Prime - Benefits | Bankmed

Key Benefits

Bankmed Prime  provides a comprehensive range of benefits at a reasonable monthly premium:

  • Comprehensive range of benefits;
  • 100% of NAMAF Tariffs;
  • Overall annual limit cover;
  • Chronic medication benefits;
  • Good individual benefit amounts;
  • Competitive contributions;
  • Available to all Bankmed Namibia Members;
  • Premiums start at  N$1,439 and N$2,887 and
  • Provision for Ex Gratia.

Contribution Table

Income Band Family Member
Option Member Adult Child
N$0 - N$2 950 1,439 1,238 269
N$2 951 - N$3 800 1,539 1,324 288
N$3 801 - N$4 910 1,647 1,408 304
N$4 911 - N$5 780 2,017 1,720 371
N$5 781 - N$7 760 2,176
1,871 401
N$7 761 - N$9 730 2,325
1,996 434
N$9 731 - N$14 480 2,450 2,097 456
N$14 481 - N$19 340 2,564 2,202
484
N$19 341 - N$24 250 2,685 2,302
502
N$24 251 - N$29 140 2,795 2,395
525
N$29 141 - N$38 670 2,823 2,424 528
N$38 671 - N$48 100 2,852 2,446 535
N$48 701 + 2,887 2,465 545

Detailed Benefits

 OVERALL ANNUAL BENEFIT  (OVERALL ANNUAL LIMIT) 

N$1 040 000 per Beneficiary 

N$1 560 000 per Family 

COVER 
CATEGORY A:  HOSPITALISATION BENEFIT  % NAMAF TARIFF 

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 

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) 

Overall Annual Limit 

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 Additional Hospital Benefit Cover excluded  100% 

Sub-limit 1

1.7 Additional Hospital Benefit Cover excluded 

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$6 000 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% 

Limited N$ 23 900 per Family 

Sub-limit 2

2.2 Nuclear Medicine  100% 

Sub-limit 2

3. 

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

- Additional Hospital Benefit Cover  included 

100%  Overall Annual Limit 
4. 

Internal Appliances & Materials 

(Subject to pre-authorisation) 

Subject to Bankmed Namibia Internal Prothesis Protocol 

Overall annual Limit

4.1 Artificial Eyes  100% of cost 

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

Sub-limit 4

4.2 Artificial Limb  100% of cost 

Limited to N$18 500 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 

(Subject to Case Management and MHC Guidelines)

100% 

Limited to N$ 600 000 pert Beneficiary

Overall Annual Limit 

6.1 Consultations and Procedures out of hospital 
100% Sub-limit 6

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

- Additional hospital benefit cover excluded

- Referral from medical specialist only

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


6.5 Hospitalization and related procedures in-hospital
100%

Overall Annual Limit

7. 

Organ Transplant  - Including immune-suppresant drugs 

(Subject to Case Management and MHC Guidelines) 

100%  Overall Annual Limit 
8. 

Private Nursing / Frail Care / Hospice

(Subject to pre-authorisation) 

100% 

Limited to N$23 800 per Family

Overall Annual Limit 

9. 

Frail Care / Hospice 

(Subject to pre-authorisation) 

100% Sub-limit 8
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$20 800 per Family 
11.

Drug & Alcohol Addiction

(Subject to prior approval and MHC Guidelines)

100%
Sub-limit 11
12. 

Refractive Surgery (all-inclusive)

(Subject to pre-authorisation & MHC Guidelines) 

100% 

N$16 000 per eye per Beneficiary

(once-off benefit) 

13. 

Phakic Implants (lens Implant)  (all-inclusive) 

(Subject to pre-authorisation) 

100% 

N$23 650 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$7 000 per Family 

Sub-limit 14

14.2 Hospitalisation  100% 

Overall Annual Limit 

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$9 000 per Beneficiary 

Limited to N$15 750 per Family 

Sub-limit 15

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

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

100% 

Limited to N$90 750 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) 

100%

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 and 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

16.4 Tests for Chromosomal and Foetal Abnormalities

- Additional Hospital Benefit Cover excluded 

100% 

Sub-limit 16

16.5 Midwifery Service 

- Additional Hospital Benefit Cover excluded 

100% 

Sub-limit 16

17. 

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

(Subject to Prior approval) 

100%  Limited to N$6 250 per Beneficiary (pro-rated from date of joining)
18.

Stomatherapy (all-inclusive)

(Subject to prior approval)

100%

Limited to N$ 22 800 per Family

Overall Annual Limit

19. 

Ambulance & Evacuation Services 

(Subject to prior approval)

Overall Annual Limit
19.1 Emergency Ambulance & Flights  (Subject to prior approval)  100%  Unlimited Benefit
19.2 Ambulance/Inter-hospital transfer  (Subject to prior approval)  100%  Sub-limit 19 

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

(Subject to prior approval and MHC Guidelines) 

80% of cost 

Limited to N$9 800 per Family 

Sub-limit 19

19. 

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 
CATEGORY B:  DAY TO DAY BENEFITS  COVER 

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

OVERALL ANNUAL LIMIT 

%  NAMAF TARIFF 
21.  General Practitioners & Specialists 

Limited to N$16 500 per Family 

Limited to N$8 500 per Beneficiary 

21.1 Consultations/Visits (out-of-hospital, including casualties)  100%  Sub-limit 21 
21.2 Procedures/Services (out-of-hospital)  100%  Sub-limit 21 
21.3 Materials and Disposable Items  100%  Sub-limit 21 
21.4 Radiology & Pathology  (Referral from Medical Practitioner)  100%  Sub-limit 21

Benefit Booster applicable 

(Additional benefit once limit is exceeded) 

Refer to Sub-limit 31 
22.  Dentistry 

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

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

22.1 Basic Dentistry  100%  Sub-limit 22
22.2 Specialised / Advanced Dentistry  100%  Sub-limit 22 
22.3 Dental Implants 
22.3.1 Consultation & Procedure (in-hospital)  100%  Limited to N$11 500 per Family 
22.3.2 Consultation & Procedure (in-Practice)  150%  Limited to N$15 000 per Family 
22.3.3 Implant Component  100% 

Limited to N$5 250 per Beneficiary 

Limited to N$11 500 per Family 

Benefit Booster applicable 

(Additional benefit once limit is exceeded) 

Refer to Sub-limit 30 
22.4 Orthodontics  100% 

Limited to N$11 000 per Beneficiary

(once-off benefit) 

23.  Medicine & Injections  80% 

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 

80% 

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 

95% 

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 

100%  Sub-limit 23 

Benefit Booster applicable 

(Additional benefit once limit is exceeded) 

Refer to Sub-limit 31 

23.5 Self Medication 

Paid at Maximum Namibia Medicine Price List on generics 

90%  Limited to N$1 300 per Beneficiary  Limited to N$2 025 per Family 
Limited to N$187 per script per beneficiary per day  Sub-limit 23 
24. 

Specified Illness Conditions

(Subject to pre-authorisation) 

Limited to N$34 550 per Beneficiary 

24.1 HIV/AIDS 

(As per National Guidelines for Antiretroviral Therapy) 

24.1.1 Medicine 

Paid at Maximum Namibia Medicine Price List on generics 

100%  Sub-limit 24 
24.1.2 First Full HIV Consultation / Assessment  N$480
Once off benefit 
Sub-limit 24
24.1.3 Consultation (after the first full HIV consultation / assessment)  N$425 

Limited to 6 consultations per Beneficiary 

Sub-limit 24 

24.1.4 HIV Counselling  100% 

Limited to N$1 350 per Beneficiary 

Sub-limit 24 

24.1.5 Pathology Tests  100%  Sub-limit 24
24.1.6. HIV Resistance Test  (Subject pre-authorisation)  100%  Sub-limit 24 
24.2 Prevention of Mother-to-Child Transmission (PMTCT)  100% 

Sub-limit 24 

As per National Guidelines 

24.3 Post-Exposure Prophylaxis (PEP)  100% 

Sub-limit 24 

As per National Guidelines 

24.4 Pre-Exposure Prophylaxis (PrEP)  100% 

Sub-limit 24

As per National Guidelines 

25.  Primary Health Care Services

Limited to N$1 200 pr Beneficiary

Limited to N$2 000 per Family

25.1 Consultations & Procedures
100%  Sub-limit 25
25.2 Medicine & Injections  Paid at Maximum Namibia Medicine Price List on generics  80%  Sub-limit 23.1 

Benefit Booster applicable 

(Additional benefit once limit is exceeded) 

Refer to Sub-limit 32
26.  Auxiliary Services (Supplementary Services) 

Limited to N$10 000 per Beneficiary 

Limited to N$12 500 per Family 


26.1 Art Therapy
100%
Sub-limit 26

26.2 Audiology / Speech Therapy
100%
Sub-limit 26
26.3 Biokinetics  100% 

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

100%
Sub-limit 26

26.5.2 Medicine
80%
Sub-limit 23.1
26.6 Clinical Psychology / Psychological Counsellor  100% 

Limited to N$3 750 per beneficiary 

Sub-limit 26

26.7 Clinical Technology  100% 

Sub-limit 26 

26.8 Dietician
100%  Sub-limit 26

26.9 Hearing Aid Acoustician

100%
Sub-limit 26
26.10 Homeopathy/Naturopathy/ Phytotherapy
100% Sub-limit 26
26.10.1 Consultation & Procedure  100%  Sub-limit 26
26.10.2 Medicine  80%  Sub-limit 23.1 

26.11 Occupational Therapy

100%  Sub-limit 26 
25.12 Orthotist / Proshetist
100%  Sub-limit 26
26.13 Physiotherapy  100%

Limited to N$3 750 er Beneficiary

Sub-limit 26 

26.14 Podiatry / Chiropody
100%  Sub-limit 26 
26.15 Social Worker  (Motivation required)  100% 

Limited to N$3 750 per beneficiary 

Sub-limit 26

Benefit Booster applicable 

(Additional benefit once limit is exceeded) 

Refer to Sub-limit 31 
27. 

Wheelchair  (Subject to prior approval) 

- Inclusive of repair & maintenance 

100% of cost  Limited to N$8 500 per Beneficiary every 4 years (2019/2022) 
28.  Appliances (External)  (Subject to MHC guidelines)  80%  Limited to N$3 750 per family 
29. 

Hearing Aids Apparatus  (Subject to prior approval) 

- Inclusive of repair & maintenance 

100% of cost  Limited to N$20 000 per Family every 2 years (2020/2021) 
30.

Medical Devices for Diabetes Management

(Subject to prior approval and MHC guidelines)

100%


30.1 Insulin Pumps 
80% of cost
Limited to N$ 35 000 per Beneficiary every 4 years (2020/2023)

30.2 Continuous Glucose Monitoring Kit / Glucose Reader
80% of cost
Limited to N$ 17 500 per Beneficiary

30.2 Diabetes Related Consumables
80% of cost
Limited to N$ 33 500 Beneficiary
31.  Optical 

N$2 650 per Beneficiary limited to every 2 years (excluding frames) (2021/2022) 

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

31.1 Eye Test  100% 

Limited to one eye test per Beneficiary per annum 

Sub-limit 31

31.2 Contact lenses/Spectacle lenses  100%  Sub-limit 31

31.3 Bi-focal / Multi-focal lenses
100%
N$700 per Beneficiary limited to every 2 years (in addition to sub-limit 31) (2021/2022)
31.4 Frame  100% of cost 

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

Sub-limit 31

32.  Benefit Booster  Applicable if Medicine & Injections, Dentistry, GP’s & Specialists, Primary Health Care and Auxiliary Services benefits are depleted 

Limited to N$1 175 per Beneficiary 

Limited to N$1 875 per Family

32.1 Medicine & Injections (Acute & Chronic) 

- Excluding Self-Medication 

70%  Sub-limit 32
32.2 Medicine & Injections (Chronic Pensioner)  90%  Sub-limit 32
32.3 Dentistry & Dental Implants (Excluding Orthodontic)  70%  Sub-limit 32
32.4 General Practitioners & Specialists (Consultations/Visits & Procedures/Services out-of-hospital, including casualties)  80%  Sub-limit 32 
32.5 Primary Health Care  80%  Sub-limit 32 
32.6 Auxiliary Services  70%  Sub-limit 32 
33.  Health SmartCard  No Additional Costs. Each Dependent will receive his/her own Smartcard. Benefits can be verified at Service Providers 24/7. In case of Emergency, Member and Dependents can be identified without Health Smartcard. Next of Kin can be contacted immediately. 

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Managed Healthcare

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HIV/AIDS Programme

Hospital Bedside Support Services

Chronic Medication Programme

Emergency Evacuation Services

Pregnant Members

Self Medication

Self-medication is medicine that can be obtained from the pharmacy for minor ailments.

Covered Medical Appliances

The following external medical appliances are covered by the Fund.

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