Blue Diamond

starting from

N$ 566

per individual principal member

Help me choose

Applying as
Principal Member Age
Spouse Age
How many children
family peace of mind

Unlimited cover for day-to-day primary care services as long as you use the designated service provider facilities

For Employer Groups, all family members use principal member’s age category

For Individuals, all family members use the eldest member’s age category

Contributions for employer group
Age Principal
Member
Adult/
Special dep
Child
dep
Contributions for individual members
Age Principal
Member
Adult/
Special dep
Child
dep

The Blue Diamond benefit option provide affordable primary healthcare services to the lower income group who previously have not had access to subsidised private healthcare. This benefit option focuses on providing treatment and services falling within the scope and context of primary healthcare. If you are a member of this benefit option, you have direct access to a network of contracted general practitioners and registered nurses and to ensure the quality of care provided. The Fund assumes direct responsibility for the network. Blue Diamond provides unlimited cover for day-to-day primary care services as long as you use the designated service provider facilities.

Blue Diamond benefits are not pro-rated with the exception of the optical and dental benefits where sub-limits are applicable.

Please note: If you are currently a member of any of the other NHP benefit options and not used to primary healthcare, we strongly recommend that you do not “buy down” to the Blue Diamond benefit options as your choice of general practitioner, nurse and healthcare facility is restricted.

  • In-hospital & out of hospital services
  • Confined to designated service providers
  • Ambulance services
  • Maternity
  • Back and Neck rehabilitation programme
  • Acute and chronic medicine
  • Primary care dentistry
  • Radiology & Pathology
  • Optical
  • HIV/Aids treatment
  NAMAF tarriff or % thereofPrincipal MemberPer Additional BeneficiaryPer FamilyConditions
Overall Annual Limit   Unlimited 
1.Doctors and SpecialistsSPA
1.1Consultations and visits: In-hospital100 %Max 5 virtual GP consultationsMax 5 virtual GP consultations
1.2Procedures: In-hospital100 %
2.Hospital servicesSPA
2.1You can be admitted into the state hospital facility (private wing) but it has to first be approved by NHP. Subject to pre-authorisation.100 %
2.2Selected private hospitals: Limited access benefit for treatment100 %
2.3Routine and scheduled and hospitalisation events100 %
2.4Ward Fees60 %
3.Ambulance services: Only for medical or trauma emergenciesSPA
3.1Air evacuation100 %
3.2In an emergency you are covered for ambulance services but only in Namibia100 %
3.3You are covered for transport between 2 hospitals100 %4,6104,610
3.4Other transportationNo Benefit
4.MaternitySPA
4.1When you are pregnant, you can go visit doctors 12 times per pregnancy – Subject to pre-authorisation100%12 visits
4.22D Sonar scans100%2 Scans
5.Back and Neck Rehabilitation Programme100 %Subject to DBC protocolSubject to DBC protocolSubject to DBC protocolOAL
  NAMAF tarriff or % thereofPrincipal MemberPer Additional BeneficiaryPer FamilyConditions
Out-of-hospital: Sub-limit     
1.Doctors and specialistsDSP
1.1Consultations or visits: Obtained from certain doctors, during normal working hours – N$ 15 per visit100 %
1.1.1Nurse: New conditions – N$15 per visit
1.1.2General practitioner: Unlimited consultations at certain doctors – N$ 15 per visit: Ned Conditions355 per visit
1.1.3Medical specialist: Upon referral from doctor – N$15 per visit
1.1.4Medical specialist: Travel assistance benefit to Windhoek or Swakopmund (Limited to 2 visits per family per year)685 per visit
1.2Out-of-hospital services100 %
1.3Limited to 2 after-hour consultations at certain doctors: Per family per year100 %
2.Medicine and injectionsUnlimitedDSP
2.1Acute Medicine
2.1.1As dispensed or prescribed by certain doctors and pharmacies: Subject to the formulary100 %215 per script
2.1.2Self-medication: Over-to-counter100 %770220 per claim
2.2Antiretroviral therapy: Dispensed – Patient needs to enrol in the AFA Programme100 %
2.3Chronic Medicine
2.3.1Chronic Medicine: Dispensed – As per chronic medicine formulary: Subject to prior registration100 %3,540
3.Primary care dentistry: N$ 15 per visit – New conditions1,5903,290DSP
3.1Subject to use of certain dentists: According to a list of approved dentist codes100 %
3.1.1Plastic dentures: Limited to 1 set per family per 24 months
3.1.2Consultants, primary extractions, fillings level 1 to 3, fluoride treatment, instructions on oral hygiene scaling and polishing.
3.1.3Surgical removal of teeth, root canal treatment and dentures: Subject to pre-authorisation
3.2Specialised dentistryNo benefit
4.RadiologyUnlimitedDSP
4.1Black and white x-rays as requested by certain doctors: According to a list of approved radiology codes100 %
5.PathologyUnlimitedDSP
5.1Basic blood tests as requested by certain doctors: According to a list of approved pathology codes100 %
6.Optical: New conditions – N$15 per visit965DSP
6.1Optical Tests100 %Limited to 90
6.2Spectacles and lenses: Limited to 1 pair of glasses per family per 24 months – When joining NHP, you cannot claim for glasses for the first 6 months100 %Claim limited to N$ 835
7.Mother and child healthcare servicesDSP
7.1Family planning, immunisations, pre- and post- antenatal care100%
8.Counselling and health educationDSP
8.1Instruction on prevention of certain illnesses, oral hygiene, poisons, HIV-AIDS etc.100%
9.Specified illness conditionsDSP
9.1HIV/AIDS: Aids and HIV Positivity, Pathology, HIV Counselling and testing, Prophylactic medicine for prevention of HIV virus, transmission in the case of needle-prick, rape or infection of mother (mother-to-child prevention)100 %Unlimited
9.2Sexually transmitted diseases100 %1,420
9.3Rehabilitation of alcohol and drug addiction or abuse100 %1,420DSP

 

  • Travel assistance for specialist visits in Namibia only, limited to 2 per family per year – Blue Diamond only.
  • International Travel benefit.
  • NHP pays for contraceptives (oral and injections) limited to N$220 per claim.
  • Immunisations are only available from designated service providers. subject to the formulary.
  • Members do not qualify for the Lifestyle Programme.
  • No Roll-Over benefit.
  • No Preventative Care benefit including Cervarix.