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$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 |
| OVERALL ANNUAL BENEFIT (OVERALL ANNUAL LIMIT) |
N$520 000 PER BENEFICIARY N$780 000 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 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 |
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| 1.3 Blood Transfusions | 100% | Sub-limit 1 |
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| 1.4 Intensive and High Care - Maximum of 3 days then motivation | 100% | Sub-limit 1 |
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| 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 |
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| 1.7.1 Physiotherapy (in hospital) | 100% | 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$11 950 per Family Sub-limit 2 |
|
| 2.2 Nuclear Medicine | 100% | Sub-limit 2 |
|
| 3. |
General Practitioners and Specialists
(in hospital services, procedures & operations) - Additional Hospital Benefit Cover included |
100% | Overall Annual Limit |
| 4. |
Internal Appliances & Materials (Subject to pre-authorisation) |
Subject to Bankmed Namibia Protocol Overall Annual Limit |
|
| 4.1 Artificial Eyes | No Benefit |
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| 4.2 Artificial Limb | No Benefit |
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| 4.3 Other Internal Appliances & Materials | 100% of cost | Sub-limit 4 | |
| 5. | Dialysis (Subject to Case Management and MHC Guidelines) |
100% | Overall Annual Limit |
| 6. |
Oncology (Subject to Case Management and MHC Guidelines) |
Limited to N$ 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 | ||
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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 |
|
16.2 Ante-natal Consultation - Additional Hospital Benefit Cover excluded |
100% |
Limited to 12 consultations per Beneficiary 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 | |
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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 |
|
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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$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 |
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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$1 600 per Beneficiary |
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26.1 Appliances (External) (Subject to MHC guidelines) |
100% of cost | Sub-limit 26 | |
| 26.2 Art Therapy | 100% | Sub-limit 26 | |
| 26.3 Audiology / Speech Therapy | 100% | Sub-limit 26 | |
| 26.4 Biokinetics | 100% | Sub-limit 26 | |
26.5 Chinese Medicine 26.5.1 Consultation & Procedure 26.5.2 Medicine | 100% 80% | Limited to N$ 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 |
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| 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 |
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| 30.2 Bi-focal / Multi-focal Lenses | 100% | 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)
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An open medical aid fund providing quality medical aid coverage to the whole of Namibia. See all branches
