SAQA All qualifications and part qualifications registered on the National Qualifications Framework are public property. Thus the only payment that can be made for them is for service and reproduction. It is illegal to sell this material for profit. If the material is reproduced or quoted, the South African Qualifications Authority (SAQA) should be acknowledged as the source.
SOUTH AFRICAN QUALIFICATIONS AUTHORITY 
REGISTERED UNIT STANDARD: 

Describe healthcare funding in South Africa and the role of intermediaries in the sector 
SAQA US ID UNIT STANDARD TITLE
9002  Describe healthcare funding in South Africa and the role of intermediaries in the sector 
ORIGINATOR
SGB Insurance and Investment 
PRIMARY OR DELEGATED QUALITY ASSURANCE FUNCTIONARY
-  
FIELD SUBFIELD
Field 03 - Business, Commerce and Management Studies Finance, Economics and Accounting 
ABET BAND UNIT STANDARD TYPE PRE-2009 NQF LEVEL NQF LEVEL CREDITS
Undefined  Regular  Level 3  NQF Level 03 
REGISTRATION STATUS REGISTRATION START DATE REGISTRATION END DATE SAQA DECISION NUMBER
Reregistered  2018-07-01  2023-06-30  SAQA 06120/18 
LAST DATE FOR ENROLMENT LAST DATE FOR ACHIEVEMENT
2024-06-30   2027-06-30  

In all of the tables in this document, both the pre-2009 NQF Level and the NQF Level is shown. In the text (purpose statements, qualification rules, etc), any references to NQF Levels are to the pre-2009 levels unless specifically stated otherwise.  

This unit standard does not replace any other unit standard and is not replaced by any other unit standard. 

PURPOSE OF THE UNIT STANDARD 
This unit standard introduces some theoretical concepts and requires a wide range of knowledge and skills that will enable learners to be informed workers in the healthcare industry. It builds on the unit standard, Explain Healthcare Benefits Administration in South Africa.

The qualifying learner is capable of:
  • Explaining the healthcare environment in South Africa.
  • Explaining the role and legal obligations of an intermediary in advising a customer about healthcare.
  • Distinguishing between a medical scheme and health insurance.
  • Explaining the legislation governing medical scheme administration. 

  • LEARNING ASSUMED TO BE IN PLACE AND RECOGNITION OF PRIOR LEARNING 
    There is open access to this unit standard. Learners should be competent in Communication and mathematical Literacy at NQF Level 2. The learner should:
  • Understand the concept of medical schemes, medical cover and medical insurance.
  • Know some of the products marketed by Healthcare Benefits Administrators.
  • Know how medical schemes are regulated in South Africa. 

  • UNIT STANDARD RANGE 
    The typical scope of this unit standard is:
  • Medical insurance, medical schemes and medical cover.
  • Managed care as a method of containing costs. 

  • Specific Outcomes and Assessment Criteria: 

    SPECIFIC OUTCOME 1 
    Know and understand the healthcare environment in South Africa. 

    ASSESSMENT CRITERIA
     

    ASSESSMENT CRITERION 1 
    1. Methods of healthcare available in South Africa are identified and compared to those in a developed country and another lesser developed country. 

    ASSESSMENT CRITERION 2 
    2. Types of agreements such as capitated, open, closed and preferred providers that can be set up within managed care are explained and compared in terms of their purposes. 

    ASSESSMENT CRITERION 3 
    3. The purpose of underwriting is explored with reference to current legislation, application of waiting periods, exclusions and previous service. 

    ASSESSMENT CRITERION 4 
    4. The basis for calculating a standard or average medical risk is explained and an indication is given as to what makes someone a high risk. 

    ASSESSMENT CRITERION 5 
    5. Special risks that are considered when underwriting medical policies are listed. 

    ASSESSMENT CRITERION 6 
    6. The effects of a particular event on a medical insurance company are compared for a scenario with or without reinsurance. 

    ASSESSMENT CRITERION 7 
    7. Different types of medical policies/products are examined and an indication is given of which kinds of insurance have the greatest need for reinsurance. 

    ASSESSMENT CRITERION 8 
    8. The implications of non-disclosure for the individual and the organisation are explained for a selected sub-sector of the insurance industry. 

    ASSESSMENT CRITERION 9 
    9. The implications of an employer changing medical schemes are explained in terms of the Labour Relations Act. 

    SPECIFIC OUTCOME 2 
    Indicate the kind of products marketed as medical insurance and the role of intermediaries 
    OUTCOME NOTES 
    Indicate the kind of products marketed as medical insurance and the role of intermediaries in the Healthcare Benefits/Medical Scheme industry. 

    ASSESSMENT CRITERIA
     

    ASSESSMENT CRITERION 1 
    1. The risks that a customer is prepared to take are considered and questions are formulated to ask of a broker. 

    ASSESSMENT CRITERION 2 
    2. Sources of new medical insurance business are indicated with reasons why the sources could be interested in a medical insurance policy. 

    ASSESSMENT CRITERION 3 
    3. The functions of an intermediary in the Healthcare Benefits/Medical Scheme industry are listed and compared to that of an intermediary in long-term and short-term insurance. 

    ASSESSMENT CRITERION 4 
    4. The advantages and disadvantages to the customer of using or not using an intermediary are listed and an indication is given of how the Internet could change the relationship. 

    ASSESSMENT CRITERION 5 
    5. The relationship between the intermediary and a medical insurance organisation is described from the perspective of the medical insurance industry. 

    ASSESSMENT CRITERION 6 
    6. Conditions that an intermediary is required to comply with are listed in terms of the Medical Schemes Act 131 of 1998. 

    SPECIFIC OUTCOME 3 
    Distinguish between a medical scheme and health insurance. 

    ASSESSMENT CRITERIA
     

    ASSESSMENT CRITERION 1 
    1. The basic classes of medical scheme cover are indicated according to structure, purpose and needs of the individual. 

    ASSESSMENT CRITERION 2 
    2. The basic classes of medical insurance are indicated according to structure, purpose and needs of the individual. 

    ASSESSMENT CRITERION 3 
    3. Examples of two specialist classes of medical insurance are named with examples. 

    ASSESSMENT CRITERION 4 
    4. Transacting risk transfer through a reinsurance company is explained with reference to the advantages to the member and the scheme. 

    ASSESSMENT CRITERION 5 
    5. Treaty reinsurance and facultative insurance as they apply in medical insurance are explained and compared using examples to illustrate the concepts. 

    SPECIFIC OUTCOME 4 
    Know and understand the legislation governing Healthcare Benefits Administration. 

    ASSESSMENT CRITERIA
     

    ASSESSMENT CRITERION 1 
    1. The Medical Schemes Act 131 of 1998 is understood and the impact it has had on South African healthcare is described for two controversial issues. 

    ASSESSMENT CRITERION 2 
    2. The basic elements of the Medical Schemes Act 131 of 1998 are interpreted with reference to their application in selected schemes. 

    ASSESSMENT CRITERION 3 
    3. The role of the Council of Medical Schemes and the Registrar of Medical Schemes is explained with an indication of the regulatory role that they play in the industry. 

    ASSESSMENT CRITERION 4 
    4. Minimum service levels prescribed by the Council of Medical Schemes are named and an indication given of how these have impacted on healthcare providers. 

    ASSESSMENT CRITERION 5 
    5. The Government Gazette is used to access information applicable to medical schemes. 

    ASSESSMENT CRITERION 6 
    6. The vision of the State and the role of the private sector in the provision of healthcare are explained and examples are given of how they complement or contradict each other. 

    SPECIFIC OUTCOME 5 
    Explain how the healthcare sector contains costs. 

    ASSESSMENT CRITERIA
     

    ASSESSMENT CRITERION 1 
    1. The effect of inflation on a medical policy is explained and indication is given of steps that medical insurers can take to contain inflation. 

    ASSESSMENT CRITERION 2 
    2. A list of factors that influence costs of healthcare is compiled and the contribution of the items is compared in terms of the impact that each has on costs. 

    ASSESSMENT CRITERION 3 
    3. The distinguishing characteristics of different models of healthcare funding are explored with an indication of how successful each is in containing costs. 

    ASSESSMENT CRITERION 4 
    4. Scheme benefit structures are described as they apply in South Africa. 

    ASSESSMENT CRITERION 5 
    5. Methods used to contain costs are described with reference to those used by medical schemes. 

    ASSESSMENT CRITERION 6 
    6. The concepts of threshold and savings as applied by medical schemes are explained with reference to the role of managed care in reducing costs. 


    UNIT STANDARD ACCREDITATION AND MODERATION OPTIONS 
    This unit standard will be internally assessed by the provider and moderated by a moderator registered by INSQA or a relevant accredited ETQA. The mechanisms and requirements for moderation are contained in the document obtainable from INSQA, - INSQA framework for assessment and moderation. 


    Critical Cross-field Outcomes (CCFO): 

    UNIT STANDARD CCFO IDENTIFYING 
    Learners can identify and solve problems by understanding the basic classes of medical scheme cover or medical insurance, and by meeting the requirements of a member according to structure, purpose and need. 

    UNIT STANDARD CCFO COLLECTING 
    Learners can collect, organise and evaluate information by compiling a list of factors influencing costs of healthcare and comparing the contribution of the items in terms of the impact each has on costs. 

    UNIT STANDARD CCFO COMMUNICATING 
    Learners can communicate effectively using visual, mathematics or language skills by compiling a list of questions to ask a broker about the risks that his/her customer is prepared to take. They can also communicate effectively by using examples to illustrate and compare concepts when explaining how treaty and facultative insurance apply in medical insurance. 

    UNIT STANDARD CCFO SCIENCE 
    A learner is able to understand the application of technology by listing some of the advantages and disadvantages of a customer using or not using an intermediary and indicating how the use of the Internet could change such a relationship. 

    UNIT STANDARD CCFO DEMONSTRATING 
    Learners can demonstrate an understanding of the world as a set of related systems when listing and comparing the functions of an intermediary in the medical insurance industry with an intermediary in long term or short term insurance. 

    UNIT STANDARD CCFO CONTRIBUTING 
    Learners can participate as responsible citizens in their organisation and the community by understanding and explaining the implication of non-disclosure for an individual and his/her organisation in a selected sub-sector of the insurance industry. 

    REREGISTRATION HISTORY 
    As per the SAQA Board decision/s at that time, this unit standard was Reregistered in 2012; 2015. 

    QUALIFICATIONS UTILISING THIS UNIT STANDARD: 
      ID QUALIFICATION TITLE PRE-2009 NQF LEVEL NQF LEVEL STATUS END DATE PRIMARY OR DELEGATED QA FUNCTIONARY
    Core  20639   National Certificate: Healthcare Benefits Administration: Claims Assessing  Level 4  NQF Level 04  Passed the End Date -
    Status was "Registered" 
    2004-12-05  INSETA 
    Elective  48494   National Certificate: Financial Services Management  Level 3  NQF Level 03  Passed the End Date -
    Status was "Reregistered" 
    2012-06-30  INSETA 
    Elective  20177   National Certificate: Insurance  Level 3  NQF Level 03  Passed the End Date -
    Status was "Registered" 
    2004-10-10  Was INSETA until Last Date for Achievement 
    Elective  48493   National Certificate: Financial Services: Wealth Management  Level 4  NQF Level 04  Passed the End Date -
    Status was "Registered" 
    2007-02-11  Was INSETA until Last Date for Achievement 
    Elective  20774   National Certificate: Insurance: Long Term: Risk Assessment  Level 4  NQF Level 04  Passed the End Date -
    Status was "Registered" 
    2004-12-05  Was INSETA until Last Date for Achievement 
    Elective  20773   National Certificate: Long Term Insurance  Level 4  NQF Level 04  Passed the End Date -
    Status was "Registered" 
    2004-12-05  INSETA 


    PROVIDERS CURRENTLY ACCREDITED TO OFFER THIS UNIT STANDARD: 
    This information shows the current accreditations (i.e. those not past their accreditation end dates), and is the most complete record available to SAQA as of today. Some Primary or Delegated Quality Assurance Functionaries have a lag in their recording systems for provider accreditation, in turn leading to a lag in notifying SAQA of all the providers that they have accredited to offer qualifications and unit standards, as well as any extensions to accreditation end dates. The relevant Primary or Delegated Quality Assurance Functionary should be notified if a record appears to be missing from here.
     
    1. Discovery Life Ltd 
    2. Faisit (Pty) Ltd 
    3. Intec College 
    4. Invuya Institute of Learning (Pty) Ltd 
    5. Masifunde Training Centre (Pty) Ltd 
    6. Umfolozi FET College - Central Office 



    All qualifications and part qualifications registered on the National Qualifications Framework are public property. Thus the only payment that can be made for them is for service and reproduction. It is illegal to sell this material for profit. If the material is reproduced or quoted, the South African Qualifications Authority (SAQA) should be acknowledged as the source.