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: 

Explain healthcare benefits administration in South Africa 
SAQA US ID UNIT STANDARD TITLE
114972  Explain healthcare benefits administration 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
8991  Explain Healthcare Benefits Administration in South Africa  Level 3  NQF Level 03  2   

PURPOSE OF THE UNIT STANDARD 
This Unit Standard provides a broad introduction to healthcare administration to enable learners to be informed workers in the industry.
The qualifying learner is capable of:
  • Explaining healthcare benefits administration
  • Comparing medical insurance and medical scheme cover.
  • Explaining what healthcare benefits administrators do with a policyholders money.
  • Explaining the ways in which healthcare benefits administrators are regulated. 
    		•

    LEARNING ASSUMED TO BE IN PLACE AND RECOGNITION OF PRIOR LEARNING 
    Learners should be competent in Communication and Mathematical Literacy at Level 2. 

    UNIT STANDARD RANGE 
    The typical scope of this Unit Standard is
  • Medical cover and medical insurance as marketed Healthcare Benefits Administrators in South Africa.
  • Legislation the Medical Schemes Act and Regulations.
  • Players in the market include, but are not limited to providers, members, healthcare benefits administrators, intermediaries and healthcare consultants. 
    		•

    Specific Outcomes and Assessment Criteria: 

    SPECIFIC OUTCOME 1 
    Explain healthcare benefits administration. 

    ASSESSMENT CRITERIA     

    ASSESSMENT CRITERION 1 
    The place of healthcare benefits administration in financial services is explained and an indication is given of the players in the healthcare benefits administration market. 

    ASSESSMENT CRITERION 2 
    The different benefits covered by medical schemes are named and compared for different options. 

    ASSESSMENT CRITERION 3 
    The difference between closed and open schemes is explained and reasons are given to explain why some public bodies and industrial concerns choose closed rather than open schemes. 

    SPECIFIC OUTCOME 2 
    Compare medical insurance and medical scheme cover. 

    ASSESSMENT CRITERIA     

    ASSESSMENT CRITERION 1 
    The concept of a medical scheme is explained with examples. 

    ASSESSMENT CRITERION 2 
    The concept of a medical insurance is explained with examples. 

    ASSESSMENT CRITERION 3 
    Two medical insurance policies are investigated and compared in terms of benefits provided to the client. 

    ASSESSMENT CRITERION 4 
    Two medical scheme options are investigated and compared in terms of benefits provided to the member. 

    ASSESSMENT CRITERION 5 
    The needs of the individual and the risks that the individual is prepared to take are considered and a personal decision is made as to whether medical insurance or medical scheme cover best provides for own needs. 

    SPECIFIC OUTCOME 3 
    Explain what healthcare benefit administrators do with policyholders' money. 

    ASSESSMENT CRITERIA     

    ASSESSMENT CRITERION 1 
    The concept of a membership fee is explained with reference to risk and savings. 

    ASSESSMENT CRITERION 2 
    The concept of a reserve is explained and an indication is given of why a reserve is necessary. 

    ASSESSMENT CRITERION 3 
    The concept of an administration fee is explained with reference to the relationship between a scheme and an administrator. 

    ASSESSMENT CRITERION 4 
    The application of formularies is explained with reference to their role in mininising cost and compliance with legislation. 

    SPECIFIC OUTCOME 4 
    Explain the ways in which healthcare benefits administrators are regulated. 

    ASSESSMENT CRITERIA     

    ASSESSMENT CRITERION 1 
    The Regulations to the Medical Schemes Act are identified with reference to their application in selected schemes and their options. 

    ASSESSMENT CRITERION 2 
    The role of the Department of Health in healthcare benefit administration is explained and an indication is given of how the Department of Health has changed the face of healthcare benefits administration in South Africa. 

    ASSESSMENT CRITERION 3 
    The concept of prescribed minimum benefits is explained with reference to current legislation. 

    ASSESSMENT CRITERION 4 
    The different fees charged by providers who offer a similar service are identified and an indication is given of who is responsible for setting fees. 

    ASSESSMENT CRITERION 5 
    The roles of the Council of Medical Schemes, the Registrar and the Appeal Board in regulating healthcare benefit administration are described in terms of monitory accreditations and appeals. 


    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 IDENTIFYING 
    Learners are able to make a decision about their own medical cover. 

    UNIT STANDARD CCFO ORGANISING 
    Learners are able to organise and manage themselves effectively by investigating the benefits covered by medical schemes and medical insurance and submitting tasks timeously. 

    UNIT STANDARD CCFO COMMUNICATING 
    Learners can communicate effectively by indicating, comparing and presenting their conclusions in the activities required by the Unit Standard. 

    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 replaces unit standard 8991, "Explain healthcare benefits administration in South Africa", Level 3, 2 credits. 

    QUALIFICATIONS UTILISING THIS UNIT STANDARD: 
      ID QUALIFICATION TITLE PRE-2009 NQF LEVEL NQF LEVEL STATUS END DATE PRIMARY OR DELEGATED QA FUNCTIONARY
    Elective  48783   National Certificate: Financial Services  Level 2  NQF Level 02  Passed the End Date -
    Status was "Reregistered"     		 2023-06-30  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  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  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 


    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.