PSEMAS (How does it work?)

How does the Medical Aid Fund Industry work?

The Medical Aid Fund industry is intricate and complicated. We have found that many members do not quite understand how the Administrator fits into the picture. We will explain the roles of the Fund, the Administrator, NAMFISA and NAMAF.

Firstly, it is important to know that NO Private Medical Aid Fund, like Namibia Medical Care, belongs to a company, an Administrator or to any other institution. The Fund belongs solely to the contributing members. The Fund operates in the form of a trust account, where members pay in monthly premiums and claims are paid out to Service Providers and members.

Trustees are representative of members of the Fund and act and make decisions on their behalf.

The claims and contributions have to be managed professionally on behalf of the members, or else the Fund means nothing. A medical aid fund administrator, such as Methealth Namibia Administrators performs this administrative function. The Administrator is paid a set fee per month to ensure that all premiums are received, all claims paid out on time and to develop new features and products for the Fund. The Trustees of a Fund appoint an administrator on a contractual basis.

A medical aid fund always has to have reserve funds. The level of these funds indicates that the Fund is healthy enough to be able to pay the approved claims received. The Administrator pays out claims according to the rules of the Fund in order to keep the Fund operational.

Methealth Namibia Administrators is proud to say that it has turned NMC around from a loss-making Fund in 1998, to a Fund with more than adequate reserves of N$42.54 million as at 31 December 2002. This is a major achievement since members still enjoy uncompromising, comprehensive benefits.

Private Medical Aid Funds must be registered with the Registrar of Medical Aid Funds and be affiliated to the Namibian Association of Medical Aid Funds (NAMAF). NAMAF co-ordinates the establishment, development and functioning of Medical Aid Funds in Namibia. They basically see that all Funds operate under the same rules and regulations.

The Namibian Financial Institutions Supervisory Authority (NAMFISA), established in 2001, oversees the activities of non-banking financial institutions in Namibia. They control and regulate the financial soundness of these institutions, which include medical aid funds.

From the above it is clear that the Medical Aid Fund Industry is well regulated and transparency is guaranteed.

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