MEDICAL AID - MOF
Administered by
Public Service Medical
Aid Scheme (PSEMAS)
Ministry of Finance
About PSEMAS
What PSEMAS Aims to Do
The Public Service Medical Aid Scheme (PSEMAS) is a benefit available to public service staff members. It aims to:
- Assist its members with the cost of medical care.
- Promote the health of members in general through its wellness and chronic disease management programmes.
Managed Care
What is the aim of Managed Care on PSEMAS?
Managed Health Care is a programme to organise and deliver cost-effective and appropriate treatment from the best source. It is the system established for the funding and provision of health care with the aim of managing costs, utilisation, quality and outcomes in a way that ensures cost-effectiveness and high quality. The main objective is the successful long-term provision of quality care at an affordable price.
The Managed Health Care system provides for contractual agreements between the Ministry of Finance, as custodian of PSEMAS, and the providers of health care. The quality of service is continually monitored and methods are in place to influence the behaviour of both consumers and service providers.
Cost Containment Strategies
NamHealth Administrators in association with Methealth Namibia Administrators follow three basic strategies in containing the cost of health care on PSEMAS:
Health Promotion
Strategies to promote health in general, including programmes for basic health and fitness. The purpose is to curb costs over the long term.
Benefit Design
Measures taken to discourage members from claiming unnecessarily, with the purpose of curbing over-utilisation. The claiming patterns of each PSEMAS member are tracked on the database.
Delivery System
Supply and delivery system strategies to effect savings. Pre-authorisation is required for members who require hospitalisation at a private hospital, to curb unnecessary expenditure and ensure correct treatment.
Claims Management & Control
All accounts submitted to NamHealth are audited in the context of appropriateness. Quality claims management not only controls cost but also delivers the best clinical outcomes for PSEMAS members. Claims are further audited in terms of the applicable benefits and conditions under PSEMAS. For costly procedures it is always important to first confirm what benefit conditions apply.
Stricter control measures are in place to govern how membership cards are used. In practice, certain PSEMAS members have been found to have provided their membership cards to family or friends who are not registered members, resulting in unnecessary financial strain to the Government of Namibia. Service providers are now required to obtain proof of identity prior to providing any service to a PSEMAS member.
Managed Health Care is a necessity to control and manage costs, to ensure efficiency, and to promote general health within an environment of accessibility and affordability.
Contact Us
Ms. Sarafina Opali
Senior Accountant