Medical Benefits Manager

Memorysoft Medical Benefits Manager assigns and monitors medical limits based on staff cadres for both in-patient and out-patient



The system supports unlimited number of staff medical scheme managers and their particulars E.g. the Manager’s Name, Addresses, Administrators name, addresses etc.

  • The system assigns and monitors medical limits based on staff cadres for both in-patient and out-patient. The scheme Master supports unlimited number of staff Medical schemes available by category.
  • The system allows unlimited number of Medical institutes e.g. Among the items to be recorded include :-Institutes Name, Address, Telephone No, Fax No, E-Mail Address, the Administrators Name and Address.
  • Unlimited number of medical care services can be user defined for use in processing claims and payments.
  • The system provides for unlimited employee medical cover limits by over all cover and by individual medical service, which may be defined by Medical scheme and/or service.


The system allows unlimited number of Medical institutions.

Unlimited number of medical care services can be user defined for use in processing claims and payments.

The Medical claim system will allow the user to register all claims made.

The claims payment system supports the recording of all payments made, and avails claim payments by scheme, service limits and dependants.

The system supports unlimited number of members, their dependants and their particulars. Dependants may be specified as spouse, child, or other relation. Where required, member-ship may be detailed for the entire family.

The system avails the user numerous reports for management, claims, payments, schemes, services limits and dependants etc.

It can alert users on-line on available unused medical allocations.

Medical Institutions.

The system supports unlimited number of Medical service providers / institutions where members may seek Medical care and health services. E.g. Kam Pharmacy, Kenyatta National Hospital, Aga Khan Hospital, St. James Hospital, Gertrude’s Children’s Home, Kikuyu PCEA Hospital etc.

Medical Service Cover Limit.

The user is capable of defining the Medical cover limits by category, medical services or by a combination of the two for example:-

Example 1: Category A cover may have a total medical cover by category equal to 100,000/=.

This covers the member for all services that one is entitled to, without service breakdown.

Example 2: Category A cover may have a medical cover by medical service.

In this scheme, the member is covered per service item. The service may or may not have a claim limit placed on the service covered. See below table:-

Service                        Claim Limit                 Cover Limit     

Consultancy                     1,000/=                            30,000/=

Pharmacy                         4,000/=                            30,000/=

Laboratory                        3,500/=                           40,000/=

Ray scan                           4,000/=                            40,000/=

Maternity                         6,000/=                            100,000/=

Theater services             10,000/=                           100,000/=

Hospitalization etc        3,000/=                             100,000/=

Medical Service Types.

This feature registers the unlimited number of the medical services that a member may seek. E.g.

  • Consultancy.
  • Hospitalization (in-patient).
  • X-ray and Scan.
  • Laboratory Services.
  • Theater Services.
  • Maternity.
  • Pharmacy.
  • Plastic Surgery.
  • Psychiatry Medicine.
  • Therapy (Occupational, Physical).
  • Etc.

Medical Records

The user may register all members may register their details, i.e. employee numbers, dependants specification (e.g. Spouse, First child, Second child, Third child.etc, age, gender, claim limit for each service and the total Medical cover by service or category and period for which this cover is valid.

Medical Claims

This feature allows for unlimited number of claims received to be recorded. Claims may be recorded generally or in detail. The General Claims details to be registered include: – Claims No, Member No, Charge Account No, Claim date and the amount claimed.

The detailed claims information will also include item No, Service; Institute attended, type of illness/injury, date of illness, individually.

Claims payments.

This sub-system will record the actual payments made for each claim.

General Claim payments details will include: –

  • Payment Number.
  • Date of Payment.
  • Amount Paid.
  • Reference and Description of Payment.
  • Claims Approval Adjustment.
  • Medical Payment History.
  • Approved Medical Claims.
  • Medical Allowance.
  • Medical Reimbursements Cheque Numbers.


The user may define unlimited number of dependants for each member. This includes Spouse(s), Children and other relations. The dependants’ details recorded by the system include; dependant description (Spouse or Child), Name, Date of birth and Birth certificate No.

Reports examples:-

  • Medical Manager List.
  • Medical Institution List.
  • Medical Scheme Listing.
  • Medical Services List.
  • Medical Service Limits.
  • Member Listing by category.
  • Medical Scheme Details Listing.
  • Injury/Illness Report.
  • Emergency Medical Information.
  • Emergency Contact Listing.
  • Next-of-Kin List.
  • Doctor/Medical Institutions Report.
  • Claim Types Reports.
  • Claim Reports by Member/Institutions /Dependants and Service.
  • Claim Reports by Illness, Medical Institutions and Service Type.
  • Medical Claims History Report.
  • Medical Payments by Member /Institutions /Dependants /Service.
  • Approved Medical Claims Report.
  • Rejected Medical Claims Report.
  • Staff Statements.
  • Expenditure Report Per Service Provider.
  • Medical Expenditure Analysis Report (Detailed & Cumulative).
  • Statements (YTD) and Available Balances.
  • Reports on Medical Excesses, Exceptions etc.
  • Monthly, Quarterly, Yearly Statements to Employees & Service Providers.