Management of risk / Managed care

The administrator has access to a comprehensive clinical team. This team uses the latest clinical guidelines to help ensure that the therapy prescribed by healthcare providers is the most appropriate for members in need of treatment. Risks are managed by providing good value for money regarding the fit between membership contributions and the need for comprehensive benefits.

Medscheme Namibia established a forensic unit in 2018 to help combat fraud, waste and abuse. In an effort to further manage the risk of the Fund, a Roll-Over Benefit reward is available to encourage members to take control of their own medical expenditure and entice them to claim less, i.e. consumer driven healthcare. All monthly contributions are determined following a comprehensive actuarial risk assessment of the inherent risk associated and arising from the demographic and claims profile of the Fund or an employer group.