20.
|
General Practitioners and Specialists
|
|
N$
12 500
|
N$
15 750
|
N$
17 750
|
N$
18 000
|
N$
18 250
|
N$
18 500
|
|
20.1 Consultations/Visits (Out-of-hospital, including casualties)
|
100%
|
15 Cons
|
25 Cons
|
35 Cons
|
40 Cons
|
45 Cons
|
50 Cons
|
|
20.2 Procedures/Services (Out-of-hospital, including casualties)
|
100%
|
Sub-limit 20
|
|
20.3 Materials and Disposable Items
|
100%
|
Sub-limit 20
|
|
20.4 Radiology and Pathology (out-of-hospital)
(Referral from a Medical Practitioner)
|
100%
|
Sub-limit 20
|
|
20.5 MRI and CT Scans
|
100%
|
Sub-limit 2
|
|
Benefit Booster applicable (Additional benefit once limit is exceeded)
|
|
Refer to Sub-limit 32
|
21.
|
Dentistry
|
|
|
|
21.1 Conservative and Specialised Dentistry
|
100%
|
N$
14 000
|
N$
16 500
|
N$
18 250
|
N$
18 750
|
N$
19 250
|
N$
19 750
|
|
N$14 000 per Beneficiary
|
|
21.2 Dental Implants – Consultation, procedure and cost of dental implant components
(Subject to pre-authorisation)
|
|
The available benefits are for either in-hospital or in-practice but not for both
|
|
21.2.1 In-Hospital
|
100%
|
N$13 000 per Beneficiary
N$21 250 per Family
N$3 250 per dental implant component
|
|
21.2.2 In-Practice
|
150%
|
N$22 500 per Beneficiary
N$34 000 per Family
N$3 250 per dental implant component
|
|
Benefit Booster applicable (Additional benefit once limit is exceeded)
|
|
Refer to Sub-limit 32
|
|
21.3 Orthodontics
|
100%
|
N$20 000 per Beneficiary once-off
|
|
21.4 Maxillo-Facial and Oral Surgery – Consultation and Procedure
(Subject to pre-authorisation)
|
|
The available benefits are for either In-hospital or In-practice but not for both
|
|
21.4.1 In-Hospital
|
100 %
|
N$
5 500
|
N$
6 500
|
N$
7 000
|
N$
7 500
|
N$
8 000
|
N$
8 500
|
|
N$5 500 per Beneficiary
|
|
21.4.2 In-Practice
|
150 %
|
N$
8 250
|
N$
9 750
|
N$
10 500
|
N$
11 250
|
N$
12 000
|
N$
12 500
|
|
N$8 250 per Beneficiary
|
22.
|
Medicine and Injections
|
|
N$
26 400
|
N$
41 050
|
N$
44 950
|
N$
45 850
|
N$
46 500
|
N$
47 150
|
|
22.1 Acute Medicine and Injections
Paid at maximum Namibia medicine price list on generics
|
80%
|
N$
7 250
|
N$
11 000
|
N$
13 750
|
N$
14 250
|
N$
14 500
|
N$
14 750
|
|
N$7 250 per Beneficiary
|
|
22.2 Chronic Medicine and Injections
Paid at maximum Namibia medicine price list on generics
|
80 %
|
N$
17 500
|
N$
28 250
|
N$
29 250
|
N$
29 500
|
N$
29 750
|
N$
30 000
|
|
22.2.1 Members aged 65 and below
22.2.2 Members aged 66 and above
|
80%
100%
|
No Limit per Beneficiary
|
|
|
|
|
|
22.3 Essential Vaccination/Immunisation (As per WHO Guidelines)
Paid at maximum Namibia medicine price list on generics
|
100%
|
Sub-limit 22
|
|
Benefit Booster applicable (Additional benefit once limit is exceeded)
|
|
Refer to Sub-limit 32
|
|
22.4 Self-medication
Paid at maximum Namibia medicine price list on generics
|
100%
|
N$
1 650
|
N$
1 800
|
N$
1 950
|
N$
2 100
|
N$
2 250
|
N$
2 400
|
|
N$200 per claim per beneficiary per day
Sub-limit 22
|
23.
|
Optical Benefits
|
|
N$
4 500
|
N$
7 750
|
N$
8 500
|
N$
9 250
|
N$
9 500
|
N$
9 750
|
|
N$4 500 per Beneficiary every 2 years (including frame)
|
|
23.1 Optical Tests
|
100%
|
Sub-limit 23
|
|
23.2 Spectacles and Lenses
|
100%
|
Sub-limit 23
|
|
23.3 Frame
|
100% of cost
|
N$1 700 per Beneficiary
Sub-limit 23
|
|
23.4 Readers Spectacles
|
100% of cost
|
N$100 per Family
Sub-limit 23
|
24.
|
Primary Health Care Services
24.1 Consultations
|
100%
|
Sub-limit 20
|
|
24.2 Medicine and Injections
Paid at maximum Namibia medicine price list on generics
|
100%
|
Sub-limit 22.1
|
|
Benefit Booster applicable
(Additional benefit once limit is exceeded)
|
|
Refer to Sub-limit 32
|
25.
|
Auxiliary Services
|
|
N$
13 500
|
N$
21 750
|
N$
23 750
|
N$
26 000
|
N$
26 500
|
N$
27 000
|
|
N$13 500 per Beneficiary
|
|
25.1 Biokinetics
|
100%
|
N$6 500 per Beneficiary
Sub-limit 25
|
|
25.2 Clinical Psychology/Psychological Counsellor
|
100%
|
N$6 500 per Beneficiary
Sub-limit 25
|
|
25.3 Physiotherapy
|
100%
|
N$6 500 per Beneficiary
Sub-limit 25
|
|
25.4 Chiropractor
25.4.1 Consultation and Procedure
|
100%
|
Sub-limit 25
|
|
25.4.2 Medicine
|
80%
|
Sub-limit 22.1
|
|
25.5 Homeopathy/Naturopathy/Phytotherapy/Osteopathy
25.5.1 Consultation and Procedure
|
100%
|
Sub-limit 25
|
|
25.5.2 Medicine
|
80%
|
Sub-limit 22.1
|
|
25.6 Audiology/Speech Therapy
|
100%
|
Sub-limit 25
|
|
25.7 Hearing Aid Acoustician
|
100%
|
Sub-limit 25
|
|
25.8 Podiatry/Chiropody
|
100%
|
Sub-limit 25
|
|
25.9 Dietician
|
100%
|
Sub-limit 25
|
|
25.10 Occupational Therapy
|
100%
|
Sub-limit 25
|
|
25.11 Social Worker
|
100%
|
N$6 500 per Beneficiary
Sub-limit 25
|
|
25.12 Orthotist/Prosthetist
|
100%
|
Sub-limit 25
|
|
Benefit Booster applicable
(Additional benefit once limit is exceeded )
|
|
Refer to Sub-limit 32
|
26.
|
Wheelchair
(Subject to prior approval)
- Inclusive of repair and maintenance
|
100 % of cost
|
N$17 000 per Beneficiary every 4 years
|
27.
|
Artificial Limbs
(Subject to prior approval)
|
100% of cost
|
N$34 000 per Beneficiary every 2 years
|
28.
|
Artificial Eyes
(Subject to prior approval)
|
100% of cost
|
N$16 500 per Beneficiary every 4 years
|
29.
|
Hearing Aid Apparatus
(Subject to prior approval)
- Inclusive of repair and maintenance
|
100% of cost
|
N$30 000 per Family every 2 years
|
30.
|
Appliances (External)
(Subject to MHC guidelines)
|
80% of cost
|
N$4 500 per Family every 2 years
|
31.
|
Specified Illness Conditions
|
|
N$
31 500
|
N$
63 000
|
N$
63 000
|
N$
63 000
|
N$
63 000
|
|
|
31.1 HIV/AIDS (As per National Guidelines for antiretroviral therapy)
|
100 %
|
N$31 500 per Beneficiary
|
|
31.1.1 Medicine
(Paid at maximum Namibia medicine price list on generics)
|
|
Sub-limit 31.1
|
|
31.1.2 First Full HIV Consultation/Assessment
|
N$400
|
Once-off benefit
Sub-limit 31.1
|
|
31.1.3 Consultation
(after the first full HIV consultation/assessment)
|
N$385
|
6 Consultations per Beneficiary
Sub-limit 31.1
|
|
31.1.4 HIV Counselling
|
100%
|
N$1 100 per Beneficiary
Sub-limit 31.1
|
|
31.1.5 Pathology Tests
|
100%
|
N$6 750 per Beneficiary
Sub-limit 31.1
|
|
31.1.6 HIV Resistance Test (Subject to prior approval)
|
100%
|
Sub-limit 31.1
|
|
31.2 Prevention of Mother-to-Child Transmission (PMTCT)
|
100%
|
Sub-limit 31.1
As per National Guidelines
|
|
31.3 Post-Exposure Prophylaxis (PEP)
|
100%
|
Sub-limit 31.1
As per National Guidelines
|
|
31.4 Pre-Exposure Prohylaxis (PrEP)
|
100%
|
Sub-limit 31.1
As per National Guidelines
|
32.
|
Benefit Booster
Applicable if Medicine and Injections, Dentistry, GP’s and Specialists, Primary
Health Care and Auxiliary Services benefits are depleted
|
|
N$3 000 per Beneficiary N$5 500 per family
|
|
32.1 Medicine and Injections (Acute and Chronic)
- Excluding Self-Medication
|
70%
|
Sub-limit 32
|
|
32.2 Dentistry and Dental Implant
(Excluding Orthodontics)
|
70%
|
Sub-limit 32
|
|
32.3 General Practitioners and Specialists
(Consultations/Visits and Procedures/Services out-of-hospital, including casualties)
|
80%
|
Sub-limit 32
|
|
32.4 Primary Health Care
|
80%
|
Sub-limit 32
|
|
32.5 Auxiliary Services
|
70%
|
Sub-limit 32
|
33.
|
Health SmartCard
|
No additional costs. Each dependant will receive his/her own SmartCard. Benefits can be verified at service providers 24/7. Next of kin
can be contacted immediately.
|