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Med Save Health Care (TPA)Ltd.

PRESENTATION. FOR. PRE-POLICY MEDICAL EXAMINATIONS AND SPECIAL MEDICAL REPORTS. Med Save Health Care (TPA)Ltd. INSURERS CURRENTLY SERVICED BY MED SAVE INDIA. HEALTH INSURANCE DELHI, UTTARANCHAL & H.P. UNITED INDIA INSURANCE COMPANY LTD. NATIONAL INSURANCE COMPANY LTD.

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Med Save Health Care (TPA)Ltd.

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  1. PRESENTATION FOR PRE-POLICY MEDICAL EXAMINATIONS AND SPECIAL MEDICAL REPORTS MedSaveHealth Care (TPA)Ltd.

  2. INSURERS CURRENTLY SERVICED BY MEDSAVE INDIA HEALTH INSURANCE DELHI, UTTARANCHAL & H.P. UNITED INDIA INSURANCE COMPANY LTD NATIONAL INSURANCE COMPANY LTD ORIENTAL INSURANCE COMPANY LTD

  3. C O M P A N Y P R O F I L E MedSaveHealthcare (TPA) Ltd.

  4. MedSave Group Presence In 3 Continents Services more than 500 insurance and assistance companies Operates a Medical Network of more than 4.5 lacs providers Corporate Offices in London, New York, Tel Aviv and New Delhi. • Insurance • Medical Services • Third Party Administration Major Business Activities :

  5. BRANCH NETWORK

  6. Medsave Heathcare [TPA] Ltd., India is part of Medsave Group with its Head Office at Delhi and having 34 branches all over the country. Medsave is an IRDA licensed company for providing TPA services to the insurance companies of India for their health policies. Medsave is one of the largest TPA in the country. Following are the major activities of Medsave. Collects policies from BODO of the Insurance companies. Maintains the database of policyholders and issues the Photo Identity cards with unique number and guide book. Does hospital empanelment to provide cashless facility. Handles the Cashless and Re-imbursement claims. Issues the payment to insured/hospitals against the claims Cost containment and Fraud elimination.

  7. LICENCE COPY

  8. Quality Policy MEDSAVEHEALTHCARE [TPA] LTD.is committed to enhancing customer satisfaction level and improving effectiveness of Quality Management System by continual improvement, meeting customer requirements and periodic review of objectives and targets. We shall constantly strive to improve and enhance the status and intellectual levels of all concerned including team members through collective learning and sharing. ISO 9001:2000 CERTIFIED COMPANY

  9. Company Overview Medsave Heathcare [TPA] Ltd. India is an ISO 9001:2000Certified Company. Total staff of 314 in India Operates a 24X7 Assistance Centre Tailor made software Operates one of the largest Hospital Network of more than 3000 Hospitals. Empanelled by Nationalized Insurance Companies including LIC Of India as TPA covering all over India. All India helpline – (011)39001234, Toll Free No:-1800111142

  10. ALL INDIA INFRASTRUCTURE SPEEDY CLAIM SETTLEMENT COST CONTAINMENT Medsave Healthcare [TPA] Ltd. WEB BASED INTEGERATED SOFTWARE ALL INDIA HOSPITAL NETWORK PROACTIVE INFORMATON FLOW SYSTEM

  11. Major Projects TPA services for RSBY Scheme in Kerla, Bihar, Punjab, Chattisgarh & Gujrat Third Party Administration for Nationalized Govt. Insurance Companies. TPA services for The Sanjivni Trust – Promoted by Govt of Punjab. TPA services for Tsunami Victims – Promoted by PMO relief Fund. TPA service for Employees of various Banks like Syndicate Bank, Indian Overseas Bank, Indian Bank. SBH,Bank of Maharastra etc. Bhai Ghanhya Scheme of Punjab Govt. Major Corporates - American Embassy, Whirlpool of India, Goodyear India Ltd. Footwear Design & Development Institute, Institute of Management Studies, ITC Ltd., Tecumseh India Pvt. Ltd., Centre for Development of Advanced Computing (C-DAC) and MAX Healthcare Group.SGPC [Punjab], Abhisekh Industry [ Punjab]

  12. Rashtriya Swasthya Bima Yojana • Benefits: • To provide improved access to quality medical care for BPL families • Through an identified network of health care providers. • A common Health insurance card across India • Pre-existing Diseases to be covered • Total sum insured per BPL family is Rs.30,000 ,for Registration fee is Rs. 30 • Transport allowance limit of Rs. 100/visit an annual ceiling of Rs. 1000 • Pre-existing conditions/disease to be covered, subject to minimal • exclusions. • Target population is 6 crores families in five years • – with budget allocation of Rs. 3500 crores

  13. Rashtriya Swasthya Bima Yojana Medsave has been awarded following districts to provide smart cards (10,00,000) to BPL families and to manage hospital network and claims. KERLA CHATTISGARH GUJRAT KASARAGOD BILASPUR BHAVNAGAR KOZHIKODE DURG JUNAGARH WAYANAD SURJUJA AMRELI JUNAGARH KANNUR AMRELI BIHAR BIHAR CHANDIGARH GAYA HOSHIARPUR CHANDIGARH DARBHANGA

  14. MedSave's Unique TPA Services 1 All India MedSavebranches setup for the customer's convenience. 2 Medical team of 41 doctors for assistance. 3 Insured can access their claim status on our website. 4 Corporates and BO/DOs of Insurance companies have been given access the website through login passwords. 5 Provision for second opinion from abroad 6 Priority to MedSavecard holder at the time of hospitalization. 7 Cost Containment - Discounted rates, Bill Scrutiny, Case Management, Second Medical Opinion, Medical Procedure Audit, Elimination of Frauds. 8 Disease coding and Classification – MedSavehas codified over 2000 diseases in its Software module based on latest ICD – 10 Codification. 9 Disease-wise, Age-wise, Geographical-wise claims analysis. 10 Free ambulance facility available at various hospitals. Help-Desk is provided to major corporate (s) 11

  15. EMPLOYEES PROFILE • Doctors (including 6 P.G’s) 41 • Software Engineers 5 • M.B.A 13 • Insurance sector people 9 • Legal Experts 3 • Post Graduates 32 • Graduates 180 • Undergraduates 31 • Total Staff 314

  16. Technology Entire process is managed on MIMS software (on SQL server as back-end and Visual Basic as Front end) Separate IBM servers for database with data redundancy, website, and financial activities. An additional stand-by server is ready in case of any failure Back-ups of database taken on daily basis on High Speed HP Backup Device, and kept in secure location outside the office. All branches are linked to the main database using our website All BO / DOs of Insurance companies have been given access to the website through unique login ids and passwords Highly robust Mercury Mail server for mailing solution ACD solution from Coral

  17. - Continued - High speed 24 hours internet connectivity All messages entering or leaving the intranet pass through the firewall, which examines each message and blocks those that do not meet the specified security criteria. Virus protection by Symantec Antivirus Corporate Edition Exclusive ISA Certified “ICD10 code” integration Reporting/Statistics like Yearly, Monthly, Agent wise, Hospital wise, ICD10 code wise, Age group wise ,Region wise , BODO Wise etc. Complete Scan of Claim Files which can be accessed by insurance co. Complete documented with Test cases and Use cases etc.

  18. Network Connectivity BRANCH USER ENROLLMENT DATABASE SERVER SIFY BROADBAND CALL CENTRE WEB SERVER TALLY SERVER CLAIM/CASHLESS INSURED/BODO INTERNET INTRANET

  19. Automated Call Center Capabilities • 24X7 call center. • Automated Call Distribution Software. • 21 telephone lines, Toll free number with 10 hunting lines can be reached from anywhere in India. • 15 work stations, with KTS systems. • Call centre is supported by in-house developed software.

  20. LIC- Pre Medical Health Check-Up MedSave was allotted this work in 2 states namely Bihar and Jharkhand - 5 Divisional Offices comprising around 100 Branches. Divisional Offices: Patna, Muzaffarpur, Bhagalpur, Hazaribagh, and Jamshedpur MedSavehas completed over 4000 cases till 2008.

  21. Centre Wise / Location Wise Details (1st April 2007-31st December 2007)

  22. Duties of TPA 1. All RELEVANT PAPERS WILL BE COLLECTED FROM BRANCHES DAILY ALL REPORTS & RELEVANT PAPERS WILL BE DELIVERED TO RESPECTIVE BRANCHES WITHIN 3DAYS. 2. 3. SOFTCOPY OF THE MEDICAL REPORTS / SPECIAL REPORTS WILL BE HANDED OVER TO THE MANAGER N B OF THE DO. 4. SOFTCOPY OF THE REPORTS WILL ALSO BE AVAILABLE ON THE NET.

  23. Duties of TPA • Full Medical Report – measurements and observations about health of the life to be assured to be reported in a prescribed format. The observations to be noted will be based on information obtained by the medical examiner from the physical examination as also information provided by the examinee by careful enquiries / questions in the proposal form. • Electrocardiogram (ECG) - 12 leads ECG along with Standardization slip, each lead with minimum of 3 complexes, long lead II. If L-III and AVF shows deep Q or T wave change, they should be recorded additionally in deep inspiration. If V1 shows a tall R-Wave, additional lead V4R be recorded. It is necessary to be properly mounted and submitted with reporting format complete in all respects. • Computerized Tread Mill Test (CTMT) – Pre-test (Supine, standing, hyperventilation), Exercise (Stage I, II, III….) and Recovery (I after one minute, II,III,IV……till ECG normalizes). Give adequate exercise time (Reaching target heart rate is sometimes not sufficient) symptoms limited. Each stage to have 12 lead tracings with long lead II. Each lead should contain at least three complexes. On separate individual paper each stage with relevant observations are to be recorded. • Haemogram – giving Red Blood Cell Count, Hb%, Haematocrit, Indices (MCV, MCH, MCHC), Morphology, Target Cells, White Blood Cells (total / differential count, Platelets and Erythrocytes Sedimentation rate

  24. Duties of TPA Contd. • Lipidogram – Lipid Profile giving total Cholesterol, High/low Density Cholesterol and S. Triglycerides • Fasting Blood Sugar Report - giving fasting blood sugar readings • Post glucose blood sugar report-giving blood sugar readings two hours after administration of 75 gms of glucose • Hba1c or Glycosylated Haemoglobin %. Hba1c is preferable. • Special Bio-chemical Tests (SBT-13) – Giving fasting blood sugar, lipid profile, S. Creatinine, S. Proteins, S. Bilirubin, SGOT, SGPT, S. Alkaline Phosphatase, GGTP, BUN, HbsAg, Elisa for HIV • Routine Urine Analysis - Physical, chemical & microscopic examination of urine • Report on X-Ray of Chest (P.A. View) • Elisa for HIV

  25. POINTS TO BE FOLLOWED Medsave will maintain and continue to have adequate internal / in-house checks and controls for safeguarding the quality of the medical examination and reports. Medsave have proper mechanism for maintaining professional confidentiality of the reports and the clients. It must be clearly understood that acceptance or otherwise of a risk on a particular life is mainly decided on the basis of the reporting in the medical report and also special reports submitted and hence correct reporting must be ensured at all costs. Computer generated reports of the special medical tests will also be accepted. However the signature of the life assured must be obtained on a separate sheet (as per enclosed format) before the tests are carried out. The full medical examination shall be conducted by a doctor with a minimum qualification of MBBS. Dentists, X-Ray Specialists, Bacteriologists, Pathologists, Ophthalmologists, Paediatricians.

  26. POINTS TO BE FOLLOWED The special reports will be conducted in your own in-house diagnostic centres / pathological labs or from other renowned centers. The place of medical examination / diagnostic centre / pathological labs should as far as possible suit the convenience of the clients Medsave have sufficient number of qualified doctors on their panel. The diagnostic centers and pathological labs may be outsourced only in case of an emergency. Medsave will contact the Manager (New Business) of the Divisional Office allotted for getting enrolled as Third Party Administrator for conducting medical examinations and special reports and collecting the names and addresses of the concerned branch offices. Medsave will supply to the Corporation the list of their nominated officials who will be authorized to collect the details of the clients and tests to be conducted from the Branch Offices on a day to day basis. E-mail addresses, office telephone numbers and mobile numbers of the nominated officials.

  27. POINTS TO BE FOLLOWED Medsave has a complaint register for clients’ complaints at each centre. Identity of the client is of utmost importance at the time of medical examination and special reports. Medical Examiner of the Medsave shall obtain the signatures of Examinee on all the reports conducted by him. The reports of medical examination and special reports will be submitted in a sealed envelope to the Branch Manager. The response time – Turn around time (TAT) should be at the earliest but in no case later than 2 days. Medsave will display LICs toll free Number 1251 and the mobile numbers of Managers (New Business) and Regional Managers (Actuarial) in case any client wishes to seek the help of LIC while he / she is at the centre The representative of the Medsave will have constant liaison with the Manager ( New Business) of the Divisions.

  28. POINTS TO BE FOLLOWED • Medsave will make available the following additional information for which no charges shall be paid: • Any possible type of statistics / MIS required by us • Reference to previous examination reports • In the case of claim investigation – details of any previous treatment taken / reports done by the client from your organization • Your general morbidity / mortality studies / analysis

  29. Our Vision To act as a catalyst in growth of healthcare industry in India by acting as one stop shop for providing complete range of boundary less and hassle free services to Insurance Companies, Insured and the Care providers.

  30. Our Mission A vibrant company committed to provide prompt, convenient and best possible quality healthcare services to the insured at the least possible cost, which should result into increased profitable business for the insurers and care providers.

  31. To Summarize MedSave has created a World-Class infrastructure, backed by a pool of talented and experienced employees, to provide boundary less, convenient and prompt services to insured, insurers and care providers. Toll Free No:-1800111142 info@medsave.in www.medsave.in

  32. MEDSAVE HEALTHCARE [TPA] LTD

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