HTML Preview Health Needs Analysis page number 1.
Healthcare Needs Analysis
This document is a guideline on aspects that could be taken into account to provide advice to healthcare
clients who want to join a medical scheme.
This document serves as a mere guide and should not be used as the definitive and only source of
information in implementing any procedures in your business and for advising clients. Your due diligence
must be done.
A) Establishing and defining a professional relationship
: Disclose the following information to the client
List the medical schemes and health insurance products you are accredited with and can
provide advice on.
Accredited with the Council of Medical Schemes and Financial Services Board (FSB)
Show that you have the necessary experience and the required credits to provide healthcare
advice.
Commission earned and how it is paid.
On-going services (Service level Agreement).
B) Gathering data from the client via the medical scheme application
form and the client’s healthcare needs & preferences
Collect the following general client information
Possible reason
1
Name, ID, Contact numbers and e-mail address
Record purposes
2
Ages of Principal member, spouse and children.
A young healthy adult may only require hospital cover for catastrophic
events and emergencies. Adults who want to start a family might
require good maternity benefits and should they have children,
sufficient day-to-day benefits. Adults older than 40 might require
sufficient chronic medication cover.
Important to determine
medical cover requirements
and late joiner penalties
when calculating
contributions.
3
Number of Dependants and if the dependants are adults or children
Important to calculate the
contribution and to
determine medical cover
requirements.
4
Date of commencement of cover
Paying in advance or arrears.
5
Is the individual currently on a South African registered Medical Scheme
has there been a break in membership or is it the first time the
individual is applying to join a Medical Scheme
To determine waiting
periods, exclusions & late
joiner penalties.
6
Is the client part of an Employer Group which enjoys group underwriting
dispensation? Employees who join the Employer’s selected medical
scheme within three months of employment will normally not attract
any waiting periods, exclusions or late joiner penalties. Employees of
some Employer Groups may not attract waiting periods or exclusions,
but employees may attract late joiner penalties even if they join within
three months of their employment date.
To determine waiting
periods, exclusions & late
joiner penalties.