Assessment: Fundamentals of Health Service Benefits 22_23

Which ONE of the following is a feature of a medical scheme benefit?

Which of the following are features of a health insurance product?

i. Benefits are triggered by a diagnosis of a health condition.
ii. Benefits are triggered by obtaining a relevant health service.
iii. Regulated under the long-term and short-term insurance Act.
iv. Regulated under the Medical Schemes Act.

What is the product that covers a member of a medical scheme in the event of a difference in the fee charged by the service provider and the medical scheme rate known as?

Which of the following statements with regard to the regulation of medical schemes are correct?

i. A medical scheme operates as a non-profit organisation.
ii. Medical schemes are permitted to render relevant health services to members.
iii. Medical schemes must obtain a minimum of 3 000 members within 3 months of registration.
iv. A medical scheme must have a registered office in South Africa.

Which ONE of the following statements with regard to the management of a medical scheme is correct?

An application for approval of additional benefit options by an existing Medical Scheme will only be approved if the following conditions are met?

i. The option will be self-supporting in terms of membership size.
ii. The option has been signed off by the various health professional registration bodies.
iii. The option includes at least the Prescriber Minimum Benefits.
iv. The option will not jeopardise the financial soundness of any existing option.

Which ONE of the following statements with regard to agreements between a medical scheme and third parties is correct?

Which ONE of the following persons need to be registered as a broker with the relevant regulator?

If the conduct of a broker in any way be unlawful, what is the most onerous action that the medical scheme can take with regard to compensation?

Which one of the following serves as a baseline against which medical schemes can individually determine benefit levels?

Which ONE of the following statements with regard to medical practitioner charges and medical scheme tariffs is correct?

Roger contracted an illness listed under the Prescribed Minimum Benefits and visited a hospital seen as a non-designated services provider by his medical scheme as immediate treatment was needed.
What does the Medical Schemes Act prescribe with regard to this circumstance?

Which of the following conditions must be prevalent in order for a late joiner penalty to be applied by a medical scheme?

i. The member or dependent must be over 35 years of age.
ii. The member or dependent must be over 45 years of age.
iii. The member or dependent must have not been a member of a medical scheme for a period of 3 months prior to the application.
iv. The member or dependent must have not been a member of a medical scheme for a period of 6 months prior to the application.

Which of the following statements regarding the financial status of a medical scheme are correct?

i. Medical schemes must maintain a level of 15% of their gross contribution income.
ii. Medical schemes must maintain a level of 25% of their gross contribution income.
iii. The Council for Medical schemes set a target of 10% for non-health care cost for medical schemes.
iv. The Council for Medical schemes set a target of 15% for non-health care cost for medical schemes.

The principle whereby the monthly contribution fee of more healthy and younger members within a scheme population who claim less is used  for sicker and older higher-claiming members is known as the principle of-

Please state if the following statement is true or false.

The aim of a medical scheme analysis is to select a portfolio of medical schemes and options that the brokers feel will maximise his broker and advisory fees.