South Africa National Health Insurance Act 20 of 2023 8: Cost coverage: free at the point of care for covered services, payment only for what the Fund does not cover

What does 8 require?

A user is entitled to receive the services the Fund has purchased on their behalf from an accredited provider or establishment with nothing to pay when care is given (section 8(1)). A person must pay, directly, through a voluntary scheme registered under medical schemes legislation, through a traveller's private insurance or out of pocket, only where they are not entitled to Fund-purchased services, seek services the Benefits Advisory Committee does not deem medically necessary, seek services that prescribed rules place outside Fund cover, or seek services outside the comprehensive package the Committee advises (section 8(2)). Billing systems must separate the two cases cleanly.