A short overview of the implications of the National Health Insurance Bill

Mandela Day
July 26, 2018
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The Minister of Health recently released the National Health Insurance Bill of 2018 (“NHI”) for public comment.

The NHI Bill aims to give effect to Section 27 of the Constitution that provides that everyone has the right to access to healthcare services. The State must take reasonable legislative and other steps, within its available resources, to achieve these rights.

The purpose of the NHI Bill

The main aim of the NHI Bill is to provide comprehensive healthcare services for all South Africans and residents irrespective of their ability to financially contribute to the National Health Insurance Fund (to be established). The Bill applies to public and private healthcare providers but not to military healthcare providers.

The Bill refers to a National Health Insurance Fund (“the Fund”) which will be the only public purchaser and financier of health services in South Africa. The Fund may enter into a contract on behalf of its members with healthcare providers, who are certified and accredited, to purchase healthcare services.

Who will it apply to?

The members of this Fund are South African citizens, permanent residents and their dependents. Asylum seekers and refugees who have not been granted refugee status also qualify but only for limited benefits, for example, emergency healthcare services.

How will it be funded?

At this stage of the legislative process, the Bill offers no clear insight into how the NHI will be funded. The Bill only states that the Minister of Health, in consultation with the Minister of Finance, determines the budget and allocation of revenue to the Fund on an annual basis. South Africans who already have medical aid insurance will also have to pay towards the Fund.

Will you still have the option to belong to a private medical aid?

Members of the Fund will be entitled to purchase complementary health service benefits that are not covered by the Fund through a voluntary medical insurance scheme or out of pocket, as the case may be. The impact of the NHI on private medical insurance schemes is uncertain at this time.

What is covered and how?

The NHI covers only certain healthcare services and a member may purchase services not covered by the Fund independently. The healthcare services that will be covered by the NHI are still unclear, as the definitions contained in the Bill are vague.

Members must register with a primary healthcare provider of their choice who will be the first point of call for their healthcare services. A member will not be allowed to seek the services of specialists and hospitals without first obtaining a referral from his or her healthcare provider, except in cases of emergency.

Public comment on the NHI Bill

Interested parties have three months, from the date of publication in the Government Gazette (21 June 2018), to comment on the Bill.

This article is a general information sheet and should not be used or relied on as legal or other professional advice. No liability can be accepted for any errors or omissions nor for any loss or damage arising from reliance upon any information herein. Always contact your legal adviser for specific and detailed advice. Errors and omissions excepted (E&OE)