SAQA

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SOUTH AFRICAN QUALIFICATIONS AUTHORITY

REGISTERED UNIT STANDARD THAT HAS PASSED THE END DATE:

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	3
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
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.

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