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 

Limited to N$600 per day per Family  (Maximum of 2 days) 

Sub-limit 1

Sub-limit 1

1.4 Intensive and High Care 

- Maximum of 3 days then motivation 

Sub-limit 1

  1.6 Radiology & Pathology (in hospital)   

- Additional Hospital benefit Cover excluded 

Sub-limit 1

  1.7 Physiotherapy   

- Additional Hospital Benefit Cover excluded 

Sub-limit 1

Sub-limit 1.7

1.7.2 Physiotherapy (post rehabilitation) 

- Additional benefit once the patient is out of hospital 

(Subject to prior approval) 

Limited to 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

Sub-limit 2

General Practitioners and Specialists 

(in- hospital services, procedures & operations) 

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 (2020/2023)

Sub-limit 4 

Limited to N$ 32 860 per Beneficiary every 4 years (2020/2023)

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 and out of hospital

- Additional hospital benefit cover

- Referral from medical specialist

Sub-limit 6

Overall Annual Limit 

Organ Transplant 

- Including immunosuppresant drugs

(Subject to Case Management and MHC Guidelines) 

Private Nursing / Frail Care / Hospice

(Subject to pre-authorisation) 

Limited to N$37 250 per Family

Overall Annual Limit 

Frail Care / Hospice

(Subject to pre-authorisation) 

Psychiatric Treatment

– Hospitalization  (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 

Alcoholism / Drug Addiction 

(Subject to prior approval and MHC Guidelines) 

Refractive Surgery (all-inclusive)

(Subject to pre-authorisation & MHC Guidelines) 

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 

Dental Surgery 

- Additional Hospital Benefit Cover Excluded 

(Subject to pre-authorisation) 

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)

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

Overall Annual Limit 

16.1 Confinement (all-inclusive) 

(Limited to 1 confinement per year for dep. other than the spouse) 

(Subject to pre-authorisation) 

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 

Overall Annual Limit 

Sub-limit 16

16.6 Midwifery Service 

- Additional Hospital Benefit Cover excluded 

Overall Annual Limit 

Sub-limit 16

Insertion of Intrauterine Device w/ hormone (Mirena) (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

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

(Subject to prior approval) 

Limited to N$9 800 per Family 

Sub-limit 19

International Medical Travel Insurance 

- Medical cover when travelling to foreign countries 

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

Specified Illness Conditions

(Subject to pre-authorisation) 

Limited to N$34 550 per Beneficiary 

Overall Annual Limit

21.1 HIV/AIDS 

(As per National Guidelines for Antiretroviral Therapy) 

Sub-limit 21

Limited to 6 consultations per Beneficiary 

Sub-limit 21 

21.1.6 HIV Resistance Test 

(Subject pre-authorisation) 

Sub-limit 21 

As per National Guidelines 

Sub-limit 21 

As per National Guidelines 

Wheelchair  (Subject to prior approval) 

- Inclusive of repair & maintenance 

Limited to N$13 250 per Beneficiary every 4 years (2019/2022) 

Overall Annual Limit

Limited to N$4 500 per family 

Overall Annual Limit

Hearing Aids Apparatus  (Subject to prior approval) 

- Inclusive of repair & maintenance 

Limited to N$30 000 per Family every 2 years (2020/2021)

Overall Annual Limit

Medical Devices for Diabetes Management

(Subject to prior approval and MHC guidelines)

N$5 200 per Beneficiary per Annum 

N$10 400 per Family per Annum 

OVERALL ANNUAL LIMIT 

Benefits are prorated from Date of Joining  Ex Gratia not Applicable 

General Practitioners & Specialists 

26.1 Consultations/Visits

26.2 Procedures/Services

26.3 Materials and Disposable Items 

26.4 Radiology & Pathology 

Dentistry 

27.1 Basic /Conservative Dentistry

27.2 Specialised / Advanced Dentistry 

27.3 Dental Implants 

27.3.1 Consultation & Procedure 

27.3.2 Implant Component

Medicine & Injections 

Paid from Day to Day Pooled Benefit 

Paid at Maximum Namibia Medicine Price List on generics 

28.1 Acute Medicine

28.2 Chronic Medicine 

Paid from Day to Day Pooled Benefit 

Paid at Maximum Namibia Medicine Price List on generics 

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

Paid form day to day pooled benefit

Paid at maximum Namibia medicine price list on generics

Paid from Day to Day Pooled Benefit 

Medicines paid at Maximum Namibia Medicine Price List on generics 

Auxiliary Services (Supplementary Services) 

30.1 Art Therapy 

30.2 Audiology/Speech Therapy 

30.3 Biokineticist 

30.5.1 Consultation & Procedure 

30.5.2 Medicine 

30.6 Clinical Psychology / Psychological Counsellor

30.7 Clinical Technology

30.8 Dietician 

30.9 Hearing Aid Acoustician 

30.10 Homeopathy/Naturopathy/ Phytotherapy 

30.10.1 Consultation & Procedure 

30.10.2 Medicine 

30.11 Occupational Therapy 

30.12 Orthotist/Prosthetist

30.13 Physiotherapy 

30.14 Podiatry/Chiropody

30.15 Social Worker

Optical 

Limited to N$3 900 per Family (excluding frames)

Limited to N$1 950 per Beneficiary every 2 years (excluding frames) (2021/2022) 

Paid from Day to Day Pooled Benefit 

Sub-limit 31

Sub-limit 31

Limited to N$750 per Beneficiary every 4 years (2021/2024)

31.1 Eye Test 

31.2 Contact lenses/Spectacle lenses

30.3 Frame