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-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 225% 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 
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 therapy and hormone therapy)  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$33 250 per Family 
10. 

Frail Care 

(Subject to pre-authorisation) 

100%  Limited to N$33 250 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$30 500 per Family 
12.
Drug & Alcohol Addiction
100%
Sub-limit 11
13. 

Refractive Surgery (all-inclusive)

(Subject to pre-authorisation & MHC Guidelines) 

100% 

N$30 000 per eye per Beneficiary

(once-off benefit) 

14. 

Phakic Implants (lens Implant)  (all-inclusive) 

(Subject to pre-authorisation) 

100% 

N$34 750 per Beneficiary

(once-off benefit) 

15. 

Reconstructive Surgery (Medical necessity only) 

(Subject to pre-authorisation and strict MHC Guidelines) 

100% 
15.1 Consultation and Procedure  100%  Limited to N$13 750 per Family 
15.2 Hospitalisation  100%  Overall Annual Limit 
16. 

Dental Surgery 

- Additional Hospital Benefit Cover Excluded 

(Subject to pre-authorisation) 

16.1 Dental Implants

– Hospitalisation 

100% 

Limited to N$9 500 per Beneficiary 

Limited to N$16 750 per Family 

16.2 Maxillo-Facial & Oral Surgery  (Elective & Non-Elective)  - All-inclusive    100%  Limited to N$133 250 per Family 
17.  Maternity 

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

(Subject to pre-authorisation) 

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

(Subject to Prior approval) 

100%  Limited to N$6 000 per Beneficiary 
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 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 perFamily
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 
    %  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 
25.1 Consultations  100%  Sub-limit 21

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 Chiropractor

26.4.1 Consultation & Procedure

100%
Sub-limit 26

26.4.3 Medicine
80%
Sub-limit 23.1
26.5 Clinical Psychology / Psychological Counsellor  100% 

Limited to N$5 250 per beneficiary 

Sub-limit 26 


26.6 Clinical Technology
100%
Sub-limit 26

26.7 Dietician
100%
Sub-limit 26

26.8 Hearing Aid Acoustician

100% 

Sub-limit 26

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

Limited to N$5 250 per Beneficiary

Sub-limit 26

26.13 Podiatry / Chiropody
100%  Sub-limit 26 
26.14 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 (2018/2019) 
30.  Optical 

N$4 500 per Beneficiary limited to every 2 years (including frames) (2019/2020) 

N$9 000 per Family (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 Bi-focal/Multi-focal lenses 

N$1 000 per Beneficiary limited to every 2 years (in addition to sub-limit 30 )

30.4 Frame  100% of cost 

Limited to N$1 150 per Beneficiary 

Sub-limit 30 

31.  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 

31.1 Medicine & Injections (Acute & Chronic) 

- Excluding Self-Medication 

70%  Sub-limit 31
31.2 Medicine & Injections (Chronic Pensioner)  90%  Sub-limit 31 
31.3 Dentistry & Dental Implants (Excluding Orthodontic)  70%  Sub-limit 31 
31.4 General Practitioners & Specialists (Consultations/Visits & Procedures/Services out-of-hospital, including casualties)  80%  Sub-limit 31 
31.5 Primary Health Care  80%  Sub-limit 31 
31.6 Auxiliary Services  70%  Sub-limit 31 
32.  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. 

Download the 2019 Member Guide PDF

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

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