All Medical Aid schemes in South Africa will be covering the cost of the COVID-19 vaccine for its members. This comes after South Africa’s Council for Medical Schemes (CMS) added the COVID-19 vaccine to its list of Prescribed Minimum Benefits.

After consultations between the Department of Health and medical aid schemes, the new list of prescribed minimum benefits, now includes screening, testing and medical management for COVID-19, including ventilation and rehabilitation.

The South African government will soon commence with its Vaccine Rollout Strategy after the country received its first consignment of AstraZeneca’s coronavirus vaccine from the Serum Institute of India last week. Half a million more vaccines are expected by the end of February.

The first consignment of COVID-19 vaccines:

The vaccine will be made available to all people in three phases, beginning with frontline healthcare workers, followed by other essential workers and high-risk groups before the rollout is extended to the rest of the population.

Damian McHugh, the Executive Head of Marketing at Momentum Health Solutions says, the coverage for the COVID-19 vaccine will be a separate benefit and will not come out of a member’s savings.

“All medical schemes have to cover the cost of the vaccine. It has been made a part of the prescribed minimum benefit which requires irrelevance which option you are on, on any medical scheme. Any person who is covered by a medical scheme will be able to have coverage for the vaccine. Many people in South Africa, buy just a hospital plan and they will be concerned about it. It will not come from your day-to-day cover. The cost of the vaccine will be covered by the medical scheme.”

The Electronic Vaccination Data System developed by the Department of Health will allow all South Africans to book and secure vaccination appointments at centres convenient for them. Currently, more than 34 000 healthcare workers have been registered under phase one of the vaccine rollout. Bonitas Medical Aid Principal Officer, Lee Callakoppen says, the scheme will also cover their member’s beneficiaries.

“Yes we will be funding the vaccine for our members as well as the beneficiaries. It will be funded out of a risk pool because the vaccine will be considered a PMB. We are currently working on the integration of the information with our members. It will enable our members through our various electronic platforms where they will be able to register, book an appointment. Keeping in mind that certain vaccines might require a second dose. It will also enable them to know when the follow-on will be required.”

While the decision by medical aid schemes to cover the vaccine for their members has been welcomed by many, what processes should to be followed by members, if any?  Medscheme’s Dr Lungi Nyathi says, schemes will follow usual claim processes. She explains exactly what schemes are required to cover.

“Schemes will pay for the vaccine in full at the legislative SAP. It is a PMB therefore all schemes will be paying for the vaccine. Usual claims process will be followed unless a specific arrangement has been entered into with specific providers. At present schemes intend to pay for the vaccine itself, the administration of the vaccine, the logistics where they apply and the protective equipment.”

President Ramaphosa, his deputy David Mabuza and Health Minister receive COVID-19 vaccines:

While Medical Aid schemes in the country have committed to funding the COVID-19 vaccine for their member and beneficiaries, what happens to the rest of the population that rely on the public healthcare system? Health Minister Dr Zweli Mkhize says, government will pay for the vaccination for South Africans that do not belong to medical aid schemes.

“Everybody who is at risk is going to be vaccinated, they don’t have to pay for it themselves. The Medical Aids will actually cover the cost of the vaccine. If you have dropped out of medical aid scheme, you will have to indicate that. It means you will fall under the category that government will sponsor and pay for. You must just give us the correct information. We will have to talk to the medical aid, they know, they have agreed. They will be able to cover it.”

President Cyril Ramaphosa has reiterated that no citizen will be forced to take the vaccine.

President Ramaphosa welcomes the arrival of the COVID-19 vaccine consignment: