The Board of Healthcare Funders (BHF) has set the record straight that medical schemes are not allowed and won't charge higher premiums to members who have not been vaccinated against Covid-19.
After Discovery Life announced that people who are unwilling to vaccinate might pay higher premiums on new policies due to the increased mortality and morbidity risk facing Covid-19 survivors, some started wondering if medical schemes will do the same.
BHF, which represents many large schemes, excluding Discovery Health Medical Scheme, said risk profiling is not applicable and not allowed in the medical scheme industry. Medical aid contributions are determined only based on members' income, the number of dependants they want to cover, or both.
"Medical schemes are not allowed by law to discriminate against any members who choose not to vaccinate," said the BHF's head of health systems strengthening, Rajesh Patel.
He said section 29 of the Medical Schemes Act clearly states that medical schemes cannot discriminate on the grounds of the present state of health of the applicant, among other things.
"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," said Patel.
According to the act, the only exception where a medical scheme can turn down a person's application is if it is a restricted scheme, which determines membership based on one's employment, profession, trade, industry or calling. But even restricted schemes can't charge people higher premiums because of their current state of health.
Discovery also explained that its medical scheme is not affected by the change in underwriting in its life insurance business because of the community rating system and open enrolment provisions in the Medical Schemes Act.
"On the health side, you've got very limited underwriting. It's basically only the late-joiner penalties, and it's legislated. So, this would not find its way into health underwriting," said Discovery Life CEO Riaan van Reenen.