A medical aid will likely pay for your Covid-19 vaccine – even if you aren’t a member

Business Insider SA
Covid-19 vaccine stored at -80 degrees Celsius in a US hospital. (Photo by Scott Olson/Getty Images)
  • If you get a coronavirus vaccine in South Africa, chances are it will be paid for by a medical scheme – even if you don't belong to a medical aid.
  • Medical schemes are expected to cover at least a third of the cost of all Covid-19 vaccinations in SA, and perhaps significantly more than that, depending on how much big companies chip in.
  • The total cost of vaccines, for the entire country, is expected to come in at around R500 per person, assuming doses can be had on non-commercial terms.
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Anyone in South Africa who receives a vaccination against Covid-19 will probably have a medical aid scheme to thank for it, even if they aren't a member.

Medical schemes are now anticipated to carry at least 30% of the cost of South Africa's entire vaccination programme, and perhaps significantly more than that, under an initial agreement.

In order to ensure herd immunity across the population – and so protect their members even if they can't or won't directly receive a vaccine – the schemes may fund at least enough doses to ensure the 67% population coverage considered the minimum necessary to bring the coronavirus under control.

There are about nine million beneficiaries across South Africa's medical schemes, accounting for roughly 16% of the total population. Last year they spent some R186 billion on healthcare between them. The total cost of vaccines to guard against the coronavirus is expected to come in at between R5 billion – for just the necessary doses, if bought on a non-commercial basis rather than from a pharmaceutical company at the sticker price – to R20 billion once the cost of distribution and administering shots is factored in.

Discussions around funding South Africa's vaccination project have included proposals that mass-employers with workers in high-risk situations for viral transmission, such as mines, should carry some of the cost. Such employers have proven willing to play their part, participants say, but are likely to pay for their own employees only, even where those employees are members of medical schemes.

The schemes will then subsidise doses for government use, and in other environments, so that they are at least heavily subsidised if not entirely free for recipients.

The Council for Medical Schemes (CMS) this week confirmed that vaccines will be a prescribed minimum benefit, which means they will be paid for from risk benefits rather than medical savings. 

"The CMS acknowledges that there may be an additional cost burden to medical schemes for the provision of the vaccine, but this is not expected to be prohibitively high," it said. "In addition, industry associations have assured the CMS that vaccine costs can be absorbed by most medical schemes."

A final agreement has not yet been reached, though, with outstanding issues including how a vaccine project will guard against fraud, waste, and abuse, and exactly what vehicle will be used to fund vaccine acquisition. 

It is not yet clear where South Africa will source vaccines, but on Wednesday President Cyril Ramaphosa seemed to suggest that Canada may share excess stock. Based on available data, Canada currently has the highest level of pre-purchase agreements in the world, with enough vaccine ordered to cover its population at least five times over.

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