Our Benefits - Options & Benefits

Key Benefits

Hospital: Major Medical Expenses

AHB Cover: GP & Specialist in-hospital services payable to a maximum of 200% of the NAMAF Tariff

Benefit	Cover
Accommodation and Theatre	100%
Physiotherapy & Biokinetics (post-rehabilitation)	100%
MRI & CT Scans	100%
Internal Appliances & Materials	100% of the Cost
Oncology – (All-inclusive In and Out of Hospital) Consultations and Procedures Hospitalisation Radiation Oncology (A referral is only acceptable from a medical specialist) Oncology Medication (chemotherapy, radiotherapy and hormone therapy)	100%
Dialysis/Organ Transplant	100%
Refractive Surgery	100%
Maternity Confinement – Full Procedure 12 Ante-natal Consultations per Beneficiary 6 Sessions, Ante / Post-natal Classes & Education 3 Sonar Scans per Beneficiary per Pregnancy	100%

Ambulance and Evacuation Services

Benefit	Cover
Emergency Ambulance & Flights	100%
Ambulance/Inter-hospital transfer	100%

International Medical Travel Insurance

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

Day-to-Day Benefits

Benefit	Cover
General Practitioners and Specialists	100%
Dentistry	100%
Medicine & Injections Acute Chronic Essential Vaccination/Immunisation (As per WHO guidelines) Self-Medication	80% 80% 100% 100%
Optical	100%
Primary Health Care Services	100%
Auxiliary Services	100%
Specified Illness Conditions	100%

Contributions

Individuals
Age Band		Main	Adult	Child
0	25	2,609	1,784	812
26	30	2,909	2,037	812
31	35	3,201	2,255	812
36	40	3,610	2,569	812
41	45	3,962	2,851	812
46	50	4,281	3,104	829
51	55	4,684	3,391	829
56	60	5,007	3,653	829
61	65	5,352	3,916	829
66+		5,687	4,197	829

Groups
Age Band		Main	Adult	Child
0	25	2,382	1,559	688
26	30	2,639	1,738	688
31	35	2,820	1,900	688
36	40	3,081	2,101	688
41	45	3,397	2,352	688
46	50	3,616	2,518	728
51	55	3,902	2,759	728
56	60	4,108	2,965	728
61	65	4,431	3,164	728
66+		4,452	3,183	728

OVERALL ANNUAL BENEFIT (OVERALL ANNUAL LIMIT)			N$1 081 600 per Beneficiary N$1 622 400 per Family
Category A: Hospitalisation Benefit		% 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.
Additional Hospital Benefit Cover: GPs and Specialists In-Hospital services are paid up to a maximum of 200% of the NAMAF Tariff OVERALL LIMIT
		COVER
1.	Hospitalisation	100%	Overall Annual Limit
	1.1 Accommodation and Theatre		Overall Annual Limit
	1.2 Accommodation (Difference between the genera and private ward tariffs)		N$7 500 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 (post-rehabilitation) 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 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 & Material (As per NMC protocol)	100% of the Cost
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$27 000 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		Overall Annual Limit
	4.2. Antenatal Consultation 12 consultations per Beneficiary (Pro-rated from the date of joining) Additional Hospital Benefit Cover is excluded		Payable from the Maternity Benefit
	4.3. Ante / Postnatal Classes & Education 6 sessions per Beneficiary per Pregnancy (Pro-rated from the 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 with Hormone (All-inclusive) (Subject to prior approval) (Pro-rated from the date of joining)	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
	6.2. MRI/CT Scans & Other Specialised Radiology Procedures In & 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 Benefit
7.	Refractive Surgery - All-inclusive Subject to prior approval and MHC guidelines) Groups have cover from the date of joining. Individuals have a one-year waiting period	100%	N$6 200 per Beneficiary once-off N$7 500 per Family
8.	Reconstructive Surgery (medical necessity only) Subject to prior approval and subject to strict MHC guidelines	100%	Overall Annual Limit
	8.1. Consultation and procedure		N$6 750 per Family
	8.2. Hospitalisation		Overall Annual Limit
9.	Private Nursing / Frail Care / Hospice (Subject to Case Management)		N$21 750 per Family
10.	Psychiatric Treatment - Hospitalisation (Subject to prior approval)	100%	N$32 750 per Family
11.	Alcoholism/Drug Addiction (Subject to prior approval and MHC guidelines)	100%	N$32 750 per Family
12.	Specialised Dental Surgery Additional Hospital Benefit cover is excluded (Subject to pre-authorisation)	100%	Overall Annual Limit
	12.1. Maxillo-Facial and Oral Surgery All-inclusive (trauma/non-elective) (Including dental extraction for children less than 10 years old and wisdom teeth extractions)		N$92 500 per Family
	12.2. Maxillo-Facial and Oral Surgery (0ther/elective) Hospitalisation Only		N$14 000 per Family
	12.3. Dental Implant - Hospitalisation		N$14 000 per Family
	12.4. Maxillo-Facial & Oral Surgery - Internal Prosthesis	100% of the Cost	Payable from Internal appliances under the Hospital Benefit
13.	Stomal Therapy (All-inclusive) (Subject to prior approval)	100%	N$28 750 per Family
14.	Ambulance & 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 two days)	100% of the Cost	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

CATEGORY B: DAY-TO-DAY BENEFIT		COVER	Sub-limits are pro-rated from date of joining, except the Optical Benefit. OVERALL LIMIT
CATEGORY B: DAY-TO-DAY BENEFIT		COVER	M	M1	M2	M3	M4	M5+
17.	General Practitioners and Specialists	100%	N$9 000	N$11 800	N$12 300	N$12 550	N$12 800	N$13 050
	17.1. Consultations/Visits (Out-Of-Hospital, Including Casualties)		Payable from General Practitioners and Specialists Benefit
	17.2. Procedures (Out-Of-Hospital Services, Including Casualties)
	17.3. Materials and Disposable Items
	17.4. Radiology and Pathology (Out-of-hospital, including radiography, sonography, medical laboratory technology and chemical biochemistry) (Referral from a medical practitioner)
	17.5 MRI and CT Scan		Payable from the MRI and CT Scan Benefit
	Benefit Booster is Applicable (Additional Benefit once limit is exceeded)
18.	Medicine & Injections		N$14 630	N$16 180	N$16 740	N$17 390	N$18 050	N$18 650
	18.1. Acute Paid at the maximum Namibia Medicine Price List on generics	80%	N$5 400	N$5 700	N$5 900	N$6 150	N$6 400	N$6 650
		80%	N$5 400 per Beneficiary
	18.2. Chronic Paid at the maximum Namibia medicine Price List on generics		N$8 100	N$9 250	N$9 450	N$9 700	N$9 950	N$10 200
	18.2.1. Members aged 65 and below	80%	No Limit per Beneficiary
	18.2.2. Members aged 66 and above	100%	Payable from Medicine & Injections
	18.3. Essential Vaccination/Immunisation (As per WHO guidelines) Paid at the maximum Namibia Medicine Price List on generics	100%	Payable from Medicine & Injections
	Benefit Booster is Applicable (Additional Benefit once limit is exceeded)
	18.4. Self-medication Paid at the maximum Namibia Medicine Price List on generics	100%	N$1 130	N$1 230	N$1 390	N$1 540	N$1 700	N$1 800
		100%	N$183 per claim per Beneficiary per day
19.	Primary Health Care Services		N$1 000	N$1 200	N$1 350	N$1 500	N$1 650	N$1 800
19.	Primary Health Care Services		N$1 000 per Beneficiary
	19.1. Consultations & Procedures	100%	Payable from Primary Health Care Services
	19.2. Medicine & Injections (Paid at the maximum Namibia Medicine Price List on generics)	100%	Payable from Acute Medication
	Benefit Booster is Applicable (Additional Benefit once limit is exceeded)
20.	Dentistry
	20.1 Conservative & Specialised Dentistry (Including Dental Therapy)	100%	N$10 500	N$12 250	N$13 500	N$14 000	N$14 250	N$14 500
		100%	N$10 500 per Beneficiary
	20.2. 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
	20.2.1 In-Hospital	100%	N$10 100 per Beneficiary N$18 450 per Family N$3 800 per dental implant component
	20.2.2 In-Practice	100%	N$18 950 per Beneficiary N$29 600 per Family N$3 800 per dental implant component
	Benefit Booster is Applicable (Additional Benefit once limit is exceeded)
	20.3 Orthodontics (Subject to prior approval and MHC Guidelines)	100%	N$13 250 per Beneficiary once-off
	20.4 Maxillo-Facial and Oral Surgery (Elective) Consultation and Procedure (Subject to pre-authorisation)		The available benefits are for either in-hospital or in-practice
	20.4.1 In-Hospital	100%	N$5 700	N$7 000	N$7 500	N$8 050	N$8 550	N$9 100
	20.4.1 In-Hospital	100%	N$5 700 per Beneficiary
	20.4.2 In-Practice	150%	N$8 550	N$10 650	N$11 400	N$12 200	N$13 000	N$13 250
	20.4.2 In-Practice	150%	N$8 550 per Beneficiary
21.	Optical Benefits Every 2 years (Including frame) (2023-2024)		N$3 350	N$6 700	N$6 900	N$7 100	N$7 300	N$7 500
21.			N$3 350 per Beneficiary
	21.1 Optical Tests	100%	Payable from Optical Benefits
	21.2 Spectacles and Lenses	100%	Payable from Optical Benefits
	21.3 Frame	100% of the Cost	N$1 140 per Beneficiary
	20.4 Readers Spectacles	100% of the Cost	N$105 per Beneficiary
22.	Auxiliary Services		N$11 850	N$13 000	N$13 150	N$13 400	N$13 650	N$13 900
22.	Auxiliary Services		N$11 850 per Beneficiary
	22.1 Art Therapy	100%	Payable from Auxiliary Services
	22.2 Audiology/Speech Therapy	100%	Payable from Auxiliary Services
	22.3 Biokinetics	100%	N$4 050 per Beneficiary
	22.4 Chiropractor		Payable from Auxiliary Services
	22.4.1 Consultation & Procedure	100%
	22.4.2 Medicine	80%
	22.5 Clinical Psychology/Psychological Counsellor	100%	N$4 050 per Beneficiary
	22.6 Clinical Technology	100%	Payable from Auxiliary Services
	22.7 Dietician	100%
	22.8 Hearing Aid Acoustician	100%
	22.9 Homeopathy/Naturopathy/Phytotherapy
	22.9.1 Consultation & Procedure	100%
	22.9.2 Medicine	80%	Payable from Acute Medicine and Injections
	22.10 Occupational Therapy	100%	Payable from Auxiliary Services
	22.11 Orthotist/Prosthetist	100%	Payable from Auxiliary Services
	22.12 Physiotherapy	100%	N$4 050 per Beneficiary
	22.13 Podiatry/Chiropody	100%	Payable from Auxiliary Services
	22.14 Social Worker	100%	N$4 050 per Beneficiary
	Benefit Booster is Applicable (Additional benefit once limit is exceeded)
23.	Wheelchair (Subject to prior approval) Inclusive of repair & maintenance	100% of the Cost	N$8 850 per Beneficiary every 4 years (2020-2023)
24.	Artificial Limbs (Subject to prior approval)	100% of the Cost	N$18 450 per Beneficiary every 2 years (2022-2023)
25.	Artificial Eyes (Subject to prior approval)	100% of the Cost	N$5 750 per Beneficiary every 4 years (2020-2023)
26.	Hearing Aid Apparatus (Subject to prior approval) Inclusive of repair & maintenance	100% of the Cost	N$28 000 per Family every 3 years for both ears (N$14 000 per ear) (2023-2025)
27.	Appliances (External) (Subject to MHC guidelines)	80% of the Cost	N$4 550 per Family
28.	Medical Devices for Diabetes Management (Subject to prior approval and MHC Guidelines)
	28.1 Insulin Pumps/Glucose Monitoring System/Glucose Reader	80% of the Cost	N$35 000 per Beneficiary every 4 years (2023– 2026)
	28.2. Other Devices (Glucose Monitoring System/Glucose Reader)		N$17 500 per Beneficiary
	28.3 Diabetes-Related Consumables		N$33 500 per Beneficiary
29.	Specified Illness Conditions		N$31 000	N$44 750	N$44 750	N$44 750	N$44 750	N$44 750
	29.1 HIV/AIDS (As per National Guidelines for antiretroviral therapy)		N$31 000 per Beneficiary
	29.1.1 Medicine Paid at the aximum Namibia Medicine Price List on generics	100%	Payable from Specified Illness Conditions
	29.1.2 First Full HIV Consultation/Assessment Once-off benefit	$480
	29.1.3 Consultation (after the first full HIV Consultation/Assessment) 6 consultations per Beneficiary	$440
	29.1.4 HIV Counselling	100%	N$1 300 per Beneficiary
	29.1.5. Pathology Tests	100%	N$5 950 per Beneficiary
	29.1.6. HIV Resistance Test (Subject to prior approval)	100%	Payable from Specified Illness Conditions
	29.2. Prevention of Mother-to-Child Transmission (PMTCT)	100%
	29.3. Post-Exposure Prophylaxis (PEP)	100%
	29.4. Pre-Exposure Prophylaxis (PrEP)	100%
30.	Benefit Booster Applicable if medicine & injections, dentistry, GPs’ & Specialists, primary health care & auxiliary services benefits are depleted		N$2 580 per Beneficiary N$3 990 per Family
	30.1. Medicine & Injections (Acute & Chronic) Excluding self-medication	70%	Payable from Benefit Booster
	30.2. Dentistry (Excluding orthodontics)	70%
	30.3. General Practitioners & Specialists (Consultations/visits & procedures/services out-of-hospital, including casualties)	80%
	30.4. Primary Health Care	80%
	30.5. Auxiliary Services	70%

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Our Benefits - Options & Benefits | NMC

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Key Benefits

Ambulance and Evacuation Services

International Medical Travel Insurance

Day-to-Day Benefits

Contributions

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Our Benefits - Options & Benefits | NMC

Key Benefits

Ambulance and Evacuation Services

International Medical Travel Insurance

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