Interpretation and application of the Medical Schemes Act

The Medical Schemes Act regulates all registered schemes. The interpretation and application of the act is not always clear. The Institute of Health Risk Managers (IHRM) offers a two-day programme for anyone working in the medical scheme industry. On successful completion of this programme the attendees will have a sound knowledge of the Medical Schemes Act and its Regulations to assist you in interpreting and applying the legislative requirements. This programme includes theory and case studies.

Day one

Overview of the Medical Schemes Act and its Regulations

  • The purpose of the Act and its Regulations
  • The layout of the legislation

Medical scheme governance

  • The obligations with regards to the trustees and principal officer in being “fit and proper”
  • Relationships between schemes, administrators, managed care companies and members

Medical scheme financial soundness

The responsibilities of trustees for maintaining the scheme in a financially sound position.

Prescribed Minimum Benefits (PMBs)

  • What are the PMBs.
  • The entitlement to benefits and how should they be paid?

Day two

Implications of managing scheme risk

Managed care

  • The obligations to be met by medical schemes, providers and members in managing health risk
  • Accreditation
  • Formularies
  • Designated service providers (DSP)
  • Voluntary and involuntary non-use of a DSP
  • Protocols

Medical scheme underwriting

What waiting periods and late joiner penalties are schemes allowed to apply, and under what conditions?

Complaint resolution

  • The process to be followed by medical schemes, members and providers
  • The rights and responsibilities of medical schemes, members and providers

Certificate of attendance will be issued to each delegate that attends the programme.

An online assessment will allow the delegate to ascertain their understanding

Cost

R3 900 excluding VAT

Training dates

15 - 16 March 2018

Venue

Apollo Hotel, 158 Bram Fischer Drive,  Ferndale, Randburg Johannesburg Phone: 011 787 5434 GPS Co-Ordinates: 26.09848°S / 28.00377°E

Registration

Download  the registration form.

Training Date: 3/15/2018

Date: 3/15/2018