AI for insurers and medical aids: Health Loops

Authorisations and claims, on your rules

Your plan rules, applied the same way every time.

A GP visit authorisation loop reads the member’s visit count, applies the plan’s limits and starts a virtual consult when a clinician needs to approve. A gap claim loop waits for every required document, works out the payable amount against tariff and annual limits, and tells you which limit applied. Every decision is written back to the member.

One front door to every benefit

Members ask once. The right benefit answers.

A benefits concierge routes members to counselling, coaching, legal or financial support, and can start a health check or book a call-back without leaving the conversation. It answers from your own benefit guides.

Engagement between claims

A reason for members to come back.

Add a phone-camera wellness scan to your app or member journey. Members get a simple 0 to 100 wellness snapshot with each reading shown, and your loop decides what happens next: a check-in, a call-back or a nudge toward the right benefit.

The wellness snapshot is not a diagnosis and is not used on its own to approve, decline or price cover.

Cover and care routing

Send members to the right place, fast.

An emergency routing loop checks the member’s cover, returns the right destination and cover limits, and records the outcome. Nearby care finds the closest pharmacy, clinic or hospital, and medicine tools surface South African medicine prices and cheaper generics.

Connected to your systems

Plugs into what you already run.

Your member, policy and claims systems start loops through a secure API, with a key scoped to each integration. Loops read from and write back to your own endpoints, keep one record per member across every journey, and log every step for audit.

Make every benefit a journey members use.

Your plan rules, applied the same way every time.

Members ask once. The right benefit answers.

A reason for members to come back.

Send members to the right place, fast.

Plugs into what you already run.

Show us the journey costing you the most. We’ll show you the loop.