Photo: Ekem, Wikimedia Commons, CC BY-SA 3.0NHI in South Africa
Where the National Health Insurance Act stands in October 2026
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The Act
The National Health Insurance Act, 2023 is Act No. 20 of 2023 — it is often called the "2024 Act" because it was assented to on 15 May 2024 and published in Government Gazette No. 50664 of 16 May 2024. It creates a National Health Insurance Fund that would buy health services for users from public and private providers.
Section 59: the Act "takes effect on a date fixed by the President by proclamation in the Government Gazette", and different dates may be fixed for different provisions.
Commencement status in October 2026
| Date | What happened | Source |
|---|---|---|
| 15 May 2024 | President assents to the NHI Act | Gazette 50664 |
| 16 May 2024 | Act published in the Government Gazette | Gazette 50664 |
| 24 February 2026 | The President, after consulting the Minister of Health, agrees to delay the proclamation of any section until the Constitutional Court rules; the undertaking was expected to be made an order of court that day | Presidency, SAnews |
| 5–7 May 2026 | Constitutional Court hearing of the challenges on public participation in the passing of the NHI Bill | Presidency |
| 29 October 2026 | No NHI judgment appears among the Court's recent judgments | Constitutional Court |
Press reports name the applicants in the public participation cases as the Board of Healthcare Funders and the Western Cape provincial government, and report that judgment was reserved after the May hearing (press, not a primary source).
What changes for medical aid members — and what does not yet
Today: nothing. Without a proclamation, the Medical Schemes Act applies in full: your scheme must keep paying the Prescribed Minimum Benefits, contributions stay based on income and dependants, and you can still join, change or leave a scheme under the usual rules (see medical aid).
Later, if the Act is brought into force as written: section 33 says that "once National Health Insurance has been fully implemented as determined by the Minister through regulations in the Gazette, medical schemes may only offer complementary cover to services not reimbursable by the Fund." The Act defines complementary cover as third-party payment for services not reimbursed by the Fund, "including any top up cover offered by medical schemes".
In other words, the restriction on medical schemes depends on three later steps: proclamation of the provisions, regulations by the Minister declaring full implementation, and the Fund actually reimbursing the services.
The CMS notes in its Annual Report 2025/26 that it has built the NHI provisions into its strategic planning and is preparing schemes for the change, including the rule that schemes may not cover services reimbursed by NHI once implemented.
What to do now
- Do not cancel medical aid because of NHI. No part of the Act is in force, and leaving a scheme can expose you to waiting periods and a late-joiner penalty if you rejoin at 35 or older.
- Keep proof of your cover history — it reduces any late-joiner penalty (Regulation 13).
- Treat sales pitches about NHI with care: any product presented as "NHI-ready" or as a replacement for medical aid should be checked against the law. Gap cover and hospital cash plans must state that they are not a medical scheme (gap cover).
- Watch for a Constitutional Court judgment and any proclamation in the Government Gazette — those are the two events that would change the position.
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Frequently asked questions
Is NHI in force in South Africa?
No. The NHI Act 20 of 2023 was signed on 15 May 2024 but takes effect only on dates proclaimed by the President, and on 24 February 2026 the Presidency said no section would be proclaimed until the Constitutional Court rules.
When was the NHI Act signed?
On 15 May 2024. It was published in Government Gazette No. 50664 on 16 May 2024.
Will NHI end medical aid?
Not now. Section 33 says that once NHI is fully implemented, as determined by the Minister in regulations, medical schemes may only offer complementary cover for services the Fund does not reimburse.
Should I cancel my medical aid because of NHI?
No part of the Act is in force, and rejoining a scheme later can mean waiting periods and a late-joiner penalty from age 35.
What is the Constitutional Court NHI case about?
Challenges to the public participation process followed by Parliament before it passed the NHI Bill, heard on 5–7 May 2026. As at 29 October 2026 we found no judgment on the Court's recent judgments page.
Sources
- Government Gazette No. 50664, 16 May 2024 — National Health Insurance Act 20 of 2023 (gov.za)
- The Presidency — Statement on National Health Insurance Act (NHI) litigation (24 February 2026)
- SAnews (Government Communication and Information System) — President delays proclamation of sections of NHI Act (24 February 2026)
- Constitutional Court of South Africa — Recent judgments (checked 29 October 2026)
- Council for Medical Schemes — Annual Report 2025/26 (copy tabled in Parliament, hosted by PMG)
- Council for Medical Schemes — Medical Schemes Act 131 of 1998 and Regulations (consolidated copy, Web Archive)