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Fund setup


  1.  The system generates bills for corporate members.
  2.  The system maintains scheme settings in locked state and only changed by certain users. When these changes occur, claims will be handled according to how the system was configured at the time of treatment – not at the time received/captured.
  3.  Scheme/fund cannot change during its policy year, but IF corrections are made, system will recalculate for all newly-captured claims in affected period.
  4.  The system maintains a ‘dependant type’ categorization which determines the waiting period.
  5.  The beneficiary’s active date (a.k.a commencement date of cover, benefits date, join-date, and effective date) can be set in future or past, no matter what date it is captured.
  6.  System allows unlimited levels of limits (parent-child limits) to be set and used in claims adjudication
  7.  Audit trail will show both the date captured and effective date for each member. This feature is provided in the form of a membership history.
  8.  Member record can be updated even when member is not active or paid up.

Pre-auth function to allocate to Specific

  1.  Tariff/treatment
  2.  Discipline
  3.  Provider
  4.  Starting date
  5.  Duration
  6.  Amount limit
  7.  The pre-auth awarded is linked to the member’s benefit balance so as to appropriately adjudicate correct available balances for incoming claims and not to overpay
  8.  User can view, for each member: Claims paid, Claims captured not paid, Claims pre-authorized.
  9.  Non-medical benefits, e.g. cashback when admitted, are included as benefits and awarded thru the system.
  10.  Option to set a fixed shortfall per plan as an amount or as a percentage.
  11.  Option to set numbering of claims which is unique for each plan.

Option to configure the whole system

  1.  Funeral Assurance
  2.  HealthCare Fund Management
  3.  Vehicle Insurance
  4.  Regular Medical Aid Society
  5.  Legal Aid
  6.  Feature to create a new plan which follows the structure of an existing plan, enabling the user to add a plan with all benefits fully defined and unique in a few minutes.

Scheme/Fund Management

  1.  All the schemes/funds/companies are managed using this feature.
  2.  Corporate receipts are made from this window.
  3.  Any monthly fixed charges per member are configured from this window.
  4.  Benefit limits for the whole fund can be set as global, annual or monthly.
  5.  Member numbering can be set here in terms of prefix and number range.
  6.  If the particular scheme is restricted to specific providers, these providers are listed using this feature.
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