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SOUTH AFRICAN QUALIFICATIONS AUTHORITY 
REGISTERED UNIT STANDARD THAT HAS PASSED THE END DATE: 

Analyse the product design/structure of different medical schemes to evaluate the benefits of each scheme 
SAQA US ID UNIT STANDARD TITLE
242567  Analyse the product design/structure of different medical schemes to evaluate the benefits of each scheme 
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 5  Level TBA: Pre-2009 was L5  5 
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 does not replace any other unit standard and is not replaced by any other unit standard. 

PURPOSE OF THE UNIT STANDARD 
This unit standard is intended for learners who work at a senior or strategic level in healthcare benefits administration and/or advise on medical schemes and products. They may recommend decisions related to a client's business policies and overall healthcare. They determine benefits and require a complete view of the healthcare benefits administration sub-sector. It would be useful for senior people in administration and managed care, professionals who consult to medical schemes, risk managers, medical advisors, Trustees, Medical Scheme Consultants, Healthcare Intermediaries, Broker Consultants, Client Liaison officers, employees of the council for Medical Schemes, Systems Designers, Actuaries, Principal Officers, and Senior Operational Administrative Staff who need to understand medical scheme design, issues of compliance and pricing and be able to compare different schemes in terms of benefits.

The qualifying learner is capable of:
  • Investigating theories of product development used by medical schemes.
  • Conducting a needs analysis of a client or target market.
  • Applying knowledge of benefit sets to a selected client or target market.
  • Analysing current developments in benefit design and the potential impact on schemes and options. 
    		•

    LEARNING ASSUMED TO BE IN PLACE AND RECOGNITION OF PRIOR LEARNING 
    It is assumed that learners are competent in Communication and Mathematical Literacy at NQF Level 4. 

    UNIT STANDARD RANGE 
    The typical scope of this unit standard is:
  • Clients may be individuals, Corporates or other business entities.
  • The Legislation includes, but is not limited to, National Health Act, Medical Schemes Act, Pharmacies Act, Medicine and Controlled Substances Act, Compensation for Occupational Injuries and Diseases Act (COIDA), Road Accident Fund (RAF), Financial Advisory and Intermediary Services Act (FAIS).
  • Impact of National Health Policy includes, but is not limited to, Low Income Medical Schemes (LIMS), Government Employees Medical Schemes (GEMS), Prescribed Minimum Benefits (PMBs) and Risk Equalisation Fund.
  • Health risk management includes, but is not limited to, disease and condition management, managed healthcare programmes, HIV/AIDS and Asthma programmes.
  • Demographic information includes, but is not limited to, health status, income, family size and age, geographic distribution, membership of other medical schemes, occupation and level of education.
  • Factors influencing member choice include, but are not limited to, professional sports injuries, cover for extreme sports, contraception, malaria precautions, Hormone Replacement Therapy (HRT), the use of formularies, designated service providers, gap cover and medical cover outside of South Africa.
  • Limitations on benefit design include, but are not limited to, risk equilisation LIMS, PMBs and primary healthcare.
  • Governance include, but are not, limited to, financial matters, communication, contracts, management of risk and service level agreements.
  • Analysis of financials includes, but is not limited to, cost drivers, income, expenses, calculation of income, contributions, solvency requirements, underwriting profits and losses, demographics, utilisation, and claims rating. 
    		•

    Specific Outcomes and Assessment Criteria: 

    SPECIFIC OUTCOME 1 
    Investigate theories of product development used by medical schemes. 

    ASSESSMENT CRITERIA     

    ASSESSMENT CRITERION 1 
    Knowledge of insurance principles is applied to explain the structure of medical schemes. 

    ASSESSMENT CRITERION 2 
    Knowledge of the current Medical Schemes Act and the demarcation debate is applied to differentiate between a medical scheme and medical insurance. 

    ASSESSMENT CRITERION 3 
    The impact of the National Health Policy and relevant legislation is explained with reference to governance and equitable, affordable and equitable healthcare for all. 

    ASSESSMENT CRITERION 4 
    Selected products are analysed to identify the principles of health risk management. 

    ASSESSMENT CRITERION 5 
    The income statement and balance sheet of a medical scheme are analysed to identify financial limitations on decisions about product design. 

    SPECIFIC OUTCOME 2 
    Conduct a needs analysis of a client or target market. 

    ASSESSMENT CRITERIA     

    ASSESSMENT CRITERION 1 
    The needs of an individual member or group are analysed with reference to demographic information. 

    ASSESSMENT CRITERION 2 
    The expectations of a selected client or target market regarding membership of a medical scheme are analysed in terms of perceptions, healthcare needs and other drivers that influence the choice of option. 

    SPECIFIC OUTCOME 3 
    Apply knowledge of benefit sets to a selected client or target market. 

    ASSESSMENT CRITERIA     

    ASSESSMENT CRITERION 1 
    Different benefit structures are analysed and compared with reference to exclusions, limitations and additional insurance cover. 

    ASSESSMENT CRITERION 2 
    Issues or factors that influence member choice are identified for a selected client or target market. 

    ASSESSMENT CRITERION 3 
    A set of scheme rules, member benefits guides and rate tables are analysed to determine cover, exclusions and limitations. 

    SPECIFIC OUTCOME 4 
    Analyse current developments in benefit design and the potential impact on schemes and options. 

    ASSESSMENT CRITERIA     

    ASSESSMENT CRITERION 1 
    Limitations on benefit design are explained with reference to legislation and Government healthcare policy. 

    ASSESSMENT CRITERION 2 
    Current industry responses to the burden of disease are investigated with reference to management of chronic and dread disease, anticipated health threats and pandemics, high cost claims and other high cost drivers. 

    ASSESSMENT CRITERION 3 
    The role of wellness initiatives is researched with reference to the contribution of wellness to the management of risk. 

    ASSESSMENT CRITERION 4 
    Challenges to the industry as a result of the introduction of low cost options are discussed with reference to threats and opportunities. 


    UNIT STANDARD ACCREDITATION AND MODERATION OPTIONS 
  • Anyone assessing a candidate against this unit standard must be registered as an assessor with the relevant ETQA or ETQA where a Memorandum of Understanding (MOU) exists with the relevant ETQA.
  • Any institution offering learning that will enable achievement of this unit standard must be accredited as a provider through the relevant ETQA or ETQA where a Memorandum of Understanding (MOU) exists with the relevant ETQA.
  • Moderation of assessment will be overseen by the relevant ETQA according to the moderation guidelines and the agreed ETQA procedures. 
    		•

    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 
    The learner is able to identify and solve problems in which responses show that responsible decisions using critical and creative thinking have been made in identifying opportunities and threats as a result of the introduction of low cost options. 

    UNIT STANDARD CCFO COLLECTING 
    The learner is able to collect, organise and critically evaluate information in conducting a need's analysis and applying knowledge of benefit sets to a client or target market. 

    UNIT STANDARD CCFO COMMUNICATING 
    The learner is able to communicate effectively in discussing challenges relating to low cost options. 

    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 
    Search words: Healthcare Benefits Administration; healthcare delivery system; trustees; medical scheme options. 

    QUALIFICATIONS UTILISING THIS UNIT STANDARD: 
      ID QUALIFICATION TITLE PRE-2009 NQF LEVEL NQF LEVEL STATUS END DATE PRIMARY OR DELEGATED QA FUNCTIONARY
    Elective  66611   National Certificate: Wealth Management  Level 5  NQF Level 05  Passed the End Date -
    Status was "Reregistered"     		 2023-06-30  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.
     
    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.