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
8991	Explain Healthcare Benefits Administration in South Africa
ORIGINATOR
SGB Financial Services
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 "Registered"		2001-10-10	2004-08-11	SAQA 0538/01
LAST DATE FOR ENROLMENT		LAST DATE FOR ACHIEVEMENT
2005-08-11		2008-08-11

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 is replaced by:

US ID	Unit Standard Title	Pre-2009 NQF Level	NQF Level	Credits	Replacement Status
114972	Explain healthcare benefits administration in South Africa	Level 3	NQF Level 03	2

PURPOSE OF THE UNIT STANDARD

This unit standard introduces the concepts of healthcare benefits administration and provides a broad introduction to healthcare administration to enable learners to be informed workers in the industry.

The qualifying learners is capable of:

Explaining medical insurance and the products classified as medical

Comparing medical schemes and medical cover.

Knowing what healthcare benefits administrators do with policy holders' money.

Asking questions to obtain information.

Using the Government Gazette to find information.

Explaining how medical schemes are regulated in South Africa.

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 2.

UNIT STANDARD RANGE

The typical scope of this unit standard is:

1. Medical cover and medical insurance as marketed Healthcare Benefits Administrators in South Africa.
2. Legislation the Medical Schemes Act and Regulations.

Specific Outcomes and Assessment Criteria:

SPECIFIC OUTCOME 1

Explain healthcare benefits.

ASSESSMENT CRITERIA

ASSESSMENT CRITERION 1

1. Providers, members, healthcare benefits administrators and healthcare consultants are indicated as the players in the healthcare benefits market.

ASSESSMENT CRITERION 2

2. The place of healthcare benefits is understood and reasons are given to explain why healthcare benefits administration is classified as long term.

ASSESSMENT CRITERION 3

3. The different classes of healthcare benefits are named and compared in terms of the different products marketed.

ASSESSMENT CRITERION 4

4. 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.

ASSESSMENT CRITERION 5

5. Reasons are given for taking out healthcare cover for two different types of benefit.

SPECIFIC OUTCOME 2

Compare medical insurance and medical scheme cover.

ASSESSMENT CRITERIA

ASSESSMENT CRITERION 1

1. The concepts of medical schemes and medical insurance are explained with examples of each.

ASSESSMENT CRITERION 2

2. Products marketed as medical insurance are researched and two similar products are compared in terms of security for the customer.

ASSESSMENT CRITERION 3

3. Products marketed as medical scheme cover are researched and two similar products are compared in terms of security for the customer.

ASSESSMENT CRITERION 4

4. The needs of the customer and the risks that the customer is prepared to take are considered and a list is compiled of questions to ask of a broker about a product.

ASSESSMENT CRITERION 5

5. 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

1. Different avenues of investment are named and compared from a healthcare benefits administration perspective.

ASSESSMENT CRITERION 2

2. The concepts of threshold and medical savings accounts as applied in new generation products are explained with reference to the role of managed care in minimising costs and optimising the quality of care.

ASSESSMENT CRITERION 3

3. The purpose of excluding the pharmacological treatment of certain expensive chronic medical conditions for the first twelve months of membership is explained with reference to the purpose/role in minimising financial risk.

ASSESSMENT CRITERION 4

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

ASSESSMENT CRITERION 5

5. Treaty reinsurance and facultative reinsurance as they apply in healthcare benefits administration are explained and compared with examples of each.

SPECIFIC OUTCOME 4

Explain the ways in which healthcare benefits administrators are regulated.

ASSESSMENT CRITERIA

ASSESSMENT CRITERION 1

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

ASSESSMENT CRITERION 2

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 positively and negatively affected healthcare benefits administration.

ASSESSMENT CRITERION 3

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

ASSESSMENT CRITERION 4

4. The role of the Board of Health Care Funders' is explained in terms of its control of the industry.

ASSESSMENT CRITERION 5

5. The relationship of the South African Medical Association to healthcare benefits administrators is outlined and an explanation is give as to how decisions are made that affect the two organisations.

ASSESSMENT CRITERION 6

6. The Government Gazette is used to access information applicable to medical schemes.

ASSESSMENT CRITERION 7

7. The role of the Council of Medical Schemes and the Appeal Board in regulating healthcare benefit administration is 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 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 are able to identify and solve problems when identifying reasons for taking out healthcare cover for 2 different types of benefits.

UNIT STANDARD CCFO ORGANISING

Learners are able to organise and manage themselves effectively by becoming responsible citizens when making personal decisions regarding their medical cover.

UNIT STANDARD CCFO COMMUNICATING

Learners can communicate effectively using visual, mathematics and language skills to indicate, compare and present their conclusions in the activities required by the unit standard.

UNIT STANDARD CCFO DEMONSTRATING

Learners are able to demonstrate an understanding of the world as a set of related systems when explaining ways in which healthcare benefits administrators are regulated.

UNIT STANDARD CCFO CONTRIBUTING

Learners are able to act as responsible citizens in the organisation and local community when researching and comparing medical cover for products relating to customer security.

UNIT STANDARD NOTES

This unit standard has been replaced by unit standard 114972, which is "Explain Healthcare Benefits Administration in South Africa", Level 3, 2 credits, as from 11 Aug 2004

QUALIFICATIONS UTILISING THIS UNIT STANDARD:

	ID	QUALIFICATION TITLE	PRE-2009 NQF LEVEL	NQF LEVEL	STATUS	END DATE	PRIMARY OR DELEGATED QA FUNCTIONARY
Core	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
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	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	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.

NONE