| What is the medical advisory committee? Medical Advisory Committee
Objectives
- To identify procedures and
treatments that are unique, high cost, and/or life threatening
and which require the establishments of Managed Care guidelines
and protocols
- To formulate Managed Care
guidelines and protocols dealing with the granting of benefit
to such events
- Ensuring Managed Care guidelines
and protocols are both medically appropriate and comply with
scheme rules
- To make decisions based on
such guidelines and protocols and communicate these to affected
parties
- To ensure that wherever possible
all stakeholders are involved in the development of guidelines
and protocols including specialists from their respective
fields
What is Ex-gratia
Exgratia Commitee
Objectives
- To consider requests for extensions of benefit in
exceptional cases
- To grant benefit in such cases according to medical
appropriateness and scheme rules
- To grant benefit in a consistent
manner for all requests from members
- To communicate decisions promptly and efficiently to
affected parties
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