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 range between N$1,192 and N$5,784 and
  • Provision for Ex Gratia.

Contribution Table

Income Band Family Member
Option Member Adult Child
N$0 - N$2 860 1,192 1,025 223
N$2 861 - N$3 690 1,274 1,096 239
N$3 691 - N$4 770 1,364 1,166 252
N$4 771 - N$5 610 1,670 1,424 307
N$5 611 - N$7 530 1,802 1,549 332
N$7 531 - N$9 450 1,925 1,652 359
N$9 451 - N$14 060 2,028 1,736 378
N$14 061 - N$18 780 2,123 1,822 401
N$18 781 - N$23 540 2,223 1,906 416
N$23 541 - N$28 290 2,314 1,982 434
N$28 291 - N$37 540 2,337 2,007 437
N$37 541 - N$46 700 2,362 2,025 443
N$46 701 + 2,391 2,040 451

Detailed Benefits

 OVERALL ANNUAL BENEFIT  (OVERALL ANNUAL LIMIT) 

N$1 000 000 per Beneficiary 

N$1 500 000 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 225% of NAMAF Tariff 
1. 

Hospitalisation

(Subject to Pre-authorisation) 

1.1 Accommodation & Theatre  100%  Overall Annual Limit 
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) 
1.3 Blood Transfusions  100%  Overall Annual Limit 
1.4 Intensive and High Care  - Maximum of 3 days then motivation  100%  Overall Annual Limit 
1.5 100%  Overall Annual Limit 
1.6 Additional Hospital Benefit Cover excluded  100%  Overall Annual Limit 
1.7 Additional Hospital Benefit Cover excluded 
1.7.1 Physiotherapy (in hospital)  100%  Overall Annual Limit 

1.7.2 Physiotherapy (post rehabilitation) 

- Additional benefit once the patient is out of hospital 

(Subject to prior approval) 

100%  N$5 800 per family 
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) 

2.1 MRI & CT Scans  100%  Limited N$ 23 000 per Family 
2.2 Nuclear Medicine  100%  Overall Annual Limit 
2.3 Radiation Oncology  100%  Overall Annual Limit 
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 Protocol 
4.1 Artificial Eyes  100% of cost  Limited to N$6 250 per Beneficiary every 2 years 
4.2 Artificial Limb  100% of cost  Limited to N$18 500 per Beneficiary every 2 years 
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

-Active therapy (surgery, chemotherapy and radiotherapy) 

100%  Overall Annual Limit 
(Subject to Case Management and MHC Guidelines) 
7. 

Organ Transplant  - Including immune-suppresant drugs 

(Subject to Case Management and MHC Guidelines) 

100%  Overall Annual Limit 
8. 

Hospice Facilities 

(Subject to pre-authorisation) 

100%  Overall Annual Limit 
9. 

Private Nursing 

(Subject to pre-authorisation) 

100%  Limited to N$21 250 per Family 
10. 

Frail Care 

(Subject to pre-authorisation) 

100%  Limited to N$21 250 per Family 
11. 

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$20 000 per Family 
12.

Drug & Alcohol Addiction

(Subject to prior approval and MHC Guidelines)

100%
Sub-limit 11
13. 

Refractive Surgery (all-inclusive)

(Subject to pre-authorisation & MHC Guidelines) 

100% 

N$16 000 per eye per Beneficiary

(once-off benefit) 

14. 

Phakic Implants (lens Implant)  (all-inclusive) 

(Subject to pre-authorisation) 

100% 

N$22 750 per Beneficiary

(once-off benefit) 

15. 

Reconstructive Surgery (Medical necessity only) 

(Subject to pre-authorisation and strict MHC Guidelines) 

100% 
15.1 Consultation and Procedure  100%  Limited to N$6 750 per Family 
15.2 Hospitalisation  100%  Overall Annual Limit 
16. 

Dental Surgery  - Additional Hospital Benefit Cover Excluded 

(Subject to pre-authorisation) 

16.1 Dental Implants – Hospitalisation  100% 

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   

100%  Limited to N$90 750 per Family 
17.  Maternity 

17.1 Confinement (all-inclusive)  (Limited to 1 confinement per year for dep. other than the spouse) 

(Subject to pre-authorisation) 

Overall Annual Limit 

17.2 Ante-natal Consultation 

- Additional Hospital Benefit Cover excluded 

100% 

Limited to 12 consultations per Beneficiary 

(Pro-rated from date of joining) 

17.3 Sonar Scans (excluding 3D) 

- Additional Hospital Benefit Cover excluded 

100%  Limited to 3 scans per Beneficiary per pregnancy 

17.4 Amniocentesis 

- Additional Hospital Benefit Cover excluded 

100%  Overall Annual Limit 

17.5 Midwifery Service 

- Additional Hospital Benefit Cover excluded 

100%  Overall Annual Limit 
18. 

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

(Subject to Prior approval) 

100%  Limited to N$6 000 per Beneficiary 
19.  Ambulance & Evacuation Services 
19.1 Emergency Ambulance & Flights  (Subject to prior approval)  100%  Overall Annual Limit 
19.2 Ambulance/Inter-hospital transfer  (Subject to prior approval)  100%  Overall Annual Limit 

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 
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 
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$12 250 per Beneficiary

(once-off benefit) 

23.  Medicine & Injections  80% 

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 

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 

100% 

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 

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 

100%  Limited to N$1 250 per Beneficiary  Limited to N$1 950 per Family 
Limited to N$180 per script per beneficiary per day  Sub-limit 23 
24. 

Specified Illness Conditions

(Subject to pre-authorisation) 

Limited to N$32 500 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$440
Once off benefit 
Sub-limit 24
24.1.3 Consultation (after the first full HIV consultation / assessment)  N$405 

Limited to 6 consultations per Beneficiary 

Sub-limit 24 

24.1.4 HIV Counselling  100% 

Limited to N$1 300 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 
25.1 Consultations  100%  Sub-limit 21 
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 31 
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$3 750 per beneficiary 

Sub-limit 26 


26.4 Chiropractor

26.4.1 Consultation & Procedure

100%
Sub-limit 26

26.4.2 Medicine
80%
Sub-limit 23.1
26.5 Clinical Psychology / Psychological Counsellor  100% 

Limited to N$3 750 per beneficiary 

Sub-limit 26

26.6 Clinical Technology  100% 

Sub-limit 26 

26.7 Dietician
100%  Sub-limit 26

26.8 Hearing Aid Acoustician

100%
Sub-limit 26
26.9 Homeopathy/Naturopathy/ Phytotherapy
100% Sub-limit 26
26.9.1 Consultation & Procedure  100%  Sub-limit 26
26.9.2 Medicine  80%  Sub-limit 23.1 

26.10 Occupational Therapy

100%  Sub-limit 26 
25.11 Orthotist / Proshetist
100%  Sub-limit 26
26.12 Physiotherapy  100%

Limited to N$3 750 er Beneficiary

Sub-limit 26 

26.13 Podiatry / Chiropody
100%  Sub-limit 26 
26.14 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 (2018/2019) 
30.  Optical 

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

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

30.1 Eye Test  100% 

Limited to one eye test per Beneficiary per annum 

Sub-limit 30

30.2 Contact lenses/Spectacle lenses  100%  Sub-limit 30 

30.3 Bi-focal / Multi-focal lenses
100%
N$700 per Beneficiary limited to every 2 years (in addition to sub-limit 30)
30.4 Frame  100% of cost 

Limited to N$1 000 per Beneficiary 

Sub-limit 30 

31.  Benefit Booster  Applicable if Medicine & Injections, Dentistry, GP’s & Specialists, Primary Health Care and Auxiliary Services benefits are depleted  Limited to N$2 350 per Beneficiary 

31.1 Medicine & Injections (Acute & Chronic) 

- Excluding Self-Medication 

70%  Sub-limit 31 
31.2 Medicine & Injections (Chronic Pensioner)  90%  Sub-limit 31
31.3 Dentistry & Dental Implants (Excluding Orthodontic)  70%  Sub-limit 31
31.4 General Practitioners & Specialists (Consultations/Visits & Procedures/Services out-of-hospital, including casualties)  80%  Sub-limit 31 
31.5 Primary Health Care  80%  Sub-limit 31 
31.6 Auxiliary Services  70%  Sub-limit 31 
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. 

Download the 2019 Member Guide PDF

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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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