Medical aid funds receive N$5,3 billion in claims

The Namibian Association of Medical Aid Funds (Namaf) has recorded an increase of N$5,3 billion in the total claim amounts made to medical aid funds.

According to Namaf’s 2022 annual financial report, the total claims and benefit amounts have been increasing constantly over time and the total value of the claims received by registered medical aid funds reached N$5,35 billion at the end of 2022.

The total value of the claims received and paid by the registered medical aid funds translates to N$25 240 claimed per average covered beneficiary for the 2022 benefit year.

According to Namaf, this figure is higher than the average claims per year that were recorded pre-pandemic.
Private hospitals received the biggest chunk of these claims, at N$1,67 billion.

“Private hospitals accounted for just over a third of the total claims paid in 2022 by registered medical aid funds, followed by medicines at 16,7%, specialists at 12,2% and general practitioners at 9,50%,” noted the report.

The total value of claims paid to medical specialists was N$596,92 million in 2022, while N$665,38 million was claimed.

“It is important to note that a lower proportion of claims received were paid for with respect to specialists in comparison to private hospitals.”
According to the report, out of the N$999,28 million claims received, only claims to the value of N$820,23 million were paid.

“The proportions of benefits paid toward general practitioners and medicines decreased when compared to the 202l benefit year, while the proportion of benefits paid toward private hospitals and medical specialists increased in 2022 relative to 2021,” noted the report.

The membership number of medical aid funds saw a small increase, while the membership of the registered medical aid funds remained constant over the two years to the end of 2022.

“The beneficiaries belonging to registered medical aid funds totalled 211 920 at the end of 2022,” noted the report.

The report added that the impact of the Covid-19 pandemic on the utilisation of elective or planned healthcare services is reflected in the value of the claims received and benefits paid by registered medical aid funds by 2020.

“In nominal terms, claims received and benefits paid reduced in 2020 when compared to 2018 and 2019 but returned to and exceeded pre-pandemic levels in 2021 and 2022.”; Twitter:@ShaniaLazarus

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