The National Health Insurance Act

The National Health Insurance Act (NHI Act) was signed into law by the President on 15 May 2024.

The purpose of the Act is to establish the NHI Fund which will allow South Africans to obtain medical services free of charge, with no co-payments.

All South Africans will be required to join and contribute to the NHI fund.

The system will be implemented gradually, in phases, and is expected to be fully functional by 2028.

Key aspects of the NHI Act are as follows:

• The NHI will cover all South Africans but also permanent residents; refugees, prisoners as well as foreigners and their children.

• Eligible persons must register with the NHI fund and will receive an NHI card. Once registered the person will become an NHI user.

• NHI users will have the legal right to free, necessary, equitable and quality healthcare services. These rights are enforceable by law.

• NHI users can choose their preferred (accredited) GP/Hospital and register there. Once registered, users must get medical treatment where they are registered (if you like your doctor, you can keep your doctor).

• NHI users must follow a referral pathway meaning that they must go to primary health care services first and cannot go directly to a specialist.

• The NHI fund will not directly manage GP’s/Hospitals. Instead, the NHI will contract with public & private hospitals, specialists, public clinics and private GP practices to provide medical services to the user, free of charge.

• The NHI benefits package (the medical services that will be covered) has not yet been revealed. A Benefits Advisory committee has been established, in terms of the Act, to determine the NHI benefits package.

• The NHI fund will determine payment rates for medical services and is required to negotiate the lowest possible prices for medicines and medical services.

• Once implemented, medical aids cannot provide the same benefits as the NHI. Medical schemes may continue to exist but they can only provide services that the NHI does not provide i.e. top up / complementary services.

• It is still not clear how the NHI will be funded. However, NHI users can expect to pay for the NHI through payroll taxes (employer and employee) possibly similar to UIF deductions. This is clear from a recent NHI funding fact sheet as well as a Department.  

           of Health pamphlet on the NHI.

• National Treasury must finalise the details on how the NHI must be funded and a costing document is expected to be released soon.

• NHI users may submit complaints / appeals if they are unsatisfied with decisions from the NHI fund or treatment from GP’s / Hospitals.

• The legislation will be implemented in phases starting with phase 1 (2023-2026) to phase 2 (2026-2028).

• The system is intended to become fully operational by 2028.

Current status of the NHI Act:

The Act is not yet operational. It will come into effect, by proclamation, on a future date, to be determined by the President.