OVERALL ANNUAL BENEFIT (OVERALL ANNUAL LIMIT)			N$1 081 600 per Beneficiary N$1 622 400 per Family
Category A: Benefits For Major Medical Expenses		% the NAMAF Tariff	Pre-authorisation: 100% of the tariff will be paid out. Without Pre-authorisation: No benefit will be paid except in the case of emergency hospital admissions and after-hours emergencies, weekends and public holidays. OVERALL LIMIT
Additional Hospital Benefit Cover: GPs and Specialists In-Hospital services are paid up to a maximum of 200% of the Tariff OVERALL LIMIT
		COVER
1.	Hospitalisation	100%	Overall Annual Limit
	1.1 Accommodation and Theatre
	1.2 Accommodation in private wards (Difference between general ward and private ward tariffs)		N$7500 per Beneficiary N$16 500 per Family
	1.3 Intensive and high care (Maximum 3 days, then motivation)		Overall Annual Limit
	1.4 Blood Transfusions
	1.5 Radiology & Pathology (in-hospital) Additional Hospital Benefit Cover is excluded
	1.6 Physiotherapy & Biokinetics Additional Hospital Benefit Cover is excluded
	1.6.1 Physiotherapy & Biokinetics (in-hospital)
	1.6.2 Physiotherapy & Biokinetics (post-rehabilitation) Additional benefit once the patient is out of the hospital 12 sessions/ visits per Beneficiary (Benefit is available within 3 months from hospital discharge) (Subject to prior approval)
	1.7 Medicine, Fixed Tariff Procedures, Hospital Apparatus and To-Take-Out Medicine (7 days' supply only)
	1.8 Dialysis (Subject to Case Management and MHC Guidelines)
	1.9 Organ Transplant (Subject to Case Management and MHC Guidelines) Including medical expenses incurred by the donor if the recipient is a Fund member
	1.10 Internal Appliances & Materials (As per NMC protocol)	100% of the Cost
	1.11 Medical & Surgical Appliances (External)		No Benefit
2.	General Practitioners and Specialists (In-Hospital Services) Additional Hospital Benefit Cover is included	200%	Overall Annual Limit
3.	Specialised Radiology Procedures (In & Out of Hospital) Additional Hospital Benefit Cover is excluded A referral is only acceptable from a medical specialist [a referral from GP acceptable in places where there is no medical specialist] [Subject to prior approval]	100%	Overall Annual Limit
	3.1 MRI & CT Scans		N$30 000 per Family
	3.2 Nuclear Medicine		Overall Annual Limit
4.	Maternity (Groups have cover from the date of joining. Individuals have a 9-month waiting period)	100%	Overall Annual Limit
	4.1 Confinement – Full Procedure
	4.2 Antenatal Consultation 12 consultations per Beneficiary (Pro-rated from the day of joining) Additional Hospital Benefit Cover is excluded		Payable from the Maternity Benefit
	4.3 Ante/ Postnatal Classes & Education 6 sessions per Beneficiary (Pro-rated from date of joining) Additional Hospital Benefit Cover is excluded
	4.4 Sonar Scans (excluding 3D) 3 scans per Beneficiary per Pregnancy Additional Hospital Benefit Cover is excluded
	4.5 Tests for Chromosomal and Foetal Abnormalities Additional Hospital Benefit Cover is excluded
	4.6 Midwifery Service Additional Hospital Benefit Cover is excluded
5.	Insertion of Intrauterine Device w/ Hormone (All-inclusive) (Subject to prior approval)	100%	N$6 500 per Beneficiary Overall Annual Limit
6.	Oncology (Subject to Case Management and MHC Guidelines)	100%	N$600 000 per Beneficiary Overall Annual Limit
	6.1 Consultation and Procedures Out-of-Hospital
	6.2 MRI/CT Scans & Other Specialised Radiology Procedures In and & Out-of-Hospital Additional Hospital Benefit Cover is excluded A referral is only acceptable from a medical specialist
	6.3 Radiation Oncology [A referral is only acceptable from a medical specialist]
	6.4 Oncology Medication [chemotherapy, radiotherapy and hormone therapy]
	6.5 Hospitalisation and Related Procedures In-Hospital		Overall Annual Limit
7.	Refractive Surgery – All-inclusive (Subject to prior approval and MHC guidelines) Groups have cover from date of joining. Individuals have a one-year waiting period.	100 %	N$6 200 per Beneficiary once-off N$7 500 per Family Overall Annual Limit
8.	Reconstructive Surgery (Medical Necessity Only) (Subject to prior approval and subject to strict MHC Guidelines)	100%	Overall Annual Limit
	8.1 Consultation and Procedures		N$6 750 per Family
	8.2 Hospitalisation		Overall Annual Limit
9.	Private Nursing / Frail Care / Hospice (Subject to Case Management)	100%	N$21 750 per Family Overall Annual Limit
10.	Psychiatric Treatment – Hospitalisation (Subject to prior approval)	100%	N$32 750 per Family Overall Annual Limit
11.	Alcoholism / Drug Addiction (Subject to prior approval and MHC guidelines)
12.	Specialised Dental Surgery Additional Hospital Benefit Cover is excluded (Subject to pre-authorisation)	100%	Overall Annual Limit
	12.1 Maxillo-Facial & Oral Surgery All-inclusive (trauma/non-elective) (Including dental extractions for children less than 10 years old and wisdom teeth extractions)		N$92 500 per Family
	12.2 Maxillo-Facial & Oral Surgery- Hospitalisation Only (other/elective)		N$14 000 per Family
	12.3 Dental Implant - Hospitalisation
	12.4 Maxillo-Facial and Oral Surgery -Internal Prosthesis (Excluding dental Implant component)		Payable from Internal appliances under Hospital Benefit
13.	Stomal Therapy (All-inclusive) (Subject to prior approval)	100 %	N$28 750 per Family Overall Annual Limit
14.	Ambulance and Evacuation Services	100%	Overall Annual Limit
	14.1 Emergency Ambulance & Flights (Territory: SADC Countries) (Subject to prior approval)		Unlimited Benefit
	14.2 Ambulance/Inter-Hospital Transfer (Subject to prior approval)		Overall Annual Limit
15.	Medical Referral Subject to accommodation and travelling reimbursement protocols (Subject to prior approval)		Overall Annual Limit
	15.1. Transport	80% of the Cost	N$10 150 per Family
	15.2.Accommodation Other than a Recognised Hospital/ Medical Institution (Maximum of 2 days)	100%	N$620 per day per Family
16.	International Medical Travel Insurance Medical cover when travelling to foreign countries For emergency cases only (not for elective surgery or procedure)	100% of the Cost	N$10 000 000 per Incident