Health Benefit Consultants (HBC) Independent Third Party Administrator Found in 1993 Address 849 Vorawat Building, Floor 19th Silom Road, Bangrak Bangkok 10500

HBC’s Services Design MEI and PA products Establish hospital network Claim assessment services Concurrent review Case management

HBC’s Competencies Full-time Nurses, experienced claim assessors, and Medical Consultants 303 Hospital Network throughout Thailand Specifically designed computer software We have 3 relevant data bases

HBC have been performing claim administration more than 1,000,000 claims since 1993

HBC’s Competencies Full-time Nurses, experienced claim assessors, and Medical Consultants 303 Hospital Network throughout Thailand Specifically designed computer software We have 3 relevant data bases

Main contents in the hospital contract To ensure that HBC can proceed the claims efficiently and accurately To provide best service to the patient (the claimant) To gather essential information/profile Hospital’s specialists and medical equipments Drug and medical supplies’ price lists and discount structures Doctor profile To cooperate with HBC i.e., supplying all relevant medical information and documents, coordinating the claim to ensure timely and accurately communication

Hospital network location

HBC’s Competencies Full-time Nurses, experienced claim assessors, and Medical Consultants 303 Hospital Network throughout Thailand Specifically designed computer software We have 3 relevant data bases

Major characteristics-Computer software Open platform system Data Security Data back up system Data control system HBC-Link

HBC’s Competencies Full-time Nurses, experienced claim assessors, and Medical Consultants 303 Hospital Network throughout Thailand Specifically designed computer software We have 3 relevant data bases

IPD--WITHOUT MATERNITY 5 10 15 20 25 30 35 40 45 50 55 60 65 AGE (0 to 70 years old) 0% 5% 10% 15% 20% % OF POPULATION M: Act. M: Est. F: Act. F: Est. HBC IPD--WITHOUT MATERNITY

Changes in Health Continuum of Managed Care

Stakeholders and Claim Control Mechanism What they want? Claim control through… Outcome Insured / Patient The best medical treatment Full cover Deductible Co-payment Least attractive product Highly claim control efficiency Insurer / NSSF Satisfy insureds Maximize sales Low claim ratio Sophisticated policy conditions Not so attractive product Poor claim control Provider Satisfy the patient/the claimant Free hand to provide the most appropriate treatment Capitation Package price policy High attractive product Sophisticated claim management

Kurnia-HBC Common Objectives Accurate To reflex the accurate Loss Ratio, Drawing Rate etc. To maximize clients’ satisfaction Clear 80% of the reimbursement claims will done within 6 working days Clean All claim assessments must be able to explain to claimants Convenience Claimants can access 24 hours a day, 7 days a week

Our services offer

Free-of-charge product development services Analyze and comment NSSF’s existing scheme Initiate / create new schemes

Claim processing Provide claim pre-certification Concurrent review Provide fax-claim services Q & A claim form insured members

Case Management / Concurrent Review Membership data update MAIN STEPS Pre-certification Case Management / Concurrent Review << REAL-TIME RESPONSE >> FAX Claim Claim assessment U/R Reports

Financial & Actuarial Reporting DATA ANALYSIS

Financial & Actuarial Reporting Time Series Analysis

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