For organisations that fund care, but are not insurers.
A hospital group, a provider network, an employer or a SACCO collects contributions from members and provides a package of care at its own facilities. From the inside it needs everything a medical insurer needs. From the outside it must speak the language of membership. The platform is built for that, with a Nairobi hospital group that is both the payer and the provider.
It runs offline-first for facilities with unreliable connectivity, and it is multi-tenant, so one operator can administer several schemes or act as a third-party administrator.
Package and benefit design
Packages with benefits, limits, waiting periods and exclusions, versioned so a change does not rewrite history.
Enrolment and eligibility
Individual, family and sponsored members, identity checks, duplicate detection, eligibility at the point of care.
Contributions and collections
Mobile money, payroll and sponsor billing, with arrears rules that decide what a lapsed member can still access.
Pre-authorisation and utilisation
Approval matrix by service and amount, live utilisation against each benefit, alerts before a cap is breached.
Adjudication and co-pays
Claims and co-pay management with fraud checks, so the facility is paid for what the package covers and no more.
Member app and reporting
Balances, approvals and check-in on the phone; utilisation, loss and retention reports for management.
On licensing
Licensing is yours and your counsel's. Kenya and Uganda treat these schemes differently, and in Uganda a health membership organisation is a licensed category. We configure the scheme's rules to match whichever regime applies and keep the records a regulator would ask for.
| Service | Est. KES | Benefit |
|---|---|---|
| Day surgery | 48,000 | Inpatient |
| Anaesthetist | 12,000 | Inpatient |
| Bed, 1 night | 6,500 | Inpatient |
Start with a thirty-minute systems review.
Tell us what runs your book today and what it cannot do. We come back with a written view of what would migrate, what would be configured and how we would stage it. If it makes sense, the next step is a demonstration on scenarios shaped like your own portfolio. Sanitised cases are fine; no customer data changes hands.