Introduction

The RIS Health cards manage internal medical schemes of organizations. A medical scheme is a scheme whereby an employer allows an employee and his beneficiaries to visit a service provider (hospital or clinic, pharmacy, etc.), and the employer pays the service provider at the end of the month for the services rendered.

The employee or beneficiary is identified by a card and each beneficiary has a card. For example if an employee has 2 children and a wife that means 3 cards will be issued to that employee.

When an employee visits the hospital, the bill is charged in full to the employer and the employer may charge part of the amount (usually a percentage) to the employee.

OPERATION OF THE HEALTH CARDS

Patient Identification

When a patient visits the hospital, he is identified by swiping his/her card. If employee card status is INACTIVE or BLOCKED, a slip is printed stating that the employee is not allowed due to INACTIVE/BLOCKED status.

If active a slip showing the employer Name, Employee or dependant name and credit balance is printed. In case the POS is not working, the doctor should be able to access the RIS web portal and do an enquiry of the card and it should show the cardholder details plus photo.

Medical Bill Payment

The cardholder swipes card and doctor enters reason for visit and amount. If ok, the application uses the tariff to capture the bill amount, calculate the employer and employee contribution.When this transaction is done, the limit is updated on the employee card, by referring to the primary card number. If Amount of bill exceeds current limit, the amount in excess is charged to the employee.

Data Capture

The application able to capture cardholders plus their dependants (the process is only finished when all dependants have been captured).An employee can add a dependant any time.The captured cards data shall be printed and exportable to Excel. This data can be used in printing cards.

Credit Limit

Every transaction will update the limit on the employee card .Some employers do not set limits, therefore it should allow NULL value in credit limit field.

Charges

The only charges that will apply on SWIPE charge.

Employer Back End

Employer shall be allowed to

• Change employee details
• Post transactions for employees that may die in hospital through the advances form and adjudicated using the tariffs.

Reports

Cardholder, employer, retailer reports to show the following extra info

• Employer contribution
• Employee Contribution
• Reason for Visit (Doctors comments at POS)
• Group Reports: Some retailers and employers have group companies. As per needs can be generated in consolidated formats, therefore in employer or retailer reports, to print the report, the user should be allowed to enter the group ID or retailer/employer ID.
• Based on requirement number of reports can be customized.