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

Research the Healthcare Benefits Administrator sub-sector in South Africa 
SAQA US ID UNIT STANDARD TITLE
12325  Research the Healthcare Benefits Administrator sub-sector 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 4  NQF Level 04  5 
REGISTRATION STATUS REGISTRATION START DATE REGISTRATION END DATE SAQA DECISION NUMBER
Passed the End Date -
Status was "Reregistered" 		 2004-12-02  2007-12-02  SAQA 1657/04 
LAST DATE FOR ENROLMENT LAST DATE FOR ACHIEVEMENT
2008-12-02   2011-12-02  

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 requires learners to conduct research into the Healthcare Benefits Administration sub-sector of the insurance industry.

The qualifying learner is capable of:
  • Explaining why Healthcare Benefits Administration exists as a sub sector of the insurance industry.
  • Indicating the role of the various stakeholders and organised groups within the industry.
  • Analysing the factors that impact on a fund's stability.
  • Investigating how the industry caters for different market sectors. 
    		•

    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:

    1. Medical schemes and medical insurance in South Africa.
    2. Reasons for regulation of the industry include social, political, economic, disease epidemiology.
    3. Stakeholders include government, members, administration company, providers, brokers/intermediaries, employers, trustees and regulatory bodies.
    4. Factors that influence fund stability include fraud, correct underwriting, administrative capability of the administration company, good managed care initiatives, epidemics and natural disasters.
    5. Threats facing the industry include HIV/AIDS, legislation, fraud, aging member profiles, inflation and the Rand exchange rate.
    6. Primary, secondary and tertiary healthcare institutions in the state and private sector.
    7. Factors that indicate stability include disease profiles, reserve ratio and adherence to forecasted budgets or budgeting predictions. 

    Specific Outcomes and Assessment Criteria: 

    SPECIFIC OUTCOME 1 
    Explain why Healthcare Benefits Administration exists as a sub sector of the insurance industry 
    OUTCOME NOTES 
    Explain why Healthcare Benefits Administration exists as a sub sector of the insurance industry in South Africa. 

    ASSESSMENT CRITERIA     

    ASSESSMENT CRITERION 1 
    1. The shortfall in the public healthcare sector is investigated and an indication is given of how this has impacted on the growth of Healthcare Benefits Administration in South Africa. 

    ASSESSMENT CRITERION 2 
    2. The difference between the Fund and the Administrator is explained and reasons are given to account for why it is necessary for the two to be separate bodies in some cases. 

    ASSESSMENT CRITERION 3 
    3. Reasons are given to explain why the Healthcare Benefits Administration sub-sector is now highly regulated. 

    ASSESSMENT CRITERION 4 
    4. The evolution of Healthcare Benefits Administration since 1994 is described with reference to stability, changing products and the consolidation of the industry. 

    SPECIFIC OUTCOME 2 
    Indicate the role of the various stakeholders and organised groups within the industry. 

    ASSESSMENT CRITERIA     

    ASSESSMENT CRITERION 1 
    1. The various stakeholders in the industry are named and the role of each and how it influences the Administrator is indicated in a table. 

    ASSESSMENT CRITERION 2 
    2. The top five Healthcare Benefits Administrators in the industry are identified according to the Duff and Phelps rating. 

    SPECIFIC OUTCOME 3 
    Investigate the factors that impact on a fund's stability. 

    ASSESSMENT CRITERIA     

    ASSESSMENT CRITERION 1 
    1. Factors that influence fund stability are discussed with reference to the stability of three different funds. 

    ASSESSMENT CRITERION 2 
    2. Threats facing the industry are investigated and an indication is given of how the industry has responded to these threats. 

    SPECIFIC OUTCOME 4 
    Investigate how the industry caters for different market sectors. 

    ASSESSMENT CRITERIA     

    ASSESSMENT CRITERION 1 
    1. Income is indicated as the factor used to describe market segments. 

    ASSESSMENT CRITERION 2 
    2. Limited choice, low benefit and low premium packages are described with reference to the role of the public healthcare sector in servicing these options. 

    ASSESSMENT CRITERION 3 
    3. Examples of primary, secondary and tertiary healthcare institutions are identified and the services offered at each are listed for public and private institutions. 

    ASSESSMENT CRITERION 4 
    4. The difference between open and closed schemes is explained with reference to why closed schemes are required to have a minimum number of members. 

    ASSESSMENT CRITERION 5 
    5. The advantages of a closed scheme are listed in terms of benefits to members. 


    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 ORGANISING 
    The learner is able to organise and manage him/herself effectively as a responsible citizen in conducting investigations into aspects of the Healthcare Benefits Administration sub sector. 

    UNIT STANDARD CCFO COLLECTING 
    The learner is able to collect, organise and critically evaluate information in investigating the factors that impact on a fund's stability and how the industry caters for different market sectors. 

    UNIT STANDARD CCFO COMMUNICATING 
    The learner is able to communicate effectively using visual, mathematics and language skills to analyse, compare and present his/her conclusions in the activities required by the unit standard. 

    UNIT STANDARD CCFO DEMONSTRATING 
    The learner is able to demonstrate an understanding of the world as a set of related systems in investigating how the shortfall in the public sector has impacted on the evolution of Healthcare Benefits Administration in South Africa and explaining why the industry is so highly regulated. 

    QUALIFICATIONS UTILISING THIS UNIT STANDARD: 
      ID QUALIFICATION TITLE PRE-2009 NQF LEVEL NQF LEVEL STATUS END DATE PRIMARY OR DELEGATED QA FUNCTIONARY
    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 


    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.