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: 

Analyse healthcare funding in South Africa and the role of intermediaries in the sector 
SAQA US ID UNIT STANDARD TITLE
119677  Analyse 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 4  NQF Level 04 
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 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 and financial services sector. It is useful for learners in Healthcare Benefits Administrators, Intermediaries and Trustees of medical schemes.

The qualifying learner is capable of:
  • Explaining management of risk in the healthcare environment in South Africa.
  • Indicating the role of intermediaries in the marketing of medical cover.
  • Selecting a product according to a client profile.
  • Analysing the regulatory environment applicable to Medical Scheme administration.
  • Explaining how the health care sector contains costs. 

  • LEARNING ASSUMED TO BE IN PLACE AND RECOGNITION OF PRIOR LEARNING 
  • Communication at NQF Level 3.
  • Mathematical Literacy at NQF Level 3.
  • Relevant legislation. 

  • UNIT STANDARD RANGE 
    The typical scope of this Unit Standard is:
  • Health insurance, medical schemes and medical cover.
  • Methods of health care include, but are not limited to traditional and new generation schemes, open, closed and preferred providers that can be set up within managed care.
  • Application of underwriting includes, but is not limited to, the application of waiting periods, exclusions and previous service.
  • Methods used by insurers and medical schemes to contain costs include, but are not limited to, above the threshold limit, medical savings, designated service provider, formularies, managed care and benefit limits. 

  • Specific Outcomes and Assessment Criteria: 

    SPECIFIC OUTCOME 1 
    Explain the management of risk in the healthcare environment in South Africa. 

    ASSESSMENT CRITERIA
     

    ASSESSMENT CRITERION 1 
    The application of underwriting in medical schemes is explored with reference to current legislation. 

    ASSESSMENT CRITERION 2 
    The basis for calculating a standard or average medical risk is explained and an indication is given as to what makes someone a high/special risk. 

    ASSESSMENT CRITERION 3 
    Different types of medical schemes/health insurance products are analysed and an indication is given of which products can make use of reinsurance. 

    ASSESSMENT CRITERION 4 
    The implications of non-disclosure for the individual and the organisation are explained for a selected sub-sector of the insurance industry. 

    ASSESSMENT CRITERION 5 
    The implications of an employer or individual changing medical schemes are explained in terms of the Labour Legislation and the Medical Schemes Act. 

    ASSESSMENT CRITERION 6 
    The impact of compulsory membership and risk equalisation is explained with reference to Government initiatives. 

    SPECIFIC OUTCOME 2 
    Indicate the role of intermediaries in the marketing of medical cover. 

    ASSESSMENT CRITERIA
     

    ASSESSMENT CRITERION 1 
    Sources of new medical cover business are indicated with reasons why the sources could be interested in medical cover. 

    ASSESSMENT CRITERION 2 
    The relationship between the intermediary and the medical scheme and health insurer is compared with reference to remuneration, relevant codes of conduct and legislation. 

    ASSESSMENT CRITERION 3 
    The advantages and disadvantages to the customer of using or not using an intermediary are listed and an indication is given of how the changing healthcare environment could change the relationship. 

    SPECIFIC OUTCOME 3 
    Select a product according to a client profile. 

    ASSESSMENT CRITERIA
     

    ASSESSMENT CRITERION 1 
    Healthcare needs and financial constraints are identified for a single person, a couple and a family of four. 

    ASSESSMENT CRITERION 2 
    The risk profiles of the three cases are analysed according to age and pre-existing conditions and in terms of restrictions and penalties allowable under the current Medical Schemes Act. 

    ASSESSMENT CRITERION 3 
    Three products and/r options are compared to establish suitability and affordability. 

    ASSESSMENT CRITERION 4 
    The basic benefit options/underwriting principles of medical scheme cover are analysed according to structure of the product and needs of the individual. 

    ASSESSMENT CRITERION 5 
    Different benefit structures are analysed with reference to the needs of the individual. 

    ASSESSMENT CRITERION 6 
    Situations where membership of a medical scheme or health insurance may be more appropriate are identified with examples. 

    SPECIFIC OUTCOME 4 
    Analyse the regulatory environment applicable to Medical Scheme Administration. 

    ASSESSMENT CRITERIA
     

    ASSESSMENT CRITERION 1 
    Legislation to relating to Medical Cover is identified and the impact it has had on South African healthcare is described for two controversial issues. 

    ASSESSMENT CRITERION 2 
    Three industry bodies in active in the Healthcare Benefits Administration sub sector are identified and an indication is given of the role played by each. 

    ASSESSMENT CRITERION 3 
    Minimum benefits and service levels prescribed by regulatory bodies are named and an indication given of how these have impacted on healthcare providers. 

    ASSESSMENT CRITERION 4 
    The Government Gazette is used to access information applicable to medical schemes. 

    SPECIFIC OUTCOME 5 
    Explain how the healthcare sector contains costs. 

    ASSESSMENT CRITERIA
     

    ASSESSMENT CRITERION 1 
    The effect of inflation on a medical scheme is explained an indication is given of steps that medical schemes can take to contain inflation. 

    ASSESSMENT CRITERION 2 
    Factors that influence costs of healthcare are identified and the contribution of each is compared in terms of the impact that it has on costs. 

    ASSESSMENT CRITERION 3 
    The distinguishing characteristics of different medical scheme benefit structures are analysed and an indication if given of how successful each is in containing costs. 

    ASSESSMENT CRITERION 4 
    The concepts of threshold and savings as applied by medical schemes are explained with examples. 


    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.
  • An individual wishing to be assessed (including through RPL) against this unit standard may apply to an assessment agency, assessor or provider institution accredited by the relevant ETQA or an ETQA that has a Memorandum of Understanding with the relevant ETQA.
  • Anyone assessing a learner against this unit standard must be registered as an assessor with the relevant ETQA or with an ETQA that has a Memorandum of Understanding with the relevant ETQA.
  • Any institution offering learning that will enable achievement of this unit standard or assessing this unit standard must be accredited as a provider with the relevant ETQA, or with an ETQA that has a Memorandum of Understanding with the relevant ETQA.
  • Moderation of assessment will be conducted by the relevant ETQA according to the policies and guidelines for assessment and moderation of that ETQA, at its discretion, in terms of agreements reached about assessment and moderation between various ETQA's (including professional bodies). 

  • 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 can identify and solve problems by understanding the basic types of medical scheme cover or health insurance, and how each meets the requirements of a member in terms of to structure and need. 

    UNIT STANDARD CCFO ORGANISING 
    Learners can collect, organise and evaluate information by identifying factors influencing costs of healthcare and comparing the contribution of each has in terms of the impact on costs. 

    UNIT STANDARD CCFO COMMUNICATING 
    Learners can communicate effectively by compiling a list of questions to ask a broker about the risks that his/her customer is prepared to take. 

    UNIT STANDARD CCFO DEMONSTRATING 
    Learners can demonstrate an understanding of the world as a set of related systems by comparing the functions of an intermediary in the medical scheme/health insurance industry with an intermediary in Long-term or short term insurance. 

    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
    Elective  49649   Further Education and Training Certificate: Long-term Insurance  Level 4  NQF Level 04  Reregistered  2023-06-30  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. Faisit (Pty) Ltd 
    7. Intec College 
    8. Invuya Institute of Learning (Pty) Ltd 
    9. Masifunde Training Centre (Pty) Ltd 
    10. Old Mutual Life Assurance Company South Africa 
    11. Ray Strodl Consulting (Pty) Ltd 
    12. Sanlam Life Insurance Ltd 
    13. Sanlam Life Insurance Ltd. 
    14. 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.