Transcript Slide 1

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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
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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.
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BOARD OF DIRECTORS
Abdul Aziz Nor
(LLB Hons Essex University, London)
Chairman
S.Gopinath
Dr. Madhavan Nair
Dr. Avtar Singh
Group
Executive Director
Director
Medical
Director Medical
(Penang)
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Our Responsibilities, Your Advantages
We :
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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
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Managing Outpatient
Scheme
on
Fixed Cost Basis
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EMPLOYEES
ABC
BERHAD
Outpatient Benefits
Present Rakyat OP
card and get treatment
Submit Reports
Monthly Payment
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
OUTPATIENT CARE BENEFITS
Plan
Individual
Plan
Family
Plan Single
Parent
GP Clinic Service for Outpatient Consultation including
Drugs
Covered
Basic Diagnostic tests including Lab Tests/X-Ray/ECG
NIL
Covered
Child : up to 21 yrs old
Childhood Immunisations
URGENT/EMERGENCY CARE
Nationwide Emergency Health Coverage
Covered
24 hours
Covered
24 hours
Covered
24 hours
Covered
in Full
Covered in
Full
Covered in
Full
Provided by GP or Specialist on an Outpatient Basis
According to Benefits Limit
Specialist Visit (referred by Panel Clinic)
Specialist Care & Diagnostic Services
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:
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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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EXCLUSION CLAUSES
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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
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Sample
Report
Date of
Visit
Monthly Clinic Claim Report-April’2004
Name
Empl
No.
Branch
Dept
R’Ship
Clinic
Doctor
Diagnosis
Klinik Ravi
Dr. Azhar
Fever/Cough/
Cold
Spouse
Klinik
Deepa
Dr. Usha
Tonsilitis
Principal
Klinik
Famili
Dr. Joe
Diarrhoea
1
35.00
Klinik
Public
Dr.
Chuah
Rashes
1
45.00
1
55.00
01/04/04
C.Sivarajan
12048
P.Klang
HR
Principal
02/04/04
Hamidon
Buang
65032
Johor
AD
Principal
02/04/04
Norhayati
03/04/04
Sulaiman Bin
Alimon
76800
Penang
AD
05/04/04
Tong Fei Loong
80963
KL
GN
06-04-05
Rita
87600
KL
AC
Principal
Klinik
Amar
Dr. Amar
Eye Infection
07-04-04
Mohd Idris
17821
Johor
AD
Principal
Klinik Nik
Isa
Dr. Aisah
Migraine
08-04-04
Abd Kadir
62145
Penang
HR
Principal
Mediviron
Dr. Tan
Bronchitis
10/04/04
Md Elai Bin
Fadzil
23456
Johor
HR
Principal
Klinik
Segara
Dr. Sasi
Back
Ache/Body
Ache
HR- Human Resource
AD - Administration
GN- General
Principal
MC
days
Charges
2
30.00
40.00
65.00
1
45.00
30.00
TOTAL 345.00
Sample
Report
Date of
Visit
Monthly Employee Claim Report-April’2004
Name
Empl
No.
Branch
Dept
R’Ship
Clinic
Doctor
Diagnosis
MC
days
Charges
2
30.00
01/04/04
C.Sivarajan
12048
P.Klang
HR
Principal
Klinik Ravi
Dr. Azhar
Fever/Cough/
Cold
02/04/04
C.Sivarajan
12048
P.Klang
HR
Principal
Klinik Ravi
Dr. Azhar
Fever
08/04/04
C.Sivarajan
12048
P.Klang
HR
Principal
Klinik
Famili
Dr. Joe
Diarrhoea
1
35.00
12/04/04
C.Sivarajan
12048
P.Klang
HR
Klinik
Public
Dr.
Chuah
Rashes
1
45.00
15-04-05
C.Sivarajan
12048
P.Klang
HR
Principal
Klinik
Amar
Dr. Amar
Eye Infection
1
55.00
25-04-04
C.Sivarajan
12048
P.Klang
HR
Principal
Klinik Nik
Isa
Dr. Aisah
Migraine
30-04-04
C.Sivarajan
12048
P.Klang
HR
Principal
Mediviron
Dr. Tan
Bronchitis
HR- Human Resource
AD - Administration
GN- General
Principal
30.00
65.00
1
45.00
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
Amount
Usage
Balance
Amount
Amount
Rita
87600
KL
AC
Principal
1500.00
300.00
1200.00
Md. Idris
17821
Johor
AD
Principal
1500.00
600.00
900.00
Kadir
62145
Penang
HR
Principal
1500.00
1200.00
300.00
Tan Foo
31361
KL
AD
Principal
1500.00
800.00
700.00
Siti
1234
KL
AC
Principal
1500.00
900.00
600.00
Ravi
4567
PJ
HR
Principal
1500.00
800.00
700.00
Afandi
3456
Johor
GN
Child
1500.00
1200.00
300.00
AC- Accounts
HR- Human Resource
GN-General
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Sample Report
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
10
35
18 %
Diarrohea/Vomiting/Food Poisoning
10
08
06
24
13 %
Diabetes Mellitus
08
07
04
19
10 %
Vertigo / Migraine
06
07
05
18
9.6 %
Gastrisitis
03
05
08
16
8.5 %
AC- Accounts
GN- General
HR- Human Resource
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Quarterly Report on MC's issued for the period April'04 - June'04
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33
30
28
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No. of MC's
25
19
20
15
15
10
10
5
0
Klinik Ravi
Poliklinik Dr. Siti
Klinik Medifom
Klinik Dr. Azhar
Klinik
Klinik 24 Jam
Klinik Mediviron
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Sample Report
Most Active Clinics
Amount (RM)
5000
4500
4000
3500
Klinik Public
Klinik Ravi
Klinik Dr. Siti
Klinik Joe
Poliklinik Azhar
3000
2500
2000
1500
1000
500
0
April'04
May'04
Month
June'04
July'04
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Sample Report
Pattern of Disease for April'04 - June'04 - Outpatient
250
213
No. of Patients
200
150
100
50
34
31
22
17
14
12
12
11
10
5
5
0
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
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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).
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..
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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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Panel Clinics in Malaysia
4
5
Kudat
10
10
65
20
2
Labuan
1
90
Semporna
Pulau Sipadan
90
300
3
Tawau
Miri
20
1
15
20
60
22
2
3
Sarikei
3
Bandar
Sri Aman
500
1
Total Panel Clinics in Malaysia : 1400
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SAMPLE RAKYAT OUT PATIENT CARD
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P.C.S. Rakyat is well equipped with all the latest Computers, Printers and
Scanners.
1.
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
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.
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PROPOSED DATA FLOW- DATA PROCESSING
CLINICS
CLINICS
CLINICS
CLINICS
CLINICS
CLINICS
CLINICS
CLINICS
CLINICS
A. Data transfer
from Clinics:
either by:
~Internet
~Diskettes
B.
Optional
~from PCS to
clinics via
Internet.
P.C.SRAKYAT
RAKYAT/ /CONTROL
CONTROL
P.C.S
CENTRE
CENTRE
ABC Berhad
Server
RakyatGroup
Server
Offline Reports
Monitoring
Purpose only
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MAJOR ACCCOUNTS UNDER RAKYAT PLAN FOR OUTPATIENT (GP) –
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
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
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Name of Client
Types of Service
Malaysian Bar Council
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
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
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WELLNESS PROGRAM
1.
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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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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LIST OF PANEL HOSPITALS
KL/Selangor
1.
AMPANG PUTERI SPECIALIST HOSPITAL
03-4270 2500
2.
ANDALAS MEDICAL CENTRE
03-3324 1000
3.
APOLLO TTDI MEDICAL CENTRE
03-7726 6911
4.
ARUNAMARI SPECIALIST HOSPITAL
03-3324 3288
5.
ASSUNTA HOSPITAL
03-7780 6197
6.
DAMAI SERVICE HOSPITAL
03-4043 4900
7.
DAMANSARA SPECIALIST CENTRE
03-7722 2692
8.
DARUL EHSAN MEDICAL CENTRE
03-5880 8868
9.
GLENEAGLES INTAN MEDICAL CENTRE
03-4257 1300
10. INSTITUT JANTUNG NEGARA
03-2617 8200
11. KAJANG MEDICAL CENTRE
03-8736 0631
12. KAMPONG BARU MEDICAL CENTRE
03-2693 1007
13. KELANA JAYA MEDICAL CENTRE
03-7805 2111
14. MEGAH MEDICAL SPECIALIST
03-7803 1212
15. PANTAI CHERAS MEDICAL CENTRE
03-9132 2022
16. PANTAI KLANG SPECIALIST MEDICAL CENTRE
03-3372 5222
17. PANTAI MEDICAL CENTRE
03-2296 0888
18. PUSAT PAKAR TAWAKAL
03-4023 3599
19. PUSAT RAWATAN ISLAM
03-4041 4922
20. SELANGOR MEDICAL CENTRE
03-5543 1111
21. SENTOSA MEDICAL CENTRE
03-4043 7166
22. SRI KOTA MEDICAL CENTRE
03-3373 3636
23. SUBANG JAYA MEDICAL CENTRE
03-5634 1212
24. SUNWAY MEDICAL CENTRE
03-5632 7688
25. TAMAN DESA MEDICAL CENTRE
03-7982 6500
26. TUNG SHIN HOSPITAL
03-2072 1655
27. UNIVERSITI MALAYA SPECIALIST CENTRE
03-7950 2650
28. HOSPITAL PANTAI INDAH
03-4289 2828
29. THE TUN HUSSEIN ONN EYE HOSPITAL
03-7956 1511
30. CMH MEDICAL CENTRE
03-2078 2055
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Penang
BAGAN SPECIALIST CENTRE
04-332 2800
BUKIT MERTAJAM SPECIALIST CENTRE
04-538 7577
GLENEAGLES MEDICAL CENTRE
04-227 6111
HOPE CHILDREN HOSPITAL
04-228 6557
HOSPITAL PANTAI MUTIARA
04-643 3888
LAM WAH EE HOSPITAL
04-657 1888
LOH GUAN LYE SPECIALIST CENTRE
04-228 8501
PENANG ADVENTIST HOSPITAL
04-226 1133
PUBLIC SPECIALIST HOSPITAL
04-226 6699
TANJUNG MEDICAL CENTRE
04-226 2323
ISLAND HOSPITAL
04-228 8222
Kedah
METRO SPECIALIST HOSPITAL
04-423 8888
KEDAH MEDICAL CENTRE
04-730 8878
PUTRA MEDICAL CENTRE
04-734 2888
STRAND HOSPITAL
04-442 8888
Melaka
MAHKOTA MEDICAL CENTRE
06-284 8222
PANTAI AYER KEROH
06-231 9999
THE SOUTHERN HOSPITAL, MELAKA
06-283 5888
Negri Sembilan
COLUMBIA HOSPITAL
06-601 1988
N. SEMBILAN CHINESE MATERNITY HOSPITAL
06-762 2104
PUSAT PAKAR PD
06-6477 588
SEREMBAN SPECIALIST HOSPITAL
06-767 7800
Johor
CENTURY MEDICAL CENTRE
07-331 1722
HOSPITAL PENAWAR
07-252 1800
JOHOR SPECIALIST CENTRE
07-223 7811
MEDICAL SPECIALIST CENTRE
07-224 3888
PUTERI SPECIALIST HOSPITAL
07-223 3377
THE SOUTHERN HOSPITAL, BATU PAHAT
07-413 3333
PUSAT PAKAR KLUANG UTAMA
07-771 8999
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Pahang
70. KUANTAN MEDICAL CENTRE
09-514 2828
71. KUANTAN SPECIALIST HOSPITAL
09-567 8588
Kelantan
72. KOTA BAHRU MEDICAL CENTRE
09-743 3399
73. HOSPITAL PAKAR PERDANA
09-745 8000
Sabah/Labuan
74. DAMAI SPECIALIST CENTRE
088-222 922
75. SABAH MEDICAL CENTRE
088-424 333
76. SANDAKAN SPECIALIST CLINIC
089-221 007
77. RAFFLESIA MEDICAL CENTRE
088-780 670
Sarawak
78. NORMAH MEDICAL CENTRE
082-440 055
79. REJANG MEDICAL CENTRE
084-330 733
80. COLUMBIA ASIA MEDICAL CENTER, MIRI
085-437 755
81. TIMBERLAND MEDICAL CENTRE
082-234 466
82. KUCHING SPECIALIST HOSPITAL
082-365 777
Perak
APOLLO MEDICAL CENTRE
05-805 6000
HOSPITAL FATIMAH
05-545 5777
IPOH SPECIALIST CENTRE
05-241 8777
KINTA MEDICAL CENTRE
05-254 2125
LARUT MEDICAL CENTRE
05-806 7817
PANTAI PUTRI HOSPITAL
05-548 4333
PERAK COMMUNITY SPECIALIST HOSPITAL
05-254 5594
TAIPING MEDICAL CENTRE
05-807 1049
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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.
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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: 03- 7726 4858
Web : www.rakyatgroup.com
Contact Person:
Chairman
:
[email protected]
Executive Director
:
[email protected], [email protected]
Manager Operations
:
[email protected]
Asst. Manager Finance & Admin
:
[email protected]
Customer Service
;
[email protected]
General Enquiries
:
info@rakyatgroup,.com
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Location Map
47