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 THAT HAS PASSED THE END DATE:

Describe healthcare cover in South Africa

SAQA US ID	UNIT STANDARD TITLE
117141	Describe healthcare cover in South Africa
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	2
REGISTRATION STATUS		REGISTRATION START DATE	REGISTRATION END DATE	SAQA DECISION NUMBER
Passed the End Date - Status was "Reregistered"		2018-07-01	2023-06-30	SAQA 06120/18
LAST DATE FOR ENROLMENT		LAST DATE FOR ACHIEVEMENT
2026-06-30		2029-06-30

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 replaces:

US ID	Unit Standard Title	Pre-2009 NQF Level	NQF Level	Credits	Replacement Status
12323	Demonstrate knowledge and understanding of different products marketed by Healthcare Benefits Administrators	Level 4	NQF Level 04	4

PURPOSE OF THE UNIT STANDARD

This unit standard requires detailed knowledge of the main products offered by Healthcare Benefits Administrators. It will be useful for intermediaries, learners in medical scheme administration, trustees and learners in call centres.

The qualifying learner is capable of:

Explaining the difference between a medical scheme and medical insurance.

Researching the move from traditional to new generation medical schemes.

Explaining the benefits that are covered by medical schemes.

Explaining and using in the correct context terminology used in the industry

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 Level 3.

UNIT STANDARD RANGE

The typical scope of this unit standard is

General characteristic of medical scheme products include, but are not limited to, general pooling of funds; a cross spectrum of benefits; defined benefits; fixed contributions; fee for service.

General characteristics of new generation scheme products include, but are not limited to, pooling of funds across certain benefits; options; savings; threshold benefits and gap cover.

Limits on benefits include, but are not limited to, pathology; optical; dental; psychological; occupational therapy; alternate medicine; auxiliary services.

Restrictions include waiting periods; limit of benefits to specific time periods; severity of ailment; pre-notification; notification to medical advisory committee and enrollment on lifestyle management programmes.

Legislation means the Medical Schemes Act and accompanying Regulations.

Reasons for the move to new generation schemes should include financial implications for the scheme, claiming patterns, increasing costs of healthcare, needs and priorities of members in terms of medical care and costs to the member.

Specific Outcomes and Assessment Criteria:

SPECIFIC OUTCOME 1

Explain the difference between a medical scheme and medical insurance.

ASSESSMENT CRITERIA

ASSESSMENT CRITERION 1

The concept of a medical scheme is explained with reference to the role of the Administrator in the structure, the role of trustees and the role of the member in the scheme.

ASSESSMENT CRITERION 2

Medical insurance is explained with reference to the role of the insurance company and the board of directors.

ASSESSMENT CRITERION 3

The payment of claims against a medical scheme is compared to claims against an insurance product with reference to the event and of the consequences of non disclosure.

ASSESSMENT CRITERION 4

Legislation governing medical schemes and insurance products is named and an indication is given of the limitations that legislation places on the structure of the different products.

SPECIFIC OUTCOME 2

Explain the move from traditional to new generation medical schemes.

ASSESSMENT CRITERIA

ASSESSMENT CRITERION 1

Types of medical cover available in South Africa are identified and compared to those in a developed country and another lesser developed country.

ASSESSMENT CRITERION 2

Three traditional medical scheme products are compared to determine the characteristics of traditional medical schemes with reference to benefits and limits.

ASSESSMENT CRITERION 3

Three new generation products are compared to determine guaranteed benefits and discretionary benefits.

ASSESSMENT CRITERION 4

Reasons why the industry has moved away from traditional to new generation products are discussed with reference to containing costs.

SPECIFIC OUTCOME 3

Explain the benefits that are covered by medical schemes.

ASSESSMENT CRITERIA

ASSESSMENT CRITERION 1

Benefits across three different medical scheme products are compared in terms of what is standard, what has limits and how they are covered.

ASSESSMENT CRITERION 2

Prescribed minimum benefits are explained with examples.

ASSESSMENT CRITERION 3

Benefits that have restricted access are named and reasons are given to explain the restriction

SPECIFIC OUTCOME 4

Explain and use in the correct context, terminology used in the industry.

ASSESSMENT CRITERIA

ASSESSMENT CRITERION 1

The concept of ex gratia payments is explained with reference to case studies.

ASSESSMENT CRITERION 2

Pro-ration of benefits is explained with reference to case studies.

ASSESSMENT CRITERION 3

The terms date of inception; date of termination and suspension are explained with reference to the effect that these have on access to benefits.

ASSESSMENT CRITERION 4

The concept of a pre-existing condition is explained with reference to the effect on a benefit and the implications of non disclosure.

ASSESSMENT CRITERION 5

Late joining penalties are explained and calculated for five different case studies.

UNIT STANDARD ACCREDITATION AND MODERATION OPTIONS

This Unit Standard will be internally assessed by the provider and moderated by a moderator registered by a relevant accredited ETQA or an ETQA that has a Memorandum of Understanding with the relevant accredited ETQA.

UNIT STANDARD ESSENTIAL EMBEDDED KNOWLEDGE

N/A

UNIT STANDARD DEVELOPMENTAL OUTCOME

N/A

UNIT STANDARD LINKAGES

N/A

Critical Cross-field Outcomes (CCFO):

UNIT STANDARD CCFO ORGANISING

Learners are able to act as responsible citizens in the organisation and local community when selecting a product according to a client profile.

UNIT STANDARD CCFO COMMUNICATING

Learners are able to communicate effectively using language skills to analyse, compare and present their conclusions in the activities required by the unit standard, calculating late joining penalties and explaining terminology commonly used in the industry.

UNIT STANDARD CCFO DEMONSTRATING

Learners are able to demonstrate an understanding of the world as a set of related systems when explaining the implications of non-disclosure, indicating ways in which legislation places limitations on the structure of different products and researching reasons why the industry is moving away from traditional schemes to new generation products.

UNIT STANDARD ASSESSOR CRITERIA

N/A

REREGISTRATION HISTORY

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

UNIT STANDARD NOTES

This unit standard has replaced 12323 which was "Demonstrate knowledge and understanding of different products marketed by Healthcare Benefits Administrators", Level 4 with 4 credits

QUALIFICATIONS UTILISING THIS UNIT STANDARD:

	ID	QUALIFICATION TITLE	PRE-2009 NQF LEVEL	NQF LEVEL	STATUS	END DATE	PRIMARY OR DELEGATED QA FUNCTIONARY
Core	49649	Further Education and Training Certificate: Long-term Insurance	Level 4	NQF Level 04	Passed the End Date - Status was "Reregistered"	2023-06-30	INSETA
Core	49356	Further Education and Training Certificate: Medical Claims Assessing	Level 4	NQF Level 04	Passed the End Date - Status was "Reregistered"	2023-06-30	INSETA
Elective	49089	National Certificate: Financial Services	Level 3	NQF Level 03	Passed the End Date - Status was "Reregistered"	2023-06-30	INSETA
Elective	57613	Further Education and Training Certificate: Short-Term Risk Management	Level 4	NQF Level 04	Passed the End Date - Status was "Reregistered"	2012-06-30	INSETA
Elective	66613	Further Education and Training Certificate: Wealth Management	Level 4	NQF Level 04	Passed the End Date - Status was "Reregistered"	2023-06-30	As per Learning Programmes recorded against this Qual

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.

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