Medical Aid Fund Administration

Fund Administration

  • Fund performance and reporting

  • Maintaining accounting, books anbooks and records of the schemes

  • Management of solvency margins

Health Risk Management

  • Disease management

  • Negotiations with pharmaceutical companies

  • Pricing and reimbursement formulae

Corporate Services

  • Support the Board of Directors (both Administrator and Schemes) in meeting their responsibility

  • Providing legal advisory services

  • Maintenance of statutory books and records in accordance with local regulation

  • Facilitating good corporate governance

  • Convening General meetings and Board meetings

Finance & Investment Services

  • Assist clients in investments options

  • Manage payments for clients

  • Investment restriction compliance monitoring

  • P & L reporting

  • Exposure calculations

  • Regulatory compianes

AFA assesses and processes all claims using Information Technology (IT) systems that are programmed to auto adjudicate and pay claims in accordance with the Rules and Guidelines of our clients, as well as AFA’s internal control processes. The IT systems currently handle more than 300 000 transaction lines per month. Payment‐runs are made every week and payments done through electronic fund transfers or cheque and corresponding remittance statements sent via electronic means and/or post.

The Company prepares and submits monthly Management Accounts, annual audited financial statements, including related reports with clear analysis of income generated, expenditure and
recommendations where necessary, to each of the administered medical aid schemes.

In addition, the Company invests excess funds of the administered schemes in near cash or cash vehicles and/or consults with contracted Asset Consultants to determine the most appropriate investment vehicle(s) per client.

Investor Services

  • Maintenance of shareholders’ registers

  • Maintenance of shareholder doumentation

  • Registration of Agency Services

Claims Processing

  • Cost effective claims adjudication

  • Documentation of transactions

  • Payments and query resolution.