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

Apply knowledge and insight of the medical scheme environment to evaluate risk in a selected medical scheme 
SAQA US ID UNIT STANDARD TITLE
242568  Apply knowledge and insight of the medical scheme environment to evaluate risk in a selected medical 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 6  Level TBA: Pre-2009 was L6  4 
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 are involved in internal audits in a medical scheme administrator. It would be useful for senior managers who input into policies and procedures, Boards of Trustees, Audit Committees, Managers, Senior Managers, Risk Managers, Fund Managers, Actuaries consulting to medical schemes, Trustees, Medical Scheme Consultants, Intermediaries and Principal Officers.

The qualifying learner is capable of:
  • Demonstrating knowledge and insight into risk in a medical scheme environment.
  • Researching models used to manage risks in the medical scheme environment.
  • Analysing the internal and external environments of a selected medical scheme.
  • Applying knowledge of the risk management process to a selected medical scheme. 
    		•

    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 and are working towards or have a Level 5 Financial Services Qualification or equivalent. 

    UNIT STANDARD RANGE 
    The typical scope of this Unit Standard is:
  • Risks include, but are not limited to, membership numbers, fraud, issues of governance, solvency, compliance, Trustees and Principle Officers.
  • Models include, but are not limited to, COSO models 1 and 2 (Committee of Sponsoring Organisations of the Tredway Commissions and Sarbanes Oxley Act, (USA).
  • The internal and external environments include, but are not limited to, the regulatory environment, policies and procedures in the organisation, implementation and application of polices, members, employees, employers, management, providers, technology, resources and health trends.
  • The regulatory environment includes pending legislation relating to health including, but 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). 
    		•

    Specific Outcomes and Assessment Criteria: 

    SPECIFIC OUTCOME 1 
    Demonstrate knowledge and insight into risk in a medical scheme. 

    ASSESSMENT CRITERIA     

    ASSESSMENT CRITERION 1 
    Risks specific to medical schemes are identified, explained and rated in terms of their potential positive or negative impact on a medical scheme. 

    ASSESSMENT CRITERION 2 
    The process used to manage risk in a selected medical scheme is explained and an indication is given of why the process is necessary. 

    ASSESSMENT CRITERION 3 
    The roles and responsibilities of individuals at all levels in the organisation are explained for a specific medical scheme. 

    SPECIFIC OUTCOME 2 
    Research models used to manage risks in the medical scheme environment. 

    ASSESSMENT CRITERIA     

    ASSESSMENT CRITERION 1 
    Different models for managing risk are researched with reference to effectiveness or application to a selected medical scheme. 

    SPECIFIC OUTCOME 3 
    Analyse the internal and external environment of a selected medical scheme. 

    ASSESSMENT CRITERIA     

    ASSESSMENT CRITERION 1 
    Threats and opportunities are analysed to identify potential areas of risk. 

    ASSESSMENT CRITERION 2 
    Risks are evaluated and prioritised in terms of the level of risk and the measures necessary to mitigate each risk. 

    ASSESSMENT CRITERION 3 
    The adequacy and effectiveness of interventions to control the risk are evaluated for a selected medical scheme. 

    ASSESSMENT CRITERION 4 
    The effectiveness of systems for communicating, reporting and monitoring, risk is evaluated for a specific medical scheme. 

    SPECIFIC OUTCOME 4 
    Apply knowledge of a risk management process to a selected medical scheme. 

    ASSESSMENT CRITERIA     

    ASSESSMENT CRITERION 1 
    The risk management process in a selected medical scheme is evaluated for adequacy and effectiveness. 

    ASSESSMENT CRITERION 2 
    Internal and external audit reports and other relevant information are analysed to determine appropriate interventions for a specific medical scheme. 


    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 evaluating the risk management processes of a medical scheme. 

    UNIT STANDARD CCFO COLLECTING 
    The learner is able to collect, organise and critically evaluate information in evaluating the risk in a medical scheme. 

    UNIT STANDARD CCFO DEMONSTRATING 
    The learner is able to see the world as a set of related systems in identifying risks in a medical scheme and proposing suitable interventions. 

    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:
  • Risk, medical scheme. 
    		•

    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.