Managing Employee Medical Benefits

This program covers the operational side of running an employee medical benefits scheme. It moves from setup and enrolment through lifecycle changes to the routine administration that keeps cover accurate and members informed.

The emphasis is on getting the day-to-day mechanics right: eligibility, additions and deletions, records, and clear member communication, so that errors and coverage gaps are avoided.

By the end of this course, participants will be able to:

– Administer member enrolments, additions, and deletions
– Apply eligibility rules correctly
– Maintain accurate member and dependant records
– Manage the joiner, mover, and leaver process
– Handle mid-term changes and endorsements
– Handle member queries about cover
– Coordinate with the insurer and TPA on administration

1- The Benefits Administration Cycle
2- The Role of the Benefits Administrator
3- Scheme Setup and Census Data
4- Eligibility Rules
5- Enrolments, Additions and Deletions
6- Managing Dependants
7- Joiner, Mover and Leaver Process
8- Mid-Term Changes and Endorsements
9- Member Records and Reconciliation
10- Handling Member Queries
11- Coordinating with the Insurer and TPA
12- Reporting and Audit

HR and benefits administrators responsible for the day-to-day running of an employee medical scheme.

Delivery is hands-on, using sample membership data and process exercises. Participants work through enrolment and change scenarios across the week and practice query handling, finishing with administration scenarios.

Participants leave able to administer employee medical benefits accurately and to keep cover and records aligned with the workforce.