NHI and your medical aid in 2026: where things stand and what to do

We found no report of a judgment, or of any proclamation, up to 29 September 2026. We could not read the Constitutional Court's own site, so check the news and the Department of Health NHI page for anything newer.

The Presidency's statement says the undertaking will not affect the NHI implementation timetable, and the Department says preparatory work continues. The Department also says NHI will "take many years to be fully realised".

The Act describes NHI as a national fund that buys health services from public and private providers. Two parts matter to scheme members, and both are in the Act itself.

Section 33. Once NHI has been "fully implemented as determined by the Minister through regulations in the Gazette", medical schemes may only offer complementary cover. That means cover for personal health services the NHI Fund does not reimburse. The Act's definition includes top-up cover offered by registered medical schemes.

Section 59. The Act takes effect on a date fixed by the President by proclamation, and different sections may start on different dates.

So the Act does not switch schemes off on a set date. Section 33 only applies after a further step: the Minister deciding, by regulation, that NHI is fully implemented. No such date exists. This is our reading of the text, not a statement from the CMS or the Department about what members should do.

Because no section has started, as far as we can tell:

• Your scheme must still cover Prescribed Minimum Benefits, and the Council for Medical Schemes still regulates it.
• The medical scheme fees tax credit for 2026/27 is R376 a month for you, R752 a month for you and one dependant, and R254 a month for each additional dependant. See the medical aid tax credit guide.
• Contributions, waiting periods and late joiner rules are unchanged.

Do not cancel because of NHI. If you leave cover and want to return later, you can face new waiting periods and a late joiner penalty:

• A scheme may apply up to three months' general waiting period and up to 12 months' condition-specific waiting period if you have been without cover for 90 days or more.
• If you are 35 or older when you rejoin, the band depends on your age minus (35 plus your years of creditable cover). The maximum penalty on your part of the contribution is 5% for 1 to 4 years, 25% for 5 to 14 years, 50% for 15 to 24 years and 75% for 25 years or more.

Example: a 45-year-old with no creditable cover is 10 years past 35, which falls in the 5 to 14 year band, so the maximum penalty is 25%. Penalties can follow you to another scheme. See the late joiner penalty guide.

The Department of Health describes NHI as a centralised national fund that buys services from public and private providers. At the signing the President said healthcare provision is currently "fragmented, unsustainable and unacceptable".

The Act is contested. The BHF and the Western Cape government argue the public participation process was flawed, and that is the case the Constitutional Court is deciding. The Health Minister says the wider health system reforms remain viable and phased. Other court challenges exist, and we have not verified their details.

Nobody can say today what the fund will cover, what it will cost members, or when it will begin. Treat any confident prediction with caution.

Several policy tracks run alongside NHI and are easy to confuse with it:

• PMB review. The CMS is reviewing PMBs and a possible primary healthcare package. Nothing has been gazetted. Circular 26 of 2026 (14 September 2026) asks schemes for claims data by 15 October 2026 to re-cost the proposal.
• 2027 increases. The CMS recommended that schemes anchor 2027 increases at 3.8%. Fedhealth and Medshield have announced early figures. See medical aid increases for 2027.
• Low-cost benefit options. The Health Minister rejected the CMS's LCBO report in February 2025. The Supreme Court of Appeal granted the BHF leave to appeal a High Court ruling on LCBOs in October 2025, and no LCBO framework has been approved.

Watch for four things: the Constitutional Court judgment, any proclamation in the Government Gazette, regulations under section 33, and CMS circulars on your scheme.

Meanwhile, keep paying. Review your plan on its merits at your scheme's yearly window. The CMS says to finalise switch decisions by late November or early December, and to check which waiting periods and penalties may apply before you move. See how medical aid works and what does medical aid cover.