CAPE TOWN - The inclusion of Covid-19 vaccine to medical scheme benefits is not likely to substantially increase medical aid payments by members, Council for Medical Schemes (CMS) acting GM for Stakeholder Relations Mmatsie Mpshane said Wednesday.
The CMS has been coordinating public-private sector collaboration aimed at ensuring universal access to vaccines when it is available in South Africa, in line with the country’s priorities and individual health needs.
Covid-19 vaccine has been included in the Prescribed Minimum Benefits of medical schemes, amendments that had also recently been approved by Health Minister Zweli Mkhize, Mpshane said in a statement.
The amendments include for the screening, diagnostic tests, medication, medical management including hospitalisation and treatment complications, and rehabilitation of Covid-19.
The CMS said the ongoing public-private approach hopes to provide equitable access to some 67 percent of the population with vaccines, to achieve herd immunity.
“The CMS acknowledges there may be an additional cost burden to medical schemes for the provision of the vaccine, but this is not expected to be prohibitively high. In addition, industry associations have assured the CMS that vaccine costs can be absorbed by medical schemes,” the statement said.
Mpshane said collaboration in the medical schemes industry about vaccines has included other organisations such as Health Funders Association, Board of Health Funders as well as the Department of Health.
Issues that still needed to be more fully explored were a clear criteria on prioritised populations, clinical guidelines and protocols, guidelines on medical scheme liquidity management and scheme reserve requirements, vaccine funding model and mechanism, an appropriate funding vehicle, government processes to prevent fraud, waste and abuse, and possible exemption of the Covid-19 vaccine from single exit price requirements.
BUSINESS REPORT ONLINE