Additional in-hospital cover

The Fund offers its members a major medical expense benefit that automatically covers a certain percentage on top of the NAMAF benchmark tariff, depending on the benefit option chosen, for services provided in hospital by healthcare providers.

This cover is over and above the normal benefits.

Benefits include:

  • Medical or dental practitioners
  • Medical or dental specialists
  • Physiotherapy, biokinetics, dieticians, occupational therapy, speech therapy, audiology and psychology while the patient is in hospital
  • Radiology
  • Pathology

The Gold, Platinum, Silver, Bronze, Titanium and the Hospital benefit options cover is 225% of the NAMAF tariff allowed for services provided in hospital by healthcare providers. This cover is included in the normal benefits.

Benefits excluded:

  • HIV/AIDS
  • National epidemics
  • Organ transplants
  • Post-hospitalisation and rehabilitation medication
  • Pre-existing conditions
  • Refractive surgery
  • Dental surgery, but for children under 8-years of age and maxillo facial surgery
  • Dental implants
  • Oral surgery
  • Orthognathic surgery

The Board of Trustees reserves the right to review all major claims before such claims are reimbursed to members.

In order to qualify for additional in-hospital cover; please ensure that all the relevant accounts are submitted to the administrator within the same 4-month grace period in which to submit normal claims. Members who have reached their benefit limit in respect of surgical prostheses will not qualify for the additional in-hospital cover benefit in respect of the additional in-hospital cover. No additional in-hospital cover will be granted in respect of any set benefits, for example in the case of oral surgery where a benefit for the full procedure has been granted.