In order to offer a competitive contribution for a given set of benefits over a period of time, it is essential that the medical scheme can manage risks appropriately and actively promotes and encourages members to improve their health. This is an aspect of medical schemes that is overlooked when comparing benefits, but is essential in the current environment. Additional services offered by the scheme. Thus, this element should also form a part of any comparison of medical scheme benefits. Medical schemes are required to maintain a specified percentage of annual contributions as reserves, as detailed in Section 29 of the Regulations made in terms of the Medical Schemes Act of 1998.
Medical practitioners submit large volumes of claims to medical schemes on behalf of their patients.
In this process these providers can assist the scheme in so far as accurate, well-detailed claims are submitted. The increasing role of technology in this process is continuously making it both faster and more cost-efficient to administer a medical scheme effectively. However, given the large volumes of transactions carried out between medical schemes and their various suppliers every day, the opportunity for fraud does arise. Fraudulent practices do increase the overall cost medical scheme membership, but a large number of initiatives, including advanced statistical modelling, are being utilised within the industry to reduce the impact of fraud. Thus, the impact that fraud has on overall costs will hopefully decline over time.