Health Insurance where healthcare is a challenge

When people work from “complicated” locations, effective access to healthcare services can very often be a major challenge. OracleMed spotted this gap in 2001 and are now operating in 18 different countries. I spoke to David van der Knaap, the CEO of OracleMed Health, a Constantia UMA, about the need for this unique product and service.

David: In all 18 countries that we operate in, we appoint a lead insurer while the business is reinsured back to Constantia Insurance. The lead insurer would issue a policy and payment would be to the lead insurer because we do business by way of admitted business. With the policy being issued on a local paper, the client knows that he’s got a legitimate and legal written paper, approved by the regulator, rather than writing it from offshore, where it is called non admitted business.

This also forms a major part of our distribution channel. By having that in-country partner, we have proper reinsurance treaties and proper agreements. OracleMed owns the products, we do the underwriting claims management and call center functions, all done in three languages (English, French and Portuguese) from our office in South Africa. Most important of all, the clients know that they are talking to us. It is written on our in-country partners’ paper, but we do everything related to claims administration, etc. They have comfort in that we have skilled people to fulfill all these functions.

The in-country insurer, working in conjunction with us, will appoint the broker, in a separate agreement, with us a signatory to that agreement. So, the in-country insurer would partner with the likes of Marsh, AON or Willis, etc., but we work through our in-country partners. A big portion of the business is generated through that in-country insurer, who are partners. While some retain a small part of the risk, some don’t and get an administration fee.

Tony – Typically, what type of clients need the service and value that you provide?

David – We deal with multinational and leading local companies. They look for quality cover for their employees. Multinational clients, board members, senior management and middle management want to offer quality cover to their staff. They would have all the bells and whistles, which would include flying to South Africa, where they want treatment or fly offshore if they want treatment in London, Paris. We have a worldwide network of 3200 hospitals.

At the top end, senior management up to middle management generally wants the top plans that allow treatment offshore. From there downwards we do what we call emergency cover, because they can’t get top end cover for their lower staff. They are looking for quality care for their staff, should there be a trauma later or in an emergency. We offer it across the whole spectrum of the company, on different levels of cover, because that is what clients want. When in Africa, they want quality health care, and they want quality life care on a dollar-based policy. A small percentage of our businesses is for the expatriates, so, it would really be mainly for the local nationals living in for example, Nigeria, Ghana, Ethiopia, etc. where they want to give quality care for their staff.

Tony – How has COVID-19 and the lockdowns affected you? What sort of impact has it had on the business?

David – It has had a significant impact on the business because COVID, pandemics and epidemics were never covered in the policies. However, now we do cover them. Multinationals are looking to ensure that their staff if they have COVID, are covered. We don’t do COVID as a standalone product, it is embedded into all the products we have, with an emergency evacuation. Over this period, we have evacuated numerous policyholders with COVID into South Africa, when they are in a critical condition. We have dispensation from the DIRCO to bring them in. Generally, they get treated in – country, we are liable for that claim, but COVID is covered with the difficulties and the problems with the limited health care in Africa. COVID has created a huge awareness amongst companies about the limited health care available for their staff in all these countries.

Tony –  In terms of brokers that you work with, who are they, are they specialists and do you provide training to get them up to speed?

David – As a rule, we would work with the top five to 10 brokers, depending on the size of the country. Brokers are appointed through our in-country partner. So as a rule, it would be the likes of Marsh, Willis, AIB, AON etc. At the same time, there are a lot of leading local brokers who know their domain well, so we appoint them too.

These companies usually have limited specialist employee benefits divisions, but are setting them up more and more because there’s a big demand. So, we do intensive regular training with these brokers and have invested a lot of money into monthly ongoing training with these brokers. Because of our knowledge and because we are in the forefront in Africa, brokers sometimes bring us along with them to meet with clients…

Tony – It seems that your year is off to a good start, and that there’s a lot of activity in the healthcare provision space.

David – It has been good, we have an almost 100% retention rate, and the need is getting ever greater. Multinationals are very conscious of the safety of their staff because of the limited health care in Africa. They want to know that they are fully covered for any form of the incident with their staff. The second part would be that somebody can deal with it and take action as it’s not always so easy to bring people out…

Companies are looking for good cover because it helps retain existing staff and entices new staff. So, people are coming in and they ask two questions, tell me about your health care and tell me about your life cover at a senior level.

People want to know that they have quality benefits at both of those levels because they won’t move if they don’t receive dollar-based benefits.