Care

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;
Only available to members who earn N$13,390 and less per month;
Premiums range between N$526 and N$1,541 and
Provision for Ex Gratia.

Contribution Table

Income Bands	Family Member
Option	Member	Adult	Child
N$0 - N$4 770	526	420	105
N$4 771 - N$5 610	1,099	878	220
N$5 611 - N$7 530	1,258	1,009	252
N$7 531 - N$9 450	1,385	1,113	277
N$9 451 - N$14 060	1,461	1,174	293
N$14 061 +	1,541	1,238	310

Detailed Benefits

OVERALL ANNUAL BENEFIT (OVERALL ANNUAL LIMIT)			N$500 000 PER BENEFICIARY N$750 000 PER FAMILY
	CATEGORY A: HOSPITALISATION BENEFIT	% NAMAF TARIFF	Pre-notification: 100% of tariff will be paid out. Without Pre-notification: 90% of tariff will be paid out Sub-limits are not Pro-rated
Additional Hospital Benefit Cover: GP’s and Specialists In-hospital services are paid up to a MAXIMUM of 225% 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$550 per day per Family 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
	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)
	2.1 MRI & CT Scans	100%	Limited to N$11 500 per Family Overall Annual Limit
	2.2 Nuclear Medicine	100%	Overall Annual Limit
	2.3 Radiation Oncology	100%	Overall Annual Limit
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 Internal Prosthesis Protocol Overall Annual Limit
	4.1 Artificial Eyes	100% of cost	Sub-limit 4
	4.2 Artificial Limb	100% of cost	Sub-limit 4
	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 Active therapy (surgery, chemotherapy and radiotherapy) (Subject to Case Management and MHC Guidelines )	100%	Overall Annual Limit
7.	Organ Transplant -Including immunosuppresant drugs (Subject to Case Management and MHC Guidelines)	100%	Overall Annual Limit
8.	Hospice Facilities (Subject to pre-authorisation)		No Benefit
9.	Private Nursing (Subject to pre-authorisation)	100%	Limited to N$11 000 per Family Overall Annual Limit
10.	Frail Care (Subject to pre-authorisation)	100%	Limited to N$11 000 per Family Overall Annual Limit
11.	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
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)
	15.1 Dental Implants - Hospitalisation		No benefit
	15.2 Maxillo Facial & Oral Surgery (Non-Elective Only) -Full Procedure	100%	Limited to N$63 000 per Family (Benefit for Trauma only) Overall Annual Limit
16.	Maternity
	16.1 Confinement (Limited to 1 confinement per year for dep. Other than the spouse) (Subject to pre-authorisation)
	16.1.1 Procedure	100%	Overall Annual Limit
	16.1.2 Hospitalisation	100%	Overall Annual Limit
	16.2 Ante-natal Consultation - Additional Hospital Benefit Cover excluded	100%	Limited to 12 consultations per Beneficiary (Pro-rated from date of joining)
	16.3 Sonar Scans (excluding 3D) - Additional Hospital Benefit Cover excluded	100%	Limited to 2 scans per Beneficiary per pregnancy
	16.4 Amniocentesis - Additional Hospital Benefit Cover excluded	100%	Overall Annual Limit
	16.5 Midwifery Service - Additional Hospital Benefit Cover excluded	100%	Overall Annual Limit
17.	Insertion Intrauterine Device w/ hormone (Mirena) (All-inclusive) (Subject to Prior approval)	100%	Limited to N$5 750 per beneficiary Overall Annual Limit
18.	Ambulance & Evacuation Services
	18.1 Emergency Ambulance & Flights (Subject to prior approval)	100%	Unlimited Benefit
	18.2 Ambulance/Inter-hospital transfer (Subject to prior approval)	100%	Overall Annual Limit
	18.3 Other Transport Transport benefit for medical services available only in RSA MHC Guidelines		Overall Annual Limit
19.	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
20.	Specified Illness Conditions (Subject to pre-authorisation)		Limited to N$31 500 per Beneficiary Overall Annual Limit
	20.1 HIV/AIDS (As per National Guidelines for Antiretroviral Therapy)
	20.1.1 Medicine - Paid at Maximum Namibia Medicine Price List on generics	100%	Sub-limit 20
	20.1.2 First Full HIV Consultation / Assessment	N$400	Once off benefit Sub-limit 20
	20.1.3 Consultation (after the first full HIV consultation / assessment)	N$385	Limited to 6 consultations per Beneficiary Sub-limit 20
	20.1.4 HIV Counselling	100%	Limited to N$1 100 per Beneficiary Sub-limit 20
	20.1.5 Pathology Tests	100%	Sub-limit 20
	20.1.6 HIV Resistance Test (Subject to pre-authorisation)	100%	Sub-limit 20
	20.2 Prevention of Mother-to-Child Transmission (PMTCT)	100%	Sub-limit 20 As per National Guidelines
	20.3 Post-Exposure Prophylaxis (PEP)	100%	Sub-limit 20 As per National Guidelines
	20.4 Pre-Exposure Prophylaxis (PrEP)	100%	Sub-limit 20 As per National Guidelines
	20.5 Drug & Alcohol Addiction	100%	Limited to N$1 200 per Family subject to report to HR Head Office Overall Annual Limit

CATEGORY B: DAY TO DAY BENEFITS		COVER	Overall Sub-Benefit Limit Limited to N$10 500 per Beneficiary Limited to N$18 500 per Family Conditions: Sub-limits are pro-rated from date of joining, Except Optical Benefit OVERALL ANNUAL LIMIT
		% NAMAF TARIFF
21.	General Practitioners & Specialists Note: Proposed to enhance benefit as per Nico’s presentation. Removed family sized limit		Limited to N$9 000 per Family Limited to N$4 500 per beneficiary
	21.1 Consultations/Visits (out-of-hospital, including casualties)	100%	Limited to 10 Consultations per Family
	21.2 Procedures/Services (out-of-hospital)	100%	Sub-limit 21
	21.3 Materials and Disposable Items	100%	Sub-limit 21
	21.4 Radiology & Pathology Referral from Medical Practitioner required	100%	Sub-limit 21
22.	Dentistry		Limited to N$3 500 per Family Limited to N$1 250 per Beneficiary (excluding Orthodontics Benefit)
	22.1 Basic Dentistry (Check ups, x-rays, preventative treatment, removal of teeth, simple filling)	100%	Sub-limit 22
	22.2 Specialised / Advanced Dentistry (Root canal treatment, plastic dentures, periodontal treatment crown & bridge work & metal & soft bases dentures).	100%	Sub-limit 22
	22.3 Dental Implants (Consultation, Procedure & Implant Component)		No Benefit
	22.4 Orthodontics		No Benefit
23.	Medicine & Injections		Limited to N$12 000 per Family Limited to N$6 000 per Beneficiary
	23.1 Acute Medicine Paid at Maximum Namibia Medicine Price List on generics	90%
	23.2 Chronic Medicine Paid at Maximum Namibia Medicine Price List on generics	100%
	23.3 Chronic Medicine (Pensioners) Paid at Maximum Namibia Medicine Price List on generics	100%
	23.4 Essential Vaccination/ Immunization (As per WHO Guidelines) Paid at Maximum Namibia Medicine Price List on generics	100%	Sub-limit 23
	23.5 Self Medication Paid at Maximum Namibia Medicine Price List on generics	100%	Limited to N$400 per Family Limited to N$70 per script per beneficiary per day Sub-limit 23
24.	Primary Health Care Services
	24.1 Consultations	100%	Sub-limit 21
	24.2 Medicine & Injections Paid at Maximum Namibia Medicine Price List on generics	100%	Sub-limit 23
25.	Auxiliary Services (Supplementary Services)		Limited to N$3 750 per Family Limited to N$1 500 per Beneficiary
	25.1 Appliances (External) (Subject to MHC guidelines)	100% of cost	Sub-limit 25
	25.2 Biokinetics	100%	Sub-limit 25
	25.3 Clinical Psychology / Psychological Counsellor	100%	Sub-limit 25
	25.4 Physiotherapy	100%	Sub-limit 25
	25.5 Chiropractor
	25.5.1 Consultation & Procedure	100%	Sub-limit 25
	25.5.2 Medicine	90%	Sub-limit 23
	25.6 Homeopathy/naturopathy/ Phytotherapy/Osteopathy
	25.6.1 Consultation & Procedure	100%	Sub-limit 25
	25.6.2 Medicine	90%	Sub-limit 23
	25.7 Audiology/Speech Therapy	100%	Sub-limit 25
	25.8 Hearing Aid Acoustician	100%	Sub-limit 25
	25.9 Podiatry/Chiropody	100%	Sub-limit 25
	25.10 Dietician	100%	Sub-limit 25
	25.11 Occupational Therapy	100%	Sub-limit 25
	25.12 Social Worker (Motivation required)	100%	Sub-limit 25
	25.13 Orthotist/Prosthetist	100%	Sub-limit 25
26.	Wheelchair (Subject to prior approval) - Inclusive of repair & maintenance	100% of cost	Limited to N$2 500 per beneficiary every 4 years (2015/2018)
27.	Hearing Aids Apparatus (Subject to prior approval) - Inclusive of repair & maintenance	100% of cost	Limited to N$15 000 per Beneficiary every 2 years (2018/2019)
28.	Optical		Limited to N$4 500 per Family Limited to N$2 250 per Beneficiary every 2 years (including frames) (2017/2018)
	28.1 Eye Test	100%	Limited to one eye test per Beneficiary per annum Sub-limit 28
	28.2 Contact lenses/Spectacle lenses	100%	Sub-limit 28
	28.3 Frame	100% of cost	Sub-limit 28
29.	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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BankMed Care 2019

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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.

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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

Care - Benefits | Bankmed