Care - Benefits | Bankmed

Key Benefits

Bankmed Care provides a fairly comprehensive range of benefits at a lower monthly premium:

  • Adequate range of benefits;
  • 100% of NAMAF Tariffs
  • Promotes use of primary healthcare facilities (clinics);
  • Limited individual benefit amounts;
  • Limited private hospitalisation;
  • Premiums range between N$635 and N$1,861 and
  • Provision for Ex Gratia.

Contribution Table

Income Bands  Family Member
Option  Member  Adult  Child
N$0 - N$4 910 635 507 127
N$4 911 - N$5 780 1,327 1,061
266
N$5 781 - N$7 760 1,520 1,219 304
N$7 761 - N$9 730 1,673 1,344 335
N$9 731 - N$14 480 1,765 1,418 354
N$14 481 + 1,861 1,495 374

Detailed Benefits

OVERALL ANNUAL BENEFIT
(OVERALL ANNUAL LIMIT)
N$520 000 PER BENEFICIARY
N$780 000 PER FAMILY 
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
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
1.7 Physiotherapy
- Additional Hospital Benefit Cover excluded
1.7.1 Physiotherapy ( in hospital) 100%

Overall Annual Limit

Sub-limit 1.7

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$11 950 per Family  

Sub-limit 2

2.2 Nuclear Medicine 100%

Sub-limit 2

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
4.2 Artificial Limb 100% of cost

No Benefit

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 
(Subject to Case Management and MHC Guidelines )
100%

Limited to N$ 400 00 per Beneficiary

Overall Annual Limit


6.1 Consultations and Procedures Out-of-Hospital
100%
Sub-limit 6

6.2 MRI/CT Scans & Other Specialized Radiology in & Out of Hospital

- Additional Hospital Benefit Cover Excluded

- Referral from medical specialist only

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


6.5 Hospitalisation and Related Procedures In-Hospital
100%

Overall Annual Limit

7. Organ Transplant
-Including immunosuppresant drugs
(Subject to Case Management and MHC Guidelines)
100% Overall Annual Limit
8. Private Nursing / Frail Care / Hospice
(Subject to pre-authorisation)
100% Limited to N$12 350 per Family
Overall Annual Limit
9. Frail Care / Hospice
(Subject to pre-authorisation)
100% Sub-limit 8
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$8 500 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
15.2 Maxillo Facial & Oral Surgery (Non-Elective Only)
- All-inclusive (including dental extractions for children less than 10 years old and wisdom teeth extractions)
100% Limited to N$63 000 per Family
(Benefit for Trauma only)
Sub-limit 15
16. Maternity
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

16.2 Ante-natal Consultation

- Additional Hospital Benefit Cover excluded

100%

Limited to 12 consultations per Beneficiary
(Pro-rated from date of joining)

Sub-limit 16


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

16.4 Sonar Scans

- Additional Hospital Benefit Cover excluded

100%

Limited to 3 scans per Beneficiary per pregnancy

Sub-limit 16

16.5 Tests for Chromosomal and Foetal abnormalities
- Additional Hospital Benefit Cover excluded
100%

Sub-limit 16

16.6 Midwifery Service

- Additional Hospital Benefit Cover excluded

100%

Sub-limit 16

17.

Insertion Intrauterine Device w/ hormone (Mirena) (All-inclusive)

(Subject to Prior approval)

100% Limited to N$6 250 per beneficiary (pro-rated from date of joining)
Overall Annual Limit
18.
Stomatherapy
100%
No benefit
19.

Ambulance & Evacuation Services

(subject to prior approval)

Overall Annual Limit
19.1 Emergency Ambulance & Flights
(Subject to prior approval)
100% Unlimited Benefit
19.2 Ambulance/Inter-hospital transfer
(Subject to prior approval)
100% Sub-limit 19
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

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$34 550 per Beneficiary
Overall Annual Limit
21.1 HIV/AIDS
(As per National Guidelines for Antiretroviral Therapy)
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$480
Once off benefit
Sub-limit 21
21.1.3 Consultation (after the first full HIV consultation / assessment) N$425  
Limited to 6 consultations per Beneficiary
Sub-limit 21
21.1.4 HIV Counselling 100% Limited to N$1 150 per Beneficiary
Sub-limit 21
21.1.5 Pathology Tests 100% Sub-limit 21
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
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$13 500 per Beneficiary 

Limited to N$27 000 per Family 

Conditions: Sub-limits are pro-rated from date of joining, Except Optical Benefit 

OVERALL ANNUAL LIMIT 

  %  NAMAF TARIFF   
22.  General Practitioners & Specialists    

Limited to N$9 500 per Family 

Limited to N$4 750 per beneficiary 

  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$13 200 per Family 

Limited to N$6 550 per Beneficiary 

 

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 

95% 
 

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 

90% 

Limited to N$437 per Family 

Limited to N$78 per script per beneficiary per day 

Sub-limit 24

25.  Primary Health Care Services   

Limited to N$ 1 000 per Beneficiary

Limited to N$ 1 500 per Family

  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
26.  Auxiliary Services (Supplementary Services)   

Limited to N$4 000 per Family 

Limited to N$1 600 per Beneficiary 

 

26.1 Appliances (External) 

(Subject to MHC guidelines) 

100% of cost  Sub-limit 26 

26.2 Art Therapy
100%
Sub-limit 26

26.3 Audiology / Speech Therapy
100%
Sub-limit 26
  26.4 Biokinetics  100%  Sub-limit 26 

26.5 Chinese Medicine

26.5.1 Consultation & Procedure

26.5.2 Medicine


100%

80%

Limited to N$ 500 per Beneficiary

Sub-limit 26

Sub-limit 23.1

  26.6 Chiropractor   100%  Sub-limit 26 
  26.6.1 Consultation & Procedure
100% Sub-limit 26
  26.6.2 Medicine
 90% Sub-limit 24
  26.7 Clinical Psychology / Psychological Counselor
100% Sub-limit 26
  26.8 Clinical Technology
100% Sub-limit 26
  26.9 Dietician
 100% Sub-limit 26
  26.10 Hearing Aid Acoustician
100% Sub-limit 26
 

26.11 Homeopathy / Naturopathy / Pathotherapy

26.11.1 Consultation & Procedure


100%

Sub-limit 26

  26.11.2 Medicine
90% Sub-limit 24
  26.12 Occupational Therapy
100% Sub-limit 26
  26.13 Orthotist / Prosthetist
100% Sub-limit 26
 

26.14 Physiotherapy

100% Sub-limit 26
 

26.15 Podiatry / Chiropody

100% Sub-limit 26
  26.16 Social Worker (motivation required)
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$3 900 per Family (excluding frames) 

Limited to N$1 950 per Beneficiary every 2 years (excluding frames) (2021/2022)

 

30.1 Eye Test

100%

Limited to one eye test per Beneficiary per annum

Sub-limit 30


30.2 Bi-focal / Multi-focal Lenses100%Sub-limit 30
  30.3 Contact lenses/Spectacle lenses 100% Sub-limit 30
  30.4 Frame

Sub-limit 30

Limited to N$750 per Beneficiary every 4 years (2021/2024)

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.

Download the 2022 Option Guide PDF

Newsletters

Subscribe to our newsletters. See all Bankmed news.

General Fund Information

Managed Healthcare

The Managed Health Care Department is the market leader in providing professional healthcare service to Members and Funds administered by Methealth Namibia Administrators. read more

HIV/AIDS Programme

Hospital Bedside Support Services

Chronic Medication Programme

Emergency Evacuation Services

Pregnant Members

Self Medication

Self-medication is medicine that can be obtained from the pharmacy for minor ailments.

Covered Medical Appliances

The following external medical appliances are covered by the Fund.

Testimonials

What do you think about Bankmed Namibia, share your thoughts here: Leave your testimonial.

The Lifestyle Management Programme

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

Healthy Lifestyle Programme for Individuals

Corporate Lifestyle Management Programme

Methealth Client Services

An open medical aid fund providing quality medical aid coverage to the whole of Namibia. See all branches