Board of Healthcare Funders (BHF) refutes claims that medical schemes will charge higher premiums to non-vaccinated members

The Board of Healthcare Funders (BHF) has refuted claims that medical aid schemes will charge higher premiums to members who have not been vaccinated against Covid-19.

According to the BHF, although risk profiling has been mooted by some companies in the life insurance industry, it is not applicable and not allowed in the medical scheme industry.

Dr Rajesh Patel, Head of Health Systems Strengthening at the BHF says, “Medical schemes are not allowed by law to discriminate against any members who choose not to vaccinate. The Medical Schemes Act Section 29 (1)(n) 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.

“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,” explains Dr Patel.

The Medical Schemes Act Section 29(3)(a) allows for open enrolment and prohibits the exclusion of an applicant or a dependent of an applicant from membership. Dr Patel notes 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.”