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 

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) 

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) 

General Practitioners and Specialists 

(in- hospital services, procedures & operations) 

Internal Appliances & Materials 

(Subject to pre-authorisation) 

Dialysis 

(Subject to Case Management and MHC Guidelines) ) 

Oncology -Active therapy

(surgery, chemotherapy, radiotherapy and hormone therapy) 

Organ Transplant 

- Including immunosuppresant drugs

(Subject to Case Management and MHC Guidelines) 

Hospice Facilities 

(Subject to pre-authorisation) 

Private Nursing 

(Subject to pre-authorisation) 

Frail Care

(Subject to pre-authorisation) 

Psychiatric Treatment

– hospitalisation  (Subject to pre-authorisation) 

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

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) 

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 

16.2 Maxillo Facial & Oral Surgery  (Elective & Non-Elective) 

- All-inclusive   

17.1 Confinement (all-inclusive) 

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

(Subject to pre-authorisation) 

17.2 Ante-natal Consultation 

- Additional Hospital Benefit Cover excluded 

17.3 Sonar Scans (excluding 3D) 

- Additional Hospital Benefit Cover excluded 

17.4 Amniocentesis 

- Additional Hospital Benefit Cover excluded 

17.5 Midwifery Service 

- Additional Hospital Benefit Cover excluded 

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

(Subject to Prior approval) 

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

(Subject to prior approval) 

Limited to N$9 800 per Family 

Overall Annual Limit 

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) 

21.1 HIV/AIDS 

(As per National Guidelines for Antiretroviral Therapy) 

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 

Hearing Aids Apparatus  (Subject to prior approval) 

- Inclusive of repair & maintenance 

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 

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 

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  30.4 Chiropractor 

30.4.1 Consultation & Procedure 

30.4.2 Medicine 

30.5 Clinical Psychology / Psychological Counsellor

30.6 Clinical Technology

30.7 Dietician 

30.8 Hearing Aid Acoustician 

30.9 Homeopathy/Naturopathy/ Phytotherapy 

30.9.1 Consultation & Procedure 

30.9.2 Medicine 

30.10 Occupational Therapy 

30.11 Orthotist/Prosthetist

30.12 Physiotherapy 

30.13 Podiatry/Chiropody

30.14 Social Worker

Optical 

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 

30.1 Eye Test 

30.2 Contact lenses/Spectacle lenses

30.3 Frame 

BENEFIT BOOSTER  

Benefit available only once day-to-day benefit claims paid from Day to Day Pooled Benefit (Category B) plus rejected day to day claims exceed 35% of the annual premium  

Calculated according to NAMAF Tariff Amount and not Claimed Amount   

Limited to N$3 250 per Beneficiary 

Limited to N$6 000 per Family 

33.1 Medicine & Injections (Acute & Chronic) 

- Excluding Self-Medication 

33.2 Medicine & Injections

(Chronic Pensioner) 

33.3 Dentistry 

(Excluding Dental Implants & Orthodontic) 

33.4 General Practitioners & Specialists

(Consultations/Visits & Procedures/Services out-of-hospital, including casualties)