5. Titanium Award for Service to Membership: Open, Closed & Self-administered Medical Schemes, Administrators and Managed Care Organisations
CATEGORY 5A – MEMBER SERVICE
1) Claims turnaround times, including age analysis
2) Appeals turnaround times, including age analysis
3) Number of complaints per 1000 beneficiaries
4) Member satisfaction survey results
5) Are your scheme benefits, appeal processes, medicine formularies & DSP arrangements accessible on your website or social platforms?
a) Yes or no.
6) If yes, it must have been included in the organisation’s report , please share links as proof and state how these are communicated to beneficiaries.
7) Demonstrate measurable member engagement e.g. outreach calls, meetings or wellness days, etc. .
CATEGORY 5B – OPERATIONAL PERFORMANCE
1) Percentage change in beneficiaries over the past three years :
a) What is the composition of your management team?
b) What is your organisation doing about transformation including skills development?
2) Proof of average increase in member contributions in the last three years
3) Is the medical scheme reserve’s ratio over 25%? Y/N
4) Does the scheme include risk based reserving in its management reports? Y/N
5) Does the scheme have a formal health governance programme in place?
a) Y/N. If yes, provide proof of implementation
b) Report on out-of-pocket payments by members included in management reports? Y/N (evidence required)
c) Does the medical scheme monitor health status measures, e.g. mortality, life expectancy and quality of care? Y/N
6) Are preventative health care benefits in place?
a) Yes or no. Demonstrate benefit uptake and improvement thereof.
b) How does this compare to the BHF recommendations?
c) Entrants are required to provide:
i) A schedule detailing preventative healthcare benefits for comparison with the BHF preventative care recommendations.
ii) A schedule detailing the funding of preventative healthcare benefits from risk.
iii) A schedule detailing the primary care benefits offered from risk.
7) Does the scheme monitor the health and productivity impact of employees?
a) Yes or no. If yes, attach a copy of the report.
Any medical scheme under curatorship will be disqualified automatically from this category.