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: 

Research the Medical Scheme Administration sub-sector in South Africa 
SAQA US ID UNIT STANDARD TITLE
118012  Research the Medical Scheme Administration sub-sector 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 4  NQF Level 04  5 
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 does not replace any other unit standard and is not replaced by any other unit standard. 

PURPOSE OF THE UNIT STANDARD 
This unit standard requires learners to conduct research into the Medical Schemes Administration sub-sector of the insurance industry.

The qualifying learner is capable of:
  • Explaining why Medical Scheme Administration exists as a sub sector of the insurance industry.
  • Indicating the role of the various stakeholders and organised groups within the industry.
  • Investigating the factors that impact on a fund's stability.
  • Investigating how the industry caters for different market sectors. 
    		•

    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
  • Reasons for regulation of the industry include social, political, economic, disease epidemiology.
  • Stakeholders include government, members, Administrators, providers, intermediaries, employers, trustees and regulatory bodies.
  • Factors that influence fund stability include fraud, underwriting, administrative capability of the Administration Company, managed care initiatives, epidemics and natural disasters.
  • Challenges facing the industry include HIV/AIDS, legislation, fraud, aging member profiles, inflation and the Rand exchange rate.
  • Primary, secondary and tertiary healthcare institutions in the state and private sector.
  • Factors that indicate financial stability include membership profiles, reserve ratio and sound corporate governance. 
    		•

    Specific Outcomes and Assessment Criteria: 

    SPECIFIC OUTCOME 1 
    Explain why Medical Scheme Administration exists as a sub sector of the insurance industry in South Africa. 

    ASSESSMENT CRITERIA     

    ASSESSMENT CRITERION 1 
    The shortfall in the public healthcare sector is investigated and an indication is given of how this has impacted on the growth of Healthcare Benefits Administration in South Africa. 

    ASSESSMENT CRITERION 2 
    The difference between the Fund and the Administrator is explained and reasons are given to account for why it is necessary for the two to be separate bodies. 

    ASSESSMENT CRITERION 3 
    Reasons are given to explain why the Medical Scheme Administration sub-sector is now highly regulated. 

    ASSESSMENT CRITERION 4 
    The evolution of Healthcare Benefits Administration since 1994 is described with reference to legislation, product development and the Government's role in providing healthcare for the nation. 

    SPECIFIC OUTCOME 2 
    Indicate the role of the various stakeholders and organised groups within the industry. 

    ASSESSMENT CRITERIA     

    ASSESSMENT CRITERION 1 
    The various stakeholders in the Medical Scheme Administration industry are named and an indication is given of the role of each. 

    ASSESSMENT CRITERION 2 
    The top five Medical Schemes in the industry are identified using the annual reports of the Council for Medical Schemes and the Board of Healthcare Funders. 

    SPECIFIC OUTCOME 3 
    Investigate the factors that impact on a fund's stability. 

    ASSESSMENT CRITERIA     

    ASSESSMENT CRITERION 1 
    Factors that influence fund stability are discussed with reference to the stability of three different funds. 

    ASSESSMENT CRITERION 2 
    Challenges facing the industry are investigated and an indication is given of how the industry has responded to these threats. 

    SPECIFIC OUTCOME 4 
    Investigate how the industry caters for different market sectors. 

    ASSESSMENT CRITERIA     

    ASSESSMENT CRITERION 1 
    Factors used to describe market segments are identified for Medical Schemes. 

    ASSESSMENT CRITERION 2 
    The role of the public healthcare sector in servicing certain benefits is explained with reference to designated service providers and public/private partnerships. 

    ASSESSMENT CRITERION 3 
    Examples of public and private primary, secondary and tertiary healthcare institutions are investigated and an indication is given of the services offered at each. 

    ASSESSMENT CRITERION 4 
    The difference between open and restricted schemes is explained with reference to eligibility and risk. 


    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 COLLECTING 
    The learner is able to collect, organise and critically evaluate information in investigating the factors that impact on a fund's stability and how the industry caters for different market sectors. 

    UNIT STANDARD CCFO COMMUNICATING 
    The learner is able to communicate effectively in analysing, comparing and presenting his/her conclusions in the activities required by the Unit Standard. 

    UNIT STANDARD CCFO DEMONSTRATING 
    The learner is able to demonstrate an understanding of the world as a set of related systems in investigating how the shortfall in the public sector has impacted on the evolution of Healthcare Benefits Administration in South Africa and explaining why the industry is so highly regulated. 

    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 
    N/A 

    QUALIFICATIONS UTILISING THIS UNIT STANDARD: 
      ID QUALIFICATION TITLE PRE-2009 NQF LEVEL NQF LEVEL STATUS END DATE PRIMARY OR DELEGATED QA FUNCTIONARY
    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  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 
    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.
     
    NONE 


    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.