Essence - Benefits | Bankmed

Key Benefits

Bankmed Essence provides a comprehensive range of benefits at a higher monthly premium:

  • Comprehensive range of benefits;
  • 100% of NAMAF Tariffs;
  • High overall annual cover;
  • High chronic medication benefits;
  • Good individual benefit amounts;
  • Competitive contributions;
  • Available to all Bankmed Namibia Members;
  • Premiums range between N$1,645 and N$3,297 and
  • Provision for Ex Gratia.

Contribution Table

Income Band Family Member
Option Member Adult Child
N$0 - N$2 860 1,645 1,322 288
N$2 861 - N$3 690 1,758 1,415 308
N$3 691 - N$4 770 1,882 1,504 326
N$4 771 - N$5 610 2,304 1,837 396
N$5 611 - N$7 530 2,486 1,999 429
N$7 531 - N$9 450 2,655 2,132 463
N$9 451 - N$14 060 2,798 2,240 488
N$14 061 - N$18 780 2,928 2,351 517
N$18 781 - N$23 540 3,066 2,460 537
N$23 541 - N$28 290 3,192 2,558 560
N$28 291 - N$37 540 3,223 2,590 564
N$37 541 - N$46 700 3,258 2,613 572
N$46 701 + 3,297 2,632 582

Detailed Benefits

 OVERALL ANNUAL BENEFIT  (OVERALL ANNUAL LIMIT)    UNLIMITED BENEFIT 
    COVER   
  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  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) 

   
  1.1 Accommodation & Theatre  100%  Overall Annual Limit 
  1.2 Accommodation other than a recognised hospital/medical institution  100% of cost  Limited to N$550 per day per Family  (Maximum of 2 days) 
  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) 

100%  N$5 500 per family 
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%  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 Protocol 
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)  100%  Overall Annual Limit 
(Subject to Case Management and MHC Guidelines)
7. 

Organ Transplant  - Including immune-suppresant drugs 

(Subject to Case Management and MHC Guidelines) 

100%  Overall Annual Limit 
8. 

Hospice Facilities 

(Subject to pre-authorisation) 

100%  Overall Annual Limit 
9. 

Private Nursing 

(Subject to pre-authorisation) 

100%  Limited to N$31 250 per Family 
10. 

Frail Care 

(Subject to pre-authorisation) 

100%  Limited to N$31 250 per Family 
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$29 500 per Family 
12. 

Refractive Surgery (all-inclusive)

(Subject to pre-authorisation & MHC Guidelines) 

100% 

N$15 000 per eye per Beneficiary

(once-off benefit) 

13. 

Phakic Implants (lens Implant)  (all-inclusive) 

(Subject to pre-authorisation) 

100% 

N$32 750 per Beneficiary

(once-off benefit) 

14. 

Reconstructive Surgery (Medical necessity only) 

(Subject to pre-authorisation and strict MHC Guidelines) 

100% 
14.1 Consultation and Procedure  100%  Limited to N$13 000 per Family 
14.2 Hospitalisation  100%  Overall Annual Limit 
15. 

Dental Surgery 

- Additional Hospital Benefit Cover Excluded 

(Subject to pre-authorisation) 

15.1 Dental Implants

– Hospitalisation 

100% 

Limited to N$9 000 per Beneficiary 

Limited to N$15 750 per Family 

15.2 Maxillo-Facial & Oral Surgery  (Elective & Non-Elective)  - All-inclusive    100%  Limited to N$125 750 per Family 
16.  Maternity 

16.1 Confinement (all-inclusive)  (Limited to 1 confinement per year for dep. other than the spouse) 

(Subject to pre-authorisation) 

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

(3 scans will be allowed if motivated by a doctor) 

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 of Intrauterine Device w/ hormone (Mirena) (All-inclusive) 

(Subject to Prior approval) 

100%  Limited to N$5 750 per Beneficiary 
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 Conveyances  Transport benefit for medical  services available only in RSA

(Subject to prior approval and MHC Guidelines) 

80% of cost  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 
CATEGORY B:  DAY TO DAY BENEFITS  COVER 

Sub-limits are pro-rated from date of joining,  except Optical Benefit. 

OVERALL ANNUAL LIMIT 

    %  NAMAF TARIFF   
20.  General Practitioners & Specialists   

Limited to N$25 000 per Family 

Limited to N$12 500 per Beneficiary 

  20.1 Consultations/Visits (out-of-hospital, including casualties)  100%  Sub-limit 20 
  20.2 Procedures/Services (out-of-hospital)  100%  Sub-limit 20 
  20.3 Materials and Disposable Items  100%  Sub-limit 20 
  20.4 Radiology & Pathology  (Referral from Medical Practitioner)  100%  Sub-limit 20 
 

Benefit Booster applicable 

(Additional benefit once limit is exceeded) 

  Refer to Sub-limit 30 
21.  Dentistry   

Limited to N$10 000 per Beneficiary (excluding Orthodontics benefit) 

Limited to N$13 500 per Family (excluding Orthodontics benefit) 

  21.1 Basic Dentistry  100%  Sub-limit 21 
  21.2 Specialised / Advanced Dentistry  100%  Sub-limit 21 
  21.3 Dental Implants     
  21.3.1 Consultation & Procedure (in-hospital)  100%  Limited to N$13 500 per Family 
  21.3.2 Consultation & Procedure (in-Practice)  150%  Limited to N$17 000 per Family 
  21.3.3 Implant Component  100% 

Limited to N$7 250 per Beneficiary 

Limited to N$13 500 per Family 

 

Benefit Booster applicable 

(Additional benefit once limit is exceeded) 

  Refer to Sub-limit 30 
  21.4 Orthodontics  100%  Limited to N$14 250 per Beneficiary (once-off benefit) 
22.  Medicine & Injections  80% 

Limited to N$25 350 per Beneficiary 

Limited to N$49 100 per Family 

 

22.1 Acute Medicine 

Paid at Maximum Namibia Medicine Price List on generics 

 

Limited to N$7 000 per Beneficiary 

Limited to N$14 000 per Family 

 

22.2 Chronic Medicine 

Paid at Maximum Namibia Medicine Price List on generics 

80% 

Limited to N$16 750 per Beneficiary 

Limited to N$33 333 per Family 

 

22.3 Chronic Medicine (Pensioners) 

Paid at Maximum Namibia Medicine Price List on generics 

100% 
 

22.4 Essential Vaccination/Immunization  (As per WHO Guidelines) 

Paid at Maximum Namibia Medicine Price List on generics 

100%  Sub-limit 22 
 

Benefit Booster applicable 

(Additional benefit once limit is exceeded) 

  Refer to Sub-limit 30 
 

22.5 Self Medication 

Paid at Maximum Namibia Medicine Price List on generics 

100% 

Limited to N$1 600 per Beneficiary 

Limited to N$2 100 per Family 

Limited to N$205 per script per beneficiary per day  Sub-limit 22 
23. 

Specified Illness Conditions

(Subject to pre-authorisation) 

Limited to N$31 500 per Beneficiary 

23.1 HIV/AIDS 

(As per National Guidelines for Antiretroviral Therapy) 

23.1.1 Medicine 

Paid at Maximum Namibia Medicine Price List on generics 

100%  Sub-limit 23 
23.1.2 First Full HIV Consultation / Assessment  N$375  N$400  (6.67%↑) 

Once off benefit 

Sub-limit 23 

23.1.3 Consultation (after the first full HIV consultation / assessment)  N$362  N$385 (6.35%↑) 

Limited to 6 consultations per Beneficiary 

Sub-limit 23 

23.1.4 HIV Counselling  100% 

Limited to N$1 300 per Beneficiary 

Sub-limit 23 

23.1.5 Pathology Tests  100%  Sub-limit 23 

23.1.6. HIV Resistance Test 

(Subject pre-authorisation) 

100%  Sub-limit 23 
23.2 Prevention of Mother-to-Child Transmission (PMTCT)  100% 

Sub-limit 23 

As per National Guidelines 

23.3 Post-Exposure Prophylaxis (PEP)  100% 

Sub-limit 23 

As per National Guidelines 

23.4 Pre-Exposure Prophylaxis (PrEP)  100% 

Sub-limit 23 

As per National Guidelines 

23.4 Sexually Transmitted Diseases  100%  Sub-limit 23 
23.5 Drug & Alcohol Addiction  100%  Limited to N$4 000 per Family subject to report to HR Head Office 
24.  Primary Health Care Services 
24.1 Consultations  100%  Sub-limit 20 

24.2 Medicine & Injections 

Paid at Maximum Namibia Medicine Price List on generics 

80%  Sub-limit 22.1 

Benefit Booster applicable 

(Additional benefit once limit is exceeded) 

Refer to Sub-limit 29 
25. 

Auxiliary Services

(Supplementary Services) 

Limited to N$11 000 per Beneficiary 

Limited to N$16 500 per Family 

25.1 Biokinetics  100% 

Limited to N$5 000 per beneficiary 

Sub-limit 25 

25.2 Clinical Psychology / Psychological Counsellor  100% 

Limited to N$5 000 per beneficiary 

Sub-limit 25 

25.3 Physiotherapy  100% 

Limited to N$5 000 per beneficiary 

Sub-limit 25 

25.4 Chiropractor 
25.4.1 Consultation & Procedure  100%  Sub-limit 25
25.4.2 Medicine  80%  Sub-limit 22.1 
25.5 Homeopathy/Naturopathy/ Phytotherapy/Osteopathy   
25.5.1 Consultation & Procedure  100%  Sub-limit 25
25.5.2 Medicine  80%  Sub-limit 22.1 
25.6 Audiology/Speech Therapy  100%  Sub-limit 25 
25.7 Hearing Aid Acoustician  100%  Sub-limit 25 
25.8 Podiatry/Chiropody  100%  Sub-limit 25 
25.9 Dietician  100%  Sub-limit 25 
25.10 Occupational Therapy  100%  Sub-limit 25 
25.11 Social Worker  (Motivation required)  100% 

Limited to N$5 000 per beneficiary 

Sub-limit 25 

25.12 Orthotist/Prosthetist  100%  Sub-limit 25 

Benefit Booster applicable 

(Additional benefit once limit is exceeded) 

Refer to Sub-limit 29 
26. 

Wheelchair 

(Subject to prior approval) 

- Inclusive of repair & maintenance 

100% of cost  Limited to N$12 500 per Beneficiary every 4 years (2016/2019) 
27. 

Appliances (External) 

(Subject to MHC guidelines) 

80%  Limited to N$4 250 per family 
28. 

Hearing Aids Apparatus 

(Subject to prior approval) 

- Inclusive of repair & maintenance 

100% of cost  Limited to N$30 000 per Family every 2 years (2018/2019) 
29.  Optical 

N$5 250 per Beneficiary limited to every 2 years (including frames) (2017/2018) 

N$9 500 per Family (including frames) (2017/2018) 

29.1 Eye Test  100% 

Limited to one eye test per Beneficiary per annum 

Sub-limit 29 

29.2 Contact lenses/Spectacle lenses  100% 

N$4 250 per Beneficiary limited to every 2 years (2017/2018) 

N$8 500 per Family (2017/2018) 

29.3 Bi-focal/Multi-focal lenses 

N$5 250 per Beneficiary limited to every 2 years (2017/2018) 

N$9 500 per Family (2017/2018) 

29.4 Frame  100% of cost 

Limited to N$1 100 per Beneficiary 

Sub-limit 29 

30.  Benefit Booster  Applicable if Medicine & Injections, Dentistry, GP’s & Specialists, Primary Health Care and Auxiliary Services benefits are depleted 

Limited to N$3 100 per Beneficiary 

Limited to N$5 700 per Family 

30.1 Medicine & Injections (Acute & Chronic) 

- Excluding Self-Medication 

70%  Sub-limit 30 
30.2 Medicine & Injections (Chronic Pensioner)  90%  Sub-limit 30 
30.3 Dentistry & Dental Implants (Excluding Orthodontic)  70%  Sub-limit 30 
30.4 General Practitioners & Specialists (Consultations/Visits & Procedures/Services out-of-hospital, including casualties)  80%  Sub-limit 30 
30.5 Primary Health Care  80%  Sub-limit 30 
30.6 Auxiliary Services  70%  Sub-limit 30 
31.  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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Self Medication

Self-medication is medicine that can be obtained from the pharmacy for minor ailments.

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The following external medical appliances are covered by the Fund.

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