Should your medical aid pay for the vaccines of non-members?

The Government has approached the Medical aid industry to request that for every vaccine they purchase for their members, they purchase one extra for a non-member.

Is this fair on paying members? Is this ethical or even legal to use the funds of paying members in this manner? COVER caught up with Craig Comrie, CEO of Profmed, to get his view on this topic.

Watch the interview below:

If you prefer you can read the transcript of the interview below:

Tony van Niekerk  00:03

Hi, this is Tony van Niekerk of COVER magazine. I’m speaking to Craig Comrie, the CEO of Profmed. Craig, thank you very much for talking to me this afternoon.

Craig Comrie  00:13

Great to be with you, Tony.

Tony van Niekerk  00:15

Craig, we’re talking about a very important, but also a topic that is on everybody’s tongue, the vaccination process. And the fact that the totals that are being talked about is 40 million people in South Africa needing to be vaccinated. Now a plan is muted, that medical aid schemes will be carrying quite a bit of that cost in the form of sponsoring vaccinations of people that are not members. Maybe you can just give us a little bit of the detail that you have around that.

Craig Comrie  00:53

I’d love to share that with you. I think you need to look at that 40 million very carefully. Effectively, 40 million is 67% of the total population of South Africa, of the 40 million, the plan actually targets 27.5 million people. And that would be the 40 million excluding children below the age of 15, who will not be planned to be vaccinated. So when you look at that age group, medical schemes have about 7 million out of that 27 and a half million that we cover. And so we are actually talking about how do we fund the 7 million that are members of medical schemes. And the minister as early as December requested, and I’ll say it was a kind request, for medical schemes to contribute an additional vaccine for every vaccine that we purchase for our members. So that has come with us since since December, the major issue for medical schemes has been the fact that every cent of every rand that’s donated, I guess it’s not a donation, it’s more of a premium that’s paid every month, is put into trust, to be used for the medical expenses expressly and only for the members, and it cannot be used for anybody else. So we have both legal and ethical, as well as a fiduciary responsibility not to spend the money on anything outside the benefits of medical scheme members. And so the requests are quite difficult to answer. And that’s what we’ve been searching for. We’ve been looking for the right way, we can still contribute to establishing herd immunity that benefits everybody in South Africa. The problem being is that in the numbers, the additional vaccine actually costs quite a bit. And we feel that obligation should be equally shared across business and corporate South Africa rather than an disproportionate share being requested from medical schemes to cover.

Tony van Niekerk  00:55

I mean, it would be unfair to ask just one segment or sector to bear the brunt rather than have sort of a round table approach, where everybody can see what that particular sector can afford. I mean, obviously, you know it is important that we do get the vaccines going and it will benefit the medical aid schemes if members are vaccinated. How do you propose we go about trying to get to this place? Can you get consensus from members to say, okay, well, we will do this, how will that work?

Craig Comrie  03:54

Here we say that if we are to contribute, and we certainly want to contribute to the broader success of the vaccine rollout program, there’s no doubt that the vaccines will save lives. And so what we want to do is, if we are supposed to contribute, we need a different mandate from our members. And with that mandate, we could approach the necessary regulators to get exemptions from the act to actually contribute. But without that agreement from members, it could be very difficult to step out of the mark. I always liken the medical scheme as similar to people having bank accounts, and the government approaching your bank and saying, I see Tony you’ve got some extra money in your savings account that we want to utilize, won’t you contribute the price of one vaccine out of your savings account. Then the bank making that decision on your behalf, I’m sure you’d be happy to allow the bank to do that… And so it’s equivalent to what has been asked at the Medical scheme space and we are saying for us to do that, we actually need the members to help and support and give us a different mandate to use their funds.

Tony van Niekerk  05:06

So let’s say we’ve overcome that hurdle and we get to a position where the vaccination is going to take place. From a medical aid scheme perspective, how do you see that rolling out to your members? The vaccination.

Craig Comrie  05:23

We are already planning for that, in fact, in the next 10 days we expect the vaccination program to start in terms of the vaccinations being delivered, and people receiving them. So much of our Profmed or many of Profmed members are in fact, healthcare workers. So we cover probably 40% of all the doctors and specialists in the country. And so we were hoping that they get the vaccine as soon as possible. So for our own members, and for members of every medical scheme, the vaccine is regarded as a prescribed minimum benefit, which means that schemes will fund it in full, there’ll be no co payments for any of the the cost of the vaccine, or the nurse or doctor that actually delivers that to the individual. So we are ready to pay that as soon as possible, probably the end of next week.

Tony van Niekerk  06:14

Okay, brilliant, great stuff Craig, thank you so much. Let’s hope you get all of these issues sorted and get the country and business up and running full steam.

Craig Comrie  06:28

Now, it’s a challenging time, we all have to contribute. We have to do what is right. And so, yeah, I think we’ve all been touched in some way or another by people near us, passing away and so this effort is essential. We have to get everybody vaccinated as soon as possible.

Tony van Niekerk  06:46

Absolutely. Craig, thank you so much for those insights and I look forward to talking to you once again when it rolls out.

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