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Here’s How The New National Health Insurance Bill Will Affect You

By 2026 all South Africans and permanent residents will be able to access core health services through the National Health Insurance (NHI). If you haven’t heard about the NHI, it’s a financing system that will make sure that all citizens of South Africa (and legal long-term residents) are provided with essential healthcare, regardless of their employment status and ability to make a direct monetary contribution to the NHI Fund.

But what does this mean for medical aids, private hospitals and how will this universal health care be funded? Here’s everything you need to know.

Medical Aids Won’t Function As We Know It

Once the NHI comes into play, medical aids as we know it will cease to exist. They will not be allowed to offer services covered by the NHI. But they will instead offer top-cover or coverage for procedures or treatment that fall outside government’s package of care. Come 2026, your current medical aid might not be any use to you unless you plan on having cosmetic or non-essential procedures. The government will also no longer provide tax subsidies for medical scheme contributions.

Only The Essentials Are Covered

This is where it gets a bit tricky. The bill hasn’t specified what treatments it will cover but it does say there will cover “comprehensive healthcare services”. According to the NHI info booklet, the NHI will not cover unnecessary procedures. These include cosmetic procedures not necessary or medically indicated,  expensive dental procedures performed for aesthetic purposes and eye-care devices such as fashionable spectacle frames. As well as medicines outside of the national essential medicine list and “diagnostic procedures outside the approved guidelines and protocols as advised by experts groups”.

You’ll Need To Be Referred To A Specialist

You’ll only be able to go to a specialist if your primary healthcare facility doctor or nurse deems it necessary. If you do consult with a specialist outside of the NHI approval, you will have to pay for it yourself.

Taxpayers Will Be Fitting The Bill

The NHI will be primarily funded by the taxes. Since we all pay taxes in some form, everyone will be contributing to the fund- some more than others. People with low income will not make any direct payment to the NHI Fund. Every person earning above a set amount will be required by law to contribute. You employer will assist the NHI Fund by ensuring that your NHI contribution is collected and submitted, in a similar manner to UIF, they will also have to match your NHI contribution.

Private And Public Hospitals Will Be The Same

The NHI will provide financing for healthcare but it will not manage hospitals, clinics or the practices of GP’s dentists, specialists and other health professionals.  “Public hospitals and clinics will be made to upgrade their facilities. Healthcare facilities will only be part of the NHI system if they meet certain standards of care and are accredited by an independent body called the Office of Health Standards Compliance (OHSC),” states the NHI info booklet.

Healthcare Will Be Improved

Only around 16.4% of South Africans have medical aid and access to the private health sector. This leaves the majority of the country making use of government hospital or access to little or no medical care, an inequality the NHI is trying to stomp out. The National Health Act is being updated to provide for the setting up of the Office of Health Standards Compliance (OHSC). The OHSC along with the Minister of Health will aim to ensure that all citizens get good quality care. They will also guide and inspect health facilities and will only certify those that meet the required standards. An OHSC certificate at a healthcare facility will be a public guarantee that standards of hygiene, safety, and respect for patients are being met.

You can read the full bill here.

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