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;
  • 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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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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