• Additional Hospital Benefit cover excluded

• 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)

• Including medical expenses incurred by the donor if the recipient is a Fund member

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

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

• Additional Hospital Benefit cover excluded

• Additional Hospital Benefit cover excluded

• Additional Hospital Benefit cover excluded

• Additional Hospital Benefit cover excluded

• Additional Hospital Benefit cover excluded

Infertility Treatment (All - inclusive)

(Subject to prior approval and MHC Guidelines)

N$33 750 per Family

Overall Annual Limit

N$35 710 per Family

Sub-limit 11

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

• All-inclusive

• All-inclusive

• In-practice (surgical procedures performed in a doctor’s room)

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

Lifestyle Management Tests

(Subject to Clinical Guidelines and Protocols)

N$1 500 per Family

Sub-limit 18

• 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

• In-practice consultation and non-surgical procedures

• Inclusive of repair and maintenance

• Inclusive of repair and maintenance

N$55 450 per Beneficiary

• Paid at the maximum Namibia medicine price list on generics

• As per national guidelines

• As per national guidelines

• As per national guidelines

• Excluding self-medication

• 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 34

• 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 2026 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 2027.
  
• 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.

• Medicine and Injections
  
• Optical
  
• Auxiliary Services