Money & claims

Corporates, insurance schemes, copay and capitation

Set up each employer and insurance scheme once with its price list, copay and how it pays; reception just picks it at check-in.

Who uses it: Administrators and finance (setting up); reception (picking the scheme)
Where to find it: Corporates & Schemes

1Set up a scheme

1
New scheme
Go to “Corporates & Schemes” → “New scheme”. Enter a code and name, and choose Insurance scheme or Corporate (employer).
2
Price list
Enter “insurance” to use your general insurance prices, “cash” for cash prices, or the scheme’s own key (for example jubilee-gold) if it has its own tariff. Set those prices on Services & Prices with “Add scheme-specific price”. A service without a scheme price uses the insurance price, then cash.
3
How the scheme pays
Fee for service: the scheme is billed for each visit and you claim from it. Capitation: the scheme pays a fixed monthly fee per member, so visits are not claimed; enter the rate per member per month.
4
Copay
No copay, a fixed amount per visit (for example KES 200) or a percentage of the bill. The copay is what the patient pays at the cashier.

1
Pick the scheme
At check-in choose the payer (Insurance or Corporate), pick the scheme and enter the member or staff number. For capitation schemes a note reminds you the patient pays only the copay.
2
The bill
The invoice shows the scheme, what the patient pays (copay) and what the insurer or employer covers. Under capitation, the covered part is shown as “Covered by capitation” and only the copay is due.
3
Old bills stay the same
Changing a scheme later does not change bills already opened.

1
Open utilisation
Click “Utilisation” next to a scheme and pick a month: visits, patients seen, the value of care at scheme prices, copays, and what was covered by capitation or is to be claimed.

Need help with this? Our team can show you on a call.