Kobus Smit
Member since: 01 February 2017
I would like to thank my medical aid for all the help and support they gave me during the time I spent in hospital. They ensured that my stay was comfortable and that my needs were met. Thank you Bankmed
| Income Band | Family Member | ||
| Option | Member | Adult | Child |
| N$0 - N$2 860 | 1,258 | 1,011 | 235 |
| N$2 861 - N$3 690 | 1,336 | 1,075 | 246 |
| N$3 691 - N$4 770 | 1,423 | 1,137 | 260 |
| N$4 771 - N$5 610 | 1,733 | 1,382 | 316 |
| N$5 611 - N$7 530 | 1,872 | 1,504 | 343 |
| N$7 531 - N$9 450 | 1,992 | 1,600 | 367 |
| N$9 451 - N$14 060 | 2,096 |
1,680 | 391 |
| N$14 061 - N$18 780 | 2,193 | 1,760 | 416 |
| N$18 781 - N$23 540 | 2,293 | 1,840 | 433 |
| N$23 541 - N$28 290 | 2,385 | 1,911 | 453 |
| N$28 291 - N$37 540 | 2,407 | 1,933 | 455 |
| N$37 541 - N$46 700 | 2,430 | 1,949 | 462 |
| N$46 701 + | 2,456 | 1,961 | 474 |
| OVERALL ANNUAL BENEFIT (OVERALL ANNUAL LIMIT) | UNLIMITED BENEFIT | ||
| 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) | ||
| 1.1 Accommodation & Theatre | 100% | Sub-limit 1 | |
| 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) Sub-limit 1 |
|
| 1.3 Blood Transfusions | 100% |
Sub-limit 1 |
|
1.4 Intensive and High Care - Maximum of 3 days then motivation |
100% | Sub-limit 1 |
|
| 1.5 Medicine, fixed tariff procedures, hospital apparatus and To Take Out Medicine (7 days supply only) | 100% |
Sub-limit 1 |
|
1.6 Radiology & Pathology (in hospital) - Additional Hospital benefit Cover excluded |
100% |
Sub-limit 1 |
|
1.7 Physiotherapy - Additional Hospital Benefit Cover excluded |
100% |
Sub-limit 1 |
|
| 1.7.1 Physiotherapy (in hospital) | 100% |
Sub-limit 1.7 |
|
1.7.2 Physiotherapy (post rehabilitation) - Additional benefit once the patient is out of hospital (Subject to prior approval) |
100% | Limited to N$5 800 per family Sub-limit 1.7 |
|
| 2. | Specialised Radiology Procedures (in & out of hospital) - Additional Hospital Benefit Cover excluded - Referral from a medical specialist only (referral from GP acceptable in places where there is no medical specialist) (Subject to prior approval) |
Overall Annual Limit |
|
| 2.1 MRI & CT Scans | 100% |
Sub-limit 2 |
|
| 2.2 Nuclear Medicine | 100% | Sub-limit 2 |
|
| 3. | General Practitioners and Specialists (in- hospital services, procedures & operations) |
100% | Overall Annual Limit |
| 4. | Internal Appliances & Materials (Subject to pre-authorisation) |
Subject to Bankmed Namibia Internal Prosthesis Protocol Overall Annual Limit |
|
| 4.1 Artificial Eyes | 100% of cost |
Limited to N$ 16 430 per Beneficiary every 4 years (2020/2023) Sub-limit 4 |
|
| 4.2 Artificial Limb | 100% of cost | Limited to N$ 32 860 per Beneficiary every 4 years (2020/2023) 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 immunosuppresant 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 |
| 9. |
Frail Care / Hospice (Subject to pre-authorisation) |
100% | Limited to N$33 250 per Family |
| 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 |
| 11. | Alcoholism / Drug Addiction (Subject to prior approval and MHC Guidelines) |
100% |
Sub-limit 10 |
| 12. | Refractive Surgery (all-inclusive) (Subject to pre-authorisation & MHC Guidelines) |
100% | Limited to N$30 000 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% | 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 Overall Annual Limit Sub-limit 15 |
|
15.2 Maxillo-acial & Oral Surgey (Elective & Non-elective) Full procedure |
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 dep. other than the spouse) (Subject to pre-authorisation) |
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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 Amniocentesis - Additional Hospital Benefit Cover excluded |
100% | Overall Annual Limit Sub-limit 16 |
|
16.6 Midwifery Service - Additional Hospital Benefit Cover excluded |
100% | Overall Annual Limit 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 | 100% | Unlimited | |
| 19.2 Ambulance/Inter-hospital transfer | 100% | Sub-limit 19 |
|
19.3 Other Conveyances Transport benefit for medical services available only in RSA (Subject to prior approval) |
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) |
Sub-limit 21 |
||
| 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$1300 per Beneficiary | |
| 21.1.5 Pathology Tests | 100% | Sub-limit 21 | |
21.1.6 HIV Resistance Test (Subject 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% | ||
| 22. | Wheelchair (Subject to prior approval) - Inclusive of repair & maintenance |
100% of cost | Limited to N$13 250 per Beneficiary every 4 years (2019/2022) Overall Annual Limit |
| 23. | Appliances (External) (Subject to MHC guidelines) | 80% | Limited to N$4 500 per family Overall Annual Limit |
| 24. | 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) Overall Annual Limit |
| 25. | Medical Devices for Diabetes Management (Subject to prior approval and MHC guidelines) |
No benefit |
|
| CATEGORY B: DAY TO DAY POOLED BENEFIT | 100% Tariff |
N$5 000 per Beneficiary per Annum N$10 000 per Family per Annum OVERALL ANNUAL LIMIT Benefits are prorated from Date of Joining Ex Gratia not Applicable |
|
| 26. |
General Practitioners & Specialists |
100% | Paid from Day to Day Pooled Benefit |
|
26.1 Consultations/Visits |
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26.2 Procedures/Services |
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26.3 Materials and Disposable Items |
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26.4 Radiology & Pathology |
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| 27. |
Dentistry |
100% | Paid from Day to Day Pooled Benefit |
|
27.1 Basic /Conservative Dentistry |
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27.2 Specialised / Advanced Dentistry |
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27.3 Dental Implants |
No benefit | ||
|
27.3.1 Consultation & Procedure |
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27.3.2 Implant Component |
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| 27.4 Orthodontics | No benefit | ||
| 28. |
Medicine & Injections |
80% |
Paid from Day to Day Pooled Benefit Paid at Maximum Namibia Medicine Price List on generics |
|
28.1 Acute Medicine |
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28.2 Chronic Medicine |
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| 28.3 Chronic Medicine (Pensioners) | 100% |
Paid from Day to Day Pooled Benefit Paid at Maximum Namibia Medicine Price List on generics |
|
| 28.4 Self Medication | 100% |
Paid from Day to Day Pooled Benefit Paid at Maximum Namibia Medicine Price List on generics |
|
28.5 Essential Vaccination / Immunization (as per WHO guidelines) Paid at maximum Namibia medicine price list on generics | 100% | Paid form day to day pooled benefit Paid at maximum Namibia medicine price list on generics | |
| 29. | Primary Health Care Services | ||
| 29.1 Consultations | 100% | Paid from Day to Day Pooled Benefit | |
| 29.2 Medicine & Injections | 80% |
Paid from Day to Day Pooled Benefit Medicines paid at Maximum Namibia Medicine Price List on generics |
|
| 30. |
Auxiliary Services (Supplementary Services) |
100% | Paid from Day to Day Pooled Benefit |
|
30.1 Art Therapy |
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30.2 Audiology/Speech Therapy |
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30.3 Biokineticist 30.4 Chiropractor |
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30.4.1 Consultation & Procedure |
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30.4.2 Medicine |
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30.5 Clinical Psychology / Psychological Counsellor |
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30.6 Clinical Technology |
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30.7 Dietician |
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30.8 Hearing Aid Acoustician |
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30.9 Homeopathy/Naturopathy/ Phytotherapy |
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30.9.1 Consultation & Procedure |
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30.9.2 Medicine |
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30.10 Occupational Therapy |
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30.11 Orthotist/Prosthetist |
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30.12 Physiotherapy |
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30.13 Podiatry/Chiropody |
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30.14 Social Worker |
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| 31. |
Optical |
100% |
Limited to N$4 750 per Family Limited to N$2 400 per Beneficiary every 2 years (including frames) (2019/2020) Paid from Day to Day Pooled Benefit |
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30.1 Eye Test |
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30.2 Contact lenses/Spectacle lenses |
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30.3 Frame |
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| 32. | Health SmartCard | No Additional Costs. Each Dependant will receive his/her own smartcard. Benefits can be verified at Service Providers 24/7. In case of Emergency, Member and Dependants can be identified without Health Smartcard. Next of Kin can be contacted immediately. | |
CATEGORY C: ADDITIONAL FUND BENEFITS (DAY TO DAY EXPENSES) | % NAMAF TARIFF | BENEFIT BOOSTER
| |
| 33. | Benefit Booster Applicable if medicine and injection, dentistry, GP's and specialists, primary healthcare and auxiliary services benefits are depleted | Limited to N$ 3 250 per Beneficiary Limited to N$ 6 000 per Family | |
33.1 Medicine & injections (acute & chronic) - Excluding self-medication | 70% | Sub-limit 33 | |
| 33.2 Medicine & injections (chronic pensioner) | 90% | Sub-limit 33 | |
| 33.3 Dentistry (excluding dental implants & orthodontic) | 70% | Sub-limit 33 | |
| 33.4 General practitioners & specialists (consultations / visits & procedures / services out-of-hospital, including casualties) | 80% | Sub-limit 33 | |
| 33.5 Primary Health Care | 80% | Sub-limit 33 | |
| 33.6 Auxiliary Services | 70% | Sub-limit 33 |
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Self-medication is medicine that can be obtained from the pharmacy for minor ailments.
The following external medical appliances are covered by the Fund.
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Member since: 01 February 2017
I would like to thank my medical aid for all the help and support they gave me during the time I spent in hospital. They ensured that my stay was comfortable and that my needs were met. Thank you Bankmed
Lifestyle Management is a continuous process of making healthy lifestyle choices on a daily basis. It requires commitment to live a more balanced and healthy lifestyle, and we therefore want to assist you in breaking those bad habits that cause unnecessary health problems. read more
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