Sapphire - Namibia Medical Care (NMC)

If you are looking for more benefits and want to ensure that you have above average benefits when visiting the doctor, Sapphire is your option. It provides extensively comprehensive benefits to ensure that you have coverage when you need it. The Sapphire option pays 100% of NAMAF tariffs and provides high overall annual cover of N$1.2 million per beneficiary and N$2.4 million per family. Sapphire also provides high chronic medication benefits to assist you in properly managing those chronic ailments. Good individual benefit amounts are provided for and contributions are competitive.

Key Benefits

Hospital: Major Medical Expenses
AHB Cover: GP & Specialist in-hospital services payable to a maximum of 225% of NAMAF Tariff

Benefit	Cover
Accommodation – private ward	100%
Accommodation – other than a recognised hospital	100% of cost
MRI & CT Scans	100%
Internal Appliances & Materials	100% of cost
Oncology – Active Therapy (Surgery, Chemotherapy and Radiotherapy)	100%
Organ Transplant	100%
Refractive Surgery	100%
Maternity - Confinement – Full Procedure 12 Ante-natal Consultations 2 Sonars per Beneficiary per pregnancy	100%

Ambulance and Evacuation Services

Benefit	Cover
Emergency Ambulance & Flights	100%
Ambulance/Inter-hospital transfer	100%
Other Transport	80% of cost

International Medical Travel Insurance

Benefit	Cover
Medical cover when travelling to foreign countries. For emergency cases only	100% of cost

Day-to-Day Benefits

Benefit	Cover
General Practitioners	100%
Dentistry	100%
Medicine & Injections Acute Chronic Self-medication	80% 80 100%
Optical	100%
Primary Health Care Services	100%
Auxiliary Services	100%
Specified Illness Conditions	100%

Contributions

Individual
Age Band		M0	M1	M2	M3	M4	M5+
0	25	2 476	4 456	5 332	6 211	7 089	7 978
26	30	2 807	5 049	5 929	6 817	7 692	8 571
31	35	3 135	5 623	6 505	7 381	8 273	9 147
36	40	3 568	6 399	7 294	8 198	9 097	9 997
41	45	3 968	7 102	8 009	8 914	9 830	10 734
46	50	4 322	7 724	8 625	9 525	10 427	11 322
51	55	4 760	8 490	9 387	10 310	11 218	12 127
56	60	5 126	9 138	10 036	10 940	11 848	12 739
61	65	5 507	9 813	10 706	11 595	12 492	13 378
66+		5 900	10 492	11 382	12 250	13 147	14 027

Groups
Age Band		M0	M1	M2	M3	M4	M5+
0	25	2 184	3 849	4 603	5 347	6 091	6 839
26	30	2 400	4 235	4 964	5 688	6 408	7 135
31	35	2 585	4 566	5 264	5 973	6 676	7 372
36	40	2 912	5 154	5 862	6 580	7 289	8 003
41	45	3 256	5 753	6 487	7 210	7 934	8 660
46	50	3 502	6 201	6 903	7 619	8 331	9 052
51	55	3 820	6 761	7 483	8 193	8 910	9 625
56	60	4 221	7 469	8 200	8 920	9 656	10 382
61	65	4 480	7 915	8 637	9 343	10 055	10 765
66+		4 486	7 927	8 646	9 361	10 068	10 779

Sapphire Individual Single Parent Contributions
Age Band		M0	M1	M2	M3	M4	M5+
0	25	2 167	3 902	4 666	5 435	6 203	6 981
26	30	2 456	4 418	5 188	5 965	6 731	7 500
31	35	2 743	4 920	5 692	6 458	7 239	8 004
36	40	3 122	5 599	6 382	7 173	7 960	8 747
41	45	3 472	6 214	7 008	7 800	8 601	9 392
46	50	3 782	6 759	7 547	8 334	9 124	9 907
51	55	4 165	7 429	8 214	9 021	9 816	10 611
56	60	4 485	7 996	8 782	9 573	10 367	11 147
61	65	4 819	8 586	9 368	10 146	10 931	11 706
66		5 163	9 181	9 959	10 719	11 504	12 274

Sapphire Group Single Parent Contributions
Age Band		M0	M1	M2	M3	M4	M5+
0	25	1 911	3 368	4 028	4 679	5 330	5 984
26	30	2 100	3 706	4 344	4 977	5 607	6 243
31	35	2 262	3 995	4 606	5 226	5 842	6 451
36	40	2 548	4 510	5 129	5 758	6 378	7 003
41	45	2 849	5 034	5 676	6 309	6 942	7 578
46	50	3 064	5 426	6 040	6 667	7 290	7 921
51	55	3 343	5 916	6 548	7 169	7 796	8 422
56	60	3 693	6 535	7 175	7 805	8 449	9 084
61	65	3 920	6 926	7 557	8 175	8 798	9 419
66		3 925	6 936	7 565	8 191	8 810	9 432

Overall Annual Benefit			Unlimited
Category A: Hospital		% NAMAF Tariff	Pre-notification: 100% of tariff will be paid. Without Pre-notification: 90% of tariff will be paid.
Additional Hospital Benefit Cover: GPs and Specialists In-Hospital services are paid up to a maximum of 225% of Tariff \|OVERALL LIMIT
		Cover	M	M1	M2	M3	M4	M5+
1.	Hospitalisation
	1.1 Accommodation and Theatre	100%	Overall Limit
	1.2 Accommodation in Private Ward (Difference between general ward and private ward tariffs)	100%	N$10 500 per Beneficiary N$23 000 per Family
	1.3 Accommodation Other than a Recognised Hospital/Medical Institution (Subject to prior approval & accommodation expenses reimbursement policy)	100% of cost	N$550 per day per family (Maximum 2 days)
	1.4 Blood Transfusions	100%	Overall Limit
	1.5 Intensive and High Care Maximum of 3 days, then motivation	100%	Overall Limit
	1.6 Medicine, Fxed Tariff Procedures, Hospital Apparatus and To Take Out medicine (7 days supply only)	100%	Overall Limit
	1.7 Radiology and Pathology (In-Hospital) - (Additional Hospital Benefit Cover excluded)	100%	Overall Limit
2.	Specialised Radiology Procedures (In and 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 and CT Scans	100%	N$29 750 per Family
	2.2 Nuclear Medicine	100%	Overall Limit
	2.3 Radiation Oncology	100%	Overall Limit
3.	General Practitioners and Specialists (In-Hospital Services) - Additional hospital benefit cover included	100%	Overall Limit
4.	Internal Appliances and Materials	100% of cost	As per NMC Protocol Overall Limit
5.	Dialysis (Subject to Case Management and MHC guidelines)	100%	Overall Limit
6.	Oncology – Active Therapy (Surgery, Chemotherapy and Radiotherapy) (Subject to Case Management and MHC guidelines)	100%	Overall Limit
7.	Organ Transplant (Subject to Case Management and MHC guidelines)	100%	Overall Limit
8.	Refractive Surgery – All-inclusive (Subject to prior approval and MHC guidelines)	100%	N$20 000 per Beneficiary once off N$25 750 per Family Groups have cover from date of joining Individuals have a one-year waiting period
9.	Reconstructive Surgery (Medical necessity only) (Subject to prior approval and subject to strict MHC guidelines)
	9.1 Consultation and Procedure	100%	N$14 000 per Family
	9.2 Hospitalisation	100%	Overall Limit
10.	Private Nursing (Subject to Case Management)	100%	N$37 250 per Family
11.	Frail Care (Subject to Case Management)	100%	Sub-limit 10
12.	Alcoholism / Drug Addiction (Subject to prior approval and MHC guidelines)	100%	N$28 500 per Family
13.	Psychiatric Treatment – Hospitalisation (Subject to prior approval)	100%	Sub-limit 12
14.	Specialised Dental Surgery – Hospitalisation (Subject to pre-authorisation)
	14.1 Maxillo-Facial and Oral Surgery – Hospitalisation (Trauma/Non-elective)	100%	N$126 000 per Family
	14.2 Maxillo-Facial and Oral Surgery - Hospitalisation (Other/Elective)	100 %	N$11 750 per Beneficiary N$18 750 per Family
	14.3 Dental Implant – Hospitalisation	100%	Sub-limit 14.2
	14.4 Maxillo-Facial and Oral Surgery - Internal Prosthesis	100% of cost	Sub-limit 4
15.	Maternity		Groups have cover from date of joining. Individuals have a 9-month waiting period.
	15.1 Confinement – Full Procedure	100%	Overall Limit
	15.2 Ante-natal Consultation - Additional hospital benefit cover excluded	100 %	12 Consultations per Beneficiary (Pro-rated from date of joining)
	15.3 Sonar Scans(Excluding 3D) - Additional hospital benefit cover excluded	100%	2 Scans per Beneficiary per Pregnancy
	15.4 Amniocentesis - Additional hospital benefit cover excluded	100%	Overall Limit
	15.5 Midwifery Service - Additional hospital benefit cover excluded	100%	Overall Limit
16.	Insertion of Intrauterine Device w/ Hormone (Mirena) (All-inclusive) (Subject to prior approval)	100%	N$5 750 per Beneficiary
17.	Stomaltherapy (All-inclusive) (Subject to prior approval)		N$28 750 per Family Sub-limit is pro-rated from date of joining
18.	Ambulance and Evacuation Services	100%
	18.1 Emergency Ambulance and Flights (Coverage Territory: Angola, Botswana, Kenya, Lesotho, Malawi, Mozambique, Namibia, South Africa, Swaziland, Tanzania, Zambia and Zimbabwe) (Subject to prior approval)	100%	Unlimited Benefit
	18.2 Ambulance/Inter-hospital Transfer (Subject to prior approval)	100%	Overall Limit
	18.3 Other Transport (Subject to prior approval & accommodation expenses re-imbursement policy)	80%	N$9 800 per Family
19.	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 Benefit		Cover	Sub-limits are pro-rated from date of joining, except Optical Benefit. OVERALL LIMIT
Category B: Day To Day Benefit		Cover	M	M1	M2	M3	M4	M5+
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.

Download Detailed Benefits

Key Benefits

Ambulance and Evacuation Services

International Medical Travel Insurance

Day-to-Day Benefits

Contributions

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