If you claim less than a certain threshold amount included in your day-to-day benefits, you will build up a Roll-Over benefit which you can use to pay for healthcare treatment and medical costs. Claims paid in accordance to the day-to-day benefits of each benefit option, taking into account the threshold level, will first be debited against the Roll-Over benefit after which the normal day-to-day risk benefits will be used.

At the end of April, in the following benefit year, if your previous year’s day-to-day claims excluding costs for chronic medication are less than the Roll-Over benefit, the remaining balance will be transferred into your accumulated Roll-Over benefit account, which you can use to pay for additional medical expenses normally excluded in terms of the Rules of the Fund.

Please note: Your Roll-Over benefit accumulates in your name for as long as you are a member of the Fund.

While you are a member of the Fund, any positive balance in your accumulated Roll-Over benefit account may be used to pay for:

• Routine medical costs,
• Outstanding member’s portions,
• Treatment normally excluded from your benefits,
• Medical treatments with a valid chargeable Nappi code which is usually excluded by the Fund. These medical treatments must be provided by a registered healthcare provider,
• The difference between the actual medical costs and the NAMAF tariff for medical services covered by the Rules, and
• Medical aid contributions and for contribution “holidays”.
• Medical expenses in respect of new dependents where a waiting period may apply

Any non-medical expenses without a valid chargeable Nappi code and which are not provided by a registered healthcare provider will not be covered by the accumulated Roll-Over benefit.

If you resign from NHP and become a member of another medical aid fund, the positive balance in the accumulated Roll-Over benefit will be transferred to the NHP Fund reserves.

Upon resignation from an employer group, the member may elect to continue membership of the Fund, either as an individual or as a member of another employer group with the Fund, in which case the accumulated Roll-Over benefit will be transferred to the new membership without forfeiture of the accumulated benefit.

Upon the death of the principal member, any accumulated amount due to the member will be transferred to his/her dependants who continue membership with the Fund. If the dependants of such deceased member decide to resign from the Fund, then such positive balance will be forfeited to the Fund.

Claiming from your accumulated Roll-Over benefit

Those members with an accumulated Roll-Over balance can now also make use of an automated function for payment of claim co-payments. In the past members with positive Roll-Over balances had to inform the Fund if they wanted to have payment towards their medical accounts and expenses deducted from their accumulated Roll-Over balances. This feature has now been automated and members have the luxury of choosing whether they want to have their co-payments deducted automatically or whether they want to continue with the manual nomination process.

Members are requested to indicate whether they want to make use of the automated payment function or continue with the manual process of nominating for the accumulated Roll-Over benefit to be paid by filling out a claim form which is available on the Fund’s website www.nhp.com.na or from any of the Fund’s Call Centers. Members opting for the manual option must attach proof of purchase and the payment will be reimbursed from the accumulated Roll-Over benefit account.

Claims for conditions, procedures or medicines excluded by the Rules, including exclusions from optical and dental benefits may thus be paid from the positive balance of member’s accumulated Roll-Over benefit.

Members may request that any amount from their accumulated Roll-Over benefit be allocated towards their monthly contributions. For employer group members, this will only apply once they have consulted their payroll or HR department. Should a member wish to apply for a contribution holiday.

All members of the Fund will have access to this functionality with the opportunity to select the automated payment function.

Claims not eligible for payment from the Roll-Over benefit:

• Non-medical expenses without a valid NAPPI code and chargeable code, which is not rendered by a registered healthcare provider.
• Any medical or non-medical expenses claimed for beneficiaries not actively registered as dependents of the main member
• Green cross shoes
• Sunglasses, whether or not prescribed by a registered optometrist or ophthalmologist

Please note:

A Roll-Over benefit instruction claims form must be completed and can be sent via fax 061 223 904 or emailed to info at nhp.com.na.

If you select the automated claims process, the completed form can be sent via fax 061 230 465 or emailed to members at nhp.com.na.

Please contact NHP, tel 061 285 5400 or download the form by clicking on the link below.

Downloads

Roll-Over benefit claim form Roll-Over benefit claim instructions form