COURSE DESCRIPTION

  • Learners have access to their course material for 180 days from date of enrolment , thus are able to complete their study preperation at their lesure. (Self-Paced) 
  • Online assessment (2 multiple choice exam attempts included.)

NQF Level 3 courses

NQF levels are intended to award registered learners with national accreditation based on their skills and knowledge. NQF 3 is equivalent to Grade 11 or Standard 9, and is often a stepping stone to NQF 4 and beyond.

NQF Level 4 courses

NQF levels are intended to award registered learners with national accreditation based on their skills and knowledge. NQF 4 is equivalent to Grade 12 or Standard 10 (Matric), and is a FET – Further Education and Training – category qualification.

NQF Level 5 courses

NQF levels are intended to award registered learners with national accreditation based on their skills and knowledge. NQF 5 is a National Certificate or National Diploma and is a HET – Higher Education and Training – category qualification

NQF Level 6 courses

NQF levels are intended to award registered learners with national accreditation based on their skills and knowledge. NQF 6 is a Bachelors Degree or Higher Diplomaand is a HET – Higher Education and Training – category qualification.

COURSE CONTENT

 

Unit 1 – The medical schemes industry and environment

  • Understand the reasons for the introduction of the Medical Schemes Act, 131 of 1998
  • Understand the difference between the business of a medical scheme and the business of health insurance
  • Illustrate the requirements to register a medical scheme
  • Understand the types of medical schemes available
  • Understand the principal of Social Solidarity that supports the Medical Schemes Act
  • Describe the structure and payment of the Prescribed Minimum Benefits

Unit 2 – Characteristics of Forex

  • Be able to list the key stakeholders
  • Demonstrate an understanding of the role and duties each stakeholder performs in the context of medical schemes
  • Show an understanding of the Minister of Health’s and Council of Medical Schemes’ (CMS) strategy/objectives
  • In terms of the Medical Schemes Act, be able to explain how Trustees and the Principal Officers are appointed
  • Understand the responsibilities that vest with Trustees and the Principal Officer and the impact on the scheme if either or both parties don’t act in accordance with their mandate, with specific reference to governance
  • Be able to describe how legislation governs the relationship between intermediaries and medical schemes, and the regulation around commission payable to intermediaries
  • Be able to describe the Code of Conduct that applies to intermediaries who market medical scheme products and the accreditation process applicable to intermediaries who provide advice to members/employers, with reference to FAIS and Medical Schemes Act
  • Be able to explain the steps that need to be followed when providing a client (both employer and individual) with advice on choosing the most suitable medical scheme and benefit option
  • Demonstrate knowledge of alternative dispute resolution channels available to members of a medical scheme
  • Explain the regulations that apply to administrators with reference to the Act
  • Outline the requirements for Managed Care Organisations to be accredited, as stipulated in the Medical Schemes Act
  • Explain the rules regarding the conditions for providing managed health care.
  • Understand the rights afforded to medical scheme members, through the Medical Schemes Act and their responsibilities
  • Explain the regulations that apply to schemes and intern administrators in terms of the Medical Schemes Act
  • Be able to explain where Bargaining Councils fit in relation to Medical Schemes.

Unit 3 – The Rules of a Medical Scheme

  • Understand the importance of the rules of a medical scheme
  • Explain the management of a medical scheme
  • Define the relationship between a medical scheme and its members
  • Know the rules of a medical scheme concerning

o  benefits and benefit options

o  personal medical savings accounts

o  payment of contributions

  • Understand the manner in which complaints and appeals are dealt with in the scheme rules

Unit 4 – Medical Schemes and Risk Management

  • Understand the entry-level controls available to medical schemes to manage opportunistic behavior by members
  • Explain the waiting periods and how they are applied
  • Define a Late Joiner Penalty and explain how this is calculated
  • Demonstrate an understanding of the managed care techniques available to medical schemes to manage health care services
  • Demonstrate knowledge of the conditions and standard for managed health care

Unit 5 – Benefit Option Structure

  • Be able to explain the limitations on benefit design with reference to legislation and Government healthcare policy
  • Differentiate between an Open medical scheme (open medical scheme) and a restricted Membership medical scheme (closed scheme)
  • Bargaining Council Fund or exempted medical scheme; Understand benefit options relevant to medical schemes

Unit 6 – Theories of product development used by medical schemes

  • Investigate theories of product development used by medical schemes
  • Apply knowledge of the current Medical Schemes Act and the demarcation debate to differentiate between a medical scheme and medical insurance
  • Explain the impact of the National Health Policy and relevant legislation with reference to governance and equitable, affordable and equitable healthcare for all
  • Analyse selected products to identify the principles of health risk management

Course Curriculum

No curriculum found !

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