Hospital
starting from
N$ 1,503
per individual principal member
starting from
N$ 1,503
per individual principal member
Adequate cover for unforeseen events that can have severe financial implications. No benefits in respect of day-to-day treatment, thus best suited to members who are younger and whose health risk is very low
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 Hospital benefit option offers comprehensive benefits for hospitalisation and related major medical expenses. The Hospital benefit option is ideal for members wishing to self-insure their day-to-day medical expenses while enjoying adequate cover for unforeseen events that can have severe financial implications. This benefit option offers no benefits in respect of day-to-day treatment, thus best suited to members who are younger and whose health risk is very low, thereby enabling them to pay their day-to-day accounts out of their pocket.
Please note: All services are paid at 100% of the NAMAF benchmark tariff, unless indicated to the contrary.
| NAMAF tarriff or % thereof | Principal Member | Per Additional Beneficiary | Per Family | Conditions | ||
| Overall Annual Limit | 1,220,000 | 2,710,000 | ||||
| 1. | Healthcare provider and medical specialists | – | – | – | – | SPA |
| 1.1 | Consultations and visits: In-hospital | 200 % | – | – | – | – |
| 1.2 | Procedures: In-hospital | 200 % | – | – | – | – |
| 2. | Chronic Medication | – | – | – | – | – |
| 2.1 | Chronic approved – Min levy of N$30: Subject to prior registration | No benefit | – | – | – | – |
| 3. | Hospital services | – | – | – | – | SPA |
| 3.1 | Accommodation and theatre | 100 % | – | – | – | – |
| 3.2 | Blood transfusions | 100 % | – | – | – | – |
| 3.3 | Dialysis | 100 % | – | – | – | – |
| 3.4 | Medication | 100 % | – | – | – | – |
| 3.5 | Accommodation in private wards | 100 % | 12,700 | – | 25,300 | – |
| 3.6 | Accommodation other than a recognised hospital or medical institution: SA only | 100 % | – | – | 835 per day | – |
| 3.7 | Appliances and prosthesis: Surgical | 100 % | 27,600 | – | 55,800 | – |
| 3.8 | Refractive surgery: Full procedure – A waiting period of 12 months will apply | 100 % | 7,110 | – | 9,250 | – |
| 3.9 | Organ transplants: Full procedure | 100 % | – | – | 116,000 | – |
| 3.10 | Private nursing | 100 % | 23,300 | – | 23,300 | – |
| 3.11 | Oncology | 100 % | – | – | 650,000 | – |
| 4. | Radiology | – | – | – | – | SPA |
| 4.1 | Radiology: Specialised MRI and CT scans in-and-out of hospital combined | 100 % | – | – | 22,300 | – |
| 4.2 | Basic radiology: In-hospital | 100 % | – | – | – | – |
| 5. | Pathology | – | – | – | – | – |
| 5.1 | Pathology: In-hospital | 100 % | – | – | – | – |
| 6. | Dentistry | – | – | – | – | SPA |
| 6.1 | Oral surgery: Full procedure | 100 % | – | – | 53,600 | – |
| 6.2 | Maxillo facial surgery: Non-elective only | 100 % | – | – | – | – |
| 6.3 | Dental implants | – | – | – | – | – |
| 6.4 | Hospitalisation | No Benefits | – | – | – | – |
| 6.5 | Consultation, procedure and cost of implants | No Benefits | – | – | – | – |
| 7. | Psychiatric treatment | – | 23,700 | – | 43,900 | SPA |
| 7.1 | Hospitalisation or institutionalisation | 100 % | – | – | – | – |
| 7.2 | Rehabilitation: Alcohol and drug addiction or abuse | 100 % | – | – | – | – |
| 8. | Maternity | – | – | – | – | – |
| 8.1 | Confinement: Full procedure | 100 % | – | – | – | SPA |
| 8.2 | Antenatal consultations (total consultations) | 100 % | – | – | 12 visits | OAL |
| 8.3 | 2D Sonar scans (total scans) | 100 % | – | – | 2 Scans | OAL |
| 8.4 | Amniocentesis | 100 % | – | – | – | SPA |
| 8.5 | Panorama Prenatal test | 100 % | – | – | – | SPA |
| 9. | Preventative care | – | – | – | – | OAL |
| 9.1 | Vaccinations: As per list | No Benefits | – | – | – | – |
| 10. | Specified illness conditions | – | – | 21,700 | – | OAL |
| 10.1 | HIV/AIDS: Including the cost of pathology tests | 100 % | – | – | – | SPA |
| 10.2 | Sexually transmitted diseases | 100 % | 3,540 | – | 4,680 | SPA |
| 11. | Ambulance services: Only for medical or trauma emergencies | – | – | – | – | SPA |
| 11.1 | Air evacuation | 100 % | – | – | – | – |
| 11.2 | Ambulance services | 100 % | – | – | – | – |
| 11.3 | Ambulance services: Inter-hospital transfer | 100 % | 4,920 | 4,920 | – | – |
| 11.4 | Other transportation | 80 % 1st transfer and subsequent | – | – | – | – |
| 12. | Artificial limbs and eyes | – | – | – | – | – |
| 12.1 | Artificial limbs | No Benefits | – | – | – | – |
| 12.2 | Artificial eyes | No Benefits | – | – | – | – |
| 13. | Heart surgery rehabilitation | 100% | – | – | 17,200 | – |
| 14. | Insertion Mirena Device: All Inclusive – Every 3 years | 100 % | – | 7,080 | – | OAL |
| 15. | Stoma Care products | 100 % | – | – | 33,200 | OAL |
| 16. | Back and Neck Rehabilitation Programme | 100 % | Subject to DBC protocol | Subject to DBC protocol | Subject to DBC protocol | OAL |
| NAMAF tarriff or % thereof | Principal Member | Per Additional Beneficiary | Per Family | Conditions | ||
| Out-of-hospital: Sub-limit | No Benefit | No Benefit | ||||
| 1. | Healthcare provider and medical specialists | – | No Benefit | No Benefit | No Benefit | – |
| 1.1 | Consultations or visits: Out-of-hospital | No Benefit | Max 5 virtual GP consultations | Max 5 virtual GP consultations | – | – |
| 1.2 | Out-of-hospital services | No Benefit | – | – | – | – |
| 1.3 | Pathology or radiology: Out-of-hospital | No Benefit | – | – | – | – |
| 1.4 | Chronic Lifestyle disease extender benefit | No benefit | – | – | – | – |
| 2. | Medicine and injections | – | No Benefit | No Benefit | No Benefit | – |
| 2.1 | Acute medicine | No Benefit | – | – | – | – |
| 2.1.1 | Acute: Pharmacy dispensed – Min. levy of N$ 30 | No Benefit | – | – | – | – |
| 2.1.2 | Acute: Doctors dispensed – Min. levy of N$ 30 | No Benefit | – | – | – | – |
| 2.1.3 | Self medication: Over-the-counter – No levy: Subject to acute medication limit | No Benefit | – | – | – | – |
| 2.1.4 | Vitamins, homeopathic and phytotherapy medication – Min levy of N$30 | No Benefit | – | – | – | – |
| 2.2 | Chronic medicine | No Benefit | – | – | – | – |
| 2.2.1 | Chronic approved: Subject to prior registration – Min. levy of N$ 30 | No Benefit | – | – | – | – |
| 3. | Dentistry | – | No Benefit | No Benefit | No Benefit | – |
| 3.1 | Basic dentistry: Subject to sub-limit | No Benefit | – | – | – | – |
| 3.2 | Dental technicians | No Benefit | – | – | – | – |
| 3.3 | Advanced dentistry | No Benefit | – | – | – | – |
| 3.3.1 | Orthodontics | No Benefit | – | – | – | – |
| 3.3.2 | Dental Implants: Full procedure | No Benefit | – | – | – | – |
| 4. | Optical | – | No Benefit | No Benefit | No Benefit | – |
| 4.1 | Eye tests | No Benefit | – | – | – | – |
| 4.2 | Spectacles and lenses: Frames every 2nd year | No Benefit | – | – | – | – |
| 4.3 | Orthoptics | No Benefit | – | – | – | – |
| 5. | Auxiliary services | – | No Benefit | No Benefit | No Benefit | – |
| 5.1 | Chiropody | No Benefit | – | – | – | – |
| 5.2 | Clinical psychology | No Benefit | – | – | – | – |
| 5.3 | Dietician | No Benefit | – | – | – | – |
| 5.4 | Homeopathy: Consultation only | No Benefit | – | – | – | – |
| 5.5 | Occupational therapy | No Benefit | – | – | – | – |
| 5.6 | Social workers | No Benefit | – | – | – | – |
| 5.7 | Appliances: Non-surgical | No Benefit | – | – | – | – |
| 5.8 | Physiotherapy | No Benefit | – | – | – | – |
| 5.9 | Biokinetics | No Benefit | – | – | – | – |
| 5.10 | Audiology and speech therapy | No Benefit | – | – | – | – |
| 5.11 | Chiropractic | No Benefit | – | – | – | – |
| 5.12 | Podiatry | No Benefit | – | – | – | – |
| 6 | Smart Saver benefit | – | – | – | – | – |
| 6.1 | Health Risk Assessment | 100% | – | – | 500 | – |
| 7 | Roll-Over Benefit | No Benefit | – | – | – | – |
No Day-to-Day benefits are available.
1 COVID-19 vaccine regimen per year is covered as part of the Preventative Care benefit for all beneficiaries older than 16 years.
No Roll-Over benefit apart from a Smart Saver benefit that is added to a family’s Accumulated Roll-Over benefit on completion of a health risk assessment by the principal member or an adult dependent at any of the Fund’s Wellness Days or at a qualifying pharmacy.
Pre-authorised travelling costs for specialist referrals in Namibia partly covered if residing more than 150km
from Windhoek – accommodation included, limited to N$ 835 per night, maximum of 2 nights per family per annum.
Intra ocular lenses included in Appliances and Prosthesis Surgical benefit – limited to N$ 6 700 per lens, refer to 3.7.
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