Namibian Health Plan, the country’s largest private medical aid fund, has started the process to replace long-term local administrator Medscheme, with a South African company.
However, the NHP will not boot their administrators out completely as Medscheme will continue to render partial service, with a key component of the administrator services now transferred to a South African entity.
The move also means about 100 Namibian jobs are in limbo.
Namibian medical aid administrators find themselves in precarious times, with the government also in the market for an administrator for its Public Service Medical Aid Scheme (PSEMAS).
However, the NHP’s decision to dump Medscheme has shocked the medical aid and medical insurance scene, especially since Medscheme Namibia has always appeared to be synonymous with NHP since inception 30 years ago.
In fact, Medscheme has been credited for playing a significant role in the establishment of the medical aid fund, which now boasts over N$200 million in cash reserves. NHP, on its website, further gave Medscheme credit for helping NHP become “the largest open medical aid fund in Namibia”.
The NHP also states that Medscheme regards itself as the leading integrated healthcare fund manager and administrator in the country.
NHP principal officer Dantago Garosas on Tuesday said the decision was made by the board and was aimed at benefiting NHP members.
Even more intriguing is the fact that NHP never went on public tender in pursuit of better services for its members. The contract to outsource a part of Medscheme’s services to a South African company, Universal Health, was conducted in secret and it is unclear how many Namibian medical aid administrators were granted an opportunity to participate. “NHP is within its rights to conduct a closed tender process as we deemed fit,” said Garosas, who added that because of the specialised nature of the services sought, NHP only reached out to a select few entities, including Medscheme, based on their reputation and experience.
Apart from confirming that the managed care component of their contract has been cancelled despite their entire contract ending December 2027, Medscheme Namibia spokesperson Kwedhi Amagulu referred questions regarding the breakup to NHP.
CONFUSION
According to Garosas, Medscheme’s current contract with NHP runs until the end of next year.
However, NHP has elected to strip them of the managed care responsibility, while the rest of the administrative functions will remain with Medscheme until then. The managed care function, The Issue understands, is considered the engine room of any medical aid administrator. It is the department that verifies and approves claims as well as medical procedures. The department employs medical professionals and it also tracks whether members have depleted their benefits.
South African entity Universal Health will now run that function.
Garosas said the move is part of an ongoing optimisation process aimed at better serving the NHP members.
However, NHP has only made a public announcement about the changes on Wednesday, on some of its social media platforms. In her Tuesday response to The Issue, Garosas did not see the need to inform the NHP members earlier because the new system, which starts at the end of February, has not yet gone live as well as the fact that Medscheme is still the primary administrator. It is not clear how the new system of an administrator working within another administrator will function.
Questions are also being asked about Universal Health’s ability to deliver real-time member updating mechanism, a service which currently gives NHP members updates on what services they qualify for and whether they have depleted their benefits as they make a booking with doctors or other service providers.
