What is National Health Insurance and how will it affect you?

Late in June, the Department of Health issued the National Health Insurance (NHI) Bill and the Medical Schemes Amendment (MSA) Bill for public comment. What is National Health Insurance and what does this mean for you as a member of TFG Medical Aid Scheme?

National Health Insurance

The idea behind National Health Insurance is to give all South Africans and long-term residents access to healthcare services without having to pay providers. The National Health Insurance Bill is a proposal to start a National Health Insurance Fund as well as its governance and the system people have to use to access the fund.

At least until 2022, the focus of National Health insurance is on funding critically needed services for certain vulnerable groups such as school children, the elderly, mental health patients and cancer patients. The current plan is to have the system fully running by 2030.

It’s not yet clear how South Africans will contribute to National Health Insurance or what benefits National Health Insurance will offer. The bills are not yet final and many details still have to be decided on.

The Medical Schemes Amendment Bill and co-payments

A co-payment is the part of your account that TFG Medical Aid Scheme does not pay for and you have to pay yourself. The media has focused on the part of the Medical Schemes Amendment Bill that has to do with co-payments. You may have read reports that the bill plans to do away with co-payments altogether. This is not true.

We already have a system where medical schemes pay the full cost of treatment for Prescribed Minimum Benefit conditions as long as your condition is on the list, the treatment you need matches the prescribed treatment and you use designated service providers (doctors in our network). Find out more about Prescribed Minimum Benefits.

Your co-payments will probably stay the same as they are at the moment. We expect the Prescribed Minimum Benefit definitions to change a bit eventually.

We look forward to continuing supporting you and your heath in the future.