Learning from experience

case studies


With the arrival of the first consignment of vaccines in South Africa, Medical Aid schemes in the country will cover the costs of the COVID-19 vaccine for its members. South Africa’s Council for Medical Schemes has furthermore added the COVID-19 vaccine to its list of Prescribed Minimum Benefits. The new list of prescribed minimum benefits will now include screening, testing and medical management for COVID-19 patients, including ventilation and rehabilitation, all classified under the PMB code 177D.

All medical schemes in terms of the Prescribed Minimum Benefit, have to cover the cost of the vaccine. It is irrelevant which option you are on, on any medical aid scheme. Any individual who is covered by a medical scheme will have access to the vaccine. The question then arises as to what happens to those individuals in South Africa who do not belong to a medical aid scheme. According to our Health Minister the Government will pay for vaccinations for those individuals in South Africa who do not belong to medical aid schemes.

Some medical aid schemes have pledged that for every medical aid scheme member who gets vaccinated, another person without medical aid will also be provided with the vaccine. If this approach were to be adopted then both medical aid members and non-members would be vaccinated against COVID-19. There is then the question of who would cover the additional costs of vaccinating those non-members and whether that would effectively increase medical aid members premiums. 

Whilst the debate over the COVID-19 vaccine and the medical aid schemes pledge to cover the cost of the vaccine for non-members of medical aid schemes, the Government have assured all South African’s that they will pay for vaccinations for those individuals who do not belong to medical aid schemes.

In the days and weeks ahead we can but only observe the country’s vaccination roll out strategy which has temporarily been paused in light of AstraZeneca’s vaccine which does not, according to research, provide significant protection against mild to moderate Covid-19 caused by the variant of the virus dominant in South Africa. 

For direct answers to your specific personal questions, please contact us directly.

Author – Kate Bailey – Hill

More Posts