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Reading the latest news on Greece imposing fines on the non-vaccinated:

"It's not a punishment," Greek Prime Minister Kyriakos Mitsotakis told his cabinet in a televised meeting. "I would say it is the price for health. It is also an act of justice for the vaccinated. It's not right that they are deprived of health care services because others stubbornly refuse to do the obvious."

I'm reminded that in countries with private healthcare insurance, meaning in the USA at least, it's common to read exclusions from "high-risk activities and extreme sports" in health-insurance coverage, e.g. (this example is actually from Hong-Kong--chosen for the brevity of the text):

Generally speaking, high-risk activities and extreme sports are excluded from standard medical insurance plans and you may have to get sport-specific insurance.

But similar ones can be found e.g. even in Canada.

So, I'm interested to know if being non-vaccinated (for something, not necessarily Covid) has been considered a high-risk action that the insured has taken, so if e.g. the insured can be denied insurance coverage (under "standard" polices) if they get a disease for which vaccines were available but were not taken. I'm interested in answers that cover any kind of healthcare system, (national) "single payer" or not, i.e. those with competing/commercial private insurers.

Note that in difference to uniform fines on the non-vaccinated, what I'm asking about here is the non-vaccinated insured being asked to foot the bill for their treatment, in case they do get sick.

Actually, it didn't take me long to find one example like this, again with respect to Covid (Singapore)

Those who are "unvaccinated by choice" will have to start paying for their own COVID-19 treatment starting Dec. 8, the Ministry of Health announced on Monday, citing the strain they are putting on the nation's health care system.

Are there other examples like this, particularly with non-Covid vaccines/diseases (and in other countries)?

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    Other countries have introduced fines for parents who don't vaccinate their children against measles and other childhood diseases, or denied them state benefits, and Italy (and possibly other places) don't allow unvaccinated children to attend state schools. It would be very cruel to refuse to treat children (for what are largely childhood diseases), which may be why denying treatment isn't used as a threat. COVID is different in whom it affects.
    – Stuart F
    Dec 4, 2021 at 14:14
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    @StuartF: I agree that children could not be personally held responsible but "denying treatment" is not the same as sending the bill to the parents (who were probably responsible for the child not being vaccinated in the first place). I can see however that this may cause an issue with parents possibly avoiding having their children treated at all, when they get sick... but that also happens for other reasons, e.g. religious.
    – Fizz
    Dec 4, 2021 at 14:18
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    @StuartF In some countries (for example, Germany) children cannot take a vaccine without parental consent (even teenagers below 18 can't!).
    – gerrit
    Dec 4, 2021 at 17:23
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    Thanks for the great question. Learned something new today. Could this benefit from tag covid-19?
    – Timur Shtatland
    Dec 4, 2021 at 19:15
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    I'm sure people wouldn't let children suffer, but a disease where the victims are older adults (as COVID) will be treated differently to one that affects children, and most vaccinated diseases primarily affect children. So this is a new thing.
    – Stuart F
    Dec 4, 2021 at 21:56

4 Answers 4

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I don’t know of any countries other than Singapore that have taken this step yet, but in the Indian state of Kerala, the Chief Minister announced a similar policy at the end of November:

After a review meeting, Chief Minister Pinarayi Vijayan said free treatment would not be given to patients who do not cooperate with the state’s Covid control measures. “The government will not bear treatment costs for those who haven’t taken vaccine shots. Those who are reluctant to take the vaccine on account of allergy or any disease should produce a certificate issued by a doctor in government service,” he said.

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    From what I can tell neither Kerala nor Singapore actually followed through with their threats in the end.
    – JonathanReez
    Dec 27, 2022 at 18:55
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In Germany (14 out of 16 states), voluntarily unvaccinated people who are quarantined as a contact person are not paid money in lieu of wages if they cannot go to work, while vaccinacted or involuntarily unvaccinated people get this compensation. Technically this quarantine compensation is not a health benefit -- if they are quarantined for being infected themselves, they get money in lieu of wages for being sick, which still applies even to the unvaccinated.

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    Your answer is a bit too brief. You mean "who are quarantined as a contact person and therefore unable to perform their work duties". It doesn't affect people who are able and willing to work from home (other regulations already require the employer to let anyone able and willing to work from home do so), so I think it doesn't fit very well as an answer to the question.
    – gerrit
    Dec 4, 2021 at 17:01
  • @gerrit, I mentioned that it is a marginal fit, but in international comparison the separation of health coverage and other government-related payments can be difficult.
    – o.m.
    Dec 4, 2021 at 17:55
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    AFAIK this is very rarely done, although legally possible.
    – Martin Schröder
    Dec 4, 2021 at 18:05
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    @o.m. I meant that it doesn't even affect all employees; it only affects the subset of employees who are unable to work from home.
    – gerrit
    Dec 4, 2021 at 18:06
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In France non-vaccinated adults have to pay for their Covid tests (except if they have a medical reason). Many activities legally require either a proof of vaccination or a recent negative test, so this can be a significant cost.

In an article from Europe 1 (October):

Le geste était gratuit depuis dix-huit mois et le début de l'épidémie de Covid-19 en France : les tests, remboursés pour tout le monde jusqu'à ce vendredi, ne le sont désormais plus pour les non-vaccinés hors motifs médicaux.

Translation:

[Covid tests] were free since the start of the Covid-19 epidemic in France: the tests, which were previously reimbursed for everyone, are no longer reimbursed for those not vaccinated except for medical reasons.

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    Does this include accessing a test of one has symptoms? If so, that sounds disastrous!
    – Tim
    Dec 4, 2021 at 20:23
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    @Tim I'm pretty sure it's not like that. One simple way to do it would be to offer the test for free for everyone, but only issue the certificate to people who pay.
    – Nobody
    Dec 4, 2021 at 20:35
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    I edited the answer to replace "people" by "adults". For minors the tests are still free (ameli.fr/yvelines/assure/actualites/…)
    – WoJ
    Dec 5, 2021 at 10:55
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    @Tim tests are still free for anybody identified as contact case or with a prescription, also for minors as pointed out by WoJ, and in various other cases (details here (fr)). Practically it's only when a non-vaccinated person needs a negative result in order to access some public place or event.
    – Erwan
    Dec 5, 2021 at 12:32
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In US law, there is a provision that insurers are not required to pay claims on easily prevented accidents or injuries where simple prudent measures were not taken to avoid the claim.

For example, it is easy to avoid injuries from driving while drunk by not driving while drunk.

While it looks like the American insurance industry is going to begin charging different premiums based on being inoculated against COVID-19, there is discussion about simply denying all COVID related claims where there is no medical exemption from vaccination. Some people are supposed to avoid the COVID vaccination due to medical conditions. The cost difference appears to be about $400 per person per month between vaccinated and not vaccinated.

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  • A premium difference that covers the benefit difference seem reasonable to me. The question is how we figure out what the real benefit difference between the vaxed insured and the unvaxed insured.
    – Walter Mitty
    Dec 5, 2021 at 17:09
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    @WalterMitty And then there is the question whether to make the intentionally unvaxed pay for the societal cost of the existence of an unvaxed population. Also, how to quantify it, and set the part they should reimburse.
    – Deduplicator
    Dec 5, 2021 at 19:24
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    @WalterMitty I have performed crude estimates from insurance industry data. It is inside my professional qualifications to be able to do that. It seems that the industry is doing pretty close to pure cost recovery at the moment. The mechanics of that are still a problem. For some firms, it is pretty simple as they are self insured and they can get the data on their own. When you get insurance you waive your privacy rights, so it is pretty simple to get vaccination data. Others are offering "discounts" if you can prove you were vaccinated.
    – Dave Harris
    Dec 5, 2021 at 19:42
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    @Deduplicator that is less difficult to measure than you would think. You have the obvious direct costs, such as insurance, but you have lost hours and the losses from one person infecting others. The difficult estimate is when an employee infects a customer. The data exists to model that but not in a form that someone could just download. Each of the 5800 health jurisdictions are collecting that information but it isn't being stored in a way that would be useable. At best, you would sample the data.
    – Dave Harris
    Dec 5, 2021 at 19:45
  • I think that premium surcharges should only address societal costs that translate to benefit payouts. Transferring other societal causes back to the unvaxed should use other means or be left unaddressed.
    – Walter Mitty
    Dec 6, 2021 at 1:55

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