DHS

An ISO 9001: 2008 Certified TPA

Dedicated Healthcare Services TPA (India) Pvt. Ltd.

Devotion Guaranteed

www.dhs-india.com

Table of Contents

Company Overview

Processes & Procedures The DHS Advantage

Dedicated Healthcareservices TPA (India) Pvt. Ltd.

Table of Contents

Company Overview

Processes & Procedures The DHS Advantage

Dedicated Healthcare Services TPA (India) Pvt. Ltd.

Company Overview
An Integrated Health Insurance Service provider servicing valued clients since April 2006 Head Office located in Mumbai

Network of 23 branches across India

Clients include 1134 Corporates Service mix of both Corporate and Individual clients Major Corporates successfully serviced for over 5 years.

Ventured into Micro Insurance in the year 2008

ISO 9001 : 2008 Certified by TV NORD Group Highly qualified, experienced and dedicated professionals Management Team of industry

Dedicated Healthcareservices TPA (India) Pvt. Ltd.

Mission & Vision Statement

Dedicated Healthcareservices TPA (India) Pvt. Ltd.

Pan India Presence

Corporate Office:
Maharashtra : Mumbai

Karnataka

Branch Offices:

Haryana Delhi Uttar Pradesh Madhya Pradesh Chhattisgarh West Bengal Orissa Gujarat

Maharashtra Andhra Pradesh Tamil Nadu

: Chandigarh : New Delhi : Lucknow : Indore : Raipur : Kolkatta : Bhubaneshwar : Ahmedabad Baroda Surat : Pune : Hyderabad : Chennai

Kerala

: Bangalore Mangalore Hubli : Kochi

Residential Representatives: Punjab : Amritsar Ludhiana Bihar : Patna Madhya Pradesh : Bhopal Raigarh Maharashtra : Nasik Gujarat : Jamnagar

Dedicated Healthcareservices TPA (India) Pvt. Ltd.

Management & Executive Team

The Company is headed by the Chief Administrative Officer, a certified Charted Account having over 10 years of experience in Insurance Industry The Chief Medical Officer, a qualified MD with over 30 years of experience in the Healthcare Insurance Industry heads a team of dedicated Medical Officers The Executive Team at Head Office and all branches include qualified Doctors, Accountants, Business Administrators and Management Professionals with degree / diplomas in Insurance Excellent Client Relationship Management (CRM) Team, ensuring highest level of personalized services to clients Internal and external processes monitored highly experienced Investigation and Audit Team

Professionals at your service DHS Dedicated Healthcareservices TPA (India)

Pvt. Ltd.

Insurance Companies serviced

Servicing More than 11 insurance companies in India in line with their business aspirations
Dedicated Healthcareservices TPA (India) Pvt. Ltd.

Partial list of Corporates serviced

Servicing More than 1400 group insurance policies for corporate clients & groups Servicing More than 3.5 million satisfied health insurance policy holders in India
Dedicated Healthcareservices TPA (India) Pvt. Ltd.

Table of Contents

Company Overview

Processes & Procedures The DHS Advantage

Dedicated Healthcare Services TPA (India) Pvt. Ltd.

Process & Procedures

Patient Information Form

Enrollment

Hospital Network Cashless Facilities

Claim Processing and Controls

Enhanced IT Infrastructure
Call Centre and Website
Dedicated Healthcareservices TPA (India) Pvt. Ltd.

Enrollment Process
Receipt of Data for Enrollment Data upload and auto check system Send data for correction to Corporate/ Insurance Company

Errors in data
No

YES

Generation of E-Card and Physical Health Cards

TAT 48 Hours Guaranteed

Dedicated Healthcareservices TPA (India) Pvt. Ltd.

Value Addition - Enrollment

Online addition of dependents Online deletion of Members by Corporate HR.

Generation of Login Id and Password for E- card generation

Welcome letter to every person along with ID cards Speedy enrollment of members

Dedicated Healthcareservices TPA (India) Pvt. Ltd.

Value Addition - Enrollment

Dedicated Healthcareservices TPA (India) Pvt. Ltd.

Value Addition - Enrollment

Dedicated Healthcareservices TPA (India) Pvt. Ltd.

Provider Network - Hospitals

Over 3700 network hospitals throughout India Standardized grading technique is devised for all hospitals. Possible bench mark rates implemented ensure new network hospitals are added to Preferred Provider Network. Rates negotiated as per location,, infrastructure, expertise etc.

Type of City Type of Network Regional Distibution Tier 1 Tier 2 Tier 3 Total Primary Secondary Tertiary Only for GIPSA Only for RSBY/UHIS Total East 83 0 316 399 85 58 43 2 211 399 North 207 153 706 1066 397 199 161 93 216 1066 South 176 496 397 1069 461 242 237 128 1 1069 West 328 519 487 1334 833 184 119 80 118 1334 Total 794 1168 1906 3868 1776 683 560 303 546 3868

Tier 1: Mumbai, Kolkata, Chennai, Delhi Tier 2: Pune, Ahmedabad, Hyderabad, Bengaluru, Goa, Raigad (District) Tier 3: Indore, Vadodara, Raipur, Kochi and rest of the Cities
Dedicated Healthcareservices TPA (India) Pvt. Ltd.

Cashless Process
Request for pre-authorization Request from at least 24 hrs prior to getting hospitalized or within 24 hrs of hospitalization incase of emergency show your insurance Card and photo identiy card

Get the preauthorization form filled and signed by the treating doctor, put your sign on the form and hand over to the hospital for the process

Authorization letter will be faxed to the hospital from TPA office and simultaneously you will be kept informed on authorization

Processing the preauthorization and authorize the reasonable amount for hospitalization based on policy terms and conditions

Hospital will stamp the form and fax it to insurer / TPA for authorization

Dedicated Healthcareservices TPA (India) Pvt. Ltd.

Claims Processing & Controls

Comprehensive and detailed review of records. Constant communication for treatment given with hospitals / nursing home. Communication to the insured and its family members. Evaluation of the effectiveness of the treatment given. Cost analysis Identification and resolution of claims issue.

Dedicated Healthcareservices TPA (India) Pvt. Ltd.

Enhanced IT Infrastructure
Secured VPN connectivity across HO and all Branches System generated Mediclaim cards Policy T&C coded in the system for claim settlement Diseases coded in the system to avoid human errors Online intimation and claims status System login IDs for Employees and Corporate HR

D Vista -A comprehensive online Mediclaim settlement solution

Dedicated Healthcareservices TPA (India) Pvt. Ltd.

Business Continuity Plan (BCP)

Real-time backup server at our Regional Office BCP provides uninterrupted Pre Authorization, Enrollment and Claims processing The BCP is implemented in the event of fire, earthquake, floods and technical failures Data restored to back-up server within 1 hour New Primary Server restored within 72 hours.

Dedicated Healthcareservices TPA (India) Pvt. Ltd.

Management Information System

Management Information System provides analysis of historical and current aspects of a policy , provide means to reduce claims ratio without reducing employee benefits offered
MIS is generated to provide analytical information on the policy ,and service standards maintained i) Analysis of Underwriting Data a)Details of addition and deletion of employees and dependents b) Age-wise / Relation-wise incidence ratio ii) Analysis of claims data (both in numbers and in percentile) a) Age wise b) Disease wise c) Hospital wise iii) Analysis of the costs incurred (amount wise / percentile wise) a) % towards Room rent , surgery charges, medicines, investigations iv) Analysis of DHS standards and performance a) TAT reports b) Cost reduction due to cost control measures adopted Dedicated Healthcareservices TPA (India)
Pvt. Ltd.

Call Center
State of the Art 24 * 7 Call Centre

Courteous and well trained staff Solutions for customer specific queries Cash claims customer support Hi end telephony and real time information retrieval systems Automatic redialing of calls dropped. Automatic SMS/Email facility for claim status changes. Toll free fax number. System generated reports for measuring customer satisfaction Customer Care toll free number 1800 209 0201

Service Features

Dedicated Healthcareservices TPA (India) Pvt. Ltd.

Website Features
Online generation of e-cards Online claim status Online intimation form Online hospital network Medical features Wellness & Life style features

www.dhs-india.com
Dedicated Healthcareservices TPA (India) Pvt. Ltd.

Website Features: E-cards generation

Dedicated Healthcareservices TPA (India) Pvt. Ltd.

Website Features: Claim Status

Dedicated Healthcareservices TPA (India) Pvt. Ltd.

Website Features: Claim intimation

Dedicated Healthcareservices TPA (India) Pvt. Ltd.

Website Features: Hospital network

Dedicated Healthcareservices TPA (India) Pvt. Ltd.

Table of Contents

Company Overview

Processes & Procedures The DHS Advantage

Dedicated Healthcare Services TPA (India) Pvt. Ltd.

The DHS Advantage - Health Talks

Interactive sessions with eminent doctors from the healthcare industry: In-depth analysis of the most common ailments suffered by the employees Discussions on lifestyle and fitness Sessions on health and wellness Common hazards faced daily Some Common Topics for Health Talks Diabetes Management Cardiology Prevention of Cancer Importance of Correct Posture Stress Management and Yoga Obesity: An epidemic in India Basic First aid in Emergencies Snoring and Sleep Apnea Arthritis and Joint problems Exercise and lifestyle modification in Low backache Exercise in Pregnancy and easing childbirth Correct Posture Smoking Hazards Asthama

Dedicated Healthcareservices TPA (India) Pvt. Ltd.

The DHS Advantage - Health Camps

Health Camps can be organized across India . Some of the most common camps organized by us so far are listed below :

Diabetes check up Cardiac Check up Weight control with Dietitian meet and BMI check Dental check up Blood donation camps Eye check up camps Basic Blood investigations like CBC, ESR, Blood group Total cholesterol with BMI and Physical checkup Bone Density check up for Osteoporosis
Dedicated Healthcareservices TPA (India) Pvt. Ltd.

Employee Benefits
Health Check ups for Employees at their location Evaluation of the Health Check up Results

Promotion of Health and Healthy Habits

Lifestyle improvement planning (Implementing Achievable actions )

Health Guidance Based on the results

Maintenance of Health data for every member over a period of years Scanned reports available to members on line Arrange for appointments with networked doctors for second opinions in case required Availing Executive Health Check ups at discounted rates

Other Wellness Programmes Conducted

DHS offers certain value added service at no cost Monthly newsletter - HAOMA: Informative health tips Detailed explanation on diseases Current developments in the health industry New innovations at DHS. Automatic SMS/Email facility for cashless and reimbursement claims: SMS / Email for cashless approvals or Reimbursement amount payable SMS / Email on query sent to hospital / employee Systematic follow ups with hospital, insurance company etc. Specialist doctors visit at multiple locations: In specific cases, specialists in cardiology, oncology, ophthalmology, dieticians etc could be made available for consultation Discounts on Pharmacy As a pilot project DHS has recently started discounts on medicine and other pharmacy products in Mumbai Only. Besides discounts the medicines will be delivered at the doorstep of the client
Dedicated Healthcareservices TPA (India) Pvt. Ltd.

The DHS Advantage Help Desk

The Help Desk manned by a qualified and experienced executive Query letters generated at the help desk and sent to the various employees Follow up on the queries can be done at the help desk Assistance provided for smooth and fast cashless services Assistance and guidance on: a) Understanding the terms and conditions of the policy

b) Filing of claims
c) Process for availing cashless cervices

Dedicated Healthcareservices TPA (India) Pvt. Ltd.

The DHS Advantage Servicing Team

Exclusive Account Management team comprising of a customer relation executive and a manager Separate team of executives and doctors handling pre authorizations and claim processing at client location A senior Manager heading the team will be present at monthly service meetings A robust system of escalations management directly reporting to the Chief Administrative Officer. shall be established

Dedicated Healthcareservices TPA (India) Pvt. Ltd.

The DHS Advantage Service standards

Authorization of cashless claims within a period of 1 - 3 hours Claims settlement within 7 days of receipt of complete documentation ID Cards issued within 5 days E-cards within 1 day Conformity to any Specific Client requirements Regular client service meetings to analyze feedback. Presentation of claims analyses to predict future trends, take corrective actions and design future covers

Dedicated Healthcareservices TPA (India) Pvt. Ltd.

The DHS Advantage Services at renewal

Advise clients on: Policy Benefits Employee Utilization patterns o Cashless Vs reimbursement o Specific requirements e.g. OPD, Super specialty care, choice of provider o Fraud control practices Budgetary allocations for renewals Ailment wise health profiling of the group Inputs based on client requirements Value added services Effectiveness of wellness programmes utilized by groups

Dedicated Healthcareservices TPA (India) Pvt. Ltd.

www.dhs-india.com