Private medical aid in South Africa at risk

Despite recent promises that South Africa’s private medical schemes would not be removed under the NHI, experts remain sceptical since the conditions of the NHI Act cannot easily be changed.

Recently, DA leader John Steenhuisen stated that the DA and the ANC had come to an agreement that parts of the NHI Act terminating private medical aid in South Africa would be removed, BusinessDay reported.

This was confirmed by Monitoring, Planning and Evaluation Minister Maropene Ramokgopa in an interview with News24, who also said that the ANC and DA had reached such an agreement.

In addition, the leaders confirmed that a ministerial advisory committee will handle the implementation of the NHI.

This committee will comprise government officials, cabinet ministers, and likely representatives from private medical scheme providers.

However, Health Minister Aaron Motsoaledi stated that he was unaware of any discussions on modifying the provisions of the private medical scheme.

Thoneshan Naidoo, CEO of the Health Funders Association, explained on The Money Show that it is not as simple as the two parties reaching an agreement.

He said that the NHI Act has been brought into law, and has definitive guidelines which must be followed. This means that it remains the law until the Act is changed by parliament or a court of law.

Section 33 is the specific part of the Act which limits the powers of private medical aid providers.

According to this section, once the NHI is fully implemented, medical schemes may only offer complementary cover to services not reimbursable by the fund.

According to Naidoo, fundamentally, the law is quite clear in terms of section 33.

The concern, however, is that there is no clear timeline or certainty about what the NHI will cover, which means there is also no clarity about what medical schemes will be allowed to cover.

“For us, we view that there is no current existence of medical schemes in the way we know it today.”

The hope, Naidoo said, is that by taking the NHI to court, there will either be some clarity about the Act or section 33 will be set aside.

Part of what makes the NHI such an appealing option for many people in South Africa is how unaffordable medical aid can be. For example, South Africa’s top medical aid providers have hiked their prices well above inflation in 2025.

Discovery Health Medical Scheme (DHMS) announced an average increase of 9.3%. Bonitas reported an increase of 10.2%, Momentum had a 9.4% increase, and Medihelp indicated a 10.8% increase.

According to Naidoo, these steep price increases result from an incomplete regulatory framework from 20 years ago.

“That, compounded with some other effects, has resulted in medical schemes increasing costs well in advance of salary inflation.”

Adding to the difficulty for many South African households is that lower-cost healthcare options have struggled to be introduced in South Africa.

Currently, the Board of Healthcare Funders (BHF) and the Council for Medical Schemes (CMS) are in a legal dispute over the introduction of low-cost medical aid plans in South Africa.

The BHF argues that these plans, which would provide basic healthcare coverage for as low as R300, are necessary to make private healthcare more accessible to millions of South Africans who cannot afford traditional medical aid.

However, the CMS has refused to approve exemptions that would allow these plans to bypass the requirement to fully cover Prescribed Minimum Benefits (PMBs).

The reason, they said, is that they do not provide sufficient financial protection and require legislative changes before being implemented.

The BHF claimed that the CMS’ reluctance to approve low-cost plans is politically motivated, since expanding access to private healthcare could reduce public support for the NHI.

Legal experts have also suggested that regulators may be avoiding decisions that could interfere with the rollout of NHI.

The case has now been taken to the High Court, with the BHF arguing that the CMS’ refusal is unfair and unlawful, depriving millions of South Africans of affordable healthcare.

If approved, these low-cost plans could provide coverage for up to 10 million additional people.