Benefit guide We re about you

Transcription

1 Benefit guide We re about you

2 Table of contents Introduction 1 How your benefit options work 2 Gold 4 Platinum 6 Titanium 8 Silver 10 Bronze 12 Hospital 14 Blue Diamond 16 Litunga 17 About the Blue Diamond and Litunga benefit options 18 Roll-Over benefit 20 Added value benefits 21 NHP Rebates 23 Disclaimer The new benefits, contributions and Rules of NHP for 2015, as approved by the Fund s Board of Trustees, are subject to final approval by the Registrar of Medical Aid Funds/NAMFISA. Members are advised that the new benefits and contributions will only become effective on 1 January 2015 (and only after approval by the Registrar of Medical Aid funds/namfisa), despite possible dissemination of revised information to the market before the effective date. Should any proposed changes to benefits and contributions not be approved, s will be informed accordingly. E&OE (Errors and omissions excepted). Whilst every care has been taken to ensure that the information in this document is correct, errors and omissions may occur and the Fund cannot be held accountable for any reliance placed on the information contained herein. The Fund s Call Centre may be contacted to confirm any information contained in the document. 02 Administered by

3 Introduction About NHP Thank you for choosing Namibia Health Plan (NHP). NHP was established in 1995 to provide a world class, uniquely Namibian medical aid plan to help cover medical costs. Since then, NHP has grown rapidly to become one of the largest medical aid funds in our country, providing for the healthcare needs of more than 50, 000 people. We are also the first choice for Namibians as shown by the results of the PMR.africa surveys where NHP was presented with the Diamond Arrow award for excellence in the medical aid industry in Namibia for four consecutive years (2010, 2011, 2012 and 2013). NHP was also nominated the most efficient medical aid fund by healthcare providers in While we are proud of these awards (which shows that we re on the right track), ultimately NHP exists to provide you and your family with meaningful medical aid benefits that help you cover your medical costs. NHP believes that its ability to innovate is part of what sets it apart from its competitors. That is why we believe that our very reason for existence is all about you our s. We re about you. How NHP is managed NHP is registered in terms of the Medical Aid Funds Act, 1995 (Act 23 of 1995). The Fund is supervised by the Namibia Financial Institutions Supervisory Authority (NAMFISA) whilst it is also a of the Namibian Association of Medical Aid Funds (NAMAF), the controlling body for medical aid funds in Namibia. The Fund is managed by a Board of Trustees elected by the s. The Board of Trustees manages the Fund on your behalf according to the Rules of the Fund. These Rules change from time to time taking changing circumstances into account. When the Rules are changed you will be informed. LifePoint biometric identification system An integrated healthcare solution In our continued drive towards service excellence, NHP in partnership with LifePoint Namibia and Medscheme Namibia is in the process of introducing an integrated healthcare solution for our s and healthcare providers. Six reasons why you should enrol: Immediate identification of you as an NHP when arriving at a healthcare provider (i.e. your Doctor); Real time claims processing; Identification and access to benefits even in an emergency; Possibility of fraud on your account is minimised; More money for healthcare services; and Easy co-payment calculation. In lieu of the aforementioned the Fund is embarking on a mass enrolment campaign to enrol all NHP s and their dependants fingerprints onto the biometric system. Initially mass enrolments will be conducted at employer groups at participating healthcare providers. During the enrolment campaign, the process will be as follows: Members fingerprint will either be captured at the place of work or at the doctor s practice on a s next visit. The fingerprint is then linked securely to the s existing ship number no new ship card will be issued. All s and dependants above the age of 12 years will need to enrol. Your Benefit Guide NHP produces an annual Benefit Guide, which is written in a simple, easy-to-read language to help you understand your medical aid fund and how the Fund works. When we use the word your we are referring to the principal. The words your family means any dependant of the principal who has been admitted to the Fund. The Benefit Guide contains the Benefits and Contributions as approved by the Board of Trustees and will apply for The changes for 2015 are subject to approval by NAMFISA. Should any proposed changes to Benefits and Contributions not be approved, you will be informed accordingly. The User Guide explains in brief the salient points contained in the Rules at present. You are provided with the User Guide only when joining the Fund. Any subsequent changes to the Fund Rules as well as changes to the benefits and contributions will be announced in the annual summary of changes document. You will also receive a new copy of the Benefit Guide annually. Therefore it is important for you to retain the summary of changes document for future reference. Please note The Fund Rules may change and if there is any discrepancy between the Benefit Guide and the Fund Rules, the Rules will apply. If you have any questions after reading through this Benefit Guide, please do not hesitate to contact NHP or your Client Liaison Officer on tel The Fund will not be held liable if your rights are prejudiced or forfeited as a result of failure or neglect to comply with the Rules of the Fund which may arise from failure or neglect to read the communications issued by the Fund in order to inform, educate and create an awareness of the Rules of the Fund as well as the benefits and contributions offered there under. Choosing the right benefit option for you It is essential that you choose a benefit option that suits your medical needs according to what you can afford. If you choose a benefit option that does not cover your needs, you may find that 1

4 you will have to pay for medical costs from your own pocket. The best approach is to balance what you can afford against what you can expect to pay for medical costs for you and your loved ones over a one year period. The answers to the following questions will help you find that balance: What are your medical aid fund contributions over one year? If your medical cover is arranged through your employer, how much does your employer contribute? What were your total medical costs last year, including what was paid for by the Fund? How much of that cost was unexpected or not covered by your benefit option? Of those, what medical costs were unplanned? Are you and your loved ones generally in good health? Do you or any of your loved ones have a serious chronic medical condition that needs continuous treatment or medication? Are any of the medical conditions not covered by your benefit option? Does the benefit option require you to use specific healthcare providers such as state hospital facilities? As a general rule, if you or a of your family have a history of high medical costs, you may need to choose a more comprehensive but also more expensive benefit option to cover your costs. Even if you are reasonably healthy, it is wise to allow for unexpected major medical expenses such as hospitalisation. If you need help with choosing the right benefit option please contact NHP, tel or your Client Liaison Officer. How your benefit options work NHP offers several benefit options to suit your needs and pocket. Traditional benefit options Gold The Gold benefit option is a traditional type benefit option, offering various sub-limits in respect of day-to-day expenses. In addition, the per family benefit concept is very popular whereby benefits are not reserved on a per basis, but rather enable s of the family to access the overall family benefit should he or she need it. 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 s wishing to ensure that their medical costs are covered to the greatest extent. The Gold benefit option is best suited for s who are older and whose health risk is high, as well as s requiring extensive chronic medicine and orthodontic benefits. Platinum The Platinum benefit option is a traditional type benefit option offering various sub-limits in respect of day-to-day expenses. In addition, the per family benefit concept is very popular whereby benefits are not reserved on a per basis, but rather 2

5 enable s of the family to access the overall family benefit should he or she need it. This benefit option offers comprehensive benefits for both major and day-to-day medical expenses and is ideal if you need comprehensive cover for your medical costs. With a generous Overall Annual Limit and high day-to-day benefits, this benefit option is better suited to s whose health risk can best be described as moderate. New benfit option Titanium NHP is excited to introduce to you our new Titanium benefit option. The Titanium benefit option is a traditional type benefit option offering s the comfort of peace of mind benefits whilst remaining affordable with well structured sublimits in respect of day-to-day expenses. This benefit option is typically aimed at the young family who prefers the security of a structured benefit package. As per the previous benefit option, the per family benefit concept also applies whereby benefits are not reserved on a per basis. Instead s are able to access the family benefits to access the overall family benefit should he or she need it. This benefit option offers comprehensive benefits for both major and day-to-day medical expenses and is ideal if a needs comprehensive cover for medical costs. With a generous Overall Annual Limit and high day-to-day benefits, this benefit option is better suited to s whose health risk can best be described as low to moderate. New generation benefit options Silver The Silver benefit option is a new generation type benefit option providing pooled benefits in respect of day-to-day expenses with no sub-limits in respect of the various benefits thereby allowing the greater flexibility in deciding how to allocate available funds. However benefits are still allocated on a per family basis, enabling s of the family to access the overall family benefit should he or she need it. This benefit option offers reasonably comprehensive benefits for both major and day-to-day medical expenses. This benefit option offers an annual monetary amount which allows s to choose how to allocate these funds for day-to-day medical expenses. This benefit option is best suited to s whose health risk can be described as low. Bronze The Bronze benefit option is a new generation type benefit option providing pooled benefits in respect of day-to-day expenses with no sub-limits in respect of the various benefits thereby allowing the greater flexibility in deciding how to allocate available funds. However benefits are still allocated on a per family basis, enabling s of the family to access the overall family benefit should he or she need it. This benefit option is ideal if you need limited medical cover at an affordable rate with comprehensive cover for major medical expenses, but limited day-to-day cover. This benefit option includes an annual monetary amount which allows you to choose how to use the funds for day-to-day medical expenses. This benefit option is best suited to s whose health risk can best be described as very low. Hospital The Hospital benefit option offers comprehensive benefits for hospitalisation and related major medical expenses and is ideal if you wish to cover the costs of your day-to-day medical expenses yourself, whilst enjoying adequate cover for major medical expenses. This benefit option offers no benefits in respect of dayto-day treatment. Primary healthcare benefit options Blue Diamond and Litunga The Blue Diamond and Litunga benefit options provide affordable primary healthcare services to people from lower income groups who have not had access to subsidised private healthcare before. These benefit options provide access to a network of contracted general healthcare providers and registered nurses and provide unlimited cover for day-to-day primary care services as long as you use the Fund s designated service provider facilities. 3

6 Gold 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 s wishing to ensure that their medical costs are covered to the greatest extent. The Gold benefit option is best suited for s who are older and whose health risk is high, as well as s requiring extensive chronic medication and orthodontic treatment. Major medical expenses limit per category additional family Overall Annual Limit (OAL) Unlimited Unlimited 1. Healthcare provider and medical specialists SPA 1.1. Consultations and visits: In-hospital 225% 1.2. Procedures: In-hospital 225% 2. Hospital services SPA 2.1. Accommodation and theatre 100% 2.2. Blood transfusions 100% 2.3. Dialysis 100% 2.4. Medication 100% 2.5. Accommodation in private wards 100% Accommodation other than a recognised hospital or medical institution - SA only 100% 485 per day 2.7. Appliances and prosthesis: Surgical 100% Refractive surgery: Full procedure 100% Organ transplants: Full procedure 100% Private nursing 100% Oncology 100% Radiology SPA 3.1. Radiology: Specialised MRI and CT scans in- and out-of-hospital 100% combined 3.2. Basic radiology: In-hospital 100% 4. Pathology 4.1. Pathology: In-hospital 100% 5. Dentistry SPA 5.1. Oral surgery: Full procedure 100% Maxillo facial surgery: Non-elective only 100% 5.3. Dental implants OAL Hospitalisation 100% Consultation, procedure and cost of implant 100% ,700 per implant 6. Psychiatric treatment SPA 6.1. Hospitalisation or institutionalisation 100% Maternity 7.1. Confinement: Full procedure 100% SPA 7.2. Antenatal consultations 100% 12 Consultations OAL D Sonar scans 100% 2 Scans OAL 7.4. Amniocentesis 100% SPA 8. Preventative care OAL 8.1. Vaccinations: As per list 100% 9. Specified illness conditions OAL 9.1. HIV/Aids: Including the cost of pathology tests 100% SPA 9.2. Sexually transmitted diseases 100% SPA 9.3. Rehabilitation of alcohol and drug addiction or abuse 100% Subject to psychiatric treatment limit SPA 10. Ambulance services: Only for medical or trauma emergencies SPA Air evacuation 100% Ambulance services 100% Ambulance services: Inter-hospital transfer 100% Other transportation 80% 1st transfer and subsequent 11. Artificial limbs and eyes SPA Artificial limbs 100% Artificial eyes 100% Heart surgery rehabilitation 100% OAL OAL = Overall Annual Limit SPA = Subject to prior approval 4

7 Day-to-day expenses limit per category additional family Out-of-hospital: Sub-limit 1. Healthcare provider and medical specialists OAL 1.1. Consultations or visits: Out-of-hospital 100% 15 Consultations 10 Consultations 1.2. Out-of-hospital services 100% 1.3. Pathology or radiology: Out-of-hospital 100% 2. Medicine and injections 2.1. Acute medication Acute: Pharmacy dispensed - Min levy of N$30 80% Acute: Doctors dispensed - Min levy of N$30 80% Self-medication: Over-the-counter - No levy 100% per claim Subject to acute medication limit Homeopathic and phytotherapy medications and vitamins 80% per claim - Min levy of N$ Chronic medication Chronic approved: Subject to prior registration - 80% Min levy of N$30 3. Dentistry Basic dentistry: Subject to sub-limit 100% Dental technicians 100% 3.3. Advanced dentistry 100% Orthodontics 100% Dental implants: Full procedure 100% Refer to OAL Optical Eye tests 100% 4.2. Spectacles and lenses - Frames every 2nd year 100% Frame limited to Orthoptics 100% 5. Auxiliary services Chiropody 100% 15 Consultations 5.2. Clinical psychology 100% 15 Consultations 5.3. Dietician 100% 15 Consultations 5.4. Homeopathy: Consultations only 100% 15 Consultations 5.5. Occupational therapy 100% 15 Consultations 5.6. Social workers 100% 15 Consultations 5.7. Appliances: Non-surgical 100% SPA 5.8. Physiotherapy 100% 15 Consultations 5.9. Biokinetics 100% 15 Consultations Audiology and speech therapy 100% 15 Consultations Chiropractic 100% 15 Consultations Podiatry 100% 15 Consultations Notes Flu vaccines are covered as part of the Acute Medication benefit. Vitamins under specific conditions to be authorised from the Chronic benefit. Limited benefit for vitamins available under above, without a prescription. NHP pays for contraceptives, oral and injections limited to N$180 per claim. Sun block 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, refer to User Guide. Contribution tables Employer groups Age Adult/ Child Individuals Age Adult/ Child Roll-Over benefit For diligent management of your healthcare expenditure: Adult/endant Child Example Roll-Over benefit: ( + spouse + two children) = per year 5

8 Platinum The Platinum benefit option offers comprehensive benefits for both major and day-to-day medical expenses. The Platinum benefit option is ideal for s wishing to enjoy comprehensive cover for their medical expenses. With a generous Overall Annual Limit and high day-to-day benefits, this benefit option is better suited to s whose health risk can best be described as moderate. Major medical expenses limit per category additional family Overall Annual Limit (OAL) Healthcare provider and medical specialists SPA 1.1. Consultations and visits: In-hospital 225% 1.2. Procedures: In-hospital 225% 2. Hospital services SPA 2.1. Accommodation and theatre 100% 2.2. Blood transfusions 100% 2.3. Dialysis 100% 2.4. Medication 100% 2.5. Accommodation in private wards 100% Accommodation other than a recognised hospital or medical institution - SA only 100% 460 per day 2.7. Appliances and prosthesis: Surgical 100% Refractive surgery: Full procedure 100% Organ transplants: Full procedure 100% Private nursing 100% Oncology 100% Radiology SPA 3.1. Radiology: Specialised MRI and CT scans in- and out-of-hospital 100% combined 3.2. Basic radiology: In-hospital 100% 4. Pathology 4.1. Pathology: In-hospital 100% 5. Dentistry SPA 5.1. Oral surgery: Full procedure 100% Maxillo facial surgery: Non-elective only 100% 5.3. Dental implants OAL Hospitalisation 100% Consultation, procedure and cost of implant 100% ,700 per implant 6. Psychiatric treatment SPA 6.1. Hospitalisation or institutionalisation 100% Maternity 7.1. Confinement: Full procedure 100% SPA 7.2. Antenatal consultations 100% 12 Consultations OAL D Sonar scans 100% 2 Scans OAL 7.4. Amniocentesis 100% SPA 8. Preventative care OAL 8.1. Vaccinations: As per list 100% 9. Specified illness conditions OAL 9.1. HIV/Aids: Including the cost of pathology tests 100% SPA 9.2. Sexually transmitted diseases 100% SPA 9.3. Rehabilitation of alcohol and drug addiction or abuse 100% Subject to psychiatric treatment limit SPA 10. Ambulance services: Only for medical or trauma emergencies SPA Air evacuation 100% Ambulance services 100% Ambulance services: Inter-hospital transfer 100% Other transportation 80% 1st transfer and subsequent 11. Artificial limbs and eyes SPA Artificial limbs 100% Artificial eyes 100% Heart surgery rehabilitation 100% OAL OAL = Overall Annual Limit SPA = Subject to prior approval 6

9 Contribution tables Day-to-day expenses limit per category or % thereof additional family Out-of-hospital: Sub-limit 1. Healthcare provider and medical specialists OAL 1.1. Consultations or visits: Out-of-hospital 100% 15 Consultations 10 Consultations 1.2. Out-of-hospital services 100% 1.3. Pathology or radiology: Out-of-hospital 100% 2. Medicine and injections 2.1. Acute medication Acute: Pharmacy dispensed - Min levy of N$30 80% Acute: Doctors dispensed - Min levy of N$30 80% Self-medication: Over-the-counter - No levy 100% per claim Subject to acute medication limit Homeopathic and phytotherapy medication and vitamins 80% per claim - Min levy of N$ Chronic medication Chronic approved: Subject to prior registration - 80% Min levy of N$30 3. Dentistry Basic dentistry: Subject to sub-limit 100% Dental technicians 100% 3.3. Advanced dentistry 100% Orthodontics 100% Dental implants: Full procedure 100% Refer to OAL Optical Eye tests 100% 4.2. Spectacles and lenses - Frames every 2nd year 100% Frame limited to Orthoptics 100% 5. Auxiliary services Chiropody 100% 15 Consultations 5.2. Clinical psychology 100% 15 Consultations 5.3. Dietician 100% 15 Consultations 5.4. Homeopathy: Consultations only 100% 15 Consultations 5.5. Occupational therapy 100% 15 Consultations 5.6. Social workers 100% 15 Consultations 5.7. Appliances: Non-surgical 100% SPA 5.8. Physiotherapy 100% 15 Consultations 5.9. Biokinetics 100% 15 Consultations Audiology and speech therapy 100% 15 Consultations Chiropractic 100% 15 Consultations Podiatry 100% 15 Consultations Notes Flu vaccines are covered as part of the Acute Medication benefit. Vitamins under specific conditions to be authorised from the Chronic benefit. Limited benefit for vitamins available under above, without a prescription. NHP pays for contraceptives, oral and injections limited to N$180 per claim. Sun block 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, refer to User Guide. Employer groups Age Adult/ Child Individuals Age Adult/ Child Roll-Over benefit For diligent management of your healthcare expenditure: Adult/endant Child Example Roll-Over benefit: ( + spouse + two children) = per year 7

10 Titanium The Titanium benefit option offers something new with comprehensive benefits for both major and day-to-day medical expenses. The Titanium benefit option is ideal for young families with children opting for a more affordable yet conservative approach towards their day-to-day benefits. With a generous Overall Annual Limit and high day-to-day benefits, this benefit option is better suited to s whose health risk can best be described as low to moderate. Major medical expenses limit per category additional family Overall Annual Limit (OAL) 1,100,000 1,600, Healthcare provider and medical specialists SPA 1.1. Consultations and visits: In-hospital 225% 1.2. Procedures: In-hospital 225% 2. Hospital services SPA 2.1. Accommodation and theatre 100% 2.2. Blood transfusions 100% 2.3. Dialysis 100% 2.4. Medication 100% 2.5. Accommodation in private wards 100% Accommodation other than a recognised hospital or medical institution - SA only 100% 435 per day 2.7. Appliances and prosthesis: Surgical 100% Refractive surgery: Full procedure 100% Organ transplants: Full procedure 100% Private nursing 100% Oncology 100% Radiology SPA 3.1. Radiology: Specialised MRI and CT scans in- and out-of-hospital 100% combined 3.2. Basic radiology: In-hospital 100% 4. Pathology 4.1. Pathology: In-hospital 100% 5. Dentistry SPA 5.1. Oral surgery: Full procedure 100% Maxillo facial surgery: Non-elective only 100% 5.3. Dental implants Hospitalisation 100% Consultation, procedure and cost of implant 100% Subject to advanced dentistry - day-to-day 6. Psychiatric treatment SPA 6.1. Hospitalisation or institutionalisation 100% Maternity 7.1. Confinement: Full procedure 100% SPA 7.2. Antenatal consultations 100% 12 Consultations OAL D Sonar scans 100% 2 Scans OAL 7.4. Amniocentesis 100% SPA 8. Preventative care OAL 8.1. Vaccinations: As per list 100% 9. Specified illness conditions OAL 9.1. HIV/Aids: Including the cost of pathology tests 100% SPA 9.2. Sexually transmitted diseases 100% SPA 9.3. Rehabilitation of alcohol and drug addiction or abuse 100% Subject to psychiatric treatment limit SPA 10. Ambulance services: Only for medical or trauma emergencies SPA Air evacuation 100% Ambulance services 100% Ambulance services: Inter-hospital transfer 100% Other transportation 80% 1st transfer and subsequent 11. Artificial limbs and eyes SPA Artificial limbs 100% Artificial eyes 100% Heart surgery rehabilitation 100% OAL OAL = Overall Annual Limit SPA = Subject to prior approval 8

11 Contribution tables Day-to-day expenses limit per category additional family Out-of-hospital: Sub-limit 1. Healthcare provider and medical specialists OAL 1.1. Consultations or visits: Out-of-hospital 100% 15 Consultations 10 Consultations 1.2. Out-of-hospital services 100% 1.3. Pathology or radiology: Out-of-hospital 100% 2. Medicine and injections 2.1. Acute medication Acute: Pharmacy dispensed - Min levy of N$30 80% Acute: Doctors dispensed - Min levy of N$30 80% Self-medication: Over-the-counter - No levy 100% per claim Subject to acute medication limit Homeopathic and phytotherapy medication and vitamins 80% per claim - Min levy of N$ Chronic medication Chronic approved: Subject to prior registration 80% - Min levy of N$30 3. Dentistry Basic dentistry: Subject to sub-limit 100% Dental technicians 100% 3.3. Advanced dentistry 100% Orthodontics 100% Dental implants: Full procedure 100% 4. Optical Eye tests 100% 4.2. Spectacles and lenses - Frames every 2nd year 100% Frame limited to Orthoptics 100% 5. Auxiliary services Chiropody 100% 15 Consultations 5.2. Clinical psychology 100% 15 Consultations 5.3. Dietician 100% 15 Consultations 5.4. Homeopathy: Consultations only 100% 15 Consultations 5.5. Occupational therapy 100% 15 Consultations 5.6. Social workers 100% 15 Consultations 5.7. Appliances: Non-surgical 100% SPA 5.8. Physiotherapy 100% 15 Consultations 5.9. Biokinetics 100% 15 Consultations Audiology and speech therapy 100% 15 Consultations Chiropractic 100% 15 Consultations Podiatry 100% 15 Consultations Notes Flu vaccines are covered as part of the Acute Medication benefit. Vitamins under specific conditions to be authorised from the Chronic benefit. Limited benefit for vitamins available under above, without a prescription. NHP pays for contraceptives, oral and injections limited to N$180 per claim. Sun block 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. No accommodation costs are covered. Employer groups Age Adult/ Child Individuals Age Adult/ Child Roll-Over benefit For diligent management of your healthcare expenditure: 2,900 Adult/endant 600 Child 600 Example Roll-Over benefit: ( + spouse + two children) = per year 9

12 Silver The Silver benefit option offers reasonably priced, yet comprehensive benefits for both major and pooled day-to-day medical expenses. The Silver benefit option offers an annual monetary amount allowing s to choose how to allocate these funds for day-to-day expenses. This benefit option is best suited to s whose health risk can be described as low. Major medical expenses limit per category additional family Overall Annual Limit (OAL) Healthcare provider and medical specialists SPA 1.1. Consultations and visits: In-hospital 225% 1.2. Procedures: In-hospital 225% 2. Chronic medication Chronic approved: Subject to prior reginstration - Min levy of N$30 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% Accommodation other than a recognised hospital or medical institution - SA only 100% 435 per day 3.7. Appliances and prosthesis: Surgical 100% Refractive surgery: Full procedure 100% Organ transplants: Full procedure 100% Private nursing 100% Oncology 100% Radiology SPA 4.1. Radiology: Specialised MRI and CT scans in- and out-of-hospital 100% combined 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% Maxillo facial surgery: Non-elective only 100% 6.3. Dental implants Hospitalisation 100% Consultation, procedure and cost of implant 100% Subject to advanced dentistry - day-to-day 7. Psychiatric treatment SPA 7.1. Hospitalisation or institutionalisation 100% Maternity 8.1. Confinement: Full procedure 100% SPA 8.2. Antenatal consultations 100% 12 Consultations OAL D Sonar scans 100% 2 Scans OAL 8.4. Amniocentesis 100% SPA 9. Preventative care OAL 9.1. Vaccinations: As per list 100% 10. Specified illness conditions OAL HIV/Aids: Including the cost of pathology tests 100% SPA Sexually transmitted diseases 100% SPA Rehabilitation of alcohol and drug addiction or abuse 100% Subject to psychiatric treatment limit SPA 11. Ambulance services: Only for medical or trauma emergencies SPA Air evacuation 100% Ambulance services 100% Ambulance services: Inter-hospital transfer 100% Other transportation 80% 1st transfer and subsequent 12. Artificial limbs and eyes SPA Artificial limbs 100% Artificial eyes 100% Heart surgery rehabilitation 100% OAL OAL = Overall Annual Limit SPA = Subject to prior approval 10

13 Contribution tables Employer groups Age Adult/ Child Day-to-day expenses limit per category additional Roll-Over benefit For diligent management of your healthcare expenditure: Adult/endant 600 Child 600 Example Roll-Over benefit: ( + spouse + two children) = per year family Out-of-hospital: Pooled limit OAL 1. Healthcare provider and medical specialists 1.1. Consultations or visits: Out-of-hospital 100% 1.2. Out-of-hospital services 100% 1.3. Pathology or radiology: Out-of-hospital 100% 2. Medicine and injections 2.1. Acute medication Acute: Pharmacy dispensed - Min levy of N$30 80% Acute: Doctors dispensed - Min levy of N$30 80% Self-medication: Over-the-counter - No levy 100% per claim Homeopathic and phytotherapy medications and vitamins 80% per claim - Min levy of N$30 3. Dentistry Basic dentistry: Subject to sub-limit 100% 3.2. Dental technicians 100% 3.3. Advanced dentistry 100% Orthodontics 100% Dental implants: Full procedure 100% 4. Optical Eye tests 100% 4.2. Spectacles and lenses - Frames every 2nd year 100% Frame limited to Orthoptics 100% 5. Auxiliary services 5.1. Chiropody 100% 15 Consultations 5.2. Clinical psychology 100% 15 Consultations 5.3. Dietician 100% 15 Consultations 5.4. Homeopathy: Consultations only 100% 15 Consultations 5.5. Occupational therapy 100% 15 Consultations 5.6. Social workers 100% 15 Consultations 5.7. Appliances: Non-surgical 100% SPA 5.8. Physiotherapy 100% 15 Consultations 5.9. Biokinetics 100% 15 Consultations Audiology and speech therapy 100% 15 Consultations Chiropractic 100% 15 Consultations Podiatry 100% 15 Consultations Chiropractic 100% 15 Consultations Podiatry 100% 15 Consultations Notes Flu vaccines are covered as part of the Acute Medication benefit. Vitamins under specific conditions to be authorised from the Chronic benefit. Limited benefit for vitamins available under above, without a prescription. NHP pays for contraceptives, oral and injections limited to N$180 per claim. Sun block 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 - No accommodation costs are covered. Pooled day-to-day benefits. Individuals Age Adult/ Child

14 Bronze The Bronze benefit option is ideal for limited day-to-day benefits at an affordable rate with comprehensive cover for major and pooled day-to-day medical expenses. The Bronze benefit option offers an annual monetary amount allowing s to choose how to allocate these funds for day-to-day expenses. This benefit option is best suited to s whose health risk can best be described as very low. Major medical expenses limit per category additional family Overall Annual Limit (OAL) Healthcare provider and medical specialists SPA 1.1. Consultations and visits: In-hospital 225% 1.2. Procedures: In-hospital 225% 2. Chronic medication Chronic approved: Subject to prior reginstration - Min levy of 80% N$30 3. Hospital services SPA 3.1. Accommodation and theatre 100% 3.2. Blood transfusions 100% 3.3. Dialysis No benefit 3.4. Medication 100% 3.5. Accommodation in private wards No benefit 3.6. Accommodation other than a recognised hospital or medical No benefit institution 3.7. Appliances and prosthesis: Surgical 100% Refractive surgery: Full procedure No benefit 3.9. Organ transplants: Full procedure 100% Private nursing No benefit Oncology No benefit 4. Radiology SPA 4.1. Radiology: Specialised MRI and CT scans in- and out-of-hospital 100% combined 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% Maxillo facial surgery: Non-elective only 100% 6.3. Dental implants No benefit Hospitalisation No benefit Consultation, procedure and cost of implant No benefit 7. Psychiatric treatment SPA 7.1. Hospitalisation or institutionalisation 100% Maternity 8.1. Confinement: Full procedure 100% SPA 8.2. Antenatal consultations 100% 12 Consultations OAL D Sonar scans 100% 2 Scans OAL 8.4. Amniocentesis 100% SPA 9. Preventative care OAL 9.1. Vaccinations: As per list 100% 10. Specified illness conditions OAL HIV/Aids: Including the cost of pathology tests 100% SPA Sexually transmitted diseases 100% SPA Rehabilitation of alcohol and drug addiction or abuse 100% Subject to psychiatric treatment limit SPA 11. Ambulance services: Only for medical or trauma emergencies SPA Air evacuation 100% Ambulance services 100% Ambulance services: Inter-hospital transfer 100% Other transportation No benefit 12. Artificial limbs and eyes SPA Artificial limbs 100% Artificial eyes 100% Subject to auxiliary services - day-to-day 13. Heart surgery rehabilitation 100% Subject to auxiliary services - day-to-day OAL = Overall Annual Limit SPA = Subject to prior approval 12

15 Contribution tables Day-to-day expenses limit per category additional family Out-of-hospital: Pooled limit OAL 1. Healthcare provider and medical specialists 1.1. Consultations or visits: Out-of-hospital 100% 1.2. Out-of-hospital services 100% 1.3. Pathology or radiology: Out-of-hospital 100% 2. Medicine and injections 2.1. Acute medication Acute: Pharmacy dispensed - Min levy of N$30 80% Acute: Doctors dispensed - Min levy of N$30 80% Self-medication: Over-the-counter - No levy 100% per claim Homeopathic and phytotherapy medicines and vitamins - 80% per claim Min levy of N$30 3. Dentistry Basic dentistry: Subject to sub-limit 100% 3.2. Dental technicians 100% 3.3. Advanced dentistry 100% Orthodontics 100% Dental implants: Full procedure No benefit 4. Optical Eye tests 100% 4.2. Spectacles and lenses - Frames every 2nd year 100% Frame limited to Orthoptics 100% 5. Auxiliary services 5.1. Chiropody 100% 15 Consultations 5.2. Clinical psychology 100% 15 Consultations 5.3. Dietician 100% 15 Consultations 5.4. Homeopathy: Consultations only 100% 15 Consultations 5.5. Occupational therapy 100% 15 Consultations 5.6. Social workers 100% 15 Consultations 5.7. Appliances: Non-surgical 100% SPA 5.8. Physiotherapy 100% 15 Consultations 5.9. Biokinetics 100% 15 Consultations Audiology and speech therapy 100% 15 Consultations Chiropractic 100% 15 Consultations Podiatry 100% 15 Consultations Chiropractic 100% 15 Consultations Podiatry 100% 15 Consultations Notes Flu vaccines are covered as part of the Acute Medication benefit. Vitamins under specific conditions to be authorised from the Chronic benefit. Limited benefit for vitamins available under above, without a prescription. NHP pays for contraceptives, oral and injections limited to N$180 per claim. Sun block 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 - No accommodation costs are covered. Pooled day-to-day benefits. Employer groups Age Adult/ Child Individuals Age Adult/ Child Roll-Over benefit For diligent management of your healthcare expenditure: Adult/endant 300 Child 300 Example Roll-Over benefit: ( + spouse + two children) = per year 13

16 Hospital The Hospital benefit option offers comprehensive benefits for hospitalisation and related major medical expenses. The Hospital benefit option is ideal for s 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 s who are younger and whose health risk is very low, thereby enabling them to pay their day-to-day accounts out of their pocket. Major medical expenses limit per category additional family Overall Annual Limit (OAL) Healthcare provider and medical specialists SPA 1.1. Consultations and visits: In-hospital 225% 1.2. Procedures: In-hospital 225% 2. Chronic medication Chronic approved: Subject to prior reginstration - Min levy of N$30 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% Accommodation other than a recognised hospital or medical institution - SA only 100% 435 per day 3.7. Appliances and prosthesis: Surgical 100% Refractive surgery: Full procedure 100% Organ transplants: Full procedure 100% Private nursing 100% Oncology 100% Radiology SPA 4.1. Radiology: Specialised MRI and CT scans in- and out-of-hospital 100% combined 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% Maxillo facial surgery: Non-elective only 100% 6.3. Dental implants Hospitalisation No benefit Consultation, procedure and cost of implant No benefit 7. Psychiatric treatment SPA 7.1. Hospitalisation or institutionalisation 100% Maternity 8.1. Confinement: Full procedure 100% SPA 8.2. Antenatal consultations 100% 12 Consultations OAL D Sonar scans 100% 2 Scans OAL 8.4. Amniocentesis 100% SPA 9. Preventative care OAL 9.1. Vaccinations: As per list 100% 10. Specified illness conditions OAL HIV/Aids: Including the cost of pathology tests 100% SPA Sexually transmitted diseases 100% SPA Rehabilitation of alcohol and drug addiction or abuse 100% Subject to psychiatric treatment limit SPA 11. Ambulance services: Only for medical or trauma emergencies SPA Air evacuation 100% Ambulance services 100% Ambulance services: Inter-hospital transfer 100% Other transportation 80% 1st transfer and subsequent 12. Artificial limbs and eyes Artificial limbs No benefit Artificial eyes No benefit 13. Heart surgery rehabilitation 100% OAL = Overall Annual Limit SPA = Subject to prior approval 14

17 Day-to-day expenses limit per category Out-of-hospital: Sub-limit 1. Healthcare provider and medical specialists 1.1. Consultations or visits: Out-of-hospital No benefit 1.2. Out-of-hospital services No benefit 1.3. Pathology or radiology: Out-of-hospital No benefit 2. Medicine and injections 2.1. Acute medication No benefit Acute: Pharmacy dispensed - Min levy of N$30 No benefit Acute: Doctors dispensed - Min levy of N$30 No benefit Self-medication: Over-the-counter - No levy No benefit Homeopathic and phytotherapy medications and vitamins - Min levy of N$30 No benefit 2.2. Chronic medication No benefit Chronic approved: Subject to prior registration - Min levy of N$30 No benefit 3. Dentistry 3.1. Basic dentistry: Subject to sub-limit No benefit 3.2. Dental technicians No benefit 3.3. Advanced dentistry No benefit Orthodontics No benefit Dental implants: Full procedure No benefit 4. Optical 4.1. Eye tests No benefit 4.2. Spectacles and lenses - Frames every 2nd year No benefit 4.3. Orthoptics No benefit 5. Paramedical services 5.1. Chiropody No benefit 5.2. Clinical psychology No benefit 5.3. Dietician No benefit 5.4. Homeopathy: Consultations 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 Audiology and speech therapy No benefit Chiropractic No benefit Podiatry No benefit additional family Notes No day-to-day benefits are available. Contribution tables Employer groups Age Adult/ Child Individuals Age Adult/ Child Roll-Over benefit For diligent management of your healthcare expenditure: Adult/endant Child No benefit No benefit No benefit 15

18 Blue Diamond Major medical expenses limit per category additional Overall Annual Limit (OAL) Unlimited Unlimited 1. Hospital services SPA 1.1. Access to "private wing" of state hospital 100% 1.2. Limited access benefit for treatment in selected private hospitals 100% 1.3. Hospital and surgical admissions 100% 2. Ambulance services: Only for medical or trauma emergencies SPA 2.1. Air evacuation 100% 2.2. Ambulance service 100% 2.3. Ambulance service: Inter-hospital transfer 100% Other transportation No benefit family Day-to-day expenses limit per category Out-of-hospital: Sub-limit additional 1. Healthcare provider and medical specialists DSP 1.1. Consultations or visits: Out-of-hospital 100% Nurse: N$15 per consultation - New conditions General practitioner: N$15 per consultation - New conditions Medical specialist: N$15 per consultation - Upon referral Medical specialist: Travel assistance benefit to Windhoek or Swakopmund (limited to 2 per family per year) family 540 per consultation 1.2. Out-of-hospital services 100% 1.3. GP consultations: After hours (limited to 2 per family per year) 100% 2. Medicine and injections Unlimited Unlimited DSP 2.1. Acute medication: Dispensed 100% 170 per script 2.2. Self-medication: Over-the-counter per claim 2.3. Chronic medication: Dispensed (as per chronic medication formulary) 100% Anti-retroviral therapy: Dispensed 100% (patient needs to enrol for the AfA Programme) 3. Dentistry - N$15 per consultation - New conditions DSP 3.1. Basic dentistry: Fillings level 1 to 3 (black), extractions, fluoride 100% treatment, instructions on oral hygiene, plastic dentures: 1 set per family every 2 years 4. Radiology Unlimited Unlimited DSP 4.1. Radiology tests 100% 5. Pathology Unlimited Unlimited DSP 5.1. Pathology test 100% 6. Optical - N$15 per consultation - New conditions DSP 6.1. Eye tests 100% 6.2. Spectacles and lenses (frames every 2nd year). A waiting period of 6 months will apply 100% Claim limited to Mother and child healthcare services Unlimited Unlimited DSP 7.1. Family planning, immunisations, pre- and post-antenatal care 8. Counselling and health education Unlimited Unlimited DSP 8.1. Instruction on prevention of certain illnesses, oral hygiene, poisons, HIV-AIDS etc. 9. Specified illness conditions DSP 9.1. HIV/Aids: Including pathology tests 100% Unlimited 9.2. Sexually transmitted diseases 100% Rehabilitation of alcohol and drug addiction or abuse 100% SPA = Subject to prior approval DSP = Designated service provider Notes Travel assistance for specialist visits in Namibia only - Blue Diamond only. International Travel benefit. NHP pays for contraceptives, oral and injections limited to N$170 per claim. Immunisations are only available from designated service providers. Script limit N$170. Members do not qualify for the Lifestyle Loyalty Programme. No Roll-Over benefit. No Preventative Care benefit including Cevarix. 16

19 Litunga Major medical expenses limit per category 1. Hospital services No benefit 2. Ambulance services: Only for medical or trauma emergencies No benefit additional family Day-to-day expenses limit per category additional family Out-of-hospital: Sub-limit 1. Healthcare providers Unlimited Unlimited DSP 1.1. Consultations or visits: Out-of-hospital 100% Nurse: N$15 per consultation - New conditions General practitioner: N$15 per consultation - New conditions Medical specialist No benefit Medical specialist: Travel assistance benefit to Windhoek or Swakopmund No benefit 1.2. Out-of-hospital services 100% 1.3. GP consultations: After hours No benefit 2. Medicine and injections Unlimited Unlimited DSP 2.1. Acute medication: Dispensed 100% 170 per script 2.2. Self-medication: Over-the-counter No benefit 2.3. Chronic medication: Dispensed (as per chronic medication formulary) 100% Anti-retroviral therapy: Dispensed 100% (patient needs to enrol for the AfA Programme) 3. Dentistry - N$15 per consultation - New conditions DSP 3.1. Basic dentistry: Fillings level 1 to 3 (black), extractions, fluoride 100% treatment, instructions on oral hygiene, plastic dentures: 1 set per family every 2 years 4. Radiology Unlimited Unlimited DSP 4.1. Radiology tests 100% 5. Pathology Unlimited Unlimited DSP 5.1. Pathology test 100% 6. Optical - N$15 per consultation - New conditions DSP 6.1. Eye tests 100% 6.2. Spectacles and lenses (frames every 2nd year). A waiting period of 6 months will apply 100% Claim limited to Mother and child healthcare services Unlimited Unlimited DSP 7.1. Family planning, immunisations, pre- and postantenatal care 8. Counselling and health education Unlimited Unlimited DSP 8.1. Instruction on prevention of certain illnesses, oral hygiene, poisons, HIV-AIDS etc. 9. Specified illness conditions DSP 9.1. HIV/Aids: Including pathology tests 100% Unlimited 9.2. Sexually transmitted diseases 100% Rehabilitation of alcohol and drug addiction or abuse 100% DSP = Designated service provider Notes Travel assistance for specialist visits in Namibia only - Blue Diamond only. International Travel benefit. Immunisations are only available from designated service providers. Script limit N$170. Members do not qualify for the Lifestyle Loyalty Programme. No Roll-Over benefit. No Preventative Care benefit including Cevarix. 17

20 Blue Diamond contribution tables Employer groups Age Adult/ Child Individuals Age Adult/ Child Roll-Over benefit For diligent management of your healthcare expenditure: Adult/endant Child No benefit No benefit No benefit Litunga contribution tables Employer groups Age Adult/ Child Individuals Age Adult/ Child Roll-Over benefit For diligent management of your healthcare expenditure: Adult/endant Child No benefit No benefit No benefit About the Blue Diamond and Litunga benefit options The Blue Diamond and Litunga benefit options provide affordable primary healthcare services to the lower income group who previously have not had access to subsidised private healthcare. These benefit options focus on providing treatment and services falling within the scope and context of primary healthcare. If you are a on any of these two benefit options, you have direct access to a network of contracted healthcare providers and registered nurses. To ensure the quality of care provided, the Fund assumes direct responsibility for the network. These benefit options provide unlimited cover for day-to-day primary care services as long as you use the designated service provider facilities. Blue Diamond and Litunga 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 on any of the other NHP benefit options and are not used to primary healthcare, we strongly recommend that you do not buy down to the Blue Diamond and Litunga benefit options as your choice of general practitioner, nurse and healthcare facilities are restricted. s: You must produce your NHP ship card and positive identification to access a designated service provider. You will be able to choose a designated service provider when you register. You will be able to use the facilities of other designated service providers and abtain acute medicine should you be away from home. If you visit a non-designated service provider, such as a private healthcare provider, not contracted to the Fund s network, you will be responsible for settling the account directly and will not be refunded by NHP. To avoid any disappointment, you should ensure that a contracted designated service provider is available where you work or live. You are advised to make an appointment before seeking advice or treatment from a contracted designated service provider. For further information on the designated service providers in the respective geographical areas, s can contact NHP, tel or download the designated service provider list from Treatment for HIV/Aids If you are HIV positive you should enrol onto the Aid for AIDS (AfA) Programme which provides medicine, treatment and support. If you are HIV positive you will receive your medicine from the pharmacy subject to enrolment and pre-authorisation. An unlimited benefit applies for anti-retroviral therapy. 18