Individual and Group Health Insurance
Private health insurance cover is generally divided into inpatient and outpatient benefits. Inpatient benefits give you cover for events that need hospitalisation whereas outpatient benefits provide cover for general treatment occurring out of hospital. All these benefits are usually available in a predefined geographical cover area depending on the plan you choose. Some plans cover you in your country of residence only whereas other plans offer cover anywhere in Africa or even worldwide.
Typical Inpatient Benefits cover the following:
- Hospital accommodation and theatre costs
- Specialist and physician costs
- Radiology and Pathology tests
- Internal and external prosthetics
- Medicines used whilst in hospital
- Maternity delivery and complications
- Neonatal care
- Organ transplants
- Cancer treatment
- Kidney dialysis
- Ambulance services
Typical Outpatient Benefits cover the following:
- General practitioner and specialist consultations
- Radiology and Pathology tests
- Prescribed Medicines
- Maternity pre-natal care
- Auxiliary services e.g. physiotherapy
- Child vaccinations
Life and Disability Insurance
While, in many cases, life and disability insurance is provided as part of an employer’s group benefits offered to its employees, some people without this type of benefit will procure their own life and disability insurance, also called individual life insurance. This type of insurance covers you and your family in the event of death or disability.
Group life insurance is a type of life insurance in which a single contract covers an entire group of people. Typically, the policyowner is an employer or an entity such as a labor organization, and the policy covers the employees or members of the group. Group life insurance is often provided as part of a complete employee benefit package. In most cases, the cost of group coverage is far less than what the employees or members would pay for a similar amount of individual protection. So if you are offered group life insurance through your employer or another group, you should usually take it, especially if you have no other life insurance or if your personal coverage is inadequate.
As the policyowner, the employer or other entity keeps the actual insurance policy, known as the master contract. All of those who are covered typically receive a certificate of insurance that serves as proof of insurance but is not actually the insurance policy. As with other types of life insurance, group life insurance allows you to choose your beneficiary.
Businesses can help their employees protect their incomes and rebuild their lives after an unexpected event with Group Disability Insurance benefits. This generally covers short term disabilities and/or long term disabilities when an employee is unable to work because of a disabling injury or illness.
While life and disability insurance provides insurance cover for a person/persons, general insurance mainly provides insurance cover for assets or possessions. While this is also referred to as short term insurance, the period you are insured for, does not define the type of insurance.
General insurance includes, but is not limited to:
- Motor insurance (individual or fleet)
- Property, homeowners, or household content insurance
- Agriculture insurance
- Professional indemnity insurance
- Insurance for goods in transit
- Commercial insurance
General insurance protect the things we value, such as our homes and cars and other valuables, from the financial impact of unforeseeable events and risks such as the damage or loss of these assets. While this type of cover generally includes fire, theft, and other mishaps, we can choose the types of risks we wish to cover by choosing the right type of policy with the features we need.
Even when you think that the risk of these things happening to you seem relatively small, you are less likely when something does happen to be left to pay the full cost on your own, which could leave you in a financial crisis. Purchasing an insurance policy buys you that peace of mind.
We all have different reasons for buying insurance and we make different decisions about this at different times of our lives.
When deciding on the policy you want, you should:
- Consider the value of the items you wish to ensure
- Compare the features, cover limits, exclusions, applicable excesses, and cost of different products
- Consider any additional cover you may need
Doing all of this can be a very daunting task, but we are here to help you. Each insurer has different policies, and the terms and conditions, features and extras can vary widely, even with products offered by the same company. Buttress Insurance Brokers partners with various insurers to market and distribute their general insurance products. We provide you with expert advice on various product portfolios, underwriting guidelines, eligibility, rates, and all other relevant information you need to make the best choice for your needs.
We help you to consider your own requirements and understand the policies most appropriate to your risk and the level of cover you need.
Individual and Group Travel Insurance
Travel insurance is designed to cover the costs and losses, and reduce the risk associated with, unexpected events you might incur while traveling, either internationally or domestically.
Travel insurance provides you with cover against travel risks such as medical emergencies, cancellation, curtailment, luggage loss, accidental death and disablement and personal liability, allowing you to relax and enjoy your journey with complete peace of mind.
If you travel without travel insurance, you open yourself up to amassing crippling medical expenses. Hospitalisation costs for serious medical conditions such as injuries resulting from motor vehicle accidents, or illnesses such as heart attacks, strokes and bowel obstructions could result in exorbitant bills. It is important to be aware of the fact that while you purchase your policy in local currency, any medical expenses you may incur would be paid in foreign currencies, and this could lead to financial ruin if you are travelling to a country with a stronger currency.
A travel insurance policy will provide you with financial security and travel assistance and protect you from potentially enormous financial costs.
We offer a range of quality travel insurance products to provide leisure and business travellers with cover for their specific requirements while travelling locally or abroad.
Self Managed Fund Administration
It is evident from worldwide trends that a self-funded option in partnership with a specialised third party health administrator is a viable alternative to fully insured plans.
With the Buttress Insurance Brokers Self-Managed Fund Administration Solution, companies now finally has a solution that offers them the best of both worlds. We offer a specialised third party health administration service and fulfil all the functions necessary to manage your self-funded health plans.
Create and price a bespoke health plan for your company
There are two options for the design of your health plan: you can either create a plan similar to your existing plan, or with our assistance you can create a brand new plan. With the help of our actuaries, accurate pricing is made possible with the use of either your own claims experience data or against existing utilisation and cost trends in the Zambian market.
Protect yourself against unexpected claims cost through stop-loss cover
We assist you in further mitigating your financial risk through the introduction of appropriate stop-loss cover. Specific stop-loss cover protects you when claims during the cover period on any individual exceed a predetermined limit. When this occurs, you are reimbursed for the excess. Aggregate stop-loss cover protects you when the annual budget is exceeded with 20%. When this occurs, you are reimbursed for all claims above 120%. We submit quotations from reputable reinsurers to you and we manage and facilitate all claims against these policies on your behalf.
Eliminate insurer profit margins and reduce non-healthcare cost
The profit margin added to premiums by the insurer is eliminated and can now be utilised for health care instead. This can result in a saving of up to 20%, which means that more money is spent on the health and wellbeing of your employees instead of on non-healthcare costs.
Improve your cash flow with surplus funds
At the end of the cover period you will retain any surplus funds. How you utilise these funds is your decision. You can decide whether you allocate these funds where it is needed at the time, or perhaps use it to reward healthy employees, or you can create a reserve fund to protect against future unexpected claim costs.
Implement the wellness initiatives you want
We define and implement proactive wellness initiatives enabling your employees to take control of and improve their health. This includes general health promotion to encourage employees to make healthy lifestyle choices, as well as onsite wellness days for screening and early detection diagnostics.
Choose your own medical providers
We establish a provider network of your choosing in Zambia and South Africa. We engage with providers on your behalf to negotiate discounted rates and tariffs for medical services rendered to your employees. This process of entering into a contract with providers is fully facilitated by us. We also visit providers regularly to ensure that the relationship with them is maintained and that employees receive the best service possible. Payment or claims disputes with providers are fully managed by us, and the company does not need to deal with providers directly at any point in time.
Employee onboarding is fully taken care of
For the ease and convenience of your employees and their families, we use online application forms to enroll them on the health plan. We also manage all subsequent changes in membership such as the addition of dependants or terminations of membership. Membership cards are issued for each family to obtain medical services on credit from the contracted providers.
Employees are trained on their new health plan
We conduct onsite training sessions for your employees to ensure that they understand their new health plan and know how the benefit structure works. We provide every employee with a comprehensive health plan guide to assist them in the management of their health benefits. General communication about their health plan is distributed directly to them and also made available for publishing on the company’s intranet.
We take care of all administration
Using a state of the art Health IT system specifically designed for the Zambian market, claims are processed against negotiated provider tariffs and according to the rules and benefit limits of the health plan. We take care of this from beginning to end, and the company has no administrative duties related to the management of benefits and claims processing. Detailed provider reconciliations and statements will keep you informed of the exact monthly payments that should be made to each provider.
Access to the skills and expertise you need to make informed decisions
For any decisions relating to extraordinary claims outside the plan rules, or where specific members or cases are concerned, you will always have the final say. Where decisions are of a clinical nature, we provide you with the clinical expertise necessary to make these decisions.
We implement financial risk management strategies for you
We reduce your financial risk by negotiating agreed tariffs with medical providers. As a result of our expertise and experience in dealing with providers, we are able to determine reasonable rates that will make benefit limits stretch further and last longer. With mandatory telephonic pre-authorisation of all medical services, the exposure to unexpected claims above benefit limits is minimised.
Effective clinical risk management
Pre-authorisation is a key component of clinical risk management and is designed to proactively determine the medical appropriateness of planned treatments or procedures. Our clinical team assesses all hospital cases on this basis as well as extraordinary outpatient cases. It also focuses on the potential cost of such treatments and ensures that the member’s existing benefit limits will indeed cover the expenses.
Assisted disease management programs
As part of our disease management services, we create specific assisted programs for all chronic or major medical conditions, including hypertension, diabetes, HIV/AIDS, and cancer. The cost of medicine and service delivery protocols for these members are pre-negotiated with preferred providers to ensure that they receive the best and most cost-effective treatment. Members are also contacted personally on a regular basis to follow-up on their compliance, and clinical information and advice on the management of their diseases is provided to them.
We provide your employees with all the support they need
We provide a 24/7 call centre to assist your employees with any enquiries they may have. Employees will also have access to a web portal to monitor their claims information and benefit utilisation. Furthermore, employees receive monthly member statements indicating their processed claims and benefit balances.
Comprehensive budget monitoring and reporting
You will receive monthly reports on claims processed and benefit utilisation against budget. We also monitor and keep you informed of any abuse or fraudulent activities. Our dedicated account manager meets with you on a weekly basis to discuss the performance of your health solution.