The bottom line is: There is no need to panic about the National Health Insurance (NHI) Bill having been signed into law

Our most recent communication to you about NHI was on 27 February 2024 (attached for ease of reference and as background to this update). The communication anticipated that President Cyril Ramaphosa would sign the NHI Bill, and we gave reasons why we believe that the signing of the Bill by the President will have no impact on medical schemes for many years.

As you know by now, President Cyril Ramaphosa signed the Bill into law on Wednesday 15 May 2024. Although this is disappointing, it was not unexpected. What makes this rather very unfortunate is the fact that the stakeholders (including Bankmed) who were opposed to the Bill are generally very much in support of Universal Health Coverage (UHC) as the overarching objective, and believe that collaboration with government could achieve this. This is the position and reality that is sadly suppressed by the political noise and rhetoric. However, in our view, the NHI Bill (now the NHI Act) in its current form, which imposes a limitation on the role of medical schemes, undermines UHC and will be to the detriment of the population of South Africa. The opportunity to collaborate, which would ensure an inclusive and sustainable healthcare solution, was unfortunately not embraced by the signing of the Bill.

We indicated to you that should the President proceed and sign the Bill, the next avenue available to us is to challenge the Bill legally on constitutional grounds, and that Bankmed intends to participate in such efforts. That is where we are now, and Bankmed is part of a collective that will be challenging this via the Health Funders Association (HFA). There are many other stakeholders who will do the same.

We therefore wish to advise you not to panic for the following reasons:

1. As already indicated above, the NHI Act, in its current form, will be legally challenged (but this takes nothing away from our continued support for a rational, inclusive and collaborative pursuit of Universal Health Coverage);

2. It will take a very long time (and estimates suggest 10 to 15 years) before NHI is "fully implemented", and the NHI Act (as it is now) suggests that is the point at which medical schemes will not be able to provide cover for services that are paid for by NHI;

3. The unfortunate financial constraints that our country faces currently make it impossible for the implementation of NHI to present any threat to the continued existence of medical schemes, for the foreseeable future;

4. Even when NHI is fully implemented based on the NHI Act as it is now, medical schemes will be allowed to exist, but (and this is what we are opposed to) confined to what is not covered by NHI. It is currently not clear what will be covered by NHI, but the financial constraints referred to above, and the implications of such NHI cover having to be available for the whole population in the country, leaves substantial room for the role of medical schemes;

5. Even the Minister of Health himself, Dr Joe Phaahla, at the signing of the Bill ceremony, is quoted saying "please don't cancel your medical aid".

Accompanying this note is a compilation of Frequently Asked Questions (FAQs) and answers thereto, aimed at addressing questions that you may have. Our effort to address questions that you may have is ongoing, evolving and will also be informed by what we pick up from our interactions with you and our employer group clients.

Our partnership in health and wellness remains very intact. We appreciate that the signing of the Bill is topical and has generated a lot of anxiety and questions. We cannot overemphasize our advice to you to NOT panic. This important matter is receiving the required attention.

We reiterate our assurance that staying close to this matter is important to us, and that our efforts are strongly informed by your interests specifically, and the interests of South Africans in general.