• Additional Hospital Benefit Cover excluded (Subject to prior approval)

• Additional Hospital Benefit Cover excluded
• Additional benefit once the patient is out of hospital or transferred to rehabilitation facility

Benefit available within three months from hospital discharge (Subject to prior approval)

• Additional Hospital Benefit Cover is included except the use of equipment and equipment hire fees

• A referral is only acceptable from a medical specialist (a referral from GP acceptable in places where there is no medical specialist)

• Additional Hospital Benefit Cover is excluded

• Additional Hospital Benefit Cover is excluded

• Additional Hospital Benefit Cover is excluded

• Additional Hospital Benefit Cover is excluded

• Additional Hospital Benefit Cover is excluded

• Additional Hospital Benefit Cover is excluded
• Referral from a medical specialist only

Corrective Eye 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

N$7 920 per Family

• Additional Hospital Benefit cover excluded
(Subject to pre-authorisation)

12.1. Maxillo-Facial and Oral Surgery (trauma/non-elective)

• All-inclusive

• All-inclusive

• Medical cover when travelling to foreign countries
• For emergency cases only (not for elective surgery or procedure)

• Paid at the maximum Namibia medicine price list on generics

• GP Telephonic/Virtual Consultations (telephonic/virtual writing of prescriptions not payable)

• Paid at the maximum Namibia medicine price list on generics

• Paid at the maximum Namibia medicine price list on generics

• Paid at the maximum Namibia medicine price list on generics

• Paid at the maximum Namibia medicine price list on generics

• Members can choose to enrol in the voluntary Benefit Booster Up each year before 15 January.

• Members who join the Fund during the year can also opt for the Benefit Booster Up, with prorated adjustments.

• Once opted in, the Extended Benefit Booster cannot be cancelled for the rest of the year.

• The available benefit is equal to the voluntary contributions paid (accumulative).

• 95% of the accumulated voluntary contributions will roll over to the next financial year.

• Any unused Benefit Booster Up will be forfeited and will not be refunded if the principal member resigns from the fund or passes away.

• Members who choose to switch to a Traditional or Hospital Plan can use their remaining voluntary contributions to fund the Traditional or Hospital Plan Day-to-Day Back Up Benefit.

• Similarly, the remainder can be transferred to any other traditional option.

• The Extended Benefit Booster can be used to cover depleted benefits, charges exceeding benchmark tariffs, exclusions, and other claims that were validly rejected.

N$ 1 500 per Family

Sub-limit 28

• The Back-up benefit aims to reward members and their dependants with low claims on the following specified day-to-day benefits:
  1. Medicine and Injections per family limit
  2. Optical per family limit
  3. Auxiliary Services per family limit
  
• Suppose the actual total amount paid by NMC per family on the day-to-day benefits stipulated above for the current benefit year is less than the threshold limit. In that case, the member qualifies for Back-Up Benefit the following year, such as on the 2027 benefit year.
  
• The Back-up benefit is calculated as 15% of the difference between the Threshold Limit and the actual total amount paid by NMC on the day-to-day benefits stipulated above.
  
• The Back-up benefit will only be calculated at the end of April 2027 to ensure that all day-to-day claims, as stipulated above for the current benefit year, are included.
  
• Claims against the Back-up benefit for the current benefit year will only be processed after the end of April 2025.
  
• The unused Back-up benefit can be accumulated and carried over to the following benefit year.
  
• If the member resigns from NMC, any Back-up benefit balance will go to the Fund reserves.
  
• If the member passes away and their dependants remain with NMC, the Back-up benefit will be transferred to the remaining dependants.
  
• The Back-up benefit can be used to pay the excess on the NAMAF Tariffs, member co-payments and rejected claims in terms of NMC rules.
  
• The Back-up benefit cannot be used to pay for claims rejected due to non-compliance with the NAMAF billing rules and guidelines.

A. The total amount paid by NMC (at the end of April 2025 for 2024 claims) for the following family limits:

• Medicine and Injections
• Optical
• Auxiliary Services

Does not qualify because
The Total Benefit Amount (A) is more
than the Threshold Limit (B)