The primary responsibility of the Committee is to assist the Board of Trustees in ensuring the efficient operations of the Scheme by providing oversight, assessment and review of all administration aspects of the business of the Scheme. To this end, the Committee assists the Board of Trustees in ensuring that seamless interaction takes place between the various service providers in order to meet the operational objectives of the Scheme. The Committee also assists the Board in ensuring growth in scheme membership and excellent member affairs by overseeing Communication and Marketing Activities, Stakeholder Relations and the Complaints Management Function as well as to:
• Assess, decide and report on the approval of ex gratia applications and payments to members of the Scheme. The Committee is mandated to approve ex gratia payments in excess of R50 000.00 and where the condition and the withholding of therapy is life threatening, the treatment will result in the improved quality of life of the applicant, the treatment is clinically appropriate and based on evidence-based treatment guidelines and protocols or the applicant has proven a financial inability to afford the treatment by any other means.
• Assist the Board in ensuring the implementation of the Healthcare Management Strategic Objective namely: To improve the Scheme’s clinical risk profile and contain claims experience; and
• Oversee the Scheme’s product development and benefit design work.