Added Value Benefits

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, and
  • Pathology.

Please note: The GoldPlatinumSilverBronze 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 maxillofacial surgery,
  • Dental implants,
  • Oral surgery, and
  • Orthognathic surgery

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

Please note: In order to qualify for GAP 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 GAP 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.

Babyline

NHP has introduced a dedicated toddler’s health advice line, called Babyline. Babyline is a 24 hour children’s health advice line. Members can call the toll-free number 0800 255 255 and they will be connected to a paediatric trained registered nurse. The Babyline service is available to members across all NHP benefit options, for children under 3 years. Members should have their membership number at hand when calling Babyline.

Back & Neck Programme

This benefit is applicable to members on all options (including the Blue Diamond and Litunga benefit options) and further subject to application and pre-authorisation. The benefit is intended to fund the cost of Document Based Care (DBC) conservative treatment for chronic back and neck ailments.

Access to this benefit is limited to the identification processes
below:

  • Referral by the treating general practitioner or specialist of eligible members who would benefit from the DBC back and neck programme, as opposed to surgery in the first instance and postsurgical rehabilitation.
  • Pre-emptive identification of eligible beneficiaries.
  • Pre-emptive identification through requests for hospital authorisation relating to surgery.
  • Identification of eligible employee as part of Wellness Day screenings, with subsequent referral to the DBC Programme. The benefit makes provision for consultations by the general practitioner and treatment by the physiotherapist and biokineticist.

The treatment protocol includes:

  • Initial assessment.
  • 1st Cycle of treatment sessions and interim assessment by medical doctor.
  • 2nd Cycle of treatment sessions and re-assessment by medical doctor.
  • Bi-monthly maintenance sessions, if approved. Funding of this conservative treatment is funded from the Major Medical Expense risk benefit and not from day-to-day, since this programme offers conservative treatment for back and neck related
    conditions.

Chronic Lifestyle Disease Extended Benefit

This benefit is limited to specific ambulatory healthcare services for beneficiaries diagnosed with one or more of the following medical conditions:

  • Hypertension
  • Hypercholesterolemia
  • Diabetes

The intention is to assist high risk chronic members to remain under treatment for the period of cover in terms of each benefit year subject to being on a qualifying benefit option and being registered on the programme. Where a member may be diagnosed with more than one of the above conditions, the allowable services for multiple conditions shall be determined by combining the services for each disease. The quantity limits will however remain as the number approved for each individual disease.

The treatment covered by this benefit includes:

  • Additional consultation(s) by healthcare providers restricted to the prescribed frequency of treatment codes.
  • Chronic medicines, inclusive diabetic disposables such as syringes, needles, strips and lancets for registered patients.
  • Additional pathology and radiology tests. The Chronic Lifestyle Disease Extender benefit will only be activated once all other acute- and chronic medication benefits as well as any available Accumulated Roll-Over benefits have been depleted. The Chronic Lifestyle Disease Extender benefit is only available to members on the Gold, Platinum and Titanium benefit options. High risk members on the Silver and Bronze benefit options, subject to approval and furthermore registration on the Beneficiary Risk Management Programme, may apply for this benefit. Members on the Hospital- Blue Diamond and Litunga benefit options will not have access to this benefit.

Emergency Evacuation

Although the Fund may make use of the services of any number of accredited emergency service providers the Fund maintains two dedicated emergency contact numbers at E-Med Rescue 24 and LifeLink EMS. Both E-Med Rescue 24 and LifeLink EMS are locally owned emergency medical evacuation companies with the appropriate infrastructure in place to provide adequate cover and peace of mind to all NHP members.

NHP emergency numbers:

  • E-Med Rescue 24 Tel: 061 222 223
  • LifeLink EMS Tel: 064 501 000

Should E-Med Rescue 24 or LifeLink EMS not have ambulances available or a physical presence in the members town of residence, then members will still be required to contact them at the above mentioned numbers and they in return will arrange with any other emergency medical evacuation provider, to be of assistance during an emergency.

International medical emergency cover – outside Namibian borders:

  • NHP members will enjoy cover for medical emergencies, both by road and air evacuation, in the SADC Region (Angola, Botswana, DR Congo, Kenya, Lesotho, Madagascar, Malawi, Mauritius, Mozambique, Namibia, Seychelles, South Africa, eSwatini, Tanzania, Zambia, and Zimbabwe.) and also internationally. In addition members will also be covered by emergency medical evacuation in the event of a motor vehicle accident.

Members requiring emergency medical assistance should provide the following information at the time of requesting such assistance:

  • Membership number,
  • Personal particulars,
  • The place and telephone number where the patient or his/her representative can be reached,
  • A brief description of the emergency, and
  • The nature of the assistance required.

For any further enquiries in this regard, please contact NHP, tel 061 285 5400 or any of our branches in Namibia.

Please note: Both E-Med Rescue 24 and LifeLink EMS are accredited service providers to the Fund. Members should note that assistance for emergency evacuation may only be requested from either E-Med Rescue 24 or LifeLink EMS and not from any other medical service provider, such as Municipal Emergency Ambulances without prior approval from the Fund. Members must correctly identify themselves as a NHP member. Under all circumstances NHP members should request for assistance via any of the two emergency numbers provided.

Non-emergency transfers must be pre-authorised by the Fund’s medical service provider call centre prior to the transfer of the patient. An authorisation number will be allocated to the case and issued to the healthcare provider at the time of the request for transportation. Authorisation numbers will not be issued for cases where the member has already been transferred.

Please note: Transfer from the hospital to the home is classified as a non-emergency.

Ex-Gratia Applications for Additional Benefits

You are advised that, should a need for an Ex-Gratia request for financial assistance arise, you should contact the Fund in which case you will be assisted in completing and submitting the relevant forms.

The Board of Trustees will not authorise payment for services other than those prescribed in the Rules of the Fund but can at its absolute discretion, increase the amount payable in terms of the Rules as an Ex-Gratia award, provided that the Board of Trustees is satisfied that the member would otherwise suffer undue financial hardship.

Please note:  The Board of Trustees decision in such cases shall always be final.

In order to realise the overall objective, the following criteria are applicable:

  • Each application is evaluated objectively and consistently.
  • Each application is evaluated and rated to determine the level of financial hardship of the member.The identity and nature of the request shall always be treated with the utmost discretion and confidentiality.
  • The identity and nature of the request shall always be treated with the utmost discretion and confidentiality.


The following relates to the application and appeal process:

  • Only applications that contain all the required information will be tabled for review.
  • All applications that are incomplete will be rejected outright and the applicant notified as such.
  • The final decision, with regards to the actual amount approved or rejected, remains entirely up to the discretion of the Ex-Gratia Committee.
  • Any member may appeal the decision of the Ex-Gratia Committee.
  • Such an appeal must be brought to the attention of the Ex-Gratia Committee. The appeal must be directed to the Principal Officer of the Fund and should be submitted within 30 days of the date of the notification by the administrator.
  • The Ex-Gratia Committee will review the merits of the appeal application as well as its decision and forward the appeal to the Board of Trustees. The member concerned shall be informed of the ruling of the Board of Trustees. The ruling of the Board of Trustees remains final and binding on the member.

Please note: Members are reminded that if any Ex-Gratia allocations made in a specific benefit year i.e. 1 January to 31 December are not used by the member, these cannot be transferred to the next benefit year.

It is therefore in the members own interest to ensure that they ensure that their treatment is completed as soon as possible after they have been informed of the outcome of their Ex-Gratia application.

NHP Wellness Programme

A rapid increase in chronic conditions fueled by lifestyle choices has resulted in an increased focus on preventative strategies to counteract their negative effects. NHP has identified preventative care as a key focus area going into the future and has incorporated a preventative care benefit into the benefit design without influencing your day-today benefit or impacting on your Roll-Over Benefit. The intention is to shift the focus from curative, to primary and preventative care. The NHP Wellness Programme forms part of a greater effort to support the focus on preventative treatment.

Becoming aware of your health risks can lead to specific goals and planning to reduce the risks of certain diseases and sicknesses, enhance health, improve productivity in the organisation, increase job satisfaction and reduce absenteeism.

Our NHP Wellness Programme is a practical programme aimed at empowering you to take ownership of your own health and well-being. The Beneficiary Risk Management (BRM) Programme targets key lifestyle factors that influence your healthcare risks. These lifestyle factors include stress, weight control, smoking, diet, nutrition and exercise. The BRM Programme is a tool to manage your healthcare risk in order to start early intervention and active engagement. NHP provides clinical expertise and guidance that equips you with vital information necessary to benchmark your health. The NHP Wellness Programme set of services are based on the following principles:

  • Face-to-face interaction with onsite screenings;
  • Identification of high risk members;
  • Communication with high risk members;
  • Active enrollment and intervention via case management;
  • Monitoring member compliance to treatment;
  • Updating beneficiary data;
  • Measuring of outcome;
  • Tailored (Individualised) feedback.

For more information contact NHP.

Preventative Care Benefit

The Preventative Care benefit has been extended to include various diagnostics and will be available to members on the Gold, Platinum, Titanium, Silver, and Bronze benefit options. This benefit is subject to the members’ overall annual limit (OAL) and will not affect their available day-to-day benefits and limits. The vaccinations listed under the Preventative Care benefit also do not affect the day-to-day benefits and limits.

Please note: Members on the HospitalBlue Diamond, and Litunga benefit options do not qualify for the preventative care benefits as listed.

The Preventative Care benefit on the aforementioned benefit options consists of the following:

  • Vaccinations
    • Members older than 50 years: 1 flu vaccination per beneficiary per year.
    • Children younger than 6 years of age, which include:
      • Polio;
      • Diphtheria;
      • Pertussis;
      • Tetanus;
      • Haemophilus influenza type B;
      • Measles;
      • Mumps;
      • Rubella;
      • Varicella (chickenpox);
      • Pneumococcal disease;
      • Rotavirus;
      • Hepatitis A and B;
      • Meningococcal disease. 
  • Preventative Care screening:
    • Women’s health:
      • Breast cancer screening with mammography for females older than 40 years: 1 screening every 3 years.
      • Cervical cancer screening for females between 21 years of age up to 65 years: 1 pap smear every 2 years. Cervarix vaccination available.
    • Sexual health:
      • HIV screening for all lives: 1 every year.
    • Men’s health:
      • PSA test for men aged 50 years and older: 1 test every 2 years.
    • Cardiac health:
      • Cholesterol screening with full lipogram for all lives for members older than 20 years: 1 screening every 5 years.
    • Geriatric health:
      • Bone densitometry test for females aged 65 years and older: 1 scan per beneficiary per annum.
    • General health:
      • Colonoscopy for all lives for members aged 50 years and older.

Please note:  Vaccinations for diseases not on the list above are covered by your Acute Medication benefit. Identification of high risk members for intervention is done through the NHP Wellness Programme, where members can form part of the NHP Beneficiary Risk Management (BRM) Programme, if they agree to enrol.

Roll-Over Benefit

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,
  • Sunglasses from a registered healthcare provider, whether or not prescribed by an optometrist or ophthalmologist,
  • 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”.

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.

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@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@nhp.com.na.

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

Travel and Accommodation Assistance Benefit

Subject to prior approval, the Fund offers its members additional assistance with travel and accommodation costs for specific medical treatment such as:

  • Accommodation other than a recognised hospital/medical institution in South Africa.
  • Accommodation other than a recognised hospital/medical institution within Namibia.
  • Travelling costs for specific medical treatment not available in Namibia.
  • Travelling costs for specialist treatment within Namibia.

Full details and terms and conditions about these benefits may be found in our User Guide, click on the link to download the latest User Guide.

For more information, contact NHP, tel 061 285 5400