{"id":1181,"date":"2017-03-28T11:13:02","date_gmt":"2017-03-28T09:13:02","guid":{"rendered":"https:\/\/www.namfisa.com.na\/educates\/?p=1181"},"modified":"2025-07-19T11:29:25","modified_gmt":"2025-07-19T09:29:25","slug":"medical-aid","status":"publish","type":"post","link":"https:\/\/www.namfisa.com.na\/educates\/medical-aid\/","title":{"rendered":"Medical Aid"},"content":{"rendered":"\t\t
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THE EFFECTS OF MEMBERS\u2019 CLAIMS ON THE IMMEDIATE FUTURE OF THE BENEFIT STRUCTURE OF MEDICAL AID FUNDS<\/h3><\/span><\/div>
Knowing Your Rights and Responsibilities as a Consumer<\/span>Medical aid funds are need to be settled out of the fund\u2019s reserves.

\n\n\u2022 visit healthcare providers;\nbased on the principle Measures to increase reserve levels reduced by Contracting with managed care organisations\nof solidarity; members to ensure the costs of healthcare are appropri-\nMpool their funds to pay for medical high claims ately contained.\nexpenditure that an individual could If the reserve level of the fund reduces significantly\nnot have budgeted for efficiently. The over a short period of time the fund may be forced to\nprinciple of solidarity and pooling do one or more of the following:

\n\n\u2022 Implement high increases in monthly member\ncontributions, with assistance from actuarial\nconsultants;\n

\n\u2022 Redesign benefit packages to reduce benefits\noffered by the fund in order to implement\nminimum contribution increases; or Require the\nmembers to make high co-payments to access\nmedical services; or

\n\n\u2022 In extreme cases the fund members may have to pro-actively reduce their claims costs, including:\ncollectively decide that the fund be terminated.

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How the medical aid fund board reduces the negative impact of high claims<\/h3><\/span><\/div>
Knowing Your Rights and Responsibilities as a Consumer<\/span>The fund\u2019s management, or board of trustees,\nimplements measures to reduce the negative\nimpact of excessive claims, some of which include:\n
\n\u2022 Investing extra cash to supplement operating\nsurpluses \u2013 the money remaining after health-\ncare and non-healthcare costs are deducted\nfrom contribution income;\n
\n\u2022 Educating members on responsible be-\nhaviour, which would reduce their need to<\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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What members can do to reduce the claims level<\/h3><\/span><\/div>
Knowing Your Rights and Responsibilities as a Consumer<\/span>Medical aid fund members own the fund and have\na responsibility to ensure that they control the\nclaims cost of the fund. The fund is established,\nand members join the fund, with the intention\nof paying the healthcare costs of members. The\nsustainability of the fund relies on the responsible\nbehaviour of the fund members.

\n\nThere are a number of ways in which members can\n\n\u2022 Participating in health and wellness programmes\nto reduce the risk of falling victim to chronic\ndiseases;

\n\n\u2022 Requesting prescriptions for generic medicines\nfrom health practitioners to reduce early\ndepletion of medicine benefits;

\n\n\u2022 Consulting general practitioners (\u201cGP\u201d), and\nonly consulting specialists on recommendations\nfrom the GP.<\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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Final Note<\/h3><\/span><\/div>
Knowing Your Rights and Responsibilities as a Consumer<\/span>Members\u2019 claims behaviour directly impacts the\nfuture operation of the fund. Therefore, medical aid\nfund members and their dependents are cautioned to\nconsider the impact of their claims on the future of the\nfund when utilising the fund\u2019s healthcare benefits.<\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"

THE EFFECTS OF MEMBERS\u2019 CLAIMS ON THE IMMEDIATE FUTURE OF THE BENEFIT STRUCTURE OF MEDICAL AID FUNDS Knowing Your Rights and Responsibilities as a ConsumerMedical aid funds are need to<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_eb_attr":"","_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"_EventAllDay":false,"_EventTimezone":"","_EventStartDate":"","_EventEndDate":"","_EventStartDateUTC":"","_EventEndDateUTC":"","_EventShowMap":false,"_EventShowMapLink":false,"_EventURL":"","_EventCost":"","_EventCostDescription":"","_EventCurrencySymbol":"","_EventCurrencyCode":"","_EventCurrencyPosition":"","_EventDateTimeSeparator":"","_EventTimeRangeSeparator":"","_EventOrganizerID":[],"_EventVenueID":[],"_OrganizerEmail":"","_OrganizerPhone":"","_OrganizerWebsite":"","_VenueAddress":"","_VenueCity":"","_VenueCountry":"","_VenueProvince":"","_VenueState":"","_VenueZip":"","_VenuePhone":"","_VenueURL":"","_VenueStateProvince":"","_VenueLat":"","_VenueLng":"","_VenueShowMap":false,"_VenueShowMapLink":false,"footnotes":""},"categories":[435],"tags":[],"class_list":["post-1181","post","type-post","status-publish","format-standard","hentry","category-medical-aid-and-freindly-societies"],"aioseo_notices":[],"aioseo_head":"\n\t\t\n\t\n\t\n\t\n\t\n\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t