For members to treat themselves until they can consult their doctor.
Benefits are per financial year, what you do not make use of expires and new benefits are allocated to you during the next financial year.
Namibian private medical aid funds pay according to the NAMAF benchmark tariffs for out of hospital (day-to-day) services rendered by health professionals to members. The benefits are designed to cover the member(s) throughout the year and paying exact amounts even when the claimed amount is above a tariff rate could result in a member depleting benefits early in the year.
I have been a member of NMC for the past three years, and I recently depleted my day-to-day benefits. I have, however, not used my dentistry benefits for the past two years. Is it possible to use my dentistry benefits to cover for my day-to-day benefits (is it possible to convert the benefits I hardly use to the benefits I use the most)?
Benefits are per financial year and specific type of benefit. That which is not used may not be carried over to the next benefit or financial year – this applies to all benefits.
The NMC Fund rules specify that for individual members the eldest person must be the main member.
Unfortunately not, only as a special dependent, under specific circumstances
Yes, this can be done on the new generation products - Amber or Emerald.
No, the member should ensure that he/she registers the newborn with the Fund within 30 days after birth.
It’s a once-off benefit; as a result it is only from time to time.
Other accommodation other than Hospitalisation will be subject to Managed Health Care’s protocol.
Separating GP and Specialist benefits will have an enormous impact on the premium.
Vitamins are claimable under the self-medication benefit
It’s an excluded benefit on the Fund. Suicide, attempted suicide or intentional self-inflicted injury forms part of the fund exclusions unless, the patient qualifies in terms of the suicide protocol.
The day-to-day doctor consultations and procedures benefits are structured to accommodate all outside hospital visits and tests. On the other hand, consultations by specialists and general practitioners whilst a member is hospitalised are paid from the Overall benefit.
The Fund does inform members once they have reached 80% of a specific benefit via remittance statements. In addition, members receive statements indicating claims paid to health professionals; members can register to have online access to benefits or they can request the benefit statement from client services any time of the year.