Covid-19 vaccinations: medical schemes ready to pay for their members

South African medical schemes have finalised their plans to assist their members to get vaccinated against Covid-19, after the Council for Medical Schemes (CMS) released a media statement on 5 January confirming that it is driving public-private sector collaborations to ensure equitable access to the vaccine.

Minister of Health Dr Zweli Mkhize identified the vaccine as a prescribed minimum benefit (PMB), which means that the Covid-19 vaccine will be regarded as PMB level of care, and will be funded in full by medical schemes, regardless of the member’s option or available benefits, when it becomes available.

The national Department of Health will be responsible for single, centralised procurement of Covid-19 vaccines and coordinate the rollout. The department will contract with suppliers to buy stock and allocate vaccines to provincial health departments and the private healthcare sector.

The Health Funders Association (HFA) is representing member schemes as an industry body at government negotiations.

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Fedhealth Medical Scheme, which currently covers 144,000 beneficiaries in total, confirmed that it would cover the costs of the vaccine.

“Delivery timelines will depend on the WHO [World Health Organization] Covax agreement that South Africa is part of. Estimations for delivery of the first vaccines to participants in the scheme is mid 2021,” says Jeremy Yatt, principal officer of Fedhealth.

He said Fedhealth would then be subject to the roll-out plan recommended by government.

“We hope that all members will be vaccinated before the end of 2021. From a scheme perspective, it is important for us to prioritise the members with co-morbidities.”

The roll-out and distribution details will be based on government decisions and recommendations, which have not yet been released, but Fedhealth plans to develop a corresponding distribution plan based on member demographics and ease of access once the vaccine becomes available. No authorisation would be required.

Bestmed said in a letter to its members that it is a health insurer and funder, not a procurer or provider of healthcare services. Therefore, it cannot adopt an internal prioritisation plan based on, for example, benefit option and/or health status for granting benefits to beneficiaries and will abide by the department’s prioritisation plan to allocate vaccines.

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Private providers will have to be accredited to administer the vaccines and Bestmed will fund the vaccination cost at any of these accredited providers. During phase one, healthcare workers will be vaccinated, during phase two it will be the turn of essential workers, people who live in close quarters, people older than 60 and people older than 18 with co-morbidities. People over the age of 18 will be vaccinated during the third phase.

“Medical schemes have an important role to play in supporting efforts to ensure wider reach and access to healthcare as the government looks towards distributing the Covid-19 vaccine,” says Thoneshan Naidoo, principal officer of Medshield in a letter to members.

“We know that government is still finalising the procurement processes and funding mechanisms. While that process is underway, our current understanding is that medical schemes will access the vaccine in line with the proposed national access protocols outlined by the minister, which will be centralised through the national Department of Health.”

Naidoo said that there was currently no firm and confirmed timelines for the rollout of the vaccine, but Medshield would communicate and provide updates to all stakeholders once more information became available, to ensure a seamless and swift rollout of the vaccine for its members.

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