Blue Diamond
starting from
N$ 687
per individual principal member
starting from
N$ 687
per individual principal member
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
| Age | Principal Member |
Adult/ Special dep |
Child dep |
|---|
| 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.
| NAMAF tarriff or % thereof | Principal Member | Per Additional Beneficiary | Per Family | Conditions | ||
| Overall Annual Limit | Unlimited | |||||
| 1. | Doctors and Specialists | – | – | – | – | SPA |
| 1.1 | Consultations and visits: In-hospital | 100 % | Max 5 virtual GP consultations | Max 5 virtual GP consultations | – | – |
| 1.2 | Procedures: In-hospital | 100 % | – | – | – | – |
| 2. | Hospital services | – | – | – | – | SPA |
| 2.1 | You can be admitted into the state hospital facility (private wing) but it has to first be approved by NHP. Subject to pre-authorisation. | 100 % | – | – | – | – |
| 2.2 | Selected private hospitals: Limited access benefit for treatment | 100 % | – | – | – | – |
| 2.3 | Routine and scheduled and hospitalisation events | 100 % | – | – | – | – |
| 2.4 | Ward Fees | 60 % | – | – | – | – |
| 3. | Ambulance services: Only for medical or trauma emergencies | – | – | – | – | SPA |
| 3.1 | Air evacuation | 100 % | – | – | – | – |
| 3.2 | In an emergency you are covered for ambulance services but only in Namibia | 100 % | – | – | – | – |
| 3.3 | You are covered for transport between 2 hospitals | 100 % | 4,920 | 4,920 | – | – |
| 3.4 | Other transportation | No Benefit | – | – | – | – |
| 4. | Maternity | – | – | – | – | SPA |
| 4.1 | When you are pregnant, you can go visit doctors 12 times per pregnancy – Subject to pre-authorisation | 100% | – | – | 12 visits | – |
| 4.2 | 2D Sonar scans | 100% | – | – | 2 Scans | – |
| 5 | Back and Neck Rehabilitation Programme | 100 % | Subject to DBC protocol | Subject to DBC protocol | Subject to DBC protocol | OAL |
| 6 | Preventative care | 100 % | – | – | – | OAL |
| 6.1 | Vaccinations: COVID-19 | 100% | – | – | – | – |
| 6.2 | Health Risk Assessment | 100% | – | – | – | – |
| NAMAF tarriff or % thereof | Principal Member | Per Additional Beneficiary | Per Family | Conditions | ||
| Out-of-hospital: Sub-limit | ||||||
| 1. | Doctors and specialists | – | – | – | – | DSP |
| 1.1 | Consultations or visits: Obtained from certain doctors, during normal working hours – N$ 15 per visit | 100 % | – | – | – | – |
| 1.1.1 | Nurse: New conditions – N$15 per visit | – | – | – | – | – |
| 1.1.2 | General practitioner: Unlimited consultations at certain doctors – N$ 15 per visit: Ned Conditions | – | – | – | 380 per visit | – |
| 1.1.3 | Medical specialist: Upon referral from doctor – N$15 per visit | – | – | – | – | – |
| 1.1.4 | Medical specialist: Travel assistance benefit to Windhoek or Swakopmund (Limited to 2 visits per family per year) | – | – | – | 730 per visit | – |
| 1.2 | Out-of-hospital services | 100 % | – | – | – | – |
| 1.3 | Limited to 2 after-hour consultations at certain doctors: Per family per year | 100 % | – | – | – | – |
| 2. | Medicine and injections | – | – | – | Unlimited | DSP |
| 2.1 | Acute Medicine | – | – | – | – | – |
| 2.1.1 | As dispensed or prescribed by certain doctors and pharmacies: Subject to the formulary | 100 % | – | – | – | 230 per script |
| 2.1.2 | Self-medication: Over-to-counter | 100 % | – | – | 825 | 235 per claim |
| 2.2 | Antiretroviral therapy: Dispensed – Patient needs to enrol in the AFA Programme | 100 % | – | – | – | – |
| 2.3 | Chronic Medicine | – | – | – | – | – |
| 2.3.1 | Chronic Medicine: Dispensed – As per chronic medicine formulary: Subject to prior registration | 100 % | – | – | 3,780 | – |
| 3. | Primary care dentistry: N$ 15 per visit – New conditions | – | 1,760 | – | 3,510 | DSP |
| 3.1 | Subject to use of certain dentists: According to a list of approved dentist codes | 100 % | – | – | – | – |
| 3.1.1 | Plastic dentures: Limited to 1 set per family per 24 months | – | – | – | – | – |
| 3.1.2 | Consultants, primary extractions, fillings level 1 to 3, fluoride treatment, instructions on oral hygiene scaling and polishing. | – | – | – | – | – |
| 3.1.3 | Surgical removal of teeth, root canal treatment and dentures: Subject to pre-authorisation | – | – | – | – | – |
| 3.2 | Specialised dentistry | No benefit | – | – | – | – |
| 4. | Radiology | – | – | – | Unlimited | DSP |
| 4.1 | Black and white x-rays as requested by certain doctors: According to a list of approved radiology codes | 100 % | – | – | – | – |
| 5. | Pathology | – | – | – | Unlimited | DSP |
| 5.1 | Basic blood tests as requested by certain doctors: According to a list of approved pathology codes | 100 % | – | – | – | – |
| 6. | Optical: New conditions – N$15 per visit | – | – | – | 1030 | DSP |
| 6.1 | Optical Tests | 100 % | – | – | – | Limited to 105 |
| 6.2 | Spectacles and lenses: Limited to 1 pair of glasses per family per 24 months – When joining NHP, you cannot claim for glasses for the first 6 months | 100 % | – | – | – | Claim limited to N$ 925 |
| 7. | Mother and child healthcare services | – | – | – | – | DSP |
| 7.1 | Family planning, immunisations, pre- and post- antenatal care | 100% | – | – | – | – |
| 8. | Counselling and health education | – | – | – | – | DSP |
| 8.1 | Instruction on prevention of certain illnesses, oral hygiene, poisons, HIV-AIDS etc. | 100% | – | – | – | – |
| 9. | Specified illness conditions | – | – | – | – | DSP |
| 9.1 | HIV/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 | – |
| 9.2 | Sexually transmitted diseases | 100 % | – | – | 1,510 | – |
| 10 | Rehabilitation of alcohol and drug addiction or abuse | 100 % | – | – | 1,510 | DSP |
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