Essence Hospital - Benefits | Bankmed

Key Benefits

  • Adequate range of benefits
  • 100% of NAMAF Tariffs
  • Limited private hospitalisation
  • Limited individual benefit amounts
  • Premiums range between N$1,333 and N$2,603

Contribution Table

Income Band  Family Member
Option  Member  Adult  Child
N$0 - N$2 860 1,333 1,072 249
N$2 861 - N$3 690 1,416 1,140 261
N$3 691 - N$4 770 1,508 1,205 276
N$4 771 - N$5 610 1,837 1,465 335
N$5 611 - N$7 530 1,984 1,594 364
N$7 531 - N$9 450 2,112 1,696 389
N$9 451 - N$14 060 2,222
1,781 414
N$14 061 - N$18 780 2,325 1,866 441
N$18 781 - N$23 540 2,431 1,950 459
N$23 541 - N$28 290 2,258 2,026
480
N$28 291 - N$37 540 2,551 2,049
482
N$37 541 - N$46 700 2,576 2,066
490
N$46 701 + 2,603 2,079
502

Detailed Benefits

 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 

(Benefit available within 3 months from hospital discharge)

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) 


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 Tests for Chromosomal and Foetal Abnormalities

- 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

 

26.2 Procedures/Services

 

26.3 Materials and Disposable Items 

 

26.4 Radiology & Pathology 

27. 

Dentistry 

100%  Paid from Day to Day Pooled Benefit 
 

27.1 Basic /Conservative Dentistry

 

27.2 Specialised / Advanced Dentistry 

 

27.3 Dental Implants 

  No benefit 
 

27.3.1 Consultation & Procedure 

 

27.3.2 Implant Component

  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

 

28.2 Chronic Medicine 

  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 

 

30.2 Audiology/Speech Therapy 

 

30.3 Biokineticist 


30.4 Chinese Medicine  (No benefit)





30.5 Chiropractor

 

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

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 

 

30.1 Eye Test 

 

30.2 Contact lenses/Spectacle lenses

 

30.3 Frame 

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

  • 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
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.

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