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National Health Insurance (NHI) in South Africa: What It Means for Expats in 2026

By The Expat Club · Updated October 2026

As of October 2026, South Africa's National Health Insurance Act is signed law but not in force. The President has undertaken not to bring any part of it into effect until the Constitutional Court rules on challenges to how Parliament passed it, and that judgment is still awaited. Medical aid and international health insurance work exactly as before, so nothing changes for expats' healthcare today.

NHI tends to come up early when people plan a move here, usually as one worried question: is my medical aid about to become useless? Here is where the law actually stands in October 2026, what would change for medical aid if it goes ahead, and what the Act says about foreign nationals.

What NHI actually is

NHI is the government's plan for a single public fund that would buy healthcare from both public and private providers on behalf of citizens, permanent residents and certain other groups, paid for through compulsory prepayment. The aim is to close the gap between a strained public system and a well-resourced private one that most people reach through medical aid. The bill went to Parliament in 2019, and President Cyril Ramaphosa signed the National Health Insurance Act in May 2024.

Signing an Act and bringing it into force are two different things. The NHI Act only takes effect on a date the President fixes by proclamation in the Government Gazette, and different sections can start on different dates. None has been proclaimed, so nobody is paying into the fund, registering with it or being treated through it.

Why nothing has started: the court challenges

The main case is in the Constitutional Court. The Board of Healthcare Funders, an industry body for medical schemes, and the Western Cape provincial government both argue that Parliament did not give the public a meaningful chance to take part before passing the Act. The court heard the matter in early May 2026 and reserved judgment, and the ruling was still awaited in mid-October 2026. In April 2026 the Health Minister told Parliament there were 15 legal challenges to the Act in total, and the High Court cases have been on hold since late February 2026 until the Constitutional Court decides.

In February 2026 the President undertook not to bring any provision of the Act into force before that judgment, and Health Minister Aaron Motsoaledi gave a matching undertaking. The government has not abandoned NHI: in October 2026 the Minister told Parliament's health committee that work to strengthen the public system, including facilities, equipment and electronic health records, would carry on regardless of the court cases.

Worth knowing: on 18 May 2026 the Constitutional Court struck down the "certificate of need" sections of the National Health Act of 2003, which would have required health practitioners and facilities to get government approval to practise or open in a particular area. Those sections had never been brought into effect. The Health Department says the ruling has no direct impact on NHI and that no part of the NHI Act has been declared unconstitutional.

What would change for medical aid if NHI goes ahead as written

This is the part that worries people, so it helps to be precise about the trigger. Section 33 of the Act says that once NHI has been "fully implemented as determined by the Minister through regulations in the Gazette", medical schemes may only offer complementary cover for services the Fund does not reimburse. No such regulations exist. The Act also sets out a phased timetable, with Phase 1 running from 2023 to 2026 and Phase 2 from 2026 to 2028, and the Phase 2 goals include running the Fund through mandatory prepayment. That timetable has already slipped, and there is no official date for full implementation. Nothing about how medical aid or international health insurance works has changed.

What NHI would mean for foreign nationals

Section 4 of the Act says the Fund would buy healthcare for South African citizens, permanent residents, refugees, prison inmates, and categories of foreigners that the Minister of Home Affairs names by notice in the Gazette. Because the Act is not in force, no categories have been named. Asylum seekers and people in the country illegally would only be entitled to emergency medical services and treatment for notifiable conditions of public health concern. All children, including the children of asylum seekers and undocumented foreigners, would be entitled to basic health care. Visitors would need travel insurance, and without it would get only that same emergency and notifiable-condition care.

The Act does not spell out where temporary residents, such as people on work or retired persons' visas, would fit, beyond the Home Affairs power to name categories. It refers to private insurance for international travellers on short-term, work or student visas, alongside medical schemes and paying out of pocket, as ways of paying for care the Fund does not cover. In practice, most foreign residents would rely on their own cover unless their category is named.

Two caveats. First, none of this has commenced, so it could be amended, struck down or implemented differently. Second, the medical cover some visa categories already require is a Home Affairs question, separate from NHI. Our guide to healthcare and medical aid in South Africa for expats explains how local medical aid and international insurance work today.

What this means for expats right now

Nothing has changed. Medical aid, international health insurance and the public system work as they did before the Act was signed, and the questions that matter for your own cover are the same as before: how long you are staying, whether your visa needs proof of cover, and whether you plan to settle or keep things portable. Our guide to medical aid in South Africa for 2026 compares what the main plan types cost.

The development to watch is the Constitutional Court ruling. It could let the Act stand, send it back to Parliament to redo parts of the public participation process, as the Western Cape asked, or declare it invalid, as the Board of Healthcare Funders asked. Whatever the outcome, the changes to medical aid would still need ministerial regulations before they applied.

Common mistake: treating NHI as if it is already changing South African healthcare. Headlines tend to run well ahead of the legal position, which today is a signed Act with no section in force, a court ruling still awaited, no implementation date and no change to medical aid. If anyone tells you NHI requires you to change your cover now, ask which section of the Act is actually in force.

The bottom line for 2026

NHI is a signed law with an ambitious goal, but in October 2026 none of it is in force, the President has paused it until the Constitutional Court rules, and nobody can predict that ruling with confidence. For anyone planning or making a move this year, the practical healthcare questions, private or public care, medical aid or international insurance, and visa medical cover, are governed by the system that exists today. The court outcome matters for the longer term, and we will update this guide when it lands.

Frequently asked questions

General information only, not tax/financial/medical advice: confirm current rules and consult a qualified professional.