N$ 1 600 000 per Beneficiary 

N$ 2 400 000 per Family 

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 

Hospitalisation

(Subject to Pre-authorisation) 

Limited to N$600 per day per Family (applicable to RSA only)

(Maximum of 2 days) 

1.4 Intensive and High Care 

- Maximum of 3 days then motivation 

1.6 Radiology & Pathology (in-hospital)

- Additional Hospital Benefit Cover excluded

1.7 Physiotherapy    

- Additional Hospital Benefit Cover excluded

1.7.2 Physiotherapy (post rehabilitation) 

- Additional benefit once the patient is out of hospital 

(Subject to prior approval) 

N$6 000 per Family 

(Benefit available within 3 months from hospital discharge)

Sub-limit 1.7

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

Limited to N$35 000 per Family

Sub-limit 2  

General Practitioners and Specialists (in- hospital services, procedures & operations) 

- Additional Hospital Benefit Cover included 

Internal Appliances & Materials 

(Subject to pre-authorisation) 

Subject to Bankmed Namibia Internal Prosthesis Protocol 

Overall Annual Limit

Limited to N$ 16 430 per Beneficiary every 4 years

Sub-limit 4 

Limited to N$ 23 860 per Beneficiary every 4 years

Sub-limit 4 

Dialysis 

(Subject to Case Management and MHC Guidelines) ) 

Oncology 

(Subject to Case Management and MHC guidelines) 

Limited to N$ 750 000 per Beneficiary

Overall Annual Limit 

6.2 MRI / CT Scans & Other Specialized Radiology Procedures in & out of hospital

- Additional hospital benefit cover excluded

- Referral from medical specialist only

Sub-limit 6

Sub-limit 6

Overall Annual Limit 

Organ Transplant  - Including immune-suppresant drugs 

(Subject to Case Management and MHC Guidelines) 

Private Nursing / Frail Care / Hospice

(Subject to pre-authorisation) 

Limited to N$33 250 per Family 

Overall Annual Limit

Frail Care / Hospice

(Subject to pre-authorisation) 

Sub-limit 8 

Psychiatric Treatment

– Hospitalisation  (Subject to pre-authorisation)

- Referral from Psychiatrist only  (Referral by GP acceptable in places where there is no Psychiatrist) 

Limited to N$31 700 per Family 

Overall Annual Limit

Refractive Surgery (all-inclusive)

(Subject to pre-authorisation & MHC Guidelines) 

Limited to N$ 35 000 per eye per Beneficiary

(once-off benefit) Overall Annula Limit

Phakic Implants (lens Implant) (all-inclusive) 

(Subject to pre-authorisation) 

Reconstructive Surgery (Medical necessity only) 

(Subject to pre-authorisation and strict MHC Guidelines) 

Overall Annual Limit

Limited to N$14 300 per Family 

Sub-limit 14

Limited to N$15 000 per Family

Sub-limit 14

Dental Surgery 

- Additional Hospital Benefit Cover Excluded 

(Subject to pre-authorisation) 

Overall Annual Limit

15.1 Dental Implants

– Hospitalisation 

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 

(Including dental extractions for children less than 10 years old and wisdom teeth extractions)

Limited to N$133 250 per Family 

Sub-limit 15

15.3 Maxillio-facial & Oral Surgery (elective) 

- Hospitalization

Limited to N$19 000per Family

Sub-limit 15

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 

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

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 

Limited to 3 scans per Beneficiary per pregnancy

Sub-limit 16

16.5 Tests for Chromosomal and Foetal Abnormalities 

- Additional Hospital Benefit Cover excluded 

16.6 Midwifery Service 

- Additional Hospital Benefit Cover excluded 

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

(Subject to Prior approval) 

Limited to N$6 250 per Beneficiary (pro-rated from date of joining)

Overall Annual Limit

Stomatherapy (all-inclusive)

(Subject to prior approval)

Limited to N$ 28 750 per Family

Overall Annual Limit

Overall Annual Limit

19.1 Emergency Ambulance & Flights 

(Subject to prior approval) 

19.2 Ambulance/Inter-hospital transfer 

(Subject to prior approval) 

Limited to N$5 500 per Beneficiary

Sub-limit 19.2

19.3 Other Conveyances Transport benefit for medical services available only in RSA

(Subject to prior approval and MHC Guidelines) 

Limited to N$ 9 800 per Family

Sub-limit 19

International Medical Travel Insurance 

- Medical cover when traveling to foreign countries 

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

Limited to N$26 500 per Family 

Limited to N$13 250 per Beneficiary 

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

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

Limited to N$7 500 per Beneficiary 

Limited to N$14 500 per Family 

Limited to N$3 500 per dental implant component

22.4 Maxillio-facial and Oral Surgery (elective) 

In-hospital and in-practice

Limited to N$27 900 per Beneficiary 

Limited to N$54 000 per Family 

23.1 Acute Medicine 

Paid at Maximum Namibia Medicine Price List on generics 

Limited to N$7 800 per Beneficiary 

Limited to N$15 600 per Family 

23.2 Chronic Medicine 

Paid at Maximum Namibia Medicine Price List on generics 

Limited to N$18 450 per Beneficiary 

Limited to N$36 400 per Family 

23.3 Chronic Medicine (Pensioners) 

Paid at Maximum Namibia Medicine Price List on generics 

23.4 Essential Vaccination/Immunization (As per WHO Guidelines) 

Paid at Maximum Namibia Medicine Price List on generics 

Vitamins, Multivitamins, Minerals, homeopathic / natural / herbal medicine (excluding supplementation during pregnancy and lactation, injections and haematinics. If prescribed, will be paid on the Acute Medicine benefit limit)

Limited to N$500 per Beneficiary

Limited to N$950 per Family

Limited to N$150 per script per Beneficiary 

Sub-limit 23.1

23.6 Self Medication 

Paid at Maximum Namibia Medicine Price List on generics 

Limited to N$1 760 per Beneficiary 

Limited to N$2 340 per Family 

Limited to N$223 per script per beneficiary per day

Sub-limit 23

Specified Illness Conditions

(Subject to pre-authorisation) 

24.1 HIV/AIDS 

(As per National Guidelines for Antiretroviral Therapy) 

24.1.1 Medicine 

Paid at Maximum Namibia Medicine Price List on generics 

Once off benefit 

Sub-limit 24 

Limited to 6 consultations per Beneficiary 

Sub-limit 24 

Limited to N$1 350 per Beneficiary 

Sub-limit 24 

Limited to N$7 800 per Beneficiary

Sub-limit 24 

24.1.6. HIV Resistance Test 

(Subject pre-authorisation) 

Sub-limit 24

As per National Guidelines 

Sub-limit 24 

As per National Guidelines 

Sub-limit 24 

As per National Guidelines 

Limited to N$1 500 per Beneficiary

Limited to N$2 500 per Family

25.1 Consultations & Procedures

25.2 Medicine & Injections 

Paid at Maximum Namibia Medicine Price List on generics 

Auxiliary Services

(Supplementary Services) 

Limited to N$11 750 per Beneficiary 

Limited to N$17 500 per Family 

Limited to N$5 250 per beneficiary 

Sub-limit 26 

26.4 Chinese Medicine

26.4.1 Consultations & Procedure

26.4.2 Medicine

100%

80%

Limited to N$ 1 500 per Beneficiary

Sub-limit 26

Sub-limit 23.1

26.5 Chiropractor

26.5.1 Consultation & Procedure

Limited to N$5 250 per beneficiary 

Sub-limit 26 

26.9 Hearing Aid Acoustician

Sub-limit 26

Limited to N$5 250 per Beneficiary

Sub-limit 26

26.15 Social Worker

(Motivation required) 

Limited to N$5 250 per beneficiary 

Sub-limit 26

Wheelchair 

(Subject to prior approval) 

- Inclusive of repair & maintenance 

Appliances (External) 

(Subject to MHC guidelines) 

Hearing Aids Apparatus 

(Subject to prior approval) 

- Inclusive of repair & maintenance 

N$3 700 per Beneficiary limited to every 2 years (excluding frames) (2023/2024)

N$7 400 per Family (excluding frames)

Limited to one eye test per Beneficiary per annum 

Sub-limit 31

N$1 000 per Beneficiary limited to every 2 years (in addition to sub-limit 31) (2023/2022)

Limited to N$1 400 per Beneficiary every 4 years (2021/2024)