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.
I recently saw a specialist, and paid cash, which I had to claim from my medical aid. Although, I still have benefits available, the medical aid only paid a portion of the claim. Why should I be liable for these co-payments, while I still have benefits available?
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.
I have been a member of NMC for the past three years, and I recently depleted my day-to-day benefits. I have, however, not used my dentistry benefits for the past two years. Is it possible to use my dentistry benefits to cover for my day-to-day benefits (is it possible to convert the benefits I hardly use to the benefits I use the most)?
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.
I am 25 years old and my husband is 30 years old respectively. We joined NMC recently as individual members. Although I am the one duly responsible for paying our NMC premiums, NMC made my husband the Main Member. Why is that?
The NMC Fund rules specify that for individual members the eldest person must be the main member.
My daughter is a dependant on my medical aid and she gave birth recently. Can I put my daughters’ daughter on my medical aid as my dependent?
Unfortunately not, only as a special dependent, under specific circumstances
I would like to structure my own benefits according to my needs. Does the Fund give members the option to structure their own benefits?
Yes, this can be done on the new generation products - Amber or Emerald.
Does NMC Fund automatically register my newborn and if not, whose responsibility is it to register my baby?
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.
Why does NMC not cover accommodation within the borders of Namibia when one is referred to see a specialist in other towns?
Other accommodation other than Hospitalisation will be subject to Managed Health Care’s protocol.
Why can’t the GP and Specialist benefit be separated from the casualty benefit, pathology, radiology, and specialist visits?
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.
If a person has a terminal illness, why are the doctor’s visits and follow-up tests outside the Hospital not paid from the overall benefit?
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.
Why aren’t members informed of their available benefits instead of being called by HP’s for claims rejected?
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.