1. Free Paper Bonne Sante’16 25 th Aug’16 C M C H I S T N

2. About us.. 2 Vidal Healthcare Services Pvt. Ltd. is the holding company of Vidal Health TPA Pvt. Ltd. (Formerly ttk Healthcare TPA Pvt. Ltd.) Vidal Healthcare Services has established itself as a preferred provider of integrated health and wellness solutions that include workplace wellness programs and worksite clinics to the corporate sector in India. Vidal Health TPA Pvt. Ltd. Established in April 2002 IRDA license :16-05-2014 to 15-05-2017 Handle more than 28 million lives Largest Hospital Network in India 6278 + hospitals in 813 locations 2000+ corporate and govt. Clients 5 Million plus Enrolment contract for FY2015-16 in RSBY India’s 1st TPA to have ISO 9001:2008 &ISO 22301:2012 Among few companies to have ISO 27001:2013

3. Proud Of... 3

4. ISO 22301:2012 certification for Business Continuity Management System. ISO 9001:2008 certification for all operational processes 4 1 st TPA in India to be certified ISO 9001:2008 & ISO 22301:2012 together ISO 27001:2013 certification for Information security CII- EXIM Bank award for Business Excellence in the SME category One of the few TPAs in India to have IS security certification and only TPA awarded by EXIM Bank Certification & Recognition We are open for external IT / IS Audits

5. Our Role in CMCHIS

6. Our Pride – Tamil Nadu Chief Minister Scheme ParticularCount Business Share40% Experience in District22/32 Families62 Lakh Lives167 Cr Claims Settled #.6.57 lakh Claims Settled Amt.1100 Cr. Lead TPA with 40% - Share Handling 14 districts-Covering 167Cr Lives

7. Call centre Grievances Claims Processing Pre-authorization & discharge Pre-authorization & discharge Enrolment Focus on quality, efficiency and accuracy Smart Cards Same Day 6* hours 3* working days Immediate Response Physical Cards available Operation Excellence-Administration( TATS) End to end administration support for a seamless experience T.A.Ts 7 * In Average

8. Smart Card Enrolment & Distribution 8 97% Smart Card Enrolled & Distributed

9. Claims Handling 9

10. Contribution towards CMCHIS Quality Through stringent Internal Processes & Systems for : a. TAT b. Scrutiny of Preauths & Claims. c. Qualitative balancing of the interests of beneficiaries, Hospitals and Insurer. d. Prompt redressal of Grievances. Service to beneficiaries Effectively coordinated with Hospitals in performing Health Camps,even in far off areas and areas in need,to increase screening & curb Communicable diseases. Eg. Monsoon Camps, Mega Health Camps in Pudukottai by top Tertiary Healthcare providers. 10

11. Health Camp & Mega Camp 11 Nearly 6000 Health Camp & 450 Mega Health Conducted Successfully Mega Camp conducted in Pudukottai District Feb’16

12. Achievements Immediate Grievance Redressals. Identified deviations from CMCHIS norms leading around 25 Hospitals to undergo disciplinary action, thus protecting patients’ interests & safeguarding quality concerns. No deviation from TAT till date. Arranged refunds of around Rs 28 lakh from the Hospitals to aggrieved beneficiaries in cases of money collection over & above package rates. 12

13. 13 Recognition of TN Scheme Health Camp UIIC Appreciation Implementation of the Project Received From District Collectors

14. Critical Analysis of CMCHIS Equality, Accessibility, Quality Health is Wealth A Healthy population leads to faster Human Development, which is being realised in TN. The Scheme is contributing immensely towards the goal of “Health for All” & placed Tamil Nadu on an accelerated path towards Universal Health Coverage. Improved peoples’ confidence in Healthcare system& Helped Increase Life expectancy All top Tertiary health care providers are part of CMCHIS and expensive procedures such as Liver Transplant, Cochlear Implantation, advanced procedures such as Stem Cell transplantation are covered. Drastic fall in out of pocket expenditure on Healthcare, preventing BPL families from vicious cycle of poverty. 14

15. Strengthening of Govt Health Systems Patient migration from Govt to Private Hospitals,even for complex procedures has come down. Today, despite the option of Corporate Hospitals, people are going to Govt Hospitals even for Advanced Tertiary care procedures. Visible improvements in Govt infrastructure & taking up of complex procedures. Today,many Govt Hospitals are on the path of NABH accreditation. Eg. Paramakudi GH – NABH accredited. Patients aren’t waiting for expensive implants in Govt Hospitals due to CMCHIS. 15

16. 16 PARAMAKUDI GH,Ramanathapuram Dt – N A B H Accredited Ramanathapuram GH

17. Providing hope & faster healthcare solutions 1. Cashless system- Providing hope & immediate healthcare for Haemodialysis, Cancer care, Cardiology, Emergencies and many life threatening illnesses. 2.Providing Follow Up,with Food and transportation led to better surgical outcomes. 3. Diagnostic procedures helped screening many serious illnesses and leading to early detection and management. 4.CMCHIS has become an exemplary & succesful Healthcare model for other Indian states and gained international recognition. 17

18. Suggestions Expanding coverage To include Geriatrics, Wellness packages etc. Increasing Flexibility To cover any lifesaving treatment if indicated, for BPL families through a TNHSP-UIIC Committee approval from Corpus Fund – No BPL patient may die for unaffordability in healthcare. Coverage to APL families Quality Implementation of NABH criteria More Technology solutions For enrolment & beneficiary data. Misuse & Fraud identification. Increase in Sum Insured To cater to the whole family for the year in case of unexpected / additional illnesses. 18

19. Thank you