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SOUTH AFRICAN QUALIFICATIONS AUTHORITY 
REGISTERED UNIT STANDARD: 

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 
REGISTRATION STATUS REGISTRATION START DATE REGISTRATION END DATE SAQA DECISION NUMBER
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 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  Complete 

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  Reregistered  2023-06-30  INSETA 
    Core  49356   Further Education and Training Certificate: Medical Claims Assessing  Level 4  NQF Level 04  Reregistered  2023-06-30  INSETA 
    Elective  49089   National Certificate: Financial Services  Level 3  NQF Level 03  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  Reregistered  2021-06-30  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.
     
    1. African Resources & Financial Training (Pty) Ltd 
    2. ALCARI 233 CC T/A ALCARI (Eversdal)(TP) 
    3. CKP Development Agency (Pty) Ltd. 
    4. De Vries Management & Training Services cc 
    5. DSBI (Pty) Ltd 
    6. Duxah (Pty) Ltd 
    7. Faisit (Pty) Ltd 
    8. Intec College 
    9. Invuya Institute of Learning (Pty) Ltd 
    10. Masifunde Training Centre (Pty) Ltd 
    11. Old Mutual Life Assurance Company South Africa 
    12. Ray Strodl Consulting (Pty) Ltd 
    13. Sanlam Life Insurance Ltd 
    14. Sanlam Life Insurance Ltd. 
    15. The Institute of Health Risk Managers (Pty) Ltd 
    16. Umfolozi FET College - Central Office 



    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.