Current position (22 September 2026): The National Health Insurance Act was signed in May 2024, but its sections have not yet been brought into operation. A court-recorded undertaking prevents the President from bringing provisions into force until the Constitutional Court decides challenges to the parliamentary process. For patients and medical-scheme members, existing arrangements continue.

National Health Insurance, or NHI, is intended to change how healthcare is funded and purchased in South Africa. It is also the subject of court cases, funding disputes and misleading claims. This article separates the law's long-term plan from what is actually operating today.

What the NHI Act is designed to do

The Act provides for a national NHI Fund that would purchase a defined package of healthcare from accredited public and private providers. The stated goal is access based on health need rather than ability to pay at the point of service.

The proposed system requires major groundwork: establishing and governing the Fund, defining benefits, accrediting providers, setting payment methods, building digital systems and improving facilities. The Act envisages phased implementation rather than a single overnight change.

What has changed for patients right now?

In practical terms, nothing in the Act is operating yet. This means:

  • Public clinics and hospitals continue under their existing rules
  • Private practices and hospitals continue to charge under existing arrangements
  • Medical schemes continue to provide their current benefits subject to their rules
  • There is no operational NHI card, public enrolment deadline or NHI benefit package
  • No NHI-specific tax has been introduced

Be wary of anyone asking for payment or personal information to “register for NHI”. Use only official Department of Health channels.

Why implementation is paused

Several organisations challenged how Parliament processed the NHI Bill and challenged parts of the Act itself. In February 2026, the President undertook not to proclaim any section until the Constitutional Court decides the process challenges. The Court heard those challenges in May 2026; at the latest confirmed update, judgment remained pending.

Other challenges to the substance of the Act are separate and may continue in the High Court. A May 2026 Constitutional Court judgment also struck down older “Certificate of Need” provisions in the National Health Act. That ruling did not invalidate the NHI Act, although it removed a mechanism government had linked to health-system planning.

What happens to medical schemes?

Medical schemes have not been abolished. Section 33 of the NHI Act says that once NHI is fully implemented, schemes may cover services not reimbursed by the Fund. What “fully implemented” means, when it will happen and which benefits would remain for schemes have not yet been settled in operating rules.

You should therefore not cancel cover because of a prediction about NHI. Base a medical-scheme decision on your current health needs, benefits and affordability.

How would NHI be funded?

The final funding plan remains unresolved. Policy proposals have mentioned general tax revenue, possible payroll-related taxes, an income-tax surcharge and changes to medical-scheme tax credits. However, no NHI-specific tax has been implemented and there is no final costed benefits package.

Published cost estimates vary widely because they assume different services, prices and implementation dates. Treat a single large number shared online as an estimate, not an approved budget.

What government can do while the Act is paused

Existing health programmes can continue: upgrading facilities, hiring and training staff, improving health information systems, buying equipment and strengthening public services. These activities do not mean the NHI Fund is already paying for everyone's healthcare.

A practical checklist for patients

  1. Continue using your current public-health or medical-scheme arrangements.
  2. Do not pay a person to register you for NHI.
  3. Check medical-scheme changes with your scheme and the Council for Medical Schemes.
  4. Check NHI announcements through the Department of Health and Presidency.
  5. Recheck the position after any Constitutional Court judgment or official commencement notice.

Sources and further reading

Important: NHI policy and court proceedings are developing. This is general information, not medical, financial or legal advice. Check official announcements before changing healthcare cover.