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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
Group Executive Director
Dr. Madhavan NairDirector
Medical
Dr. Avtar Singh
Director Medical (Penang)
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Our Responsibilities, Your AdvantagesWe :
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
EMPLOYEES
Panel Clinics/ Specialist
Su
bm
it Rep
orts
Submit Claim Forms & Bills
Outpatient BenefitsP
resent R
akyat O
P
card a
nd
get
treatmen
t
Pay Clinic Bills
Mo
nth
ly Pay
men
t
Managed by P.C.S.Rakyat Sdn Bhd
ABC BERHAD
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 24 hours
Covered 24 hours
Covered 24 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
P.C.S. RAKYAT OUT-PATIENT SCHEME
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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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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
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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. AzharFever/
Cough/Cold2 30.00
02/04/04Hamidon
Buang65032 Johor AD Principal
02/04/04 Norhayati SpouseKlinik Deepa
Dr. Usha Tonsilitis 40.00
03/04/04Sulaiman Bin
Alimon76800 Penang AD Principal
Klinik Famili
Dr. Joe Diarrhoea 1 35.00
05/04/04 Tong Fei Loong 80963 KL GNPrincipal Klinik
PublicDr.
ChuahRashes 1 45.00
06-04-05 Rita 87600 KL AC PrincipalKlinik Amar
Dr. Amar Eye Infection 1 55.00
07-04-04 Mohd Idris 17821 Johor AD PrincipalKlinik Nik
IsaDr. Aisah Migraine 65.00
08-04-04 Abd Kadir 62145 Penang HR Principal Mediviron Dr. Tan Bronchitis 1 45.00
10/04/04Md Elai Bin
Fadzil23456 Johor HR
Principal Klinik Segara
Dr. SasiBack
Ache/Body Ache
30.00
Monthly Clinic Claim Report-April’2004
TOTAL 345.00
Sample Report
HR- Human Resource
AD - Administration
GN- General
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. AzharFever/
Cough/Cold2 30.00
02/04/04 C.Sivarajan 12048 P.Klang HR Principal Klinik Ravi Dr. Azhar Fever 30.00
08/04/04 C.Sivarajan 12048 P.Klang HR PrincipalKlinik Famili
Dr. Joe Diarrhoea 1 35.00
12/04/04 C.Sivarajan 12048 P.Klang HRPrincipal Klinik
PublicDr.
ChuahRashes 1 45.00
15-04-05 C.Sivarajan 12048 P.Klang HR PrincipalKlinik Amar
Dr. Amar Eye Infection 1 55.00
25-04-04 C.Sivarajan 12048 P.Klang HR PrincipalKlinik Nik
IsaDr. Aisah Migraine 65.00
30-04-04 C.Sivarajan 12048 P.Klang HR Principal Mediviron Dr. Tan Bronchitis 1 45.00
Monthly Employee Claim Report-April’2004
TOTAL 305.00
Sample Report
HR- Human Resource
AD - Administration
GN- General
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Name Empl No.
Branch Dept R’Ship Eligibility Usage Balance
Amount 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
Usage Vs Eligibility Report for the period
of April’2004 – June’2004
Sample Report
AC- Accounts
HR- Human Resource
GN-General
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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 %
Most Active Treatment for the period April’04 – June’04
Quarterly Report
Sample Report
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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15
19
28
10
0
5
10
15
20
25
30
35
Klinik Ravi Poliklinik Dr. Siti Klinik Medifom Klinik Dr. Azhar Klinik 24 Jam Klinik Mediviron
Klinik
No
. o
f M
C's
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0
500
1000
1500
2000
2500
3000
3500
4000
4500
5000
April'04 May'04 June'04 July'04
Klinik Public
Klinik Ravi
Klinik Dr. Siti
Klinik Joe
Poliklinik Azhar
Amount (RM)
Month
Most Active Clinics
Sample Report
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Pattern of Disease for April'04 - June'04 - Outpatient
213
34 3122
17 14 12 12 11 105 5
0
50
100
150
200
250
Diagnosis
No
. of
Pat
ien
ts
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
Sample Report
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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
6022
300
20
20
90
90
20
6510
500
Total Panel Clinics in Malaysia : 1400
15
10
3 Tawau
Kudat
Miri
Semporna Pulau Sipadan
Labuan
Sarikei
3
3
21
5
2
1
Bandar Sri Aman
1
4
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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.
2. 4 Printers - Colour3. 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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CLINICSCLINICS CLINICSCLINICSCLINICSCLINICS
PROPOSED DATA FLOW-DATA PROCESSING
CLINICSCLINICS CLINICSCLINICS CLINICSCLINICS
A. Data transferfrom Clinics:either by:~Internet~Diskettes
B. Optional~from PCS toclinics via Internet.P.C.S RAKYAT / CONTROL
CENTREP.C.S RAKYAT / CONTROL
CENTRE
ABC Berhad
Server
Offline ReportsMonitoring Purpose only
RakyatGroupServer
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• MAJOR ACCCOUNTS UNDER RAKYAT PLAN FOR OUTPATIENT (GP) –
1. INTEGRATED LOGISTICS BERHAD2. SURIA BUSINESS SOLUTIONS (Subsidiary of Scomi Berhad)3. PICSEL TECHNOLOGIES MALAYSIA (UK Based)4. KOPERASI PERDANAJAYA SDN BHD5. TRONOH CONSOLIDATED BERHAD6. ZELAN CONSTRUCTION SDN BHD7. ZELAN HOLDINGS (M) SDN BHD8. ZELAN ENTERPRISES SDN BHD9. ZELAN CORPORATION SDN BHD10. ZELAN DEVELOPMENT SDN BHD11. PANDUAN PELANGI SDN BHD12. EUROPEAN PROFILES (M) SDN BHD13. MALAYSIAN BAR COUNCIL14. INFRASOFT TECHNOLOGIES LTD.15. KOLEJ SAINS KESIHATAN BERSEKUTU16. GAYA BINA CONTRUCTION SDN BHD17. SILVER RIDGE HOLDINGS BERHAD18. WOODLANDOR HOLDINGS BERAHD19. SPECIFIC RESOURCES SDN BHD20. JVC MANUFACTURING MALAYSIA21. MISC INTEGRATED LOGISITICS SDN BHD22. EDARAN OTOMOBIL NASIONAL BERHAD (EON)23. EPE SWITCHGEAR SDN BHD
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Name of Client Types of Service
Malaysian Bar Council Hospital & Surgical Group Personal Accident
Suria Business Solutions Sdn Bhd Outpatient( Subsidiary of Scomi Berhad) Hospital & Surgical
Group Term LifePicsel Technologies (UK based) Outpatient
Hospital & Surgical Group Personal Accident
Bumi Gajah Agencies Sdn Bhd OutpatientHospital & Surgical Marine InsuranceContractors All RiskForeign Workers Compensation
SilverRidge Holdings Berahd Group Personal AccidentErection All Risk - General
Bumihighway Foreign Workers CompensationFireBurglaryProperty
Koperasi Perdanajaya OutpatientHospital & Surgical Annual Medical Health Screening
Securiforce Hospital & Surgical K-Card Technologies Group Personal AccidentMechanalysis Sdn Bhd Group Personal Accident
Hospital & Surgical Koshin Kitamula (M) Sdn BHd Group Personal AccidentABM Metal Sdn BHd Fire
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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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KL/Selangor
1. AMPANG PUTERI SPECI ALIST HOSPITAL 03-4270 2500
2. ANDALAS MEDI CAL 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 SPECI ALIST CENTRE 03-7722 2692
8. DARUL EHSAN MEDICAL CENTRE 03-5880 8868
9. GLENEAGLES INTAN MEDICAL CENTRE 03-4257 1300
10. INSTITUT J ANTUNG NEGARA 03-2617 8200
11. KAJ ANG MEDICAL CENTRE 03-8736 0631
12. KAMPONG BARU MEDICAL CENTRE 03-2693 1007
13. KELANA J AYA MEDICAL CENTRE 03-7805 2111
14. MEGAH MEDICAL SPECI ALIST 03-7803 1212
15. PANTAI CHERAS MEDICAL CENTRE 03-9132 2022
16. PANTAI KLANG SPECIALIST MEDICAL CENTRE 03-3372 5222
17. PANTAI MEDI CAL CENTRE 03-2296 0888
18. PUSAT PAKAR TAWAKAL 03-4023 3599
19. PUSAT RAWATAN ISLAM 03-4041 4922
20. SELANGOR MEDI CAL CENTRE 03-5543 1111
21. SENTOSA MEDI CAL CENTRE 03-4043 7166
22. SRI KOTA MEDICAL CENTRE 03-3373 3636
23. SUBANG J AYA MEDICAL CENTRE 03-5634 1212
24. SUNWAY MEDICAL CENTRE 03-5632 7688
25. TAMAN DESA MEDI CAL CENTRE 03-7982 6500
26. TUNG SHIN HOSPITAL 03-2072 1655
27. UNIVERSITI MALAYA SPECI ALI ST 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
LIST OF PANEL HOSPITALS
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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 UsOffice : 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