Services Offered

The Managed Health Care Department is the market leader in providing professional healthcare service to Members and funds administered by Methealth Namibia Administrators. Qualified professional nurses, pharmacists, pharmacist assistants, as well as medical and dental advisorsenable the Administrator to provide excellent services to the Fund and its Members.

The Department offers the following services:

• Member and practice claims profile management;
• Ex Gratia case management;
• Medication Management Programme (Chronic Disease Management Programme and Drug Utilisation Review);
• Hospital Benefit Management (Hospital Admission Pre-authorisation, Case Management Programme and Retrospective Review);
• Hospital bedside visit services;
• Dental Management Programme;
• Clinical auditing of claims, claims revision and the subsequent identification of claims tendencies and questionable practices; and
• Pro-active management of high-cost cases by identifying high risk patients.

HIV/AIDS Programme

As continuous and uninterrupted treatment is critical to infected individuals, this section of the Programme ensures optimum treatment for a full year within the allocated benefit per individual. To have the above-mentioned benefit, HIV/AIDS patients must register on the Programme as soon as possible. Please contact our AIDS Outreach Programme Case Managers via landline on: 061 375 950.

Aids Social Programme

Methealth Namibia Administrators and Bankmed Namibia have allocated a toll-free number that reaches our HIV/AIDS Counsellors directly. This makes the Programme accessible to all Members that are registered on the HIV Disease Management Programme.

Toll-free number: 0800 00 7777.

Hospital Bedside Support Services

Bankmed Namibia offers specialised supportive bedside assistance for Members in hospital. The Patient Care Co-ordinator provides compassionate counselling that addresses Members’ immediate and specific needs.

Chronic Medication Programme

Chronic medication is repetitive or life-sustaining medicine usually prescribed for a period of six months or longer. Bankmed Namibia covers medication costs for chronic ailments listed in the Fund’s List of Chronic Conditions up to a certain maximum. Bankmed Namibia pays for only one month’s supply of chronic medication at a time. If the medication you are taking does not meet the criteria for chronic medication benefits, your chronic medication claim will still be paid out, but under your prescribed Acute Medication Benefit.

List of Chronic Conditions

Acne / Addison’s Disease / Allergic Rhinitis / Alzheimer’s Disease / Angina / Ankylosing Spondylitis / Anorexia Nervosa / Asthma / Attention Deficit Disorder (ADD) / Barrett’s Oesophagus / Benign Prostatic Hyperplasia / Bipolar Mood Disorder / Bronchiectasis / Bulimia Nervosa / Cancer / Cardiac Arrhythmias / Cardiomyopathy / Chronic Bronchitis / Chronic Obstructive Pulmonary Disease (COPD) / Chronic Renal Disease / Congestive Cardiac Failure / Conn’s Syndrome / Coronary Artery Disease/ Crohn’s Disease / Cushing’s Syndrome / Cystic Fibrosis / Deep Vein Thrombosis / Dermatomyositis / Diabetes Mellitus / Insipidus / Eczema / Emphysema / Endocarditis / Epilepsy / Glaucoma / Gout / Hyperuricaemia / Haemophilia / Hypercholesterolaemia (full lipogram results required) / Hypertension / Hypoparathyroidism / Ischaemic Heart Disease / Major Depression / Menopause (Hormone Replacement Therapy) / Migraine (Prophylactics) / Motor Neuron Disease / Multiple Sclerosis / Muscular Dystrophy / Myasthenia Gravis / Narcolepsy / Obsessive Compulsive Disorder / Osteoporosis (Bone density test required) / Paget’s Disease of the Bone / Pancreatic Disease / Panic Disorder / Paraplegia and Quadriplegia (Associated Medicine) / Parkinson’s Disease / Peripheral Vascular Disorders / Pituitary Adenoma / Polyarteritis Nodosa / Post Traumatic Stress Syndrome / Psoriasis / Pulmonary Intestitial Fibrosis / Rheumatoid Arthritis / Schizophrenia (if managed by a Psychiatrist) / Scleroderma / Stroke / Systemic Lupus Erythematosus / Thromboangitis Obliterans / Thrombocytopaenic Purpura / Tourette’s Syndrome / Ulcerative Colitis / Unipolar Mood Disorder / Upper Gastro- Intestinal Tract Disorder (Gastroscopy and HP test results required) / Valvular Heart Disease / Zollinger-Ellison Syndrome

Emergency Evacuation Services

The Fund offers emergency air and road ambulance evacuation services to Bankmed Namibia Members. All air ambulance flights and long distance road ambulance transport services are covered for the SADC Region. The cover provides the most effective and efficient emergency evacuation services. All emergency services for life-sustaining conditions that require emergency transport are covered.

Please note that Members can make use of any registered emergency evacuation provider in Namibia of their choice.

Where the service provider chosen by the Member has an agreement for direct payment with Bankmed Namibia, the process will be:

1. The Member contacts the ambulance or evacuations provider;
2. The Provider contacts the Fund for pre-authorisation;
3. The service is delivered to the Member;
4. The evacuation provider submits the claim to the Fund for settlement;
5. The Fund settles the claim directly with the provider.

Herewith a list of all evacuation providers (with their contact details) who have agreed to claim directly from the Fund and within tariff (no additional payment by the Member):

Emergency Evacuation Provider	Emergency Contact Number	Main area of coverage
AEMS Ambulance Services	081963	Windhoek & surrounding areas
Crisis Response	081 8818131	Windhoek & surrounding areas
Emergency Assist 991	081 128 8903	Okahandja
Helixtract Emergency Medical Assistance	081 943 54	All major centres
Intensive Therapy Unit Ambulance Services	081 444 7807	Eenhana & surrounding areas
Lifelink Emergency Services	999 (from any landline) 085900 (from cell)	All major centres
Mr 24/7	085 956	Windhoek & surrounding areas
Namibia Private Ambulance Services	081 9696	Northern Namibia & Rundu, Katima & Tsumeb
Namibia Private Ambulance Services	081 9696	Northern Namibia & Rundu, Katima & Tsumeb
Ohangwena Private Ambulance Services	081 9797	Ohangwena & surrounding areas
Ondangwa Ambulance Services	081 902 00	Ondangwa & surrounding areas
Roshcare Clinic Ambulance Services	063 274 911	Rosh Pinah
Shaduka Ambulance Services	081 404 7945	Oshakati Region
St Gabriel Community Ambulance Trust	085955	Coast (Walvis Bay, Swakopmund & Henties Bay)

Note: All the above Service Providers charge emergency evacuation at NAMAF Tariffs except E-Med Rescue who will treat Bankmed members as private clients with a rate of NAMAF plus 15% and they will require from Bankmed front up payments before any evacuation are done for inter-hospital transfers.

Where the service provider chosen by the Member does not have an agreement for direct payment with Bankmed Namibia, the process will be:

1. The Member contacts the ambulance or evacuations provider;
2. The service is delivered to the Member; then
3. The Member submits the claim to the Fund for settlement at the Fund’s prescribed tariffs.

The Member shall remain liable for any amount in excess of the Fund’s prescribed tariffs and in excess of the Member’s available benefit.

Herewith a list of evacuation providers (with their contact details) who will require upfront payment at private rates (in excess of tariff):

Emergency Evacuation Provider	Emergency Contact Number	Main area of coverage
E-Med Rescue 24	081924	All major centres

Pregnant Members

Register your pregnancy with the Bankmed Patient Care co-ordinator and she will do your Hospital Pre-Authorization booking on your behalf. Send an email to patientcare1@methealth.com.na with the completed Hospital Pre-Authorization form as well as the name and contact details of your HR in order to receive this complimentary service or phone client services office +264 61 287 6000.

Bankmed wishes you all the best during your pregnancy.

The Following information is required:

• Member Number and Dependent Code
• Hospital Name and Practice Number
• Type of delivery, normal delivery or Caesarean section 
• Expected date of delivery
• HR Contact telephone Number and email address
• Completed Hospital Pre-Authorization Form