Self-funded Schemes

A self fund scheme is whereby the client deposits a specified amount of money with APA Insurance. Any medical claims arising are settled from these funds i.e. all claims are paid from your own money.

 The administration rules are drawn by the client and these rules are usually in line with your staff terms of employment.

 APA will vet all claims before settling and if there are any doubtful ones, we refer them back to the company. If the claims are straightforward, they should be settled within the third day of their being received in our office and a cheque is dispatched at the very latest by the 10th day.

ADVANTAGES

  1. There is a lot of flexibility where these schemes are concerned. The decision to settle any claim lies with you.
  2. For those with large work-force, the premium outlay if the scheme is insured is large; there isn’t as much pressure on their cash-flow as the funds are sent to us and when the funds needs to be replenished.

DISADVANTAGES

  1. You are the Risk Bearer. If you have an open-ended scheme and one of the scheme members is hospitalized for a long time, say one month, or has to be evacuated overseas when the medical attention they require is not locally available, you can well imagine the amount that would be involved.
  2. The amount spent in a given year could outstrip the budget for Staff Medical Aid.
  3. Due to flexibility of rules of these Medical Schemes, some claims that are not genuine are paid.
  4. There is also a tendency that these Medical Schemes are over-used and misused.
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APA Insurance | Self-funded Schemes

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