Our overall solution has evolved from traditional administration and managed care to an integrated healthcare-consumer-based solution. As a well-entrenched, cost-effective service partner with a proven track record, our key differentiators include flexibility, scalability of systems, excellent data warehousing, and analytics capabilities This differentiated approach stems from years of experience in funding healthcare in South Africa and abroad, and a deep understanding of the provider landscape, governing legislation and consumer behaviour.
Our integrated solutions enable us to deliver the following for our clients:
- Driving cost efficiencies and service excellence.
- Benefiting from economies of scale we aim to offer affordable healthcare services at a very competitive cost per member per month.
- We pride ourselves on maintaining service levels that exceed our SLA agreements without compromising on the quality of service.
- Telephonic, email, and online chat servicing capabilities offered.
- Seamless billing agreements and processes.
- Minimising fraud, waste, and abuse.
Health Risk Administration
Our insights-driven approach to health risk management allows us to provide sustainable healthcare with long-term outcomes. We use robust data management systems and advanced data analytics to guide our decision-making processes and have partnered with field experts to provide specialised services in a cost-efficient manner.
Some of our unique features include:
- An integrated care model
- Risk stratification algorithms initiating patient-centric lifestyle and wellness coaching
- Robust health technology assessment and health economic evaluation methods
- Broad range of in-hospital interventions
- Predictive health management
- Enhanced customer experience solutions
- Robust provider profiling informing outcomes-based reimbursement models
- Incentivised wellness solutions linking benefit design and complementary products
- Experienced and agile teams to ensure basics are managed appropriately
- Interactive maternity programme
- Capacity to explore innovation and new technology
- Rich fraud, waste, and abuse profiling system with interactive analytics tools
Our insights-driven approach to benefit design puts the Scheme at the centre and allows us to deliver custom-made, innovative solutions for our clients. We offer stand-alone or integrated medical scheme, insurance, wellness, and complementary product solutions with competitive pricing that complement product design and benefit from the economies of scale we offer.
We can provide:
- Flexibility that speaks to the actual client and scheme needs
- Complete legislative compliance ensured
- Data analysis, segmentation, and reporting facilitate recommendations
- Offered as a stand-alone but works hand in hand when integrated with our health risk management and provider engagement
- Design can be complemented by a range of value-add products like Multiply+, HealthReturns+, and HealthSaver+
Our intelligent reporting allows us to identify and predict the effects of our health management initiatives to navigate opportunities, spot trends, identify actionable insight and focus our efforts in the most effective way possible. Reporting can be adapted and customised to best meet individual stakeholder needs.
Health Insurance Solutions
We offer quality, affordable health insurance solutions that operate alongside our medical scheme solutions.
- Gap Cover: We offer a tailor-made and affordable Gap Cover for public sector employees to complement the medical scheme and help members pay for medical bills not covered by their scheme.