South Africa
National Health Insurance Act, 2023
Act 20 of 2023
- Published in Government Gazette 50664 on 16 May 2024
- Assented to on 15 May 2024
- Not commenced
- [This is the version of this document from 16 May 2024.]
1. Definitions
In this Act, unless the context indicates otherwise—“accredited” means to be in possession of a valid certificate of accreditation from the Fund as issued in terms of section 39;“ambulance services” means ambulance services as contemplated in Part A of Schedule 5 to the Constitution;“Appeal Tribunal” means the Appeal Tribunal established by section 44;“asylum seeker” has the meaning ascribed to it in section 1 of the Refugees Act;“basic health care services” means services provided by health care service providers which are essential for maintaining good health and preventing serious health problems including preventative services, primary health care, emergency medical services, diagnostic services, treatment services and rehabilitation services;“Benefits Advisory Committee” means the Benefits Advisory Committee established in terms of section 25;“Board” means the Board of the Fund established by section 12;“central hospital” means a public hospital designated as such by the Minister as a national resource to provide health care services to all residents, irrespective of the province in which they are located, and that must serve as a centre of excellence for conducting research and training of health workers;“certified”, in respect of a health establishment, means to be in possession of a valid certificate issued by the Office of Health Standards Compliance as provided for in the National Health Act;“Chief Executive Officer” means the person appointed in terms of section 19;“child” means a person under the age of 18 years as defined in section 28(3) of the Constitution;“complementary cover” means third party payment for personal health care service benefits not reimbursed by the Fund, including any top up cover offered by medical schemes registered in terms of the Medical Schemes Act or any other voluntary private health insurance fund;“comprehensive health care services” means health care services that are managed so as to ensure a continuum of health promotion, disease prevention, diagnosis, treatment and management, rehabilitation and palliative care services across the different levels and sites of care within the health system in accordance with the needs of users;“Constitution” means the Constitution of the Republic of South Africa, 1996;“Contracting Unit for Primary Health Care” means a Contracting Unit for Primary Health Care referred to in section 37;“Department” means the National Department of Health established in terms of the Public Service Act, 1994 (Proclamation No. 103 of 1994);“District Health Management Office” means a District Health Management Office referred to in section 36;“emergency medical services” means services provided by any private or public entity dedicated, staffed and equipped to offer acute medical treatment and transport of the ill or injured;“financial year” means a financial year as defined in section 1 of the Public Finance Management Act;“Formulary” means the Formulary and its composition referred to in section 38(4);“Fund” means the National Health Insurance Fund established by section 9;“health care service” means—(a)health care services, including reproductive health care and emergency medical treatment, contemplated in section 27 of the Constitution;(b)basic nutrition and basic health care services contemplated in section 28(1)(c) of the Constitution;(c)medical treatment contemplated in section 35(2)(e) of the Constitution; and(d)where applicable, provincial, district and municipal health care services;“health care service provider” means a natural or juristic person in the public or private sector providing health care services in terms of any law;“health establishment” means a health establishment as defined in section 1 of the National Health Act;“health goods”, in respect of the delivery of health care services, includes medical equipment, medical devices and supplies, health technology or health research intended for use or consumption by, application to, or for the promotion, preservation, diagnosis or improvement of, the health status of a human being;“health product” means a product regulated in terms of the Medicines and Related Substances Act, 1965 (Act No. 101 of 1965), the Hazardous Substances Act, 1973 (Act No. 15 of 1973), the Foodstuffs, Cosmetics and Disinfectants Act, 1972 (Act No. 54 of 1972), or any other product regulated by a law governing its quality, efficacy or performance and used in the provision of health care services;“health related product” means any commodity other than orthodox medicine, complementary medicine, veterinary medicine, medical device or scheduled substance which is produced by human effort or some mechanical, chemical, electrical or other human engineering process for medicinal purposes or other preventive, curative, therapeutic or diagnostic purposes in connection with human health;“health research” means health research as defined in section 1 of the National Health Act;“hospital” means a health establishment which is classified as a hospital by the Minister in terms of section 35 of the National Health Act;“Immigration Act” means the Immigration Act, 2002 (Act No. 13 of 2002);“mandatory prepayment” means compulsory payment for health services before they are needed in accordance with income levels;“medical scheme” means a medical scheme as defined in the Medical Schemes Act;“Medical Schemes Act” means the Medical Schemes Act, 1998 (Act No. 131 of 1998);“medicine” means medicine as defined in section 1 of the Medicines and Related Substances Act, 1965 (Act No. 101 of 1965);“Minister” means the Cabinet member responsible for health;“National Health Act” means the National Health Act, 2003 (Act No. 61 of 2003); “national health system" has the meaning ascribed to it in section 1 of the National Health Act;“Office of Health Standards Compliance” means the Office of Health Standards Compliance established by section 77 of the National Health Act;“permanent resident” means a person having permanent residence status in terms of the Immigration Act;“personal information” means personal information as defined in section 1 of the Promotion of Access to Information Act;“pooling of funds” means the aggregation of financial resources for the purpose of spreading the risk across the population so that individual users can access health services without financial risk;“prescribed” means prescribed by regulation made under section 55;“primary health care” means addressing the main health problems in the community through providing promotive, preventive, curative and rehabilitative services and—(a)is the first level of contact of individuals, the family and community with the national health system, bringing health care as close as possible to where people live and work, and constitutes the first element of a continuing health care process; and(b)in the public health sector, is the clinic, and in the private health sector, is the general practitioner, primary care nursing professional, primary care dental professional and primary allied health professional, through multi-disciplinary practices;“procurement” has the meaning ascribed to it in section 217(1) of the Constitution;“Promotion of Access to Information Act” means the Promotion of Access to Information Act, 2000 (Act No. 2 of 2000);“provider payment” means the payment to providers in a way that creates appropriate incentives for efficiency in the provision of quality and accessible health care services using a uniform reimbursement strategy;“public entity” means a national public entity as reflected in Schedule 3 to the Public Finance Management Act;“Public Finance Management Act” means the Public Finance Management Act, 1999 (Act No. 1 of 1999);“referral” means the transfer of a user to an appropriate health establishment in terms of section 44(2) of the National Health Act;“refugee” has the meaning ascribed to it in section 1 of the Refugees Act;“Refugees Act” means the Refugees Act, 1998 (Act No. 130 of 1998);“Republic” means the Republic of South Africa;“social solidarity” means providing financial risk pooling to enable crosssubsidisation between the young and the old, the rich and the poor and the healthy and the sick;“strategic purchasing” means the active purchasing of health care services by the pooling of funds and the purchasing of comprehensive health care services from accredited and contracted providers on behalf of the population;“supplier” means a natural or juristic person in the public or private sector providing goods and services other than personal health care services;“this Act” includes any regulation promulgated, directive or rule made or notice issued by the Minister and directive issued by the Fund in terms of this Act; and “user” means a person registered as a user in terms of section 5.Chapter 1
Purpose and application of Act
2. Purpose of Act
The purpose of this Act is to establish and maintain a National Health Insurance Fund in the Republic funded through mandatory prepayment that aims to achieve sustainable and affordable universal access to quality health care services by—3. Application of Act
Chapter 2
Access to health care services
4. Population coverage
5. Registration as users
6. Rights of users
Without derogating from any other right or entitlement granted under this Act or under any other law, a user of health care services purchased by the Fund is entitled—7. Health care services coverage
8. Cost coverage
Chapter 3
National Health Insurance Fund
9. Establishment of Fund
The National Health Insurance Fund is hereby established as an autonomous public entity, as contained in Schedule 3A to the Public Finance Management Act.10. Functions of Fund
11. Powers of Fund
Chapter 4
Board of Fund
12. Establishment of Board
A Board that is accountable to the Minister is hereby established to govern the Fund in accordance with the provisions of the Public Finance Management Act.13. Constitution and composition of Board
14. Chairperson and Deputy Chairperson
15. Functions and powers of Board
16. Conduct and disclosure of interests
17. Quorum, decisions and procedures
18. Remuneration and reimbursement
The Fund may remunerate a Board member and compensate him or her for expenses as determined by the Minister in consultation with the Minister of Finance and in line with the provisions of the Public Finance Management Act.Chapter 5
Chief Executive Officer
19. Appointment
20. Responsibilities
21. Relationship of Chief Executive Officer with Director-General and Office of Health Standards Compliance
22. Staff at executive management level
The Chief Executive Officer may not appoint or dismiss members of staff at executive management level without the prior written approval of the Board.Chapter 6
Committees established by Board
23. Committees of Board
24. Technical committees
Chapter 7
Advisory Committees established by Minister
25. Benefits Advisory Committee
26. Health Care Benefits Pricing Committee
27. Stakeholder Advisory Committee
The Minister must, after consultation with the Board and by notice in the Gazette, appoint a Stakeholder Advisory Committee comprised of representatives from the statutory health professions councils, health public entities, organised labour, civil society organisations, associations of health professionals and providers as well as patient advocacy groups in such a manner as may be prescribed.28. Conduct and disclosure of interest
29. Procedures and remuneration
When establishing a committee under this Chapter, the Minister must determine by notice in the Gazette—30. Vacation of office
A member of a committee established in terms of this Act ceases to be a member if—Chapter 8
General provisions applicable to operation of Fund
31. Role of Minister
32. Role of Department
33. Role of medical schemes
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.34. National Health Information System
35. Purchasing of health care services
36. Role of District Health Management Office
A District Health Management Office established as a national government component in terms of section 31A of the National Health Act must manage, facilitate, support and coordinate the provision of primary health care services for personal health care services and non-personal health services at district level in compliance with national policy guidelines and relevant law.37. Contracting Unit for Primary Health Care
38. Health Products Procurement Unit
39. Accreditation of service providers
40. Information platform of Fund
41. Payment of health care service providers
Chapter 9
Complaints and appeals
42. Complaints
43. Lodging of appeals
A natural or juristic person, namely a user, health care service provider, health establishment or supplier aggrieved by a decision of the Fund delivered in terms of section 42 may, within a period of 60 days after receipt of written notification of the decision, appeal against such decision to the Appeal Tribunal.44. Appeal Tribunal
45. Powers of Appeal Tribunal
46. Secretariat
The Chief Executive Officer must designate a staff member of the Fund to act as secretary of the Appeal Tribunal and the Fund must keep the minutes and all records of a decision of the Appeal Tribunal for a period of at least three years after the decision has been recorded.47. Procedure and remuneration
Chapter 10
Financial matters
48. Sources of funding
The revenue sources for the Fund consist of—49. Chief source of income
50. Auditing
The Auditor-General must audit the accounts and financial records of the Fund annually as outlined in the Public Audit Act, 2004 (Act No. 25 of 2004).51. Annual reports
Chapter 11
Miscellaneous
52. Assignment of duties and delegation of powers
Subject to the Public Finance Management Act—53. Protection of confidential information
Nothing in this Act affects the provisions in any other legislation or law prohibiting or regulating disclosure of personal or other sensitive information accessible to or in possession of the Fund.54. Offences and penalties
55. Regulations
56. Directives
57. Transitional arrangements
58. Repeal or amendment of laws
59. Short title and commencement
History of this document
16 May 2024 this version
15 May 2024
Assented to
Cited documents 21
Legislation 21
Documents citing this one 1
Gazette 1
1. | South Africa Government Gazette dated 2024-05-16 number 50664 |