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$599 and N$1,756 and
  • Provision for Ex Gratia.

Contribution Table

Income Bands  Family Member
Option  Member  Adult  Child
N$0 - N$4 770 599 479
120
N$4 771 - N$5 610 1,252 1,000
251
N$5 611 - N$7 530 1,433 1,150 287
N$7 531 - N$9 450 1,578 1,268 316
N$9 451 - N$14 060 1,665 1,338 334
N$14 061 + 1,756 1,411 353

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 215% 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

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$11 500 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 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 (all-inclusive in and out of hospital)
Active therapy (surgery, chemotherapy and radiotherapy)
(Subject to Case Management and MHC Guidelines )
100%

Limited to N$ 400 00 per Beneficiary

Overall Annual Limit


6.1 Consultations and Procedures
100%
Sub-limit 6

6.2 Hospitalization
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

7. Organ Transplant
-Including immunosuppresant drugs
(Subject to Case Management and MHC Guidelines)
100% Overall Annual Limit
8. Private Nursing
(Subject to pre-authorisation)
100% Limited to N$11 000 per Family
Overall Annual Limit
9. Frail Care / Hospice
(Subject to pre-authorisation)
100% Limited to N$11 000 per Family
Overall Annual Limit
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$8 250 per Family
Overall Annual Limit
11.
Drug & Alcohol Addiction
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)
-Full Procedure
100% Limited to N$63 000 per Family
(Benefit for Trauma only)
Sub-limit 15
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 C;asses & 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$6 000 per beneficiary
Overall Annual Limit
18.
Stomatherapy
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
19.3 Other Transport
Transport benefit for medical services available only in RSA (Subject to prior approval and MHC Guidelines)
80% 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$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   

 Limited to N$ 150 per Beneficiary

Limited to N$ 750 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

No benefit
  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 (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 (2020/2021)
29.
Medical Devices for Diabetes Management (Subject to prior approval and MHC guidelines)

No benefit
30. Optical  

Limited to N$4 750 per Family(2019/2020)

Limited to N$2 400 per Beneficiary every 2 years (including frames) (2019/2020)

  30.1 Eye Test 100%

Limited to one eye test per Beneficiary per annum

Sub-limit 30

  30.2 Contact lenses/Spectacle lenses 100% Sub-limit 30
  30.3 Frame
Sub-limit 30
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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