What is actually law right now
The National Health Insurance Act 20 of 2023 was assented to and published in 2024. In South African law, signing an Act does not automatically put all of its provisions into operation: sections take effect on dates fixed by presidential proclamation in the Government Gazette. The NHI Act is being implemented in phases, which means parts of it can be in force while others are not.
In the meantime, medical schemes continue to operate under the Medical Schemes Act 131 of 1998 and remain registered with and supervised by the Council for Medical Schemes. Prescribed Minimum Benefits — including the 27 Chronic Disease List conditions — still apply to every registered scheme.
Section 33: the part people argue about
Section 33 of the Act deals with the future role of medical schemes. It provides that once National Health Insurance has been fully implemented, medical schemes may only offer complementary cover — cover for services that are not reimbursable by the NHI Fund.
Two things follow from that wording. First, the Act does not abolish medical schemes. Second, the limitation is conditional on full implementation of NHI, which has not occurred. What "fully implemented" means in practice, and what the Fund would reimburse, is not settled in the Act itself.
What still has to happen
- Further proclamations bringing remaining sections into operation.
- Regulations giving practical effect to the Act.
- Establishment and staffing of the NHI Fund and its governance structures.
- Funding legislation — the Act itself does not set the tax or contribution mechanism.
- Resolution of the legal challenges to the Act that have been brought before the courts.
What this means for you today
Practically: nothing about your cover changes because of NHI right now. Your scheme still publishes annual contribution tables, still applies its hospital networks, and still pays claims under its registered rules. Contributions for 2026 are published and filed with the regulator in the normal way.
If you are choosing cover now, compare on the things that affect you this year — contribution, hospital network, chronic list and day-to-day benefits. You can do that on the scheme comparison hub, the chronic conditions finder and the hospital network checker.
Questions members ask
Is NHI law in South Africa?
Yes. The National Health Insurance Act 20 of 2023 was signed into law and published in 2024. Being signed is not the same as being in force: the Act's provisions come into operation on dates fixed by presidential proclamation in the Government Gazette, and it is being implemented in phases.
Do I still need medical aid under NHI?
For now, nothing about your medical scheme membership changes. Medical schemes remain registered and regulated under the Medical Schemes Act 131 of 1998 and continue to pay claims, including Prescribed Minimum Benefits, exactly as before.
Will medical aid be banned by NHI?
The Act does not ban medical schemes. Section 33 of the Act provides that, once National Health Insurance has been fully implemented, medical schemes may only offer complementary cover for services that are not reimbursable by the NHI Fund. That limitation depends on full implementation, which has not happened.
When will NHI actually be implemented?
No completed implementation date is fixed in the Act. Implementation depends on further proclamations, regulations, funding legislation and the establishment of the NHI Fund and its governance structures. Several applications challenging the Act are also before the courts. Check gov.za and the Department of Health for the current status.
Should I cancel my medical aid because of NHI?
This page is information, not advice. Cancelling cover has consequences under the Medical Schemes Act — including late-joiner penalties and waiting periods if you rejoin later. Speak to an accredited financial adviser about your own circumstances.
Sources
- National Health Insurance Act 20 of 2023 (full text, gov.za)
- Council for Medical Schemes (regulator of medical schemes)
- Medical Schemes Act 131 of 1998 (gov.za)
- National Department of Health — NHI
This page summarises legislation for general information. It is not legal, financial or medical advice, and the status of NHI implementation can change — always check the official sources above for the current position.
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