The NHI Act is signed into law, but nothing changes for medical scheme members right now. Here is a clear, broker-balanced explainer of what it means, and what it does not.
President Cyril Ramaphosa signed the National Health Insurance (NHI) Bill into law on 15 May 2024. Since then, the question we have been asked more than any other is some version of: “Should I still bother with medical aid?”
Short answer: yes. Long answer below, including what the law actually says, what changes for you in the short term, and where the genuine uncertainties lie.
What the NHI Act is trying to do
The aim of NHI is universal health coverage funded through a single state-administered fund. In principle, every South African would access an agreed package of healthcare services without paying at the point of care. As a country, we support that goal. The disagreements are about the design and the funding.
What stays the same right now
Your medical scheme cover and benefits remain unchanged for the foreseeable future. If you are a Discovery, Bonitas, Momentum, Fedhealth, Bestmed, Profmed, or any other registered scheme member, your plan, your hospital benefits, your chronic medication, and your gap cover all continue exactly as they were on 14 May 2024.
There is no implementation date for full NHI yet. Industry estimates put full implementation at a decade or more, given the scale of the reform and the regulations that still need to be drafted.
Section 33: the clause that caused the concern
Section 33 of the NHI Act is the clause that, once NHI is fully implemented, would restrict medical schemes to covering only services that NHI does not provide. That is a real change, but two important caveats apply:
- It only takes effect once NHI is “fully implemented.” Industry consensus is that we are years, not months, away from anything resembling full implementation.
- Legal challenges to the Act are already in process. The constitutional questions around medical scheme members’ rights to choose their own care are far from settled.
Will medical aid still be needed?
Yes. Even in countries with much older, better-funded universal health systems, private medical insurance fills gaps the state cannot. Given South Africa’s fiscal constraints, the NHI is unlikely to fund an extensive range of benefits in the early years. Private medical schemes will continue to cover services that NHI does not, and gap cover will continue to bridge the shortfalls between scheme tariffs and what providers actually charge.
What about the cost?
Conservative estimates suggest NHI funding will require tax increases of at least R1,500 per taxpayer per month once the system is operating at full scale. That is on top of existing income tax, VAT, and current medical scheme contributions. Until the funding model is finalised, these are estimates, not certainties.
Should you change anything today?
No, not in response to NHI alone. The thing to do today is the thing you should do every year: review whether your current plan still suits your stage of life, your family structure, your chronic conditions, and your budget. If the answer is no, change schemes or change plans. If the answer is yes, leave it alone.
We are independent brokers. We are not aligned to any single scheme, and we are happy to run side-by-side plan comparisons for you at no cost.
Where we stand as a brokerage
We support the principle of universal health coverage. We do not believe the current form of the NHI Act is feasible without stronger private-sector collaboration, a broader funding base, and an honest conversation about how to strengthen the public sector without weakening the private one. Both sectors are needed.
If anything material changes, whether court rulings, new regulations, or scheme-level announcements, we will be in touch. In the meantime, your medical aid, gap cover, and the rest of your insurance arrangements continue exactly as before.
Review your medical aid cover
We compare medical aid options across multiple schemes at no cost to you. If your current plan no longer fits, we will find one that does.
Related reading
This article is for general information only and does not constitute financial or legal advice. Insurance policy terms vary by insurer. The NHI Act and its implementation timeline are subject to change. Graham Silva Insurance Consultants CC, FSP No. 5671, is an authorised financial services provider regulated by the FSCA.