Are you a medical aid member? Here's all you need to know about Covid-19 vaccination

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Medical scheme vaccination sites also vaccinate state patients as allocated to them by the Department of Health.
Medical scheme vaccination sites also vaccinate state patients as allocated to them by the Department of Health.
Deaan Vivier/Beeld/Gallo Images via Getty Images
  • People who are on a medical aid must indicate and provide details in the Department of Health's booking portal.
  • For now, private medical scheme members are being allocated to privately managed vaccination sites.
  • But these sites also vaccinate state patients as allocated to them by the Department of Health.

Phase 2 of the Covid-19 vaccine rollout is in full swing, but only for people over 60 and frontline health-care workers - for now. The rules are the same for medical aid members as schemes don't have a separate plan for private sector health-care users.

The Board of Healthcare Funders (BHF) - whose members include Bonitas, Medshield and the Government Employees' Medical Scheme (GEMS) - said what schemes are doing besides supporting the government's rollout plan is funding all of their members' vaccines. The same goes for schemes that are not BHF members, such as Discovery, Bestmed and Fedhealth.

Because any Covid-19-related treatment, testing, prevention and hospitalisation is now a prescribed minimum benefit (PMB), members of all schemes will be fully covered for these events without incurring out-of-pocket expenses.

No quick queue or exclusive sites for medical aid members

But everyone has to register on the government's Electronic Vaccination Data System (EVDS) portal to get a vaccination appointment.

"Everyone waits to be scheduled. It doesn't mean that you jump the queue if you are a member of the medical scheme," said BHF's MD, Dr Katlego Mothudi.

Mothudi said many schemes have also contracted with certain pharmacy companies to get their members vaccinated at their sites.

"If scheme A has indicated to EVDS that it has contracted with this pharmacy company or other healthcare provider, that will be loaded on the back-end so that when an appointment is issued, members are sent to those particular set points," he said.

But even if a scheme has not entered into any contract with specific pharmacies, members will be sent to the vaccination site closest to the address they provide. Discovery Health said, for now, private medical scheme members are being allocated to privately-managed vaccination sites closest to them, and these cannot be changed.

"We, therefore, encourage everyone to be flexible in attending the site they have been allocated, and we also urge those who have not yet received their invitation from EVDS to be patient as the system scales up," said Discovery Health in a written response to Fin24.

Some medical schemes, including Discovery Health Medical Scheme and some administered by Afrocentric, have set up their own vaccination sites. 

"We've been informed that Afrocentric has put up few sites, and obviously, they support a number of medical schemes within their stable. But there has been no formal indication from other BHF schemes. These sites are not for the exclusive use of medical scheme members only," said Mothudi.

Discovery Health said its 1 Discovery Place vaccination site is also open to everyone who meets the criteria of phase 2, including people who are members of other medical aids, as well as state patients. 

Mothudi said the user experience would be the same for everyone, referred to these sites.

"There is no difference at all on how vaccinees are treated, whether they are funded or not because, at the point of care, there is no payment," he said.

How much will it cost the schemes?

Medical schemes would pay just under R800, including the administration fee for each member who gets the double-dose Pfizer vaccines. They expect to pay around R350 for those who received the Johnson & Johnson jabs. The Johnson & Johnson vaccine only requires one dose.

This is based on prices quoted in the circular that the Department of Health sent to medical schemes the weekend before phase 2 commenced. These prices also include a markup on the discount that the government negotiated for its mass vaccine procurement. This markup may help the state fund some vaccines for non-medical aid members.

Because only people over 18 are eligible for vaccination, medical schemes will need to fund doses of about 6.5 million medical aid beneficiaries. But Mothudi said this was a small price to pay.

"It's important to reach herd immunity. You can't stand back and say it's a public health issue because if any part of the population that needs to be vaccinated isn't vaccinated, it's a problem for the entire country," he said.

Mothudi added that medical schemes had spent more on testing and hospital admissions related to Covid-19. For example, one Covid-19 test costs a scheme R850 and medical aids have already tested about 6.5 million people. 

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