The Board of Healthcare Funders (BHF) has put down its foot against medical aid schemes who have threatened to charge higher premiums for members who choose not to get vaccinated against Covid-19.
The BHF warning comes after Discovery Life became the first Mzansi insurer to consider Covid-19 vaccinations in its underwriting process.
Discovery Life chief executive Riaan van Reenen ruffled some feathers when he recently said, “Refusal to be vaccinated is treated similarly to smoking or lifestyle diseases such as diabetes, which receive a higher premium. This premium will be adjusted should an unvaccinated client later decide to get vaccinated.”
Hayikona, said Dr Rajesh Patel, head of health systems strengthening at the BHF. Medical aid schemes are strictly prohibited from charging unvaccinated members a higher premium.
The law is very clear on this, said Patel. “Medical schemes are not allowed by law to discriminate against any members who choose not to vaccinate.
“Section 29 (1)(n) [of the medical scheme act] clearly states that medical schemes cannot discriminate on grounds, including age, sex, past or present state of health of the applicant, or one or more of the applicant’s dependants.”
The act further clarifies that the determination of contributions is based on the member’s income or the number of dependants, or both. Member risk profiling is not allowed, as has been the perception.
Community rating system
“This means medical schemes cannot increase contributions based on whether or not a member has been vaccinated. Contributions are determined through a community rating system that is guided by the medical schemes act.
“The community rating system is a method of pooling contributions proportionally among all members and dependents,” said Patel.
Section 29(3)(a) allows for open enrolment and prohibits the exclusion of an applicant or a dependant of an applicant from membership. Patel said that the only exception is restricted membership schemes, which can restrict membership based on one’s employment, profession, trade, industry or calling.
“Although members are encouraged to vaccinate as a measure to minimise the impact of Covid-19 and to ensure that we reach the 67% herd immunity target for the country to return to normality, whether a member is vaccinated will, however, not impact a member’s contribution to, or eligibility for medical aid cover.”
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