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Real Time Monitoring of Schemes
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Contents
Introduction ............................................................................................................................... 2
Technology ................................................................................................................................ 2
All Single Indicators required ..................................................................................................... 4
Definitions for the Indicators ...................................................................................................... 4
Variable Mappings ..................................................................................................................... 9
The time period to submit is as follows: ........................................................................... 10
Retrieving the wsdl File ........................................................................................................... 11
User Name and Password....................................................................................................... 12
Schedule for sending data ......................................................... Error! Bookmark not defined.
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Introduction
The Council for Medical Schemes (CMS) is embarking on a project that will enable them to
collect data from schemes on a monthly basis. The project is called Real time monitoring
(RTM). The data includes statistics that represent the current activity on schemes that can
help determine usage patterns and trends. Statistics are only useful if the time period during
which they are collected is meaningful. CMS will be collecting the data at the end of the third
week of every month. The data collected will be from the previous month. The data collected
will only be utilised for internal monitoring as it is unaudited.
Technology
Web services will collect the indicators from schemes. Web services are application
programming interfaces that can be accessed over a network, such as the Internet, and be
executed on a remote system hosting the requested services (CMS).
The web service technology was decided upon as all schemes do not utilise the same
architecture for their systems, some may use oracle, and others may use Microsoft etc. Web
services are designed to support interoperable interaction over a network.
When consuming the web service, it is important to note that the CMS prohibits schemes from
merely creating a front end where a user can capture the required indicators. CMS requires
schemes to consume the web service, mapping directly to the financial systems transactional
database or data warehouse used by the scheme and do the passing of the required
indicators automatically.
A diagram of the architecture is illustrated below.
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RTM Web
Service
Database
CMS Web Server
Scheme 1Scheme 2
Scheme n
Web Servers
Application
Application
Application
Web Service will receive
indicators and save it to the
CMS RTM database
Database
Passes requested data
from the data warehouse
or transactional database
Each scheme will have to write an application to consume the RTM web service that is
exposed on the CMS web server. This application will extract the indicators we stipulated in
the RTM web service from the schemes data warehouse or transactional database and pass it
through the RTM web service which in turn saves it onto the CMS RTM database. The
application that schemes develop to consume and pass the requested data must be
programmed in a way that it can run unattended on the specific dates stipulated at the end of
this document.
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All Single Indicators required
Scheme Reference Number
Beneficiaries
Average age
Pensioner ratio
Net (deficit) or surplus
gross contributions
savings contribution
net claims incurred in respect of risk carried by the scheme (including claims incurred
in respect of commercial reinsurance contracts)
total net claims incurred in respect of related risk transfer arrangements (excluding
claims incurred in respect of commercial reinsurance contracts)
administration expenditure
managed care: management services
broker fees
net impairment losses: trade and other receivables
net income or (expense) on commercial reinsurance contracts
Current Assets
Current liabilities
Total Member Funds
Unrealised non distributable reserves (revaluation reserves)
Funds set Aside for specific purpose
Cumulative net gains
Encumbered Assets
Subordinated loans
Total admissions to private hospitals
Total beneficiaries admitted to hospital ( count distinct)
Total number of days in hospital
Total amount charged (Admissions in Hospital)
The month the data is being submitted for
The year the data is being submitted for
A total 0f 27 indicators will be submitted by schemes
Definitions for the Indicators
Scheme Reference Number: This is the registration number of the scheme as listed
in the government gazette. This can be obtained from the table below.
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Scheme Name Ref No
AECI MEDICAL AID SOCIETY 1005
AFROX MEDICAL AID SOCIETY 1567
ALLIANCE MIDMED MEDICAL SCHEME 1465
ALTRON MEDICAL AID SCHEME 1534
ANGLO MEDICAL SCHEME 1012
ANGLOVAAL GROUP MEDICAL SCHEME 1571
BANKMED 1279
BARLOWORLD MEDICAL SCHEME 1507
BESTMED MEDICAL SCHEME 1252
BMW EMPLOYEES MEDICAL AID SOCIETY 1526
BONITAS MEDICAL FUND 1512
BP MEDICAL AID SOCIETY 1237
BUILDING & CONSTRUCTION INDUSTRY MEDICAL AID FUND 1590
CAPE MEDICAL PLAN 1034
CHARTERED ACCOUNTANTS (SA) MEDICAL AID FUND (CAMAF) 1043
COMMUNITY MEDICAL AID SCHEME (COMMED) 1552
COMPCARE WELLNESS MEDICAL SCHEME 1491
DE BEERS BENEFIT SOCIETY 1068
DISCOVERY HEALTH MEDICAL SCHEME 1125
ENGEN MEDICAL BENEFIT FUND 1572
EYETHUMED MEDICAL SCHEME 1585
FEDHEALTH MEDICAL SCHEME 1202
FISHING INDUSTRY MEDICAL SCHEME (FISH-MED) 1271
FOOD WORKERS MEDICAL BENEFIT FUND 1086
GENESIS MEDICAL SCHEME 1554
GOLD FIELDS MEDICAL SCHEME 1568
GOLDEN ARROWS EMPLOYEES' MEDICAL BENEFIT FUND 1270
GOVERNMENT EMPLOYEES MEDICAL SCHEME (GEMS) 1598
GRINTEK ELECTRONICS MEDICAL AID SCHEME 1523
HORIZON MEDICAL SCHEME 1566
HOSMED MEDICAL AID SCHEME 1537
IBM (SA) MEDICAL SCHEME 1111
IMPALA MEDICAL PLAN 1591
IMPERIAL GROUP MEDICAL SCHEME 1559
KEYHEALTH 1087
LA-HEALTH MEDICAL SCHEME 1145
LIBCARE MEDICAL SCHEME 1197
LIBERTY MEDICAL SCHEME 1576
LONMIN MEDICAL SCHEME 1599
MAKOTI MEDICAL SCHEME 1466
MALCOR MEDICAL SCHEME 1547
MASSMART HEALTH PLAN 1495
MBMED MEDICAL AID FUND 1039
MEDIHELP 1149
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MEDIMED MEDICAL SCHEME 1506
MEDIPOS MEDICAL SCHEME 1548
MEDSHIELD MEDICAL SCHEME 1140
METROCARE 1535
METROPOLITAN MEDICAL SCHEME 1105
MINEMED MEDICAL SCHEME 1569
MMED 3315
MOMENTUM HEALTH 1167
MOTOHEALTH CARE 1600
NAMPAK (SA) MEDICAL SCHEME 1154
NASPERS MEDICAL FUND 1241
NEDGROUP MEDICAL AID SCHEME 1469
NETCARE MEDICAL SCHEME 1584
OLD MUTUAL STAFF MEDICAL AID FUND 1214
PARMED MEDICAL AID SCHEME 1441
PG BISON MEDICAL AID SOCIETY 1515
PG GROUP MEDICAL SCHEME 1186
PHAROS MEDICAL PLAN 1546
PICK N PAY MEDICAL SCHEME 1563
PLATINUM HEALTH 1583
PRO SANO MEDICAL SCHEME 1454
PROFMED 1194
QUANTUM MEDICAL AID SOCIETY 1516
RAND WATER MEDICAL SCHEME 1201
REMEDI MEDICAL AID SCHEME 1430
RESOLUTION HEALTH MEDICAL SCHEME 1575
RETAIL MEDICAL SCHEME 1176
RHODES UNIVERSITY MEDICAL SCHEME 1013
SABC MEDICAL AID SCHEME 1424
SAMWUMED 1038
SAPPI MEDICAL AID SCHEME 1527
SASOLMED 1234
SEDMED 1531
SELFMED MEDICAL SCHEME 1446
SIZWE MEDICAL FUND 1486
SOUTH AFRICAN BREWERIES MEDICAL SCHEME 1209
SOUTH AFRICAN POLICE SERVICE MEDICAL SCHEME (POLMED) 1580
SPECTRAMED 1141
SUREMED HEALTH 1464
TFG MEDICAL AID SCHEME 1578
THEBEMED 1592
TIGER BRANDS MEDICAL SCHEME 1544
TOPMED MEDICAL SCHEME 1422
TRANSMED MEDICAL FUND 1582
TSOGO SUN GROUP MEDICAL SCHEME 1579
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UMVUZO HEALTH MEDICAL SCHEME 1597
UNIVERSITY OF KWA-ZULU NATAL MEDICAL SCHEME 1520
UNIVERSITY OF THE WITWATERSRAND - JOHANNESBURG STAFF MEDICAL AID FUND 1282
WITBANK COALFIELDS MEDICAL AID SCHEME 1291
WOOLTRU HEALTHCARE FUND 1293
XSTRATA ALLOYS MEDICAL AID SCHEME 1253
Member: is a natural person, admitted to membership of a medical scheme, who is
entitled to healthcare benefits, in terms of the rules of the medical scheme, in
exchange for a contribution.
Dependant: is the spouse or partner, dependent children or other members of the
members’ immediate family in respect of whom the member is liable for family care
and support or other person that, under the rules of a medical scheme, is recognised
as a dependant of such a member and is eligible for benefits under the rules for the
medical scheme.
Beneficiaries: the sum total of members and dependants (adult & child dependants).
This includes suspended beneficiaries.
Average age: this should be computed per beneficiary based on age as at 01
January of the financial year concerned.
Pensioner ratio: beneficiaries older than 65 years of age as a percentage of total
beneficiaries.
Gross contributions: is amounts payable by members and/or employers, in terms of
the rules of the medical scheme for the purchase of healthcare benefits. Gross
contributions include savings plan. Net contributions are gross contributions net of
savings.
Net contributions: Gross contributions net of savings contributions.
Relevant healthcare expenditure: represents claims incurred adjusted with net
income/ (expense) on risk transfer adjustments.
Net Claims ratio: net relevant healthcare expenditure incurred as a percentage of
net contributions.
Non health expenditure: are costs incurred to administer the medical scheme,
inclusive of marketing expensive. Total non health expenditure constitutes of
administration expenses, managed care: management services, broker fees and
impairment receivables.
Administration expenditure: represents costs incurred to administer a medical
scheme, inclusive of marketing expenses i.e. operating costs.
Managed care: management services: is the cost of managing healthcare
expenditure such as disease management, case management and hospital referrals,
but does not include the cost of any relevant healthcare services.
Broker fees: the remuneration paid to brokers by a medical scheme in respect of the
introduction of a member to a medical scheme by that broker and the provision of
ongoing services or advice to that member.
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Impairment losses: losses recorded when the carrying value of an asset exceeds its
recoverable amount.
Solvency ratio: the ratio of net assets i.e. accumulated funds, expressed percentage
of annualised gross contributions for the period under review.
Components for solvency calculation. Refer to Circular 13 of 2001.
Total admissions to private hospitals: o Hospital admissions = admitted for more than 23 hours, that is count all date
of discharge-date of admission> 23 hours o Hospital admissions ( please exclude day cases or same- day procedures)
Total beneficiaries admitted to hospital ( count distinct): o Count distinct beneficiaries who were admitted for more than 23 hours.
Total number of days in hospital:
o Count total number of days for all beneficiaries admitted for more than 23
hours (inclusive of the first day).
Total amount charged (Admissions in Hospital):
o Count total amount paid for all hospital admissions ( discharge date –
admission date > 23 hours
The month the data is being submitted for:
o The scheme must also send through the month number for which they are
submitting data. The numbers and corresponding months are as follows:
Month Number
January 1
February 2
March 3
April 4
May 5
June 6
July 7
August 8
September 9
October 10
November 11
December 12
The year the data is being submitted for:
o The scheme must also send through the year for which they are submitting
data for.
Please note: If any of the indicators do not apply to your scheme, please send through a 0.
The month the data is being submitted for is important and should never be 0.
The help file http://www.medicalschemes.com/returns/2012QuarterlyReturn-Help-
Low%20Quality.pdf, will also provide a better understanding of the indicators.
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Variable Mappings
Variable Name Type Description Validations
iSchemeRefNo Integer Scheme Reference Number numeric
iBeneficiaries Integer Beneficiaries Values must be greater than 0
iAverageAge Decimal (18,2)
Average age Values must be between 1 and 100
iPensionerRatio Decimal (18,2)
Pensioner ratio Values must be between 0 and 100
iNetDeficitSurplus Decimal (18,2)
Net (deficit) or surplus Values may not be 0
iGrossContributions Decimal (18,2)
gross contributions Values must be greater than 0
iSavingsContribution Decimal (18,2)
savings contribution Values may be 0 or greater than 0
iNetClaimsIncurred Decimal (18,2)
net claims incurred in respect of risk carried by the scheme (including claims incurred in respect of commercial reinsurance contracts)
Values must be greater than 0
iTotalNetClaimsIncurred Decimal (18,2)
total net claims incurred in respect of related risk transfer arrangements (excluding claims incurred in respect of commercial reinsurance contracts)
Values must be greater than 0
iAdministrationExpenditure Decimal (18,2)
administration expenditure Values must be greater than 0
iManagedCareManagementServices
Decimal (18,2)
managed care: management services Values may be 0 or greater than 0
iBrokerFees Decimal (18,2)
broker fees Values may be 0 or greater than 0
iNetImpairmentLossesTradeAndOtherReceivables
Decimal (18,2)
net impairment losses: trade and other receivables
Numeric
iNetIncomeExpenseCommReInsContract
Decimal (18,2)
net income or (expense) on commercial reinsurance contracts
Numeric
iCurrentAssets Decimal (18,2)
Current Assets Values must be greater than 0
iCurrentLiabilities Decimal (18,2)
Current liabilities Values must be greater than 0
iTotalNoAdmPvtHosp Integer Total admissions to private hospitals Values must be greater than 0
iTotalNoBenAdmHosp Integer Total beneficiaries admitted to hospital (count distinct)
Values must be greater than 0
iTotalAmtCharged Decimal (18,2)
Total amount charged (Admissions in Hospital)
Values must be greater than 0
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iTotalNoDayInHosp Decimal (18,0)
Total number of days in hospital Values must be greater than 0
iTotalMemberFunds Decimal (18,2)
Total Member Funds Values may not be 0
iUnrealisedNonDistRes Decimal(18,2)
Unrealised non distributable reserves Numeric
iFundsSetAside Decimal (18,2)
Funds set Aside for specific purpose Values may be 0 or greater than 0
iCumulativeNetGains Decimal (18,2)
Cumulative net gains
iEncumberedAssets Decimal (18,2)
Encumbered Assets Values must be 0 or greater
iSubordinatedLoans Decimal (18,2)
Subordinated loans Values may be 0 or greater than 0
iMonthSubmittingFor int The month number the data is being submitted for. The table with the corresponding numbers to send are displayed above.
Values must be greater than 0
IYearSubmittingFor int The year for which you are submitting data.
numeric
Username string Use the Username found below
Password string Use the Password found below
The time period to submit is as follows:
Beneficiaries : Must be as at the end of the relevant month
Average age : Must be as at the end of the relevant month
Pensioner ratio : Must be as at the end of the relevant month
Net Deficit Surplus : Must be as at the end of the relevant month including all the months from January – Year to Date (YTD)
Gross contributions : Must be as at the end of the relevant month including all the months from January – YTD
Savings contribution : Must be as at the end of the relevant month including all the months from January – YTD
Net claims incurred : Must be as at the end of the relevant month including all the months from January – YTD
Total claims incurred : Must be as at the end of the relevant month including all the months from January – YTD
Admin : Must be as at the end of the relevant month including all the months from January – YTD
Managed care : Must be as at the end of the relevant month including all the months from January – YTD
Broker fees : Must be as at the end of the relevant month including all the months from January – YTD
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Net impairment losses : Must be as at the end of the relevant month including all the months from January – YTD
Net income on re-insurance : Must be as at the end of the relevant month including all the months from January – YTD
Current assets : Must be as at the end of the relevant month
Current liabilities : Must be as at the end of the relevant month
Total admissions to private hospitals: Must be as at the end of the relevant month including all the months from January – YTD
Total beneficiaries admitted to hospital: Must be as at the end of the relevant month including all the months from January – YTD
Total amount charged (Admissions in Hospital): Must be as at the end of the relevant
month including all the months from January – YTD
Total number of days in hospital: Must be as at the end of the relevant month
including all the months from January – YTD
Total member funds : Must be as at the end of the relevant month
Unrealised non distributable reserves: Must be as at the end of the relevant month
Funds set aside : Must be as at the end of the relevant month
Cumulative net gains : Must be as at the end of the relevant month
Encumbered assets : Must be as at the end of the relevant month
Subordinated loans : Must be as at the end of the relevant month
Retrieving the wsdl File
The web service resides at
https://www.medicalschemes.com/RTMWebService/RealTimeMonitoring.asmx , the wsdl file
can be retrieved using the above address.
Copy and paste the above address in your web browser.
You will be presented with the screen below
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Click on Service description and save the page you get as RealTimeMonitoring.wsdl
You will be able to consume the web service using this file.
The web service has one method called GetKeyIndicators, which accepts the
variables.
User Name and Password
Please call Rozana Abdul on 012 431 0573 or email [email protected] for your
schemes username and password.
