COPORATE OVERVIEW

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P.C.S. RAKYAT SDN BHD
COPORATE OVERVIEW
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Company Background

• Pioneer time proven Managed Care Organisation
  (MCO) in Malaysia
• Third Party Administrator (TPA)
• Established on 15th Nov2001
• Specialist- dedicated core business activity (not
  a side business)
• Managed by insurance experts and supported by
  full time medical doctors

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Companys Goal

• To be Malaysias 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.

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P.C.S. RAKYAT SDN BHD
BOARD OF DIRECTORS
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P.C.S. RAKYAT SDN BHD
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)
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P.C.S. RAKYAT SDN BHD
ABOUT US
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P.C.S. RAKYAT SDN BHD

• 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.

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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

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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.

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PRODUCT
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• OUTPATIENT (CLINICAL)
• SCHEME

P.C.S. RAKYAT SDN BHD
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• Managing Outpatient
• Scheme
• on
• Fixed Cost Basis

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Managed Care Flow Chart for Outpatients
EMPLOYEES
ABC BERHAD
Outpatient Benefits
Monthly Payment
Present Rakyat OP card and get treatment
Submit Reports
Managed by P.C.S.Rakyat Sdn Bhd
Panel Clinics/ Specialist
Submit Claim Forms Bills
Pay Clinic Bills
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P.C.S. RAKYAT OUT-PATIENT SCHEME
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P.C.S. RAKYAT SDN BHD

• 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

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P.C.S. RAKYAT SDN BHD

• 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 /
  Workmens 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
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P.C.S. RAKYAT SDN BHD
REPORTS
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Sample Report
P.C.S. RAKYAT SDN BHD
Monthly Clinic Claim Report-April2004
TOTAL 345.00
HR- Human Resource AD - Administration GN- General
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Sample Report
P.C.S. RAKYAT SDN BHD
Monthly Employee Claim Report-April2004
TOTAL 305.00
HR- Human Resource AD - Administration GN- General
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P.C.S. RAKYAT SDN BHD
Sample Report
Usage Vs Eligibility Report for the period of
April2004 June2004
AC- Accounts HR- Human Resource GN-General
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Sample Report
P.C.S. RAKYAT SDN BHD
Most Active Treatment for the period April04
June04
Quarterly Report
AC- Accounts GN- General HR- Human Resource
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P.C.S. RAKYAT SDN BHD
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Sample Report
P.C.S. RAKYAT SDN BHD
Most Active Clinics
Amount (RM)
Month
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Sample Report
P.C.S. RAKYAT SDN BHD
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OUTPATIENT PROCEDURES AND FLOWCHART
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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).
Patients 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..
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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
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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.
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P.C.S. RAKYAT SDN BHD
Panel Clinics in Malaysia
4
5
Kudat
10
10
65
2
20
Labuan
1
90
Semporna Pulau Sipadan
90
300
3
Tawau
Miri
20
1
2
15
3
20
3
Sarikei
60
22
Bandar Sri Aman
500
1
Total Panel Clinics in Malaysia 1400
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P.C.S. RAKYAT SDN BHD
SAMPLE RAKYAT OUT PATIENT CARD
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P.C.S. RAKYAT SDN BHD
EQUIPMENTS/TOOLS/SYSTEMS
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P.C.S. RAKYAT SDN BHD

• P.C.S. Rakyat is well equipped with all the
  latest Computers, Printers and Scanners.
• 10 Personal Computers Pentium IV All PCs are
  interconnected via Local Area Netwrok (LAN) and
  24 Hours connected to Internet.
• 4 Printers - Colour
• HP Scanner
• 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.

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CLINICS
CLINICS
CLINICS
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P.C.S. RAKYAT SDN BHD
TRACK RECORD
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P.C.S. RAKYAT SDN BHD

• 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

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P.C.S. RAKYAT SDN BHD
OTHER CLASSES OF INSURANCE CLIENTS
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P.C.S. RAKYAT SDN BHD

• WELLNESS PROGRAM
• Free Health Wellness talks for Employees and
  their Dependants (Twice in a year)
• 2. Medical Advice (2nd Opinion)
• 3. Legal Assistance on Medical Matters
• All the above services will be Free of Cost

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• Hospital Surgical Scheme
• Underwritten by
• MCIS Zurich Insurance Berhad

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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.
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P.C.S. RAKYAT SDN BHD
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)
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P.C.S. RAKYAT SDN BHD
WHY YOU SHOULD CHOOSE P.C.S.RAKYAT ?
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Contact Us
Office 79 M, Jalan SS 21/1A, Damansara
Utama 47400 Petaling Jaya, Selangor Tel 03- 7726
5229, 03 7726 4858 Fax [phone] Web
www.rakyatgroup.com Contact Person Chairman a
ziz_at_rakyatgroup.com Executive Director gspl22_at_
hotmail.com, gopi_at_rakyatgroup.com Manager
Operations prakash_at_rakyatgroup.com Asst.
Manager Finance Admin vani_at_rakyatgroup.com Cu
stomer Service karishma_at_rakyatgroup.com Gener
al Enquiries info_at_rakyatgroup,.com
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Location Map