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$699 and N$2,047 

Contribution Table

Income Bands  Family Member
Option  Member  Adult  Child
N$0 - N$5 160 699 558 140
N$5 161 - N$6 070 1,460 1,167
292
N$6 071 - N$8 150 1,671 1,341 335
N$8 151 - N$10 220 1,840 1,479 368
N$10 221 - N$15 200 1,941 1,560 389
N$15 201 + 2,047 1,645 412

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 200% of NAMAF Tariff
1.

Hospitalisation

(Subject to Pre-authorisation)

OVERALL ANNUAL LIMIT
1.1 Accommodation & Theatre 100% Sub-limit 1
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 (Applicable to RSA only) (Maximum of 2 days)
Overall Annual Limit
1.3 Blood Transfusions 100% Sub-limit 1
1.4 Intensive and High Care - Maximum of 3 days then motivation 100% Sub-limit 1
1.5 Medicine, fixed tariff procedures, hospital apparatus and To Take Out Medicine (7 days supply only) 100% Sub-limit 1
1.6 Radiology & Pathology (in hospital)
- Additional Hospital benefit Cover excluded
100% Sub-limit 1
1.7 Physiotherapy
- Additional Hospital Benefit Cover excluded

1.7.1 Physiotherapy (in hospital) 100%

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
No Benefit
4.2 Artificial Limb

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)

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 (Subject to prior approval and MHC Guidelines)
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

15.3 maxillo-Facial & Oral Surgery (Elective) (all-inclusive)
No benefit
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 Classes & 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 (all-inclusive) (subject to prior approval)
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

19.2.1 Metropolitan (in-town)100%

Limited to N$2,250 per Benficiary

Sub-limit 19.2


19.2.3 Long Distance (>100km)100%Sub-limit 19.2
19.3 Other Transport
Transport benefit for medical services available only in RSA (Subject to prior approval and MHC Guidelines)
60% 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%

Limited to N$7,800 per Beneficiary

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 (Checkups, 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 Maxillo-Facial and Oral Surgery (elective) In-hospital and In-practice
No Benefit
  23.5 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

23.5 Vitamins, Multivitamins, Minerals & homeopathic / natural / herbal medicine (excluding supplementation during pregnancy and lactation, injections and haematinics. If possible, will be paid on the Acute Medicine benefit limit)90%

Limited to N$120 per Beneficiary

Limited to N$230 per Family 

Sub-limit 24

 

24.6 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 (2023/2026)
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 (2023/2025)
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) (2023/2023)

 

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)

Download the 2023 Option Guide PDF

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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.

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