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$1,892 and N$3,792 and
  • Provision for Ex Gratia.

Contribution Table

Income Band Family Member
Option Member Adult Child
N$0 - N$2 860 1,892 1,520 332
N$2 861 - N$3 690 2,022
1,627 354
N$3 691 - N$4 770 2,165 1,730 375
N$4 771 - N$5 610 2,650 2,113
456
N$5 611 - N$7 530 2,859 2,299 493
N$7 531 - N$9 450 3,054
2,452 533
N$9 451 - N$14 060 3,219 2,577 562
N$14 061 - N$18 780 3,368 2,704 595
N$18 781 - N$23 540 3,527 2,830 617
N$23 541 - N$28 290 3,671 2,943 644
N$28 291 - N$37 540 3,708 2,979 648
N$37 541 - N$46 700 3,747 3,006
658
N$46 701 + 3,792 3,027
670

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-authorization: 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) 

   
  1.1 Accommodation
100%  Overall Annual Limit 
  1.2 Accommodation other than a recognised hospital/medical institution  100% of cost  Limited to N$600 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$5 800 per Family 

(Benefit available within 3 months from hospital discharge)

Sub-limit 1.7

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%  Overall Annual Limit 
2.2 Nuclear Medicine  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 

Limited to N$ 16 430 per Beneficiary every 4 years

Sub-limit 4 

4.2 Artificial Limb  100% of cost 

Limited to N$ 23 860 per Beneficiary every 4 years

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 - (all-inclusive in and out of hospital) 

(Subject to Case Management and MHC guidelines) 

100% 

Limited to N$ 750 000 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 immune-suppresant drugs 

(Subject to Case Management and MHC Guidelines) 

100%  Overall Annual Limit 
8. 

Private Nursing 

(Subject to pre-authorisation) 

100% 

Limited to N$33 250 per Family 

Overall Annual Limit

9. 

Frail Care / Hospice

(Subject to pre-authorisation) 

100% 

Limited to N$33 250 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$30 500 per Family 

Overall Annual Limit

11.
Drug & Alcohol Addiction
100%
Sub-limit 10
12. 

Refractive Surgery (all-inclusive)

(Subject to pre-authorisation & MHC Guidelines) 

100% 

Limited to N$ 30 000 per eye per Beneficiary

(once-off benefit) 

13. 

Phakic Implants (lens Implant)  (all-inclusive) 

(Subject to pre-authorisation) 

100% 

Limited to N$ 34 750 per Beneficiary

(once-off benefit) 

14. 

Reconstructive Surgery (Medical necessity only) 

(Subject to pre-authorisation and strict MHC Guidelines) 

100% 

Overall Annual Limit

14.1 Consultation and Procedure  100% 

Limited to N$13 750 per Family 

Sub-limit 14

14.2 Hospitalisation  100% 

Overall Annual Limit 

Sub-limit 14

15. 

Dental Surgery 

- Additional Hospital Benefit Cover Excluded 

(Subject to pre-authorisation) 

Overall Annual Limit

15.1 Dental Implants

– Hospitalisation 

100% 

Limited to N$9 500 per Beneficiary 

Limited to N$16 750 per Family 

Sub-limit 15

15.2 Maxillo-Facial & Oral Surgery  (Elective & Non-Elective)  - All-inclusive    100% 

Limited to N$133 250 per Family 

Sub-limit 15

16.  Maternity 

Overall Annual Limit 

16.1 Confinement (all-inclusive)  (Limited to 1 confinement per year for dependent 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 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 of Intrauterine Device w/ hormone (Mirena) (All-inclusive) 

(Subject to Prior approval) 

100% 

Limited to N$6 000 per Beneficiary 

Overall Annual Limit

18.

Stomatherapy (all-inclusive)

(Subject to prior approval)

100%

Limited to N$ 28 750 per Family

Overall Annual Limit

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 Conveyances  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 traveling to foreign countries 

- For emergency cases only (not for elective surgery or procedure) 

100% of cost  N$ 10 000 000 per incident 
    %  NAMAF TARIFF   
21.  General Practitioners & Specialists   

Limited to N$26 500 per Family 

Limited to N$13 250 per Beneficiary 

  21.1 Consultations/Visits (out-of-hospital, including casualties)  100%  Sub-limit 21 
  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)  100%  Sub-limit 21 
 

Benefit Booster applicable 

(Additional benefit once limit is exceeded) 

  Refer to Sub-limit 31
22.  Dentistry   

Limited to N$10 500 per Beneficiary (excluding Orthodontics benefit) 

Limited to N$14 250 per Family (excluding Orthodontics benefit) 

  22.1 Basic Dentistry  100%  Sub-limit 22
  22.2 Specialised / Advanced Dentistry  100%  Sub-limit 22 
  22.3 Dental Implants     
  22.3.1 Consultation & Procedure (in-hospital)  100%  Limited to N$14 000 per Family 
  22.3.2 Consultation & Procedure (in-Practice)  150%  Limited to N$18 500 per Family 
  22.3.3 Implant Component  100% 

Limited to N$7 500 per Beneficiary 

Limited to N$14 500 per Family 

 

Benefit Booster applicable 

(Additional benefit once limit is exceeded) 

  Refer to Sub-limit 31
  22.4 Orthodontics  100%  Limited to N$20 000 per Beneficiary (once-off benefit) 
23.  Medicine & Injections  80% 

Limited to N$26 850 per Beneficiary 

Limited to N$52 000 per Family 

 

23.1 Acute Medicine 

Paid at Maximum Namibia Medicine Price List on generics 

 

Limited to N$7 000 per Beneficiary 

Limited to N$15 000 per Family 

 

23.2 Chronic Medicine 

Paid at Maximum Namibia Medicine Price List on generics 

80% 

Limited to N$17 750 per Beneficiary 

Limited to N$35 000 per Family 

 

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
 

Benefit Booster applicable 

(Additional benefit once limit is exceeded) 

  Refer to Sub-limit 31
 

23.5 Self Medication 

Paid at Maximum Namibia Medicine Price List on generics 

100% 

Limited to N$1 700 per Beneficiary 

Limited to N$2 250 per Family 

Limited to N$215 per script per beneficiary per day  Sub-limit 23
24. 

Specified Illness Conditions

(Subject to pre-authorisation) 

Limited to N$33 250 per Beneficiary 

24.1 HIV/AIDS 

(As per National Guidelines for Antiretroviral Therapy) 

24.1.1 Medicine 

Paid at Maximum Namibia Medicine Price List on generics 

100%  Sub-limit 24
24.1.2 First Full HIV Consultation / Assessment  N$440 

Once off benefit 

Sub-limit 24 

24.1.3 Consultation (after the first full HIV consultation / assessment)  N$405

Limited to 6 consultations per Beneficiary 

Sub-limit 24 

24.1.4 HIV Counselling  100% 

Limited to N$1 300 per Beneficiary 

Sub-limit 24 

24.1.5 Pathology Tests  100%  Sub-limit 24 

24.1.6. HIV Resistance Test 

(Subject pre-authorisation) 

100%  Sub-limit 24 
24.2 Prevention of Mother-to-Child Transmission (PMTCT)  100% 

Sub-limit 24

As per National Guidelines 

24.3 Post-Exposure Prophylaxis (PEP)  100% 

Sub-limit 24 

As per National Guidelines 

24.4 Pre-Exposure Prophylaxis (PrEP)  100% 

Sub-limit 24 

As per National Guidelines 

25.  Primary Health Care Services

Limited to N$ 500 per Beneficiary

Limited to N$ 1 500 per Family

25.1 Consultations  & Procedures

100%  Sub-limit 25

25.2 Medicine & Injections 

Paid at Maximum Namibia Medicine Price List on generics 

80%  Sub-limit 23.1 

Benefit Booster applicable 

(Additional benefit once limit is exceeded) 

Refer to Sub-limit 31
26. 

Auxiliary Services

(Supplementary Services) 

Limited to N$11 750 per Beneficiary 

Limited to N$17 500 per Family 


26.1 Art Therapy
100%
Sub-limit 26

26.2 Audiology / Speech Therapy
100%
Sub-limit 26
26.3 Biokinetics  100% 

Limited to N$5 250 per beneficiary 

Sub-limit 26 


26.4 Chinese Medicine

No beneift

26.5 Chiropractor

26.5.1 Consultation & Procedure

100%
Sub-limit 26

26.5.3 Medicine
80%
Sub-limit 23.1
26.6 Clinical Psychology / Psychological Counsellor  100% 

Limited to N$5 250 per beneficiary 

Sub-limit 26 


26.7 Clinical Technology
100%
Sub-limit 26

26.8 Dietician
100%
Sub-limit 26

26.9 Hearing Aid Acoustician

100% 

Sub-limit 26

26.10 Homeopathy/Naturopathy/ Phytotherapy/Osteopathy  100% Sub-limit 26 
26.10.1 Consultation & Procedure  100%  Sub-limit 26
26.10.2 Medicine  80%  Sub-limit 23.1 
26.11 Occupational Therapy  100%  Sub-limit 26
26.12 Orthotist / Prosthetist 100%  Sub-limit 26
26.13 Physiotherapy  100% 

Limited to N$5 250 per Beneficiary

Sub-limit 26

26.14 Podiatry / Chiropody
100%  Sub-limit 26 

26.15 Social Worker

(Motivation required) 

100% 

Limited to N$5 250 per beneficiary 

Sub-limit 26

Benefit Booster applicable 

(Additional benefit once limit is exceeded) 

Refer to Sub-limit 31 
27. 

Wheelchair 

(Subject to prior approval) 

- Inclusive of repair & maintenance 

100% of cost  Limited to N$13 250 per Beneficiary every 4 years (2019/2022) 
28. 

Appliances (External) 

(Subject to MHC guidelines) 

80%  Limited to N$4 500 per family 
29. 

Hearing Aids Apparatus 

(Subject to prior approval) 

- Inclusive of repair & maintenance 

100% of cost  Limited to N$30 000 per Family every 2 years (2020/2021) 
30.
Medical D3evices for Diabetes Management (Subject to prior approval and MHC guidelines)



30.1 Insulin Pimps / Glucose Monitoring Kit / Glucose Reader
80% of cost
Limited to N$ 40 000 per beneficiary every 4 years (2020 / 2023)

30.2 Diabetes Related Consumables
80% of cost
Limited to N$ 2 500 per Beneficiary
31.  Optical 

N$4 500 per Beneficiary limited to every 2 years (including frames)

N$9 000 per Family (including frames)

31.1 Eye Test  100% 

Limited to one eye test per Beneficiary per annum 

Sub-limit 31

31.2 Contact lenses/Spectacle lenses  100%  Sub-limit 31
31.3 Bi-focal/Multi-focal lenses 

N$1 000 per Beneficiary limited to every 2 years (in addition to sub-limit 31 )

31.4 Frame  100% of cost 

Limited to N$1 150 per Beneficiary 

Sub-limit 31

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

Limited to N$3 250 per Beneficiary 

Limited to N$6 000 per Family 

32.1 Medicine & Injections (Acute & Chronic) 

- Excluding Self-Medication 

70%  Sub-limit 32
32.2 Medicine & Injections (Chronic Pensioner)  90%  Sub-limit 32 
32.3 Dentistry & Dental Implants (Excluding Orthodontic)  70%  Sub-limit 32 
32.4 General Practitioners & Specialists (Consultations/Visits & Procedures/Services out-of-hospital, including casualties)  80%  Sub-limit 32
32.5 Primary Health Care  80%  Sub-limit 32 
32.6 Auxiliary Services  70%  Sub-limit 32
33.  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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