Health Insurance and TPA

The company does this through insurance and TPA programs that do the following:

Reducing or removing the administrative burden on senior management bodies in determining eligibility and priority of those receiving medical services.
Providing medical reports for each Subscribe with the financial cost for him, and providing a permanent central file for each patient.

The use of modern technologies in managing medical expenses according to the various contractual terms, and preventing any violations so that claims are examined before they occur to be subjected to the terms of the contract and making decisions automatically using the appropriate communication mechanism:

Availability of limits or ceilings for benefits (wages – recipes – services) to create self-censorship.
Agreement with service providers on specific costs for procedures, medicines, supplies, and others.

Regulating the treatment mechanism inside and outside the hospitals:

Matching the procedure with the physician’s specialization, and matching the procedure with another procedure, and observing the period from one procedure to another (repeating the procedures).
Matching the procedure with the diagnosis, then matching them all with the dispensed medicine while observing the amount of procedures with the status of the disease.
Conformity of medical procedure with age and gender.
Monitor the doctor’s right to perform, check, or dispense a specific drug.
Monitor the average days of stay and the average cost per case.
The company has the right to see the patient’s file.
Apply a mechanism that leads service providers to bear any increases in treatments

Regulating the medicine dispensing mechanism:

Monitor the compatibility of the drug with sex and age.
Monitoring the periods between drugs (repeated dispensing of drugs).
Monitor the compatibility of the drug with other drugs.
Monitor the prices and quantities of prescribed medications.
Determining the price, the insurance company incurs for each drug scientific name.

Consulting and Training

MIS center provides its consultations according to the agreement with the beneficiaries and seeks to lay the foundations and rules for the profession in the health and insurance work, whether by relying on the self-capabilities of the company and its advisors from university professors and local and international experts, in addition to the possibility of cooperation with experts of the cooperating bodies with the company from institutes, institutions, universities and other relevant bodies The relationship inside and outside Yemen, in the following areas:

Health Insurance

Considering that our specialized health insurance company is the first Yemeni health insurance company in addition to its partnership with Jordanian companies with long experience in health insurance, it is natural that it be the first reference authority in health insurance in Yemen, which prompted many governmental, union and private bodies (including the major Yemeni insurance companies). To benefit from the consulting and training department, whether in setting up studies or research, or evaluating the mechanisms implemented to provide health services to the affiliates of these entities, or assisting these bodies in choosing the appropriate insurance program for them, and assisting insurance companies in preparing insurance offers for different entities.

health consultations

• Formulating the necessary strategies for the work of health institutions.

• Prepare “technical, economic, etc.” feasibility studies needed to establish health institutions.

• Evaluating and developing the level of administrative performance in these institutions.

• Developing technical and technical performance systems for health institutions.

• Providing health consultations for local and international programs operating in Yemen.

• Providing medical consultations for entities and individuals to benefit from the consultants of the medical network in various medical specialties.

Insurance Consulting

• Contribute to organizing insurance companies through:

• Developing systems to conduct business in these companies, and maintaining and developing these systems.

• Evaluating the performance of insurance companies, and opening new uninhibited horizons to increase the volume of work.

• Covering all the requirements of insurance companies related to health insurance, as shown in the following paragraph.

Training Programmes

The department evaluates and investigates training needs through surveys and questionnaires that it performs through the close and contractual and professional relationships and relationships between the specialized health insurance and the various health institutions and insurance companies, and the various relevant authorities, with the aim of investigating the training needs for each of them through various possible means, and through knowledge and evaluation Needs Training programs of all kinds are developed

Courses and Programmes

These are programs that are frequently requested by health institutions and companies, and they are included in an annual training plan, targeting a number of institutions and companies associated with general needs, whether they are related to health insurance, health management, or the like, and the most important of which is holding health insurance courses ( For insurance companies, health institutions, interested parties and individuals), as well as courses in health management, health facility management, and other training programs with a recurring demand so that they issue a training plan specifying the date and duration of each course.

contracting programmes

Contract design and implementation of contractual programs are made according to the request of the beneficiaries and based on the results of the training needs of these agencies in accordance with the specifics of the work of each of the beneficiaries, and whether the required program is a classroom training or on the job site or they are both based on the nature of the training and the means Ideal for achieving its goals.