Running a Medical Insurance Book Is Getting Harder
Rising loss ratios. Increasing IRA scrutiny. IFRS 17 data requirements. Medvex takes the operational burden off your team and gives you the controls your book needs.
The Challenge Facing Uganda's Medical Insurers
Uganda's medical insurance market is growing, but so is the cost of running it. Industry loss ratios have risen from 43% in 2022 to over 50% in 2024, according to IRA data. Provider billing fraud, unmanaged admissions, and manual processing are driving this increase. Meanwhile, the IRA is raising its expectations on claims quality, data reporting, and IFRS 17 compliance. In-house claims teams, even experienced ones, are not built to manage these pressures at scale.
What You Get When You Work With Medvex
Lower Loss Ratios
Systematic pre-authorisation and utilisation management reduces avoidable admissions, unnecessary procedures, and inflated provider billing. A 10-point improvement on a UGX 2 billion health premium book saves UGX 200 million in claims. The Medvex administration fee on the same book is typically UGX 120 to 180 million. The saving is greater than the cost from day one.
Fraud and Leakage Recovery
Clinical audit and rules-based fraud detection identifies 5 to 12% in recoverable billing leakage across typical unmanaged health books. For an insurer paying UGX 1.5 billion in annual medical claims, that is UGX 75 to 180 million in recoverable overpayments each year.
Fixed Cost to Variable Cost
Your in-house claims team is a fixed overhead regardless of claims volume. Medvex's per-member-per-month model scales with your book, reducing your operational risk and supporting your capital efficiency under the IRA's risk-based supervision framework.
IRA and IFRS 17 Compliance
We provide monthly granular claims experience data in formats compatible with IRA regulatory returns and IFRS 17 insurance liability reporting. You no longer need to build a separate data function to meet your reporting obligations.
Faster Service for Your Members
Committed service levels of 2 to 4 hours for pre-authorisation and 5 to 10 working days for claims payment reduce policyholder complaints to the IRA and improve your retention.
Capacity That Scales With You
When you win a large new corporate scheme, Medvex absorbs the volume immediately. No recruitment, no retraining, no operational disruption.
What We Administer
- Pre-authorisation and case management for inpatient and outpatient procedures
- Claims receipt, triage, adjudication, and payment processing
- Provider billing audit and reconciliation
- Fraud, waste, and abuse detection and recovery
- Member helpdesk via call centre, SMS, and WhatsApp
- Provider network credentialing and management
- IRA-compliant claims data reporting and regulatory returns
- Monthly management information and analytics reports