Prepared by The Institute of Health Risk Managers, an independent training provider specialising in the healthcare industry.
This course covers evaluating the financial soundness of a medical scheme.
We discuss governance requirements for maintaining financial soundness including trustee expertise, skills and knowledge, the principal officer and the executive team, administrators, managed care organisations, brokers , the use of sound actuarial principles, complaint resolution and benefit design.
In addition to the governance criteria we also discuss the financial criteria for evaluating financial soundness. This includes reserve requirements solvency, asset management, contribution increases, risk claims ratio, size of medical scheme, membership trends, age profile and non-healthcare costs.
• Introduction and scheme liability
• Approach to evaluating financial soundness and governance
• Trustee and principal officer Administrator
• Managed Care organisations Brokers
• Complaint resolution
• Benefit design
• Has the scheme been placed under close monitoring of the CMS?
• Medical scheme financial soundness and solvency
• Contribution increases risk claims ratio
• Size of a medical scheme and membership trends
• Age of a scheme
• Operational surplus/deficit
• Non-healthcare costs
• Asset management
• Claims paying ability of a scheme
- Total CPD points on successful completion: 1.5
- 1 CPD hour for knowlege / 0.5 CPD hour for Ethics and Practice Standards
- 60% pass rate with 3 attempts
- Approval number: FPI19110116
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