N$1 000 000 per Beneficiary 

N$1 500 000 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) 

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) 

- Additional Hospital Benefit Cover  included 

Internal Appliances & Materials 

(Subject to pre-authorisation) 

Dialysis 

(Subject to Case Management and MHC Guidelines) ) 

Oncology

-Active therapy (surgery, chemotherapy and radiotherapy) 

Organ Transplant  - Including immune-suppresant 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) 

Drug & Alcohol Addiction

(Subject to prior approval and MHC Guidelines)

Refractive Surgery (all-inclusive)

(Subject to pre-authorisation & MHC Guidelines) 

N$16 000 per eye per Beneficiary

(once-off benefit) 

Phakic Implants (lens Implant)  (all-inclusive) 

(Subject to pre-authorisation) 

N$22 750 per Beneficiary

(once-off benefit) 

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$9 000 per Beneficiary 

Limited to N$15 750 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 

Limited to 12 consultations per Beneficiary 

(Pro-rated from date of joining) 

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 and MHC Guidelines) 

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 

Benefit Booster applicable 

(Additional benefit once limit is exceeded) 

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 

Benefit Booster applicable 

(Additional benefit once limit is exceeded) 

Limited to N$12 250 per Beneficiary

(once-off benefit) 

Limited to N$15 750 per Beneficiary 

Limited to N$29 750 per Family 

23.1 Acute Medicine 

Paid at Maximum Namibia Medicine Price List on generics 

Limited to N$5 750 per Beneficiary 

Limited to N$12 250 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$8 750 per Beneficiary

Limited to N$15 550 per Family

Sub-limit 23

23.4 Essential Vaccination/Immunization  (As per WHO Guidelines) 

Paid at Maximum Namibia Medicine Price List on generics 

Benefit Booster applicable 

(Additional benefit once limit is exceeded) 

23.5 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$1 300 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 

Benefit Booster applicable 

(Additional benefit once limit is exceeded) 

Limited to N$10 000 per Beneficiary 

Limited to N$12 500 per Family 

Limited to N$3 750 per beneficiary 

Sub-limit 26 

26.4 Chiropractor

26.4.1 Consultation & Procedure

Limited to N$3 750 per beneficiary 

Sub-limit 26

Sub-limit 26 

26.8 Hearing Aid Acoustician

26.10 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 

N$3 250 per Beneficiary limited to every 2 years (including frames) (2019/2020) 

N$6 500 per Family (including frames) 2019/2020) 

Limited to one eye test per Beneficiary per annum 

Sub-limit 30

Limited to N$1 000 per Beneficiary 

Sub-limit 30 

31.1 Medicine & Injections (Acute & Chronic) 

- Excluding Self-Medication