Medical risk
Utilisation monitoring, hospital case management, chronic disease management and provider profiling.
The scheme
Built as a regulatory project, not a marketing exercise.
Stratum Medical Scheme is proposed as a registered open medical scheme under the Medical Schemes Act 131 of 1998 — not a health-insurance product presented as medical aid.
Governance
Board of Trustees
The Board consists of fit-and-proper persons with expertise across healthcare, finance, actuarial matters, governance, legal and regulatory affairs, risk management and technology. The Principal Officer executes the scheme's strategy and regulatory obligations and reports to the Board.
Administration and managed-care functions are contracted to accredited providers, but remain firmly subject to scheme governance. Outsourced providers never effectively control the scheme.
Standing committees
- Audit & Risk Committee
- Clinical & Benefits Committee
- Investment Committee
- Remuneration & Nominations Committee
- Governance & Ethics Committee
- Appeals & Complaints Committee
- Information & Technology Risk Committee
Regulatory position
Compliance framework
- Scheme registration
- Application to the Registrar of Medical Schemes
- Scheme rules
- Formal registered rules drafted and submitted
- Benefit options
- Each option submitted for approval
- Prescribed Minimum Benefits
- Included in every benefit option
- Actuarial model
- Independent costing and five-year projections
- Solvency
- Statutory reserves of 25% of gross annual contributions
- Governance
- Board of Trustees and Principal Officer
- Administration
- Accredited medical scheme administrator
- Managed care
- Accredited managed care organisation
- Data protection
- POPIA-compliant member and health-information controls
Financial sustainability
Three layers of financial discipline.
01
Claims
Member contributions fund healthcare claims, monitored through utilisation review, hospital case management and provider profiling.
02
Administration
Tight control of administration fees, technology, broker remuneration, governance, contact centre and managed-care costs.
03
Reserves
Build and protect statutory reserves, with an internal solvency target above the 25% regulatory minimum once the scheme reaches scale.
Establishment roadmap
From concept to registered scheme
- Phase 1
Feasibility
0–3 months
Market study, actuarial and regulatory feasibility, administrator procurement, initial network discussions.
- Phase 2
Product development
3–6 months
Final benefits, contribution model, scheme rules, business plan, governance and managed-care model.
- Phase 3
Regulatory submission
6–12 months
CMS application, actuarial submission, financial model, rules and provider arrangements.
- Phase 4
Implementation
12–18+ months
Systems, provider network, staffing, contact centre, broker training and compliance testing.
- Phase 5
Launch
On approval
Access, Core, Plus and Premier go live; Stratum Saver follows once claims experience justifies it.
Risk management
Protecting the member pool
Financial risk
Monthly solvency monitoring, claims development, contribution adequacy and liquidity management.
Provider risk
Credentialing, tariff controls, quality monitoring and contract governance.
Fraud, waste & abuse
Provider analytics, duplicate-claim detection, beneficiary verification, claims audits and a whistle-blower channel.
Corporate, broker or employer enquiry?
We work with SMEs, employer groups and accredited brokers to structure affordable employee healthcare.