1. P.C.S. RAKYAT SDN BHD
COPORATE OVERVIEW

2. 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

3. 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.

4. P.C.S. RAKYAT SDN BHD
BOARD OF DIRECTORS

5. P.C.S. RAKYAT SDN BHD BOARD OF DIRECTORS Abdul Aziz Nor Chairman
(LLB Hons Essex University, London)
Chairman
S.Gopinath
Group Executive Director
Dr. Madhavan Nair
Director Medical
Dr. Avtar Singh
Director Medical (Penang)

6. P.C.S. RAKYAT SDN BHD
ABOUT US

7. Our Responsibilities, Your Advantages
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.

8. 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

9. 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.

10. PRODUCT

11. OUTPATIENT (CLINICAL)
SCHEME
P.C.S. RAKYAT SDN BHD

12. Managing Outpatient
Scheme on
Fixed Cost Basis

13. 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

14. Specialist Visit (referred by Panel Clinic)
P.C.S. RAKYAT OUT-PATIENT SCHEME
OUTPATIENT CARE BENEFITS
Plan Individual
Plan Family
Plan Single Parent
GP Clinic Service for Outpatient Consultation including
Covered
NIL
Covered Child : up to 21 yrs old
Drugs
Basic Diagnostic tests including Lab Tests/X-Ray/ECG
Childhood Immunisations
URGENT/EMERGENCY CARE
Nationwide Emergency Health Coverage
Covered hours
Provided by GP or Specialist on an Outpatient Basis
According to Benefits Limit
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

15. OUT PATIENT SCHEME P.C.S. RAKYAT SDN BHD
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

16. Any changes can be discussed
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 / 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

17. P.C.S. RAKYAT SDN BHD
REPORTS

18. Monthly Clinic Claim Report-April’2004
Sample Report
P.C.S. RAKYAT SDN BHD
Monthly Clinic Claim Report-April’2004
Date of Visit
Name
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 2
30.00
02/04/04
Hamidon Buang
65032
Johor AD
Norhayati
Spouse
Klinik Deepa
Dr. Usha
Tonsilitis
40.00
03/04/04
Sulaiman Bin Alimon
76800
Penang
Klinik Famili
Dr. Joe
Diarrhoea 1
35.00
05/04/04
Tong Fei Loong
80963 KL GN
Klinik Public
Dr. Chuah
Rashes
45.00
Rita
87600 AC
Klinik Amar
Dr. Amar
Eye Infection
55.00
Mohd Idris
17821
Klinik Nik Isa
Dr. Aisah
Migraine
65.00
Abd Kadir
62145
Mediviron
Dr. Tan
Bronchitis
10/04/04
Md Elai Bin Fadzil
23456
Klinik Segara
Dr. Sasi
Back Ache/Body Ache
HR- Human Resource
AD - Administration
GN- General
TOTAL

19. Monthly Employee Claim Report-April’2004
Sample Report
P.C.S. RAKYAT SDN BHD
Monthly Employee Claim Report-April’2004
Date of Visit
Name
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 2
30.00
02/04/04
Fever
08/04/04
Klinik Famili
Dr. Joe
Diarrhoea 1
35.00
12/04/04
Klinik Public
Dr. Chuah
Rashes
45.00
Klinik Amar
Dr. Amar
Eye Infection
55.00
Klinik Nik Isa
Dr. Aisah
Migraine
65.00
Mediviron
Dr. Tan
Bronchitis
HR- Human Resource
AD - Administration
GN- General
TOTAL

20. Usage Vs Eligibility Report for the period
P.C.S. RAKYAT SDN BHD
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
87600 KL AC
Principal
300.00
Md. Idris
17821
Johor AD
600.00
900.00
Kadir
62145
Penang HR
Tan Foo
31361
800.00
700.00
Siti
1234
Ravi
4567 PJ
Afandi
3456 GN
Child
AC- Accounts
HR- Human Resource
GN-General

21. Most Active Treatment for the period April’04 – June’04
Sample Report
P.C.S. RAKYAT SDN BHD
Most Active Treatment for the period April’04 – June’04
Quarterly Report
Diagnosis
Department
Total AC GN HR
No.
Percentage
Fever/Cough/Cold 25 18 32 75
40 %
Back Ache/Body Ache/ Joint Ache 15 10 35
18 %
Diarrohea/Vomiting/Food Poisoning 08 06 24
13 %
Diabetes Mellitus 07 04 19
10 %
Vertigo / Migraine 05
9.6 %
Gastrisitis 03 16
8.5 %
AC- Accounts
GN- General
HR- Human Resource

22. P.C.S. RAKYAT SDN BHD

23. P.C.S. RAKYAT SDN BHD Sample Report Most Active Clinics Amount (RM)
Month

24. Sample Report
P.C.S. RAKYAT SDN BHD

25. OUTPATIENT PROCEDURES AND FLOWCHART

26. 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..

27. 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 – (24 Hours)
H/P:

28. In case of Emergency patient visits a Non-Panel Clinic.
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.

29. Panel Clinics in Malaysia
P.C.S. RAKYAT SDN BHD
Panel Clinics in Malaysia 4 5
Kudat 10 10 65 2 20 1
Labuan 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

30. SAMPLE RAKYAT OUT PATIENT CARD
P.C.S. RAKYAT SDN BHD
SAMPLE RAKYAT OUT PATIENT CARD

31. EQUIPMENTS/TOOLS/SYSTEMS
P.C.S. RAKYAT SDN BHD
EQUIPMENTS/TOOLS/SYSTEMS

32. P.C.S. RAKYAT SDN BHD Software System :
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
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.

33. A. Data transfer from Clinics: either by: ~Internet ~Diskettes
PROPOSED DATA FLOW -
DATA PROCESSING
CLINICS
A. Data transfer
from Clinics:
either by:
~Internet
~Diskettes
B Optional
~from PCS to
clinics via
Internet.
P.C.S RAKYAT / CONTROL
CENTRE
ABC Berhad
Server
Offline Reports
Monitoring
Purpose only
RakyatGroup
CLINICS
CLINICS
CLINICS

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

35. 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
WOODLANDOR HOLDINGS BERAHD
SPECIFIC RESOURCES SDN BHD
JVC MANUFACTURING MALAYSIA
MISC INTEGRATED LOGISITICS SDN BHD
EDARAN OTOMOBIL NASIONAL BERHAD (EON)
EPE SWITCHGEAR SDN BHD

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

38. All the above services will be Free of Cost
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

39. Hospital & Surgical Scheme Underwritten by
MCIS Zurich Insurance Berhad

40. 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.

41. 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 – (24 HOURS)

45. P.C.S. RAKYAT SDN BHD
WHY YOU SHOULD CHOOSE P.C.S.RAKYAT ?

46. Contact Us Office : 79 M, Jalan SS 21/1A, Damansara Utama
47400 Petaling Jaya,
Selangor
Tel: , 03 –
Fax:
Web :
Contact Person:
Chairman :
Executive Director :
Manager Operations :
Asst. Manager Finance & Admin :
Customer Service ;
General Enquiries :

47. Location Map