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: 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 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$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
	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
	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 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 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.	Drug & Alcohol Addiction	100%	Sub-limit 11
13.	Refractive Surgery (all-inclusive) (Subject to pre-authorisation)		No Benefit
14.	Phakic Implants (lens Implant) (all-inclusive) (Subject to pre-authorisation)		No Benefit
15.	Reconstructive Surgery (Medical necessity only) (all-inclusive) (Subject to pre-authorisation and strict MHC Guidelines)		No Benefit
16.	Dental Surgery - Additional Hospital Benefit Cover Excluded (Subject to pre-authorisation)
	16.1 Dental Implants - Hospitalisation		No benefit
	16.2 Maxillo Facial & Oral Surgery (Non-Elective Only) -Full Procedure	100%	Limited to N$63 000 per Family (Benefit for Trauma only) Overall Annual Limit
17.	Maternity
	17.1 Confinement (Limited to 1 confinement per year for dep. Other than the spouse) (Subject to pre-authorisation)
	17.1.1 Procedure	100%	Overall Annual Limit
	17.1.2 Hospitalisation	100%	Overall Annual Limit
	17.2 Ante-natal Consultation - Additional Hospital Benefit Cover excluded	100%	Limited to 12 consultations per Beneficiary (Pro-rated from date of joining)
	17.3 Sonar Scans (excluding 3D) - Additional Hospital Benefit Cover excluded	100%	Limited to 3 scans per Beneficiary per pregnancy
	17.4 Amniocentesis - Additional Hospital Benefit Cover excluded	100%	Overall Annual Limit
	17.5 Midwifery Service - Additional Hospital Benefit Cover excluded	100%	Overall Annual Limit
18.	Insertion Intrauterine Device w/ hormone (Mirena) (All-inclusive) (Subject to Prior approval)	100%	Limited to N$6 000 per beneficiary Overall Annual Limit
19.	Ambulance & Evacuation Services
	19.1 Emergency Ambulance & Flights (Subject to prior approval)	100%	Unlimited Benefit
	19.2 Ambulance/Inter-hospital transfer (Subject to prior approval)	100%	Overall Annual Limit
	19.3 Other Transport Transport benefit for medical services available only in RSA (Subject to prior approval and MHC Guidelines)	80% of cost	Overall Annual Limit
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$33 250 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$440	Once off benefit Sub-limit 21
	21.1.3 Consultation (after the first full HIV consultation / assessment)	N$405	Limited to 6 consultations per Beneficiary Sub-limit 21
	21.1.4 HIV Counselling	100%	Limited to N$1 100 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$13 000 per Beneficiary Limited to N$26 000 per Family Conditions: Sub-limits are pro-rated from date of joining, Except Optical Benefit OVERALL ANNUAL LIMIT
		% NAMAF TARIFF
22.	General Practitioners & Specialists Note: Proposed to enhance benefit as per Nico’s presentation. Removed family sized limit		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$12 700 per Family Limited to N$6 300 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	100%
	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	100%	Limited to N$420 per Family Limited to N$75 per script per beneficiary per day Sub-limit 24
25.	Primary Health Care Services
	25.1 Consultations	100%	Sub-limit 22
	25.2 Medicine & Injections Paid at Maximum Namibia Medicine Price List on generics	100%	Sub-limit 24.1
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 Biokinetics	100%	Sub-limit 26
	26.3 Clinical Psychology / Psychological Counsellor	100%	Sub-limit 26
	26.4 Physiotherapy	100%	Sub-limit 26
	26.5 Chiropractor
	26.5.1 Consultation & Procedure	100%	Sub-limit 26
	26.5.2 Medicine	90%	Sub-limit 24
	26.6 Homeopathy/naturopathy/ Phytotherapy/Osteopathy
	26.6.1 Consultation & Procedure	100%	Sub-limit 26
	26.6.2 Medicine	90%	Sub-limit 24
	26.7 Audiology/Speech Therapy	100%	Sub-limit 26
	26.8 Hearing Aid Acoustician	100%	Sub-limit 26
	26.9 Podiatry/Chiropody	100%	Sub-limit 26
	26.10 Dietician	100%	Sub-limit 26
	26.11 Occupational Therapy	100%	Sub-limit 26
	26.12 Social Worker (Motivation required)	100%	Sub-limit 26
	26.13 Orthotist/Prosthetist	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 (2018/2019)
29.	Optical		Limited to N$4 750 per Family(2019/2020) Limited to N$2 400 per Beneficiary every 2 years (including frames) (2019/2020)
	29.1 Eye Test	100%	Limited to one eye test per Beneficiary per annum Sub-limit 29
	29.2 Contact lenses/Spectacle lenses	100%	Sub-limit 29
	29.3 Frame		Sub-limit 29
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.

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Benefit Guide 2019

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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