSPITAL FATIMAH IPOH SPECIALIST CENTRE KINTA MEDICAL CENTRE LARUT MEDICAL CENTRE PANTAI PUTRI HOSPITAL PERAK COMMUNITY SPECIALIST HOSPITAL TAIPING MEDICAL CENTRE

18 Managing Outpatient (Clinical) Scheme On Management Fee Basis

19 Managed Care Flow Chart Outpatient Scheme ABC Outpatient Benefits Employees / Dependents Monthly Payment + Management Fee Submit Reports Managed by P.C.S.Rakyat Sdn Bhd Present Rakyat OP card and get treatment Submit Claim Forms & Bills Panel Clinics/ Specialist Pay Clinic Bills

20 DATA FLOW PROCESS CLINICS CLINICS CLINICS P.C.S RAKYAT SERVER A. Data transfer from clinics either by:- ~ Internet ~ CD B. Optional ~ from PCS to clinics via Internet. ABC SERVER Offline reports for monitoring purpose only

21 The Outpatient (Scheme) Schedule of Benefits OUTPATIENT General Practitioners (OP) Care Routine Consultation Medication Injection Diagnostic Lab / X-Ray Procedures Outpatient Surgical Procedures Specialist Visits Routine Consultation Medication Injection Diagnostic Lab/ X-Ray Procedures Outpatient Surgical Procedures Coverage Covered on cashless basis in PCS Panel Clinics Referral Letter from GP Compulsory Pay and reimburse basis Cashless in PCS Panel Hospitals Annual Limit for OP & SP Care per Employee / Family We will follow the present Annual Limits

22 COST (Sample) Management Fee per head per month : TBA OP Card Printing (One time) per card : RM 1.50

23 How the Scheme works? All Staff / Dependent s of ABC BERHAD will be issued Rakyat s Outpatient card which they can produce at Rakyat s GP Panel Clinic and will get the treatment. Panel Clinics will be sending the Bills to Rakyat s office and PCS will compile and generate the Reports (As per sample attached) and will forward to ABC BERHADHR department. P.C.S. Rakyat will charge a Management fee to manage the above scheme. Monthly headcount declaration need to be done by ABC BERHAD HR department.

24 How the Scheme works? conti After compiling the Clinic Bills PCS will forward the Report to ABC BERHAD for payment processing on monthly basis. ABC BERHAD will issue one cheque to PCS for Clinic Bills + Management Fee. PCS will pay to all clinics. Our emphasis will be as follows : a. Minimise the usage of Medical. b. Monitoring the MC s and frequent visits of ABC BERHADstaff. c. Checking & Monitoring the Clinic Bills. d. We also negotiate rates with clinics and appoint new clinics as per the request from ABC BERHAD. e. The quality of Medicine will be maintained.

25 Exclusions (negotiable) Pregnancy and pregnancy-related conditions including abortion. Family planning services, sterilization procedures and work-up or treatment of infertility. Treatment, examination and lab tests not ordered by Medical Practitioner. Traditional & 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 Dietary supplements, appetite, suppressants, anabolic steroids and cosmetics products. Expenses which should be claim under SOCSO / Workmen s Compensation Scheme.

26 Exclusions (negotiable) conti 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. 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.

27 Sample Report Monthly Clinic Claim Report - April 2009 Date of Visit Name Empl No. Branch Dept R Ship Clinic Doctor Diagnosis MC days Charges 01/04/09 C.Sivarajan P.Klang HR Principal Klinik Ravi Dr. Azhar 02/04/09 Hamidon Buang Johor AD Principal Fever/Cough/ Cold /04/09 Norhayati Spouse 03/04/09 Sulaiman Bin Alimon Penang AD Principal 05/04/09 Tong Fei Loong KL GN Principal 06/04/00 Rita KL AC Principal 07/04/09 Mohd Idris Johor AD Principal Klinik Deepa Klinik Famili Klinik Public Klinik Amar Klinik Nik Isa Dr. Usha Tonsilitis Dr. Joe Diarrhoea Dr. Chuah Rashes Dr. Amar Eye Infection Dr. Aisah Migraine /04/09 Abd Kadir Penang HR Principal Mediviron Dr. Tan Bronchitis /04/09 Md Elai Bin Fadzil Johor HR Principal Klinik Segara Dr. Sasi Back Ache/Body Ache HR - Human Resource AD - Administration GN - General TOTAL

28 Sample Report Usage Report for the period of April 2009 June 2009 Name Empl No. Branch Dept R Ship Visits Usage Amount Rita KL AC Principal Md. Idris Johor AD Principal Kadir Penang HR Principal Tan Foo KL AD Principal Siti 1234 KL AC Principal Ravi 4567 PJ HR Principal Afandi 3456 Johor GN Child AC - Accounts HR - Human Resource GN -General

29 Most Active Treatment for the period April 09 June 9 Sample Report Quarterly Report Diagnosis Department Total AC GN HR No. Percentage Fever/Cough/Cold % Back Ache/Body Ache/ Joint Ache % Diarrohea/Vomiting/Food Poisoning % Diabetes Mellitus % Vertigo / Migraine % Gastrisitis % AC - Accounts GN - General HR - Human Resource

30 Quarterly Report on MC's issued for the period April'09 - June' No. of MC's Klinik Ravi Poliklinik Dr. Siti Klinik Medifom Klinik Dr. Azhar Klinik 24 Jam Klinik Mediviron Klinik

31 Sample Report Amount (RM) Most Active Clinics Klinik Public Klinik Ravi Klinik Dr. Siti Klinik Joe Poliklinik Azhar April'09 May'09 June'09 July'09 Month

32 Sample Report 250 Pattern of Disease for April'09 - June'09 - Outpatient No. of Patients Diagnosis FEVER/URTI/COUGH/COLD BACKACHE/BODYACHE/JOINTACHE DIARRHOE/VOMITING/FOOD POISONING DIABETES MELLITUS RASHES / URTICARIA VERTIGO/MIGRAINE GASTRITIS ECZEMA/DERMATITIS HYPERTENSION TONSILITIS/PHARYNGITIS EAR INFECTION ASTHMA

33 SAMPLE OUTPATIENT CARD

PANEL CLINICS IN MALAYSIA FOR DETAILS PLEASE LOG ON TO : www.rakyatgroup.

34 PANEL CLINICS IN MALAYSIA FOR DETAILS PLEASE LOG ON TO : Kudat 3 Miri Tawau 3 Labuan 2 Semporna Pulau Sipadan Sarikei Bandar Sri Aman 1 3 Total Panel Clinics in Malaysia : 1200

35 COST SAVINGS The Medical Cost will be reduced because of our Monitoring Saving per year Year 5 : 20% C o s t s Year 4 : 17 % Year 3 : 15% Year 2 : 10% Year 1 : 5%

36 IMPLEMENTATION SCHEDULE To Implement the scheme successfully, we need : 45 Days of processing time to implement the scheme. ( Print Cards / Appoint Panel Clinics ) Detailed List of Employees and Family stating the Full Name, Date of Birth and IC Number / Birth Cert Number. Present list of Panel Clinics. ( Which can be absorbed as Rakyat Panel Clinics ) List of Branches, if any?

37 TRACK RECORD Major Accounts PICSEL TECHNOLOGIES MALAYSIA (UK Based) KOPERASI PERDANAJAYA SDN BHD ZELAN BERHAD INFRASOFT TECHNOLOGIES LTD. KOLEJ SAINS KESIHATAN BERSEKUTU WOODLANDOR HOLDINGS BERBHD SELIA OIL AND GAS SAYFOL INTERNATIONAL SCHOOL EPE SWITCHGEAR (M) SDN BHD SAZIEN HUMAN RESOURCES SDN BHD HABIB JEWELS SDN BHD HALIM MAZMIN BERHAD UNIVERSITY INDUSTRI SELANGOR (UNISEL) NCT GROUP OF COMPANIES MALAYSIAN SHEET GLASS SDN BHD FRENCH SCHOOL, KL SECURIFORCE SDN BHD CLARIANT MALAYSIA PATCO MALAYSIA BERHAD FORMULA D SDN BHD CONSTRUCTION LABOUR CENTRE BHD. SILVER RIDGE HOLDINGS BERHAD MECHANALYSIS SDN BHD TUNTAS CONSULTANCY PETCARE ENTERPRISE ABM METAL SDN BHD MAJLIS PERBANDARAN SELAYANG

38 Thank You

ABC COMPANY. P.C.S. RAKYAT SDN. BHD. Web: Hotline :

ABC COMPANY. P.C.S. RAKYAT SDN. BHD. Web: Hotline : Hospital & Surgical Scheme Proposal for ABC COMPANY Managed By P.C.S. RAKYAT SDN. BHD. Web: www.rakyatgroup.com E-mail : info@rakyatgroup.com Hotline : 03-7726 5229 Table of Contents Company Profile Board