South Africa National Health Insurance Act 20 of 2023
South Africa's National Health Insurance Act: the single-purchaser Fund and what it requires of providers, establishments, suppliers, medical schemes and users once in force, from user registration, users' rights, referral pathways and free-at-point-of-care delivery, through accreditation criteria, Formulary procurement, information submission, confidentiality, performance monitoring and complaints, to complementary-only medical scheme cover, the offences for false claims and misuse of Fund money, and the daily penalty for withholding information.
South Africa National Health Insurance Act 20 of 2023 is a compliance framework from South Africa with 4 domains and 14 controls. The largest domains are Chapter 8: operation of the Fund, medical schemes, procurement, accreditation, information and payment – South Africa National Health Insurance Act 20 of 2023 (7 controls), Chapter 2: access to health care services, registration, users' rights, referral and cost coverage – South Africa National Health Insurance Act 20 of 2023 (4 controls), Chapters 10 and 11: financial matters, offences, regulations and transition – South Africa National Health Insurance Act 20 of 2023 (2 controls). Every control below carries what it requires and what an assessor expects to see.
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Framework Domains (4)
Chapter 2: access to health care services, registration, users' rights, referral and cost coverage – South Africa National Health Insurance Act 20 of 2023
| Code | Title |
|---|---|
| south-africa-national-health-insurance-act-20-of-2023::5 | Registration of users: establishments keep the register, verify identity and help register children |
| south-africa-national-health-insurance-act-20-of-2023::6 | Users' rights that providers and establishments must honour |
| south-africa-national-health-insurance-act-20-of-2023::7 | Service delivery through registration, portability, transfer and referral pathways |
| 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 |
Chapter 8: operation of the Fund, medical schemes, procurement, accreditation, information and payment – South Africa National Health Insurance Act 20 of 2023
| Code | Title |
|---|---|
| south-africa-national-health-insurance-act-20-of-2023::33 | Medical schemes: complementary cover only once National Health Insurance is fully implemented |
| south-africa-national-health-insurance-act-20-of-2023::34 | Accurate, accessible health data and compliance with the health records provisions |
| south-africa-national-health-insurance-act-20-of-2023::38-6 | Procure according to the Formulary; listed suppliers deliver direct to the accredited facility |
| south-africa-national-health-insurance-act-20-of-2023::39-2 | Accreditation requirements: professional registration, OHSC certification and the performance criteria |
| south-africa-national-health-insurance-act-20-of-2023::39-5 | Submit the prescribed clinical and administrative information to be accredited and reimbursed |
| south-africa-national-health-insurance-act-20-of-2023::39-6 | Performance monitoring, five-yearly renewal and the grounds for withdrawal of accreditation |
| south-africa-national-health-insurance-act-20-of-2023::40-4 | Confidentiality of user information held on the Fund's platform |
Chapter 9: complaints and appeals – South Africa National Health Insurance Act 20 of 2023
| Code | Title |
|---|---|
| south-africa-national-health-insurance-act-20-of-2023::42 | Complaints: lodge, investigate within 30 days, and give providers notice and representations before adverse decisions |
Chapters 10 and 11: financial matters, offences, regulations and transition – South Africa National Health Insurance Act 20 of 2023
| Code | Title |
|---|---|
| south-africa-national-health-insurance-act-20-of-2023::54-1 | Offences: false information, false representations, misuse of Fund money and disclosure of Fund information |
| south-africa-national-health-insurance-act-20-of-2023::54-2 | Daily penalty for failing to furnish information required by the Act or a directive |
What is South Africa National Health Insurance Act 20 of 2023 and who does it apply to?
South Africa National Health Insurance Act 20 of 2023 is a compliance framework from South Africa with 4 domains and 14 controls. South Africa's National Health Insurance Act: the single-purchaser Fund and what it requires of providers, establishments, suppliers, medical schemes and users once in force, from user registration, users' rights, referral pathways and free-at-point-of-care delivery, through accreditation criteria, Formulary procurement, information submission, confidentiality, performance monitoring and complaints, to complementary-only medical scheme cover, the offences for false claims and misuse of Fund money, and the daily penalty for withholding information. It is used by organisations to establish and maintain compliance with industry standards and regulatory requirements.
What does South Africa National Health Insurance Act 20 of 2023 actually require?
South Africa National Health Insurance Act 20 of 2023 has 14 controls organised across 4 domains. The largest domains are Chapter 8: operation of the Fund, medical schemes, procurement, accreditation, information and payment – South Africa National Health Insurance Act 20 of 2023 (7 controls), Chapter 2: access to health care services, registration, users' rights, referral and cost coverage – South Africa National Health Insurance Act 20 of 2023 (4 controls), Chapters 10 and 11: financial matters, offences, regulations and transition – South Africa National Health Insurance Act 20 of 2023 (2 controls). Each control defines specific requirements that organisations must implement to achieve compliance.
If I already comply with another framework, how much of South Africa National Health Insurance Act 20 of 2023 do I already cover?
South Africa National Health Insurance Act 20 of 2023 does not currently have cross-framework mappings in our system. Check back as we continuously expand our mapping database.
How do I implement South Africa National Health Insurance Act 20 of 2023?
Start your South Africa National Health Insurance Act 20 of 2023 compliance journey by running a self-assessment on our platform to identify your current compliance posture. Our AI advisory can answer specific questions about South Africa National Health Insurance Act 20 of 2023 requirements, and cross-framework mapping helps you leverage existing controls from other frameworks you may already comply with. Create a free account to access all 14 controls and track your progress.
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