By: Dwight Links
NHP announced their preparedness in adapting to the Financial Institutions and Markets Act (FIMA) .
As of 30 April 2027, NHP will be aligning the Claims Assessment function of the fund with the FIMA regulations for medical aids.
According to the company, the process through which claims are submitted by healthcare providers or members are reviewed against the NHP Fund Rules to determine what benefits are payable.
“NHP will take direct responsibility for the claims assessing functions rather than the function being performed by an external service provider,” the company outlined in the engagement.
This does not mean the process will be immediate, it will be gradually integrated.
“The claims will continue to be assessed in accordance with the applicable NHP Fund rules. Members should continue using existing processes until NHP communicates otherwise,” the company said.
This is as the company indicated to the media how they are aligning to the act and what adjustments they have made to be compliant in terms of strengthening their operations.
According to the act, it was developed “to consolidate and harmonise the laws regulating financial institutions, financial intermediaries and financial markets in Namibia and to provide for incidental matters.”
The act lumps eight non-banking financial sectors into the same basket for regulation, with each having their specific regulations defined in a respective chapter.
Principal Officer for NHP, Dantagos Garosas, indicated that their intention is to provide clear information to their stakeholders over the now active FIMA legislation as of this year.
“FIMA is broader than one administrative operational change, as it strengthens the governance, accountability, transparency, member protection with the regulatory oversight that medical aids need to operate in,” Garosas indicated.
NHP noted that FIMA has implications for the fund, its members and the broader medical aid environment.
“These implications must be understood in the broader governance member protection framework,” the company explained.
Focus Areas
For the medical aid sector, the act introduces a strengthened regulatory framework that governs how a fund is managed and governed.
“It places greater emphasis on responsible management, on transparency, on oversight and by the customers served by these institutions. The framework has broader information on governance, complaint handling, accountability, risk management and control over outsourced functions,” Garosas explained.
The company indicated that the alignment with FIMA resulted in six key areas of preparation since the act became functional.
In terms of governance, they had to align accordingly and improve accountability requirements. On policies, NHP says they reviewed relevant policies, procedures and documentation.
Internally, systems also had to be reviewed. NHP says this involved the strengthening of systems and operational processes which included claims assessing.
“On capability, we had to build internal capability for key fund responsibilities.This led to the transition phases where the company managed confirmed operational changes carefully,” Garosas outlined the journey of internal alignment by the fund.
