Kobus Smit
Member since: 01 February 2017
I would like to thank my medical aid for all the help and support they gave me during the time I spent in hospital. They ensured that my stay was comfortable and that my needs were met. Thank you Bankmed
Bankmed Care provides a fairly comprehensive range of benefits at a lower monthly premium:
| Income Bands | Family Member | ||
| Option | Member | Adult | Child |
| N$0 - N$4 770 | 565 | 452 | 113 |
| N$4 771 - N$5 610 | 1,181 | 944 |
237 |
| N$5 611 - N$7 530 | 1,352 | 1,085 | 271 |
| N$7 531 - N$9 450 | 1,489 | 1,796 | 298 |
| N$9 451 - N$14 060 | 1,571 | 1,262 | 315 |
| N$14 061 + | 1,657 | 1,331 | 333 |
| OVERALL ANNUAL BENEFIT (OVERALL ANNUAL LIMIT) |
N$500 000 PER BENEFICIARY N$750 000 PER FAMILY |
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| CATEGORY A: HOSPITALISATION BENEFIT | % NAMAF TARIFF |
Pre-notification: 100% of tariff will be paid out. Without Pre-notification: No benefit will be paid out except in the case of emergency hospital admissions and emergencies after hours, weekends and public holidays. Sub-limits are not Pro-rated. OVERALL ANNUAL LIMIT. |
|
| Additional Hospital Benefit Cover: GP’s and Specialists In-hospital services are paid up to a MAXIMUM of 215% of NAMAF Tariff | |||
| 1. | Hospitalisation (Subject to Pre-authorisation) |
OVERALL ANNUAL LIMIT | |
| 1.1 Accommodation & Theatre | 100% | Overall Annual Limit | |
|
1.2 Accommodation other than a recognised
hospital/medical institution (Subject to prior approval & Accommodation Expenses Re-imbursement Policy) |
Limited to N$600 per day per Family (Maximum of 2 days) Overall Annual Limit |
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| 1.3 Blood Transfusions | 100% | Overall Annual Limit | |
| 1.4 Intensive and High Care - Maximum of 3 days then motivation | 100% | Overall Annual Limit | |
| 1.5 Medicine, fixed tariff procedures, hospital apparatus and To Take Out Medicine (7 days supply only) | 100% | Overall Annual Limit | |
|
1.6 Radiology & Pathology (in hospital) - Additional Hospital benefit Cover excluded |
100% | Overall Annual Limit | |
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1.7 Physiotherapy - Additional Hospital Benefit Cover excluded |
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| 1.7.1 Physiotherapy ( in hospital) | 100% | Overall Annual Limit Sub-limit 1.7 |
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1.7.2 Physiotherapy (post rehabilitation) - Additional benefit once the patient is out of hospital (Subject to prior approval) |
No benefit | ||
| 2. | Specialised Radiology Procedures (in & out of hospital) - Additional Hospital Benefit Cover excluded - Referral from a medical specialist only (referral from GP acceptable in places where there is no medical specialist) (Subject to prior approval) | Overall Annual Limit |
|
| 2.1 MRI & CT Scans | 100% | Limited to N$11 500 per Family Sub-limit 2 |
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| 2.2 Nuclear Medicine | 100% | Sub-limit 2 |
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| 3. |
General Practitioners and Specialists
(in hospital services, procedures & operations) - Additional Hospital Benefit Cover included |
100% | Overall Annual Limit |
| 4. |
Internal Appliances & Materials (Subject to pre-authorisation) |
Subject to Bankmed Namibia Protocol Overall Annual Limit |
|
| 4.1 Artificial Eyes | 100% of cost | No Benefit |
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| 4.2 Artificial Limb | 100% of cost | No Benefit |
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| 4.3 Other Internal Appliances & Materials | 100% of cost | Sub-limit 4 | |
| 5. | Dialysis (Subject to Case Management and MHC Guidelines) |
100% | Overall Annual Limit |
| 6. |
Oncology (all-inclusive in and out of hospital) Active therapy (surgery, chemotherapy and radiotherapy) (Subject to Case Management and MHC Guidelines ) |
100% | Limited to N$ 400 00 per Beneficiary Overall Annual Limit |
| 6.1 Consultations and Procedures | 100% | Sub-limit 6 | |
| 6.2 Hospitalization | 100% | Sub-limit 6 | |
| 6.3 Radiation Oncology (referral from medical specialist only) | 100% | Sub-limit 6 | |
| 6.4 Oncology Medication (chemotherapy, radiotherapy and hormone therapy) | 100% | Sub-limit 6 | |
| 7. |
Organ Transplant -Including immunosuppresant drugs (Subject to Case Management and MHC Guidelines) |
100% | Overall Annual Limit |
| 8. | Private Nursing (Subject to pre-authorisation) |
100% | Limited to N$11 000 per Family Overall Annual Limit |
| 9. |
Frail Care / Hospice (Subject to pre-authorisation) |
100% | Limited to N$11 000 per Family Overall Annual Limit |
| 10. |
Psychiatric Treatment – hospitalisation (Subject to pre-authorisation) - Referral from Psychiatrist only (Referral by GP acceptable in places where there is no Psychiatrist) |
100% | Limited to N$8 250 per Family Overall Annual Limit |
| 11. | Drug & Alcohol Addiction | 100% | Sub-limit 10 |
| 12. |
Refractive Surgery (all-inclusive) (Subject to pre-authorisation) |
No Benefit | |
| 13. |
Phakic Implants (lens Implant)
(all-inclusive) (Subject to pre-authorisation) |
No Benefit | |
| 14. |
Reconstructive Surgery (Medical necessity only) (all-inclusive) (Subject to pre-authorisation and strict MHC Guidelines) |
No Benefit | |
| 15. |
Dental Surgery - Additional Hospital Benefit Cover Excluded (Subject to pre-authorisation) |
Overall Annual Limit |
|
| 15.1 Dental Implants - Hospitalisation | No benefit | ||
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15.2 Maxillo Facial & Oral Surgery (Non-Elective Only) -Full Procedure |
100% | Limited to N$63 000 per Family (Benefit for Trauma only) Sub-limit 15 |
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| 16. | Maternity | ||
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16.1 Confinement (all-inclusive) (Limited to 1 confinement per year for dep. Other than the spouse) (Subject to pre-authorisation) |
100% | Sub-limit 16 |
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16.2 Ante-natal Consultation - Additional Hospital Benefit Cover excluded |
100% |
Limited to 12 consultations per Beneficiary Sub-limit 16 |
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16.3 Ante-natal / Post-natal C;asses & Education - Additional hospital benefit cover excluded | 100% | Limited to 6 sessions per Beneficiary per pregnancy (pro-rated from date of joining) Sub-limit 16 | |
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16.4 Sonar Scans (excluding 3D) - Additional Hospital Benefit Cover excluded |
100% | Limited to 3 scans per Beneficiary per pregnancy Sub-limit 16 |
|
|
16.5 Amniocentesis - Additional Hospital Benefit Cover excluded |
100% | Sub-limit 16 |
|
16.6 Midwifery Service - Additional Hospital Benefit Cover excluded |
100% | Sub-limit 16 |
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| 17. | Insertion Intrauterine Device w/ hormone (Mirena) (All-inclusive) (Subject to Prior approval) |
100% | Limited to N$6 000 per beneficiary Overall Annual Limit |
| 18. | Stomatherapy | 100% | No benefit |
| 19. | Ambulance & Evacuation Services (subject to prior approval) |
Overall Annual Limit | |
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19.1 Emergency Ambulance & Flights (Subject to prior approval) |
100% | Unlimited Benefit | |
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19.2 Ambulance/Inter-hospital transfer (Subject to prior approval) |
100% | Sub-limit 19 |
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19.3 Other Transport Transport benefit for medical services available only in RSA (Subject to prior approval and MHC Guidelines) |
80% of cost |
Limited to N$ 9 800 per Family Sub-limit 19 |
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| 20. |
International Medical Travel Insurance - Medical cover when travelling to foreign countries - For emergency cases only (not for elective surgery or procedure) |
100% of cost | N$10 000 000 per incident |
| 21. | Specified Illness Conditions (Subject to pre-authorisation) |
Limited to N$33 250 per Beneficiary Overall Annual Limit |
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21.1 HIV/AIDS (As per National Guidelines for Antiretroviral Therapy) |
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21.1.1 Medicine - Paid at Maximum Namibia Medicine Price List on generics |
100% | Sub-limit 21 | |
| 21.1.2 First Full HIV Consultation / Assessment | N$440 |
Once off benefit Sub-limit 21 |
|
| 21.1.3 Consultation (after the first full HIV consultation / assessment) | N$405 |
Limited to 6 consultations per Beneficiary Sub-limit 21 |
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| 21.1.4 HIV Counselling | 100% | Limited to N$1 100 per Beneficiary Sub-limit 21 |
|
| 21.1.5 Pathology Tests | 100% | Sub-limit 21 | |
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21.1.6 HIV Resistance Test (Subject to pre-authorisation) |
100% | Sub-limit 21 | |
| 21.2 Prevention of Mother-to-Child Transmission (PMTCT) | 100% |
Sub-limit 21 As per National Guidelines |
|
| 21.3 Post-Exposure Prophylaxis (PEP) | 100% |
Sub-limit 21 As per National Guidelines |
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| 21.4 Pre-Exposure Prophylaxis (PrEP) | 100% |
Sub-limit 21 As per National Guidelines |
|
| CATEGORY B: DAY TO DAY BENEFITS | COVER | Overall Sub-Benefit Limit Limited to N$13 000 per Beneficiary Limited to N$26 000 per Family Conditions: Sub-limits are pro-rated from date of joining, Except Optical Benefit OVERALL ANNUAL LIMIT |
|
| % NAMAF TARIFF | |||
| 22. | General Practitioners & Specialists Note: Proposed to enhance benefit as per Nico’s presentation. Removed family sized limit | Limited to N$9 500 per Family Limited to N$4 750 per beneficiary |
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| 22.1 Consultations/Visits (out-of-hospital, including casualties) | 100% | Limited to 16 Consultations per Family | |
| 22.2 Procedures/Services (out-of-hospital) | 100% | Sub-limit 22 | |
| 22.3 Materials and Disposable Items | 100% | Sub-limit 22 | |
| 22.4 Radiology & Pathology Referral from Medical Practitioner required | 100% | Sub-limit 22 | |
| 23. | Dentistry | Limited to N$3 700 per Family Limited to N$1 300 per Beneficiary (excluding Orthodontics Benefit) | |
| 23.1 Basic Dentistry (Check ups, x-rays, preventative treatment, removal of teeth, simple filling) | 100% | Sub-limit 23 | |
| 23.2 Specialised / Advanced Dentistry (Root canal treatment, plastic dentures, periodontal treatment crown & bridge work & metal & soft bases dentures). | 100% | Sub-limit 23 | |
| 23.3 Dental Implants (Consultation, Procedure & Implant Component) | No Benefit | ||
| 23.4 Orthodontics | No Benefit | ||
| 24. | Medicine & Injections | Limited to N$12 700 per Family Limited to N$6 300 per Beneficiary |
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24.1 Acute Medicine Paid at Maximum Namibia Medicine Price List on generics |
90% | ||
24.2 Chronic Medicine Paid at Maximum Namibia Medicine Price List on generics |
100% | ||
24.3 Chronic Medicine (Pensioners) Paid at Maximum Namibia Medicine Price List on generics |
100% | ||
24.4 Essential Vaccination/ Immunization (As per WHO Guidelines) Paid at Maximum Namibia Medicine Price List on generics |
100% | Sub-limit 24 | |
24.5 Self Medication Paid at Maximum Namibia Medicine Price List on generics |
100% | Limited to N$420 per Family Limited to N$75 per script per beneficiary per day Sub-limit 24 |
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| 25. | Primary Health Care Services | Limited to N$ 150 per Beneficiary Limited to N$ 750 per Family |
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25.1 Consultations / Procedures |
100% | Sub-limit 22 | |
25.2 Medicine & Injections Paid at Maximum Namibia Medicine Price List on generics |
100% |
Sub-limit 24 |
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| 26. | Auxiliary Services (Supplementary Services) | Limited to N$4 000 per Family Limited to N$1 600 per Beneficiary |
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26.1 Appliances (External) (Subject to MHC guidelines) |
100% of cost | Sub-limit 26 | |
| 26.2 Biokinetics | 100% | Sub-limit 26 | |
| 26.3 Clinical Psychology / Psychological Counsellor | 100% | Sub-limit 26 | |
| 26.4 Physiotherapy | 100% | Sub-limit 26 | |
| 26.5 Chiropractor | |||
| 26.5.1 Consultation & Procedure | 100% | Sub-limit 26 | |
| 26.5.2 Medicine | 90% | Sub-limit 24 | |
| 26.6 Homeopathy/naturopathy/ Phytotherapy/Osteopathy | |||
| 26.6.1 Consultation & Procedure | 100% | Sub-limit 26 | |
| 26.6.2 Medicine | 90% | Sub-limit 24 | |
| 26.7 Audiology/Speech Therapy | 100% | Sub-limit 26 | |
| 26.8 Hearing Aid Acoustician | 100% | Sub-limit 26 | |
| 26.9 Podiatry/Chiropody | 100% | Sub-limit 26 | |
| 26.10 Dietician | 100% | Sub-limit 26 | |
| 26.11 Occupational Therapy | 100% | Sub-limit 26 | |
| 26.12 Social Worker (Motivation required) | 100% | Sub-limit 26 | |
| 26.13 Orthotist/Prosthetist | 100% | Sub-limit 26 | |
| 27. | Wheelchair (Subject to prior approval) - Inclusive of repair & maintenance | 100% of cost | Limited to N$2 650 per beneficiary every 4 years (2019/2022) |
| 28. | Hearing Aids Apparatus (Subject to prior approval) - Inclusive of repair & maintenance | 100% of cost | Limited to N$15 000 per Beneficiary every 2 years (2020/2021) |
| 29. | Medical Devices for Diabetes Management (Subject to prior approval and MHC guidelines) | No benefit | |
| 30. | Optical | Limited to N$4 750 per Family(2019/2020) Limited to N$2 400 per Beneficiary every 2 years (including frames) (2019/2020) |
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| 30.1 Eye Test | 100% | Limited to one eye test per Beneficiary per annum Sub-limit 30 |
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| 30.2 Contact lenses/Spectacle lenses | 100% | Sub-limit 30 | |
| 30.3 Frame | Sub-limit 30 | ||
| 30. | Health SmartCard | No Additional Costs. Each Dependant will receive his/her own smartcard. Benefits can be verified at Service Providers 24/7. In case of Emergency, Member and Dependants can be identified without Health Smartcard. Next of Kin can be contacted immediately. | |
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Member since: 01 February 2017
I would like to thank my medical aid for all the help and support they gave me during the time I spent in hospital. They ensured that my stay was comfortable and that my needs were met. Thank you Bankmed
Lifestyle Management is a continuous process of making healthy lifestyle choices on a daily basis. It requires commitment to live a more balanced and healthy lifestyle, and we therefore want to assist you in breaking those bad habits that cause unnecessary health problems. read more
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