Guide to Health Coverage for Expats Living in South Africa
South Africa stands out as a major destination for expats across the continent. It functions as a regional hub for transportation, international conferences, trade, and social events. It is also the destination of choice for many travelers and expats who require advanced medical care, making it a key center for high-level treatment in Africa.
Yet there is much more to life in South Africa than business trips and emergency services. For expats who settle here full-time, understanding how health insurance works is essential. What does medical coverage in South Africa actually look like for long-term residents?
Find the Best International Medical Insurance
- Compare multiple quotes from top insurers
- Get expert advice at no additional cost
- Find the right plan for your needs and budget
Overview of South Africa’s Healthcare System
South Africa does not have universal healthcare. Instead, a private healthcare system and a public healthcare system operate beside each other. The majority of the public, approximately 80% of the population, relies on the public healthcare system for their care.
Fees are determined by using the Uniform Patient Fee Schedule (UPFS) as a guide for billing and payments. This system categorizes fees for different patient types and medical situations.
There are three categories of patients under the UPFS system. Full-paying patients are either being treated by a private physician, are externally funded, or are non-citizens. Partially subsidized patients are eligible to have the cost of their care partially covered based on their income.
Finally, fully subsidized patients are those referred to a hospital by Primary Healthcare Services. Additionally, certain medical services are provided free of charge on occasion.
There are more than 400 public hospitals and more than 600 private hospitals in South Africa. Large regional hospitals are managed by provincial health departments.
One of those larger hospitals is Johannesburg’s Chris Hani Baragwanath Hospital, the third-largest hospital in the world. Meanwhile, smaller hospitals and primary care clinics are managed at the municipal or district level.
According to the 2025 Global Healthcare Index, South Africa’s healthcare system ranks 49th out of 89 countries. In that position, it’s the highest-ranked African country. However, it is still ranked below countries such as India, Sri Lanka, and the Philippines.
The National Health Insurance System in South Africa
South Africa’s healthcare system is poised for significant changes in the coming years. The government is working to establish a national health insurance (NHI) system.
This change aims to address disparities in care among different socioeconomic groups. It also intends to make healthcare more affordable for everyone. At present, however, this is still in the very preliminary stages of development.
Essential Factors to Consider Before Buying Insurance
Healthcare in rural South Africa falls somewhere between limited and nonexistent. Nearly half of the population resides in rural areas, yet only about 3% of new doctors opt to work there. As a result, the country’s rural areas are tremendously underserved.
This isn’t just about physicians, but also about facilities and support staff. Due to challenges accessing comprehensive care during an emergency, expats residing in rural areas should ensure their insurance coverage includes emergency air evacuation.
Comparing Public and Private Healthcare Options for Expats in South Africa
Public Healthcare: Strengths and Challenges
Public hospitals in South Africa face significant resource constraints. Many facilities are underfunded, understaffed, and overcrowded, resulting in long waiting times, limited privacy, and difficulties maintaining modern equipment or fully stocked pharmacies.
Because public hospitals often struggle to pay competitive wages, retaining top medical professionals is challenging. This contributes to ongoing shortages of skilled staff across the public system.
Teaching Hospitals: Higher Quality but Longer Wait Times
Public teaching hospitals affiliated with major universities offer better care, more advanced resources, and higher clinical standards. However, because these facilities are well known for their superior treatment, they experience heavy demand and long waiting periods for most services.
Private Healthcare: High Quality and Efficient Care
South Africa’s private healthcare sector is considered excellent and attracts a large portion of the country’s medical professionals. Nearly 80 percent of doctors work in private facilities, drawn by higher wages and improved working conditions.
For patients with private coverage, this translates into shorter wait times, modern equipment, greater privacy, and more comfortable hospital stays.
Recommended Health Insurance Plans for South Africa
Best Health Insurance for US Expats in South Africa
BCBS Global Solutions Worldwide Premier
- Unlimited annual and lifetime coverage
- Pre-existing conditions covered with prior insurance
- For U.S. citizens abroad or foreign nationals in the U.S.
Best Health Insurance in South Africa for US and Non-US Expats
Cigna Global Insurance Plan
- Flexible plans tailored to your needs and budget
- 1.5M+ providers in 200+ countries
- 24/7 multilingual customer support
William Russell Health Insurance
- Worldwide coverage with access to private hospitals and trusted medical networks.
- Comprehensive benefits, covering inpatient care, outpatient treatment, mental health, and emergency evacuation.
- Flexible plan levels that let expats choose the coverage and budget that fit their lifestyle.
How Expats Can Qualify for South African Health Insurance
The South African Constitution guarantees everyone access to healthcare services. As such, everyone living in South Africa, including expats, refugees, and asylum seekers, is entitled to healthcare.
Thus, expats qualify to visit public healthcare facilities simply based on living in the country. In the case of refugees and asylum seekers, there is no need for a permit or identification documents to have access to free antiretroviral treatment for HIV/AIDS.
What You Need to Know About Processes
Registering for healthcare in South Africa is straightforward. You can sign up at your local doctor’s clinic. You need to fill out a form, provide your address, personal identification, and proof of address. There is no monthly fee, and no payroll deductions are required. Patients pay according to the Uniform Patient Fee Schedule.
The Uniform Patient Fee Schedule serves as a sliding scale. That means that low-income and unemployed individuals pay only a modest fee for their treatment.
Expats are considered to be in a high-income bracket. As a result, they’re responsible for paying their healthcare costs out of pocket at public hospitals.
However, all this is expected to change if the proposed National Health Insurance plan is implemented. The NHI is likely to rely on general taxation and a patient contribution, possibly through payroll deduction. In the future, the public healthcare system in South Africa may take on a significantly different form.
How Routine Doctor Visits Work
A general practitioner addresses day-to-day problems and refers patients to specialists as needed.
However, patients can book appointments directly with a specialist if they wish. The cost of visiting a GP can vary, but appointments start at about 55 Rand.
How to Find a Family Physician or GP in South Africa
Many public insurance doctors practice in hospitals and larger clinics. Meanwhile, private doctors often have individual or group practices in addition to working in clinics and hospitals.
A recommendation from a local friend or colleague is a good starting point.
Traditional and Alternative Medicine in South Africa
Conventional and alternative medicine play a significant role in healthcare in South Africa. An estimated 80% of the country’s citizens report using a traditional healer in some capacity. This percentage is even higher in rural areas.
Healers and alternative practitioners are regulated. Alternative practitioners include those practicing homeopathy, osteopathy, chiropractic medicine, and naturopathy.
They’re required to be licensed and registered and to hold specific qualifications from their governing body where applicable.
Traditional and alternative medicine aren’t included in most private insurance packages. In conclusion, if this kind of treatment is essential to you, you most likely will have to pay out of pocket for care.
Find the Best International Medical Insurance
- Compare multiple quotes from top insurers
- Get expert advice at no additional cost
- Find the right plan for your needs and budget
Joe Cronin, President of ICI, is a leading expert in international health, life, and travel insurance. An MBA and founder of multiple global businesses, he helps expatriates and travelers access trusted, comprehensive insurance solutions worldwide.
View
Full Bio
