N$1 040 000 per Beneficiary 

N$1 560 000 per Family 

Pre-notification: 100% of tariff will be paid out. Without per-authorization: NO benefit will be paid out except in the case if emergency hospital admissions and emergencies after hours, weekends and public holidays.

Sub-limits are not Pro-rated

OVERALL ANNUAL LIMIT 

Hospitalisation

(Subject to Pre-authorisation) 

Overall Annual Limit 

Limited to N$600 per day per Family (applicable to RSA only)

(Maximum of 2 days)

Sub-limit 1 

Sub-limit 1

Sub-limit 1

Sub-limit 1

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 N$ 23 900 per Family 

Sub-limit 2

Sub-limit 2

General Practitioners and Specialists (in- hospital services, procedures & operations) 

- Additional Hospital Benefit Cover included 

Internal Appliances & Materials 

(Subject to pre-authorisation) 

Subject to Bankmed Namibia Internal Prothesis Protocol 

Overall annual Limit

Limited to N$6 250 per Beneficiary every 4 years (2020/2023)

Sub-limit 4

Limited to N$18 500 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$ 600 000 pert Beneficiary

Overall Annual Limit 

6.2 MRI / CT scan & Other specialized radiology procedures in & out of hospital

- Additional hospital benefit cover excluded

- Referral from medical specialist only

Sub-limit 6

Sub-limit 6

Overall Annual Limit

Organ Transplant - Including immune-suppresant drugs 

(Subject to Case Management and MHC Guidelines) 

Private Nursing / Frail Care / Hospice

(Subject to pre-authorisation) 

Limited to N$23 800 per Family

Overall Annual Limit 

Frail Care / Hospice 

(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) 

Drug & Alcohol Addiction

(Subject to prior approval and MHC Guidelines)

Refractive Surgery (all-inclusive)

(Subject to pre-authorisation & MHC Guidelines) 

Limited to N$23 000 per eye per Beneficiary

(Once-off benefit) 

Phakic Implants (lens Implant) (all-inclusive) 

(Subject to pre-authorisation) 

Sub-limit 12  

Reconstructive Surgery (Medical necessity only) 

(Subject to pre-authorisation and strict MHC Guidelines) 

Limited to N$7 000 per Family 

Sub-limit 14

Limited to N$7 500 per Family  

Sub-limit 14

Dental Surgery - Additional Hospital Benefit Cover Excluded 

(Subject to pre-authorisation) 

Overall Annual Limit

Limited to N$9 000 per Beneficiary 

Limited to N$15 750 per Family 

Sub-limit 15

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

- All-inclusive (including dental extractions for children less than 10 years old and wisdom teeth)

Limited to N$90 750 per Family 

Sub-limit 15

15.3 Maxillo-facial & Oral Surgery (elective)

- Hospitalization

limited to N$13 000 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 and 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

16.4 Tests for Chromosomal and Foetal Abnormalities

- Additional Hospital Benefit Cover excluded 

Sub-limit 16

16.5 Midwifery Service 

- Additional Hospital Benefit Cover excluded 

Sub-limit 16

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

(Subject to Prior approval) 

Stomatherapy (all-inclusive)

(Subject to prior approval)

Limited to N$ 22 800 per Family

Overall Annual Limit

Ambulance & Evacuation Services 

(Subject to prior approval)

Limited to N$3 550 per Beneficiary

Sub-limit 19.2 

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

(Subject to prior approval and MHC Guidelines) 

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) 

Sub-limits are pro-rated from date of joining,  except Optical Benefit. 

OVERALL ANNUAL LIMIT 

Limited to N$16 500 per Family 

Limited to N$8 500 per Beneficiary 

Limited to N$8 750 per Beneficiary (excluding Orthodontics benefit) 

Limited to N$11 500 per Family (excluding Orthodontics benefit) 

Limited to N$5 250 per Beneficiary 

Limited to N$11 500 per Family 

Limited to N$2 500 per dental implant component

22.4 Maxillo-facial and Oral Surgery (elective)

In-hospital & In-practice 

Limited to N$11 000 per Beneficiary

(Once-off benefit) 

Limited to N$16 350 per Beneficiary 

Limited to N$30 900 per Family 

23.1 Acute Medicine 

Paid at Maximum Namibia Medicine Price List on generics 

Limited to N$5 950 per Beneficiary 

Limited to N$12 700 per Family 

23.2 Chronic Medicine 

Paid at Maximum Namibia Medicine Price List on generics 

Limited to N$8 750 per Beneficiary 

Limited to N$15 550 per Family 

Sub-limit 23

23.3 Chronic Medicine (Pensioners) 

Paid at Maximum Namibia Medicine Price List on generics 

Limited to N$9 100 per Beneficiary

Limited to N$16 150 per Family

Sub-limit 23

23.4 Essential Vaccination/Immunization  (As per WHO Guidelines) 

Paid at Maximum Namibia Medicine Price List on generics 

23.5 Vitamins, Multivitamins, Minerals, homeopathic / natural / herbal medicine (excluding supplementation during pregnancy and lactation, injections and haematinics. If prescribed, will be paid on the Acute Medicine benefit limit)

Limited to N$300 per Beneficiary

Limited to N$550 per Family

Limited to N$150 per script per Beneficiary 

Sub-limit 23.1  

23.6 Self Medication 

Paid at Maximum Namibia Medicine Price List on generics 

Specified Illness Conditions

(Subject to pre-authorisation) 

24.1 HIV/AIDS 

(As per National Guidelines for Antiretroviral Therapy) 

24.1.1 Medicine 

Paid at Maximum Namibia Medicine Price List on generics 

Limited to 6 consultations per Beneficiary 

Sub-limit 24 

Limited to N$1 350 per Beneficiary 

Sub-limit 24 

Limited to N$7 800 per Beneficiary

Sub-limit 24

Sub-limit 24 

As per National Guidelines 

Sub-limit 24 

As per National Guidelines 

Sub-limit 24

As per National Guidelines 

Limited to N$1 200 pr Beneficiary

Limited to N$2 000 per Family

Limited to N$10 000 per Beneficiary 

Limited to N$12 500 per Family 

Limited to N$3 900 per beneficiary 

Sub-limit 26 

26.4 Chinese Medicine

26.4.1 Consultation & procedure 

26.4.2 Medicine

100%

80%

Limited to N$1 000 per beneficiary

Sub-limit 26

Sub-limit 23.1

26.5 Chiropractor

26.5.1 Consultation & Procedure

Limited to N$3 750 per beneficiary 

Sub-limit 26

Sub-limit 26 

26.9 Hearing Aid Acoustician

26.11 Occupational Therapy

Limited to N$3 750 er Beneficiary

Sub-limit 26 

Limited to N$3 750 per beneficiary 

Sub-limit 26

Benefit Booster applicable 

(Additional benefit once limit is exceeded) 

Wheelchair  (Subject to prior approval) 

- Inclusive of repair & maintenance 

Hearing Aids Apparatus  (Subject to prior approval) 

- Inclusive of repair & maintenance 

Medical Devices for Diabetes Management

(Subject to prior approval and MHC guidelines)

N$2 650 per Beneficiary limited to every 2 years (excluding frames) (2023/2024) 

N$5 300 per Family (including frames) (2021/2022) 

Limited to one eye test per Beneficiary per annum 

Sub-limit 31

Limited to N$1 200 per Beneficiary every 4 years (2021/2024)

Sub-limit 31