Corporate Brochure
1 A powerful blend of solid resources, proven capabilities and industry expertise with a vision for the future.
We believe that medical schemes and their members have heard the word No for far too long. Now is a time for solutions. We aim to be the brick and mortar that will build the bridge between meaningful healthcare cover and the people that need it. We are a Yes company all the way. - Dr Johan Pretorius, CEO of Universal Healthcare 2
Table of contents Executive summary Corporate character Leading the Universal team Universal Healthcare Administrators Universal Care Occupational healthcare Universal 360 Universal Training Academy Universal marketing and distribution Universal IT systems Optional additional services Sound corporate governance Contact us pg3 pg5 pg5 pg6 pg7 pg8 pg9 pg9 pg10 pg10 pg11 pg12 pg12 3
Executive summary 4
Executive summary Introducing Universal Healthcare Universal Healthcare is a dynamic healthcare industry player that provides clients with a comprehensive range of healthcare management services. Core to the group are Universal Healthcare Administrators and Universal Care. With a reputation for service excellence spanning close on forty years, these two entities have provided a solid, well-established foundation from which Universal Healthcare has evolved into the forward-thinking, innovative company that it is today. Many years of experience have taught us that the best way to ensure quality cost-effective care is to implement all managed care processes in line with clinical protocols based on internationally acclaimed evidence-based medicine. Importantly, this is done with a caring approach. Innovative, personalised healthcare solutions are key to the success of Universal Healthcare. Our comprehensive and fully integrated service offering has the distinct advantage of being highly flexible, which enables us to meet the every need of clients, time and time again. Founders - a trio of industry experts Universal Healthcare was founded by a trio of industry experts: Dr Johan Pretorius (CEO), Catharina Sevillano-Barredo (CFO) and Prof Jan van der Merwe (Chairman). Together, our core senior management team has a cumulative experience base spanning several decades, while line managers have an average tenure of more than 10 years service within Universal Healthcare. Medical scheme administration Universal Healthcare Administrators (formerly known as Status Medical Aid Administrators) was established in 1974. We are an accredited medical scheme administrator and currently administer both open and restricted medical schemes. 5
Managed care Universal Care (formerly known as QA Care Plus) was established in the early 1990s when managed care principles were first introduced to South Africa. Universal Care was one of the first privately owned companies contracted to provide hospital utilisation management and other managed care services to medical scheme clients. This accredited managed care organisation performs care management services for open and restricted medical schemes, including a scheme not administered by Universal Healthcare. Universal Care offers a comprehensive portfolio of individualised and carefully designed services, including disease management and provider network management to meet the specific needs of our clients. Occupational healthcare division Universal Healthcare is meeting the individual needs of South African employers with unique occupational health and worker wellness solutions. Specifically created for the South African labour market, the Universal WorkerPlan, brought to you by our occupational healthcare division, provides employers in all sectors and of all sizes with flexible, cost-effective solutions. Universal 360 Universal 360 is a health and wellness loyalty programme, designed to offer members something different by taking every aspect of their health into consideration. Preventative care is pivotal to this programme, which aims to reduce lifestyle related illness, thereby improving member health and reducing costs. Universal 360 has cultivated a range of diverse and superior partnerships, affording members every opportunity to make the right health and wellness choices, and to enjoy their leisure time in a fun and active manner, thus reinforcing positive lifestyle and wellness behaviours. Universal Training Academy The Universal Training Academy (UTA) is an Insurance Sector Education and Training Authority (INSETA) accredited institution (INSETA Accreditation Number 130215). It was established in early 2010 and has since been providing delegates with well-researched, accredited courses, which provide a strong foundation towards a qualification in wealth management. Studies have shown that the highly interactive and informative courses offered by UTA lead to excellent results. Corporate health and wellness Universal provides corporate health solutions to ensure the health and wellness of employees at all levels within an organisation. Our services include comprehensive executive health programmes aimed at identifying health risks and introducing appropriate interventions to ensure the health of senior executives and managers within an organisation. Wellness days and health promotion campaigns, including HIV know your status campaigns, are tailored to the requirements of each client. 6
Marketing and distribution At Universal Healthcare we know that membership growth and retention for our medical scheme clients depend heavily on a sharp, effective marketing strategy. Our dedicated marketing and distribution division comprises a young, dynamic team of full-time broker consultants, key accounts managers, new business development managers, a public relations department and even an in-house design studio for the development of customised marketing and co-marketing campaigns for corporate clients, often done in collaboration with our network of intermediaries on a national basis. This division truly has the required experience, capability and infrastructure to ensure the continued sustainability and success of our clients. Flexible in-house IT administration system Universal s in-house IT system has been developed over a period of more than 10 years with continuous enhancement of new modules using the latest technology. With our highly skilled IT team and reliable functionality, efficient outcomes are guaranteed. Over the life of the system more than 100 different medical scheme options have been managed. Sound internal controls and corporate governance Universal Healthcare fully subscribes to the principles of good corporate governance. Our systems of internal controls have been independently reviewed by Deloitte annually since 2005 to assist trustees in discharging their fiduciary duties. We are proud of the fact that Universal has enjoyed a positive outcome of this review year after year. Optional additional services We offer a number of optional additional services including two short-term insurance products in collaboration with registered financial services providers, providing cover for excess charges not covered by a medical scheme ( gap cover and top-up cover ) as well as a cash and liquidity management service, aimed at optimising the returns on cash invested by our medical scheme clients. 7
Corporate character 8
Corporate character We aim to be a world-class company respected for providing fully integrated, technology-enabled, evidence-based healthcare financing solutions to support the health and wellness of our customers. We are committed to exceptional patient care and the improvement of human life and wellness. In recognition of this commitment, we strive to deliver the highest quality, scientifically justifiable, cost-effective healthcare financing solutions utilising evidence-based protocols and technology-enabled solutions to the customers we serve. What do we value most above all else? Commitment to excellence, from a client-focused service to provider support, and from efficient claims reimbursement to product knowledge. Diversity in providing flexible, customised solutions, from pure hospital plan cover to traditional plans, and from new generation to composite and network-based capitation plans. Experience, which leads to consistent improvement and superior performance. Effective communication with all stakeholders, including scheme members, service providers, corporate and individual clients and with our own staff at Universal Healthcare. Innovation in information technology and business processes. Ethics and governance that extends beyond mere compliance to endeavouring to make a positive impact on the lives of all Universal Healthcare stakeholders. 9
Leading the Universal Healthcare team 10
Leading the Universal Healthcare team Dr Johan Pretorius (CEO) is a qualified medical practitioner with a Masters Degree in Business Administration, and has served at senior management and CEO level in the healthcare industry for more than 20 years. He has considerable industry experience garnered within some of the top healthcare companies in South Africa. Johan was a founding member and former Medical and Operations Director of Medicross Healthcare Group prior to serving as founder member and CEO of two clinical contract research organisations involved in new medicines development for the pharmaceutical industry. Both of these organisations are successful subsidiaries of multi-national contract research organisations today. Later Johan joined Prime Cure, a managed healthcare organisation, where he played a major role in the successful turnaround of the company. Johan founded Universal Healthcare in 2007, and pioneered the acquisition of Status Medical Aid Administrators and QA Care Plus in 2008/9. Under his leadership, various new business initiatives were created in the Universal Group, including a new occupational health and corporate wellness division, a loyalty programme and an accredited training academy. Johan is a director of the Board of Healthcare Funders and plays an active role in the healthcare industry. Catharina Sevillano-Barredo (CFO) is a chartered accountant with a passion for the healthcare industry. Catharina believes that with the application of sound business principles, private healthcare can be delivered in an innovative manner and will always have a future in South Africa. She is a key investor in Universal Healthcare and serves as Group CFO. Catharina is the founder of Sevillano Hausmann and Associates, a corporate advisory business. She is Non-Executive Director and Chairman of the Audit Committee of Distell and Honorary Treasurer of the Johannesburg Chamber of Commerce. Catharina previously served on the audit committees of the Department of Justice and the National Prosecuting Authority and is a former Non-Executive Director of Wiphold and Concor. Catharina has an excellent track record within the healthcare industry and has advised on a number of healthcare acquisitions in South Africa. Professor Jan van der Merwe was a dedicated researcher, who became known for his research in the field of in vitro fertilisation of the human embryo and as a pioneer of this modality in South Africa. He has published work in more than 80 authoritative, local and international medical journals. Furthermore, he was instrumental in the founding of the In Vitro Fertilisation unit in Genk, Belgium. This became one of the leading units in Europe. He delivered numerous papers at medical congresses in South Africa, Europe and the USA. In 1996 he was appointed an extraordinary Professor to the Faculty of Medicine, University of Leuven in Belgium until June 2002. Prof van der Merwe was a member of several statutory councils, namely the Medicine Control Council, National Population Development Council, South African Medical and Dental Council, Policy Council for Academic Hospitals and Council of the University of Pretoria where he served on the Exco for several years. He was Vice-President of the South African Medical and Dental Council and became a member of the Health Professions Council of South Africa. He served as Dean of Health Sciences, University of Pretoria. Prof van der Merwe was a member of the Board of Directors of several companies in the medical scheme industry. As such he spent most of his time in managed care, particularly addressing quality of healthcare and ethics as well as acting as ombudsman. His main responsibility was the development of instruments to ensure quality, such as a scientific formulary, clinical guidelines and disease management programmes, amongst others. More recently he was medical advisor to the Council for Medical Schemes and the Prescribed Minimum Benefits evolved under his leadership. 11
Universal Healthcare Administrators 12
Universal Healthcare Administrators The role of the medical scheme administrator is to act on behalf of the medical scheme, performing all administrative and healthcare management functions required to ensure that members are provided with healthcare cover. Universal Healthcare Administrators has been doing this successfully for nearly forty years since its establishment in 1974. Universal Healthcare Administrators is unconditionally accredited with the Council for Medical Schemes. The company provides a highly flexible and professional service, and has a long-standing reputation for excellence. Our administration systems and business processes are subjected to an annual independent internal control review by Deloitte, the outcome of which has been extremely satisfactory year after year. Universal Healthcare Administrators currently administers both open and restricted schemes. We provide comprehensive, cost effective medical aid administration services with optimal efficiency and responsiveness. Core to our service offering is personalised service to the companies as well as individual members of our client medical schemes. Services include: Membership management; Contribution management; Claims processing; Customer services and call centre support; Financial administration; Member communication services; Benefit design; Secretarial services; Marketing; Broker support; Contract management; Forensic auditing; and Cash and liquidity management. 13
Universal Care 14
Universal Care Universal Care was established in the early 1990s when managed care principles were first introduced to South Africa. Universal Care was one of the first privately owned companies contracted to provide hospital utilisation management to medical scheme clients. It is fully accredited with the Council for Medical Schemes. Universal Care manages healthcare costs whilst improving health outcomes through appropriate clinical and financial interventions and support programmes. International, evidence-based clinical protocols underpin all clinical interventions. Our services are available either individually or as a suite, and are all electronically and clinically integrated to ensure a holistic and co-ordinated approach to each member s care. Services include: Hospital utilisation management, including pre-authorisation of hospital admissions, case management, acuity level management and discharge planning (including sub-acute or step-down facilities and home-based care) and hospital account auditing; Trauma benefit (Road Accident Fund) recovery services; HIV/AIDS management; Disease management programmes; Prescribed minimum benefit management and care plan management; Acute and chronic medicine management; Oncology management; Preferred provider network and contracts management, including risk transfer and capitation arrangements; Medical advisory services; Pathology services management; Dental benefit management; High cost member management; and High cost provider management. 15
Occupational healthcare 16
Occupational healthcare Universal Healthcare offers an innovative service specifically designed to meet the needs of the South African labour market. Brought to you by the occupational healthcare division of Universal Healthcare Services (Pty) Ltd, the Universal WorkerPlan provides flexible, appropriate occupational health and worker wellness solutions to employers across the board, regardless of sector or size. Universal WorkerPlan is unlike any other product in the market because it offers a cost effective tool for meeting the corporate governance obligations of employers in relation to employee health and well-being while sustaining employee efficiency and improving productivity through reduced absenteeism and down-time in the workplace. Scope of WorkerPlan services Formulation of medical surveillance plans for employers Our service assists an employer to cover all its bases when it comes to ensuring the general well-being of employees. This involves the development and facilitation of effective plans for managing industry or company specific healthcare concerns such as health risk identification, health management and wellness promotion in the workplace. Biological and health monitoring, and health promotion programmes When it comes to addressing employee health issues such as biological exposure and/or the detection and treatment of illnesses, WorkerPlan provides the expert assistance you require. This service enables you to ensure the biological safety of employees in the workplace while facilitating the management of lifestyle related and communicable diseases. Occupational health and hygiene services As part of our service offering WorkerPlan assists you to take control of protecting all employees from health hazards in the work environment. This includes achieving and maintaining the correct safety and hygiene standards, co-ordinating the use of multidisciplinary professional services and advising on the management of disability in the workplace. Packaged modular services WorkerPlan offers employers a comprehensive range of packaged, modular occupational healthcare and worker wellness services including: Onsite services; Mobile clinics; Offsite services offered within a dedicated network of healthcare providers; Executive health services; Wellness days; and Occupational health consulting services. 17
Universal 360 18
Universal 360 Universal 360 is Universal Healthcare s health and wellness loyalty product, designed to offer members something different by taking every aspect of their health into consideration. Preventative care is pivotal to this programme, which aims to reduce lifestyle related illnesses thereby improving member health and reducing costs. The Universal 360 approach to wellness is greatly influenced by the sciences of both the human body and mind, which have proven that each and every person is different and has different health and wellness needs. As a result of this Universal 360 has cultivated a range of diverse and truly superior partnerships, affording members every opportunity to make the right health and wellness choices. Universal 360 offers two membership options: Universal 360 Alpha This comprehensive option provides members with greater discounts and access to all our loyalty partners. The product is available to everyone, no matter which medical scheme they belong to or whether they belong to one at all. Partners Universal 360 Beta This basic option is available free of charge to all principal members of medical aid schemes administered by Universal Healthcare Administrators, employees of employer groups contracted with Universal WorkerPlan as well as VIP stakeholders such as Universal Network healthcare service providers and brokers contracted with the Universal Group and its clients. Universal 360 Beta provides members with discounted access to certain of our loyalty partners. 19 Health and wellness days, executive health and workshops Universal 360 offers health and wellness days, executive health and corporate wellness workshops to organisations that want to raise awareness about health and wellness issues internally and improve employee health. Knowing that each individual is on a different level of readiness to make health choices, Universal 360 focuses on awareness, assessments and screenings as well as providing a variety of facilities, activities and programmes to support employees on their journey towards total wellness.
Universal Training Academy The Universal 360 approach to wellness is greatly influenced by the sciences of both the human body and mind, which have proven that each and every person is different and has different health and wellness needs. As a result of this Universal 360 has cultivated a range of diverse and truly superior partnerships, affording members every opportunity to make the right health and wellness choices. 20
Universal Training Academy The Universal Training Academy (UTA) is an Insurance Sector Education and Training Authority (INSETA) accredited institution (INSETA Accreditation Number 130215), which was established with the aim of providing all those who graduate with a strong foundation in wealth management. UTA offers credits towards the National Certificate in Wealth Management through the Universal Financial Services Skills Programme. This qualification is appropriate for those individuals in industry sub-sectors who require status as FAIS compliant financial services providers, with specific reference to long-term insurance and short-term insurance including life benefits, medical schemes administration, servicing and sales. All learning modules are INSETA registered skills programmes that are unit standard based. The courses are facilitated by INSETA accredited, qualified facilitators/trainers. Each of our courses guarantees that the learner obtains the required minimum number of 120 credits in the shortest time possible. There are four different courses available so that learners can choose the course most convenient for them. In this way time spent away from work is minimised while learning acumen is maximised. 21
Universal marketing and distribution 22
Universal marketing and distribution Membership growth and retention depend heavily on an effective marketing and distribution strategy. It is for this reason that Universal has a dedicated marketing and distribution division, headed by a general manager. Our marketing and distribution division comprises a team of full-time broker consultants, key accounts managers, new business development managers, a public relations department and even an in-house design studio for the development of customised marketing campaigns. With the strategic combination of marketing campaigns, establishment of internal capacity and networking with distribution channels, we have successfully created a continuous flow of business for each of our clients. Services include: - Support, training and troubleshooting; - Member education about medical scheme products, services and rules; - Special attention to members when required; - Rapid resolution of queries; Customised health and wellness days for corporate clients in collaboration with the Universal Corporate health and wellness division. On-site offices to facilitate member interaction, when feasible; and Assistance with the creation, publishing and distribution of educational and promotional material. 23
Universal IT systems 24
Universal IT systems Medical scheme administration is a complex environment involving high volumes of transaction data. The ability to provide a reliable technology solution that operates accurately and efficiently is core to our offering. The Universal IT system is proprietary and has been developed in-house over a period of more than a decade and is considered a key competitive strength in our business. We have the ability to develop new applications rapidly without reliance on third parties by virtue of the fact that we have a full time team comprising programmers, developers, an IT project manager and an IT manager in-house. The system is audited annually by Deloitte as part of the internal control fact-finding review. The core functionality of the system has been tried and tested on the full spectrum of products ranging from traditional medical scheme products to new generation plans with medical savings and excess accounts for a number of years. The system also manages partial and full risk capitation plans, hospital plans and composite plans, providing a combination of capitation as well as fee-for-service or alternative reimbursement options. Various other permutations with extended benefits are also possible. Over the life of the system more than 100 different options have been managed. Our system allows us: Flexibility Due to the in-house ownership and maintenance, and the structure of the system database, it is possible to implement flexible solutions with rapid response times. Scalability When new clients join or existing clients grow their membership. our systems are able to accommodate this without large-scale investment in hardware or development of systems. Reliability Universal Healthcare uses tried and trusted technologies to ensure that we continue delivering a consistently high standard of service. IT services include: Comprehensive medical scheme administration and care management systems; Integrated loyalty programme; Website design and management; Electronic statements, remittance advices and communication; Third party integration; Network and server management; Disaster recovery, redundancy and information management; and A fully adaptable and managed call centre. 25
Optional additional services 26
Optional additional services Universal Gap Cover and Gap Plus Cover Cash and liquidity management services Gap Cover is a short-term insurance product, providing cover for incidents that necessitate hospitalisation, at charges that are well above the rate reimbursed by the medical scheme. This product is available to groups as well as individuals. Cover up to 400% of the medical scheme tariff is offered. Gap Cover also offers cover for certain out-of-hospital procedures that previously had to take place in-hospital but can now, due to modern procedures, be done on an outpatient basis. Gap Plus Cover provides Gap Cover as well as cover for charges in the form of a co-payment or deductibles applied for in-hospital admissions and outpatient treatment limited to specialised diagnostic radiology (MRI and CT Scans). Gap Cover and Gap Plus Cover are insurance products offered in collaboration with registered financial services providers. Universal Healthcare offers a service to boards of trustees whereby it formulates and executes an investment strategy for its scheme clients. Universal Healthcare manages the daily liquidity requirements to ensure that an optimal interest return is earned. In co-operation with financial services providers, Universal Healthcare provides technical support and runs sensitivity models to determine an optimal allocation strategy on a monthly basis, based on a rolling cash flow forecast. The assumptions that drive the sensitivity model include forecasts of the economic growth rates, exchange rates, inflation, historic interest rate yield curves and prime rate (high, expected and low forecasts). The allocation strategy determines the optimal mix of call, term and fixed deposits. 27
Sound corporate governance 28
Sound corporate governance In 2005 Universal Healthcare commissioned an independent annual audit of its systems of internal controls to assist the trustees of contracted medical schemes in discharging their fiduciary duties. Universal Healthcare prides itself on the fact that the independent evaluation of the design, implementation and operating effectiveness of key controls within the business cycles and the general computer controls that govern the computer systems demonstrate sound systems of internal control and governance. 29
Contact us 30
Contact us Tel: 011 208 1000 Email: info@universal.co.za Website: www.universal.co.za Physical address: Universal House 15 Tambach Rd Sunninghill Park Sandton 2191 Postal address: PO Box 1411 Rivonia 2128 31