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.
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.
The Fund
pays for vitamins from the acute medication benefit if prescribed by a doctor
for members above 50
and below 5-years of age. For other age categories, vitamins
are payable
from self-medication benefit. Members above 50 and below 5-years old may also
claim vitamins under their 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.
Benefit Guide
International Medical Travel Insurance
NMC offers members International Medical Travel Insurance cover of N$10 million for emergency medical expenses. Remember to apply for International Medical Travel Insurance before embarking on your trip.
The Lifestyle Management Programme
Are you within a healthy weight range? Use the Body Mass Index (BMI) calculator to find out more.
