Medical aids can't push up premiums for not being vaxxed

Risk profiling has been mooted by some companies in the life insurance industry, with Discovery recently announcing that new life insurance clients will be offered lower premiums if they are vaccinated. “Refusal to be vaccinated is treated similarly to smoking or lifestyle diseases such as diabetes, which receive a higher premium. This premium will be adjusted should an unvaccinated client later decide to get vaccinated," says Discovery Life CEO Riaan van Reenen

Medical schemes Act

However, it is prohibited for medical aid schemes. “Medical schemes are not allowed by law to discriminate against any members who choose not to vaccinate. The Medical Schemes Act Section 29 (1)(n) clearly states that medical schemes cannot discriminate on grounds, including age, sex, past or present state of health of the applicant, or one or more of the applicant’s dependants," says Dr Rajesh Patel, head of health systems strengthening at the BHF says

The Act further clarifies that the determination of contributions is based on the member’s income or the number of dependants, or both. Member risk profiling is not allowed, as has been the perception.

“This means, medical schemes cannot increase contributions based on whether or not a member has been vaccinated. Contributions are determined through a community rating system that is guided by the Medical Schemes Act.

The community rating system is a method of pooling contributions proportionally among all members and dependents.

Section 29(3)(a) allows for open enrolment and prohibits the exclusion of an applicant or a dependent of an applicant from membership. Patel says that the only exception is restricted membership schemes, which can restrict membership based on one’s employment, profession, trade, industry or calling.

“Although members are encouraged to vaccinate as a measure to minimise the impact of Covid-19 and to ensure that we reach the 67% herd immunity target for the country to return to normality, whether a member is vaccinated will, however, not impact a member’s contribution to, or eligibility for medical aid cover.”