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Gold [2019]

Contributions start from

N$ 3,646.00

for an individual principal member

The Gold benefit option offers the most comprehensive benefits for both major and day-to-day medical expenses. This benefit option is considered ideal for members wishing to ensure that their medical costs are covered to the greatest extent. The Gold benefit option is best suited for members who are older and whose health risk is high, as well as members requiring extensive chronic medication and orthodontic treatment.

Please note: All services are paid at 100% of the NAMAF benchmark tariff, unless indicated to the contrary..

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Major medical expenses limit per category

Major medical expenses limit per category (Gold Option for 2019)

		NAMAF tarriff or % thereof	Principal Member	Per Additional Beneficiary	Per Family	Conditions
*Overall Annual Limit*				*Unlimited*
1.	*Healthcare provider and medical specialists*	-	-	-	-	SPA
1.1	Consultations and visits: In-hospital	225 %	-	-	-	-
1.2	Procedures: In-hospital	225 %	-	-	-	-
2.	*Chronic Medication*	-	29,600	59,800	-	-
2.1	Chronic approved - Min levy of N$30: Subject to prior registration	80 %	-	-	-	-
3.	*Hospital services*	-	-	-	-	SPA
3.1	Accommodation and theatre	100 %	-	-	-	-
3.2	Blood transfusions	100 %	-	-	-	-
3.3	Dialysis	100 %	-	-	-	-
3.4	Medication	100 %	-	-	-	-
3.5	Accommodation in private wards	100 %	25,000	-	50,400	-
3.6	Accommodation other than a recognised hospital or medical institution: SA only	100 %	-	-	750 per day	-
3.7	Appliances and prosthesis: Surgical	100 %	69,400	-	112,000	-
3.8	Refractive surgery: Full procedure - A waiting period of 12 months will apply	100 %	29,800	-	36,800	-
3.9	Organ transplants: Full procedure	100 %	-	-	594,000	-
3.10	Private nursing	100 %	67,300	-	67,300	-
3.11	Oncology	100 %	-	-	740,000	-
4.	*Radiology*	-	-	-	-	SPA
4.1	Radiology: Specialised MRI and CT scans in-and-out of hospital combined	100 %	-	-	37,200	-
4.2	Basic radiology: In-hospital	100 %	-	-	-	-
5.	*Pathology*	-	-	-	-	-
5.1	Pathology: In-hospital	100 %	-	-	-	-
6.	*Dentistry*	-	-	-	-	SPA
6.1	Oral surgery: Full procedure	100 %	-	-	60,800	-
6.2	Maxillo facial surgery: Non-elective only	100 %	-	-	-	-
6.3	Dental implants	-	-	-	-	OAL
6.4	Hospitalisation	100 %	-	-	16,100	-
6.5	Consultation, procedure and cost of implants	100 %	-	-	17,400	N$ 3,470 per implant
7.	*Psychiatric treatment*	-	32,200	-	59,500	SPA
7.1	Hospitalisation or institutionalisation	100 %	-	-	-	-
7.2	Rehabilitation: Alcohol and drug addiction or abuse	100 %	-	-	-	SPA
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	100 %	-	-	-	-
10.	*Specified illness conditions*	-	-	49,500	-	OAL
10.1	HIV/AIDS: Including the cost of pathology tests	100 %	-	-	-	SPA
10.2	Sexually transmitted diseases	100 %	6,220	-	8,350	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 %	4,440	4,440	-	-
11.4	Other transportation	80 % 1st transfer and subsequent	-	-	-	-
12.	*Artificial limbs and eyes*	-	-	-	-	SPA
12.1	Artificial limbs	100 %	-	64,300	-	-
12.2	Artificial eyes	100%	-	25,700	-	-
13.	*Heart surgery rehabilitation*	100 %	-	-	21,500	OAL
14.	*Insertion Mirena Device: All Inclusive - Every 3 years*	-	-	6,400	-	OAL
15.	*Stoma Care products*	100 %	-	-	30,000	OAL
16.	*Back and Neck Rehabilitation Programme*	100 %	Subject to DBC protocol	Subject to DBC protocol	Subject to DBC protocol	OAL

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Day-to-day expenses limit per category

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Contributions for Employer Groups

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Contributions for Individual Members

Roll-Over Benefit

For diligent management of your healthcare expenditure:

Principal	N$ 6,810.00
Adult/Special dependant	N$ 1,740.00
Child	N$ 1,740.00

Example Roll-over Benefit:
(Principal member + spouse + two children) = N$10,660 per year.

Notes

Flu vaccines are covered as part of the Preventative Care benefit.
Vitamins under specific conditions to be authorised from the chronic medication benefit.
Limited benefit for vitamins available under 2.1.4. above, without a prescription.
NHP pays for contraceptives (oral and injections) limited to N$220 per claim.
Sunblock may be purchased at pharmacies under the Self-medication benefit.
Pre-authorised travelling costs for specialist referrals in Namibia partly covered if residing more than 150km from Windhoek - Accommodation included, limited to N$750 per night, maximum of 2 nights per family per annum.
No basic dentistry will be covered under the oral surgery benefit.

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		NAMAF tarriff or % thereof	Principal Member	Per Additional Beneficiary	Per Family	Conditions
*Out-of-hospital: Sub-limit*
1.	*Healthcare provider and medical specialists*	-	16,600	4,500	-	-
1.1	Consultations or visits: Out-of-hospital	100 %	15 visits	10 visits	-	-
1.2	Out-of-hospital services	100 %	-	-	-	-
1.3	Pathology or radiology: Out-of-hospital	100 %	-	-	-	-
1.4	Chronic Lifestyle disease extender benefit	100 %	Additional benefits as specified	Additional benefits as specified	Additional benefits as specified	OAL
2.	*Medicine and injections*	-	-	-	-	-
2.1	Acute medicine	-	9,580	5,570	-	-
2.1.1	Acute: Pharmacy dispensed - Min. levy of N$ 30	80 %	-	-	-	-
2.1.2	Acute: Doctors dispensed - Min. levy of N$ 30	80 %	-	-	-	-
2.1.3	Self medication: Over-the-counter - No levy: Subject to acute medication limit	100 %	1,770	445	-	220 per claim
2.1.4	Vitamins, homeopathic and phytotherapy medication - Min levy of N$30	80 %	950	260	-	220 per claim
2.2	Chronic medicine	-	-	-	-	-
2.2.1	Chronic approved: Subject to prior registration - Min. levy of N$ 30	-	-	-	-	-
3.	*Dentistry*	-	18,000	-	35,800	-
3.1	Basic dentistry: Subject to sub-limit	100 %	10,100	3,480	-	-
3.2	Dental technicians	100 %	-	-	-	-
3.3	Advanced dentistry	-	-	-	-	-
3.3.1	Orthodontics	100 %	-	-	-	-
3.3.2	Dental Implants: Full procedure	100 %	Refer to OAL - 5.3	Refer to OAL - 5.3	Refer to OAL - 5.3	-
4.	*Optical*	-	5,990	2,230	-	-
4.1	Eye tests	100 %	-	-	-	-
4.2	Spectacles and lenses: Frames every 2nd year	100 %	-	-	-	Frame limit to N$ 2,160
4.3	Orthoptics	100 %	-	-	-	-
5.	*Auxiliary services*	-	18,700	5,510	-	-
5.1	Chiropody	100 %	-	15 visits	-	-
5.2	Clinical psychology	100 %	-	15 visits	-	-
5.3	Dietician	100 %	-	15 visits	-	-
5.4	Homeopathy: Consultation only	100 %	-	15 visits	-	-
5.5	Occupational therapy	100 %	-	15 visits	-	-
5.6	Social workers	100 %	-	15 visits	-	-
5.7	Appliances: Non-surgical	100 %	-	-	-	SPA
5.8	Physiotherapy	100 %	-	15 visits	-	-
5.9	Biokinetics	100 %	-	15 visits	-	-
5.10	Audiology and speech therapy	100 %	-	15 visits	-	-
5.11	Chiropractic	100 %	-	15 visits	-	-
5.12	Podiatry	100 %	-	15 visits	-	-

Age Group	Principal	Adult/Special dependant	Child
0 - 25	N$ 2,821.00	N$ 2,110.00	N$ 1,173.00
26 - 30	N$ 3,209.00	N$ 2,588.00	N$ 1,173.00
31 - 35	N$ 3,513.00	N$ 2,881.00	N$ 1,173.00
36 - 40	N$ 4,078.00	N$ 3,460.00	N$ 1,173.00
41 - 45	N$ 4,420.00	N$ 3,895.00	N$ 1,173.00
46 - 50	N$ 4,659.00	N$ 4,048.00	N$ 1,173.00
51 - 55	N$ 4,820.00	N$ 4,274.00	N$ 1,173.00
56 - 60	N$ 5,066.00	N$ 4,442.00	N$ 1,173.00
61 - 65	N$ 5,637.00	N$ 4,805.00	N$ 1,173.00
66+	N$ 5,860.00	N$ 4,946.00	N$ 1,173.00

Age Group	Principal	Adult/Special dependant	Child
0 - 25	N$ 3,646.00	N$ 2,831.00	N$ 1,483.00
26 - 30	N$ 4,095.00	N$ 3,442.00	N$ 1,483.00
31 - 35	N$ 4,587.00	N$ 3,776.00	N$ 1,483.00
36 - 40	N$ 5,345.00	N$ 4,708.00	N$ 1,483.00
41 - 45	N$ 5,704.00	N$ 5,142.00	N$ 1,483.00
46 - 50	N$ 6,152.00	N$ 5,372.00	N$ 1,483.00
51 - 55	N$ 6,152.00	N$ 5,670.00	N$ 1,483.00
56 - 60	N$ 6,668.00	N$ 5,982.00	N$ 1,483.00
61 - 65	N$ 7,559.00	N$ 6,524.00	N$ 1,483.00
66+	N$ 7,900.00	N$ 6,776.00	N$ 1,483.00

Gold [2019]

Major medical expenses limit per category (Gold Option for 2019)

Day-to-day expenses limit per category (Gold Option for 2019)

Contributions for Employer Groups (Gold Option for 2019)

Contributions for Individual Members (Gold Option for 2019)

Roll-Over Benefit

Notes

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