Evolve Care Medical Aid Package
OAL Per family N$ 1.1 Million / Per beneficiary N$ 787,500 | From N$1,185/Month
As your life evolves, your medical aid should too. Evolve Care is a medical aid option which evolves around your stage in life; your monthly contributions can be determined by either your income or age, giving you the financial flexibility you need.
Hospital Benefit
Part of the overall yearly limit
Doctor Service
N$ 15, 700 per year
Optical Benefit
N$ 10, 700 per year
Dental Benefit
N$ 5, 300 per year
| MONTHLY CONTRIBUTIONS | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| AGE | INDIVIDUAL RATES 9 members or less | GROUP RATE 1 For groups with 10 - 49 Principal Members | GROUP RATE 2 For groups with 50 - 249 Principal Members | GROUP RATE 3 For groups with 250 and more Principal Members | ||||||||
| Principal Member | Adult Dependant | Child Dependant | Principal Member | Adult Dependant | Child Dependant | Principal Member | Adult Dependant | Child Dependant | Principal Member | Adult Dependant | Child Dependant | |
| 0 - 25 | 1,185 | 825 | 535 | 1,030 | 710 | 460 | 975 | 665 | 435 | 910 | 625 | 405 |
| 26 - 30 | 1,290 | 885 | 535 | 1,115 | 765 | 460 | 1,050 | 720 | 435 | 985 | 675 | 405 |
| 31 - 35 | 1,395 | 960 | 535 | 1,200 | 830 | 460 | 1,125 | 775 | 435 | 1,060 | 740 | 405 |
| 36 - 40 | 1,535 | 1,140 | 535 | 1,340 | 980 | 460 | 1,250 | 935 | 435 | 1,180 | 870 | 405 |
| 41 - 45 | 1,710 | 1,260 | 535 | 1,490 | 1,095 | 460 | 1,390 | 1,025 | 435 | 1,320 | 960 | 405 |
| 46 - 50 | 1,905 | 1,510 | 535 | 1,650 | 1,315 | 460 | 1,545 | 1,215 | 435 | 1,460 | 1,170 | 405 |
| 51 - 55 | 2,175 | 1,780 | 535 | 1,895 | 1,555 | 460 | 1,760 | 1,455 | 435 | 1,670 | 1,365 | 405 |
| 56 - 60 | 2,400 | 2,030 | 535 | 2,085 | 1,765 | 460 | 1,935 | 1,635 | 435 | 1,825 | 1,540 | 405 |
| 61 - 65 | 2,610 | 2,175 | 535 | 2,265 | 1,880 | 460 | 2,115 | 1,765 | 435 | 1,990 | 1,665 | 405 |
| 66+ | 2,785 | 2,295 | 535 | 2,410 | 1,975 | 460 | 2,250 | 1,855 | 435 | 2,140 | 1,750 | 405 |
| MONTHLY CONTRIBUTIONS | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Income | INDIVIDUAL RATES 9 members or less | GROUP RATE 1 For groups with 10 - 49 Principal Members | GROUP RATE 2 For groups with 50 - 249 Principal Members | GROUP RATE 3 For groups with 250 and more Principal Members | ||||||||
| Principal Member | Adult Dependant | Child Dependant | Principal Member | Adult Dependant | Child Dependant | Principal Member | Adult Dependant | Child Dependant | Principal Member | Adult Dependant | Child Dependant | |
| 0 - 2, 000 | 1,335 | 800 | 495 | 1,180 | 680 | 425 | 1,090 | 640 | 415 | 1,040 | 625 | 380 |
| 2, 001 - 4, 000 | 1,510 | 925 | 495 | 1,325 | 795 | 425 | 1,220 | 745 | 415 | 1,175 | 725 | 380 |
| 4, 001 - 6, 000 | 1,870 | 1,310 | 505 | 1,610 | 1,140 | 430 | 1,495 | 1,070 | 420 | 1,445 | 1,030 | 390 |
| 6, 001+ | 1,955 | 1,345 | 520 | 1,685 | 1,180 | 445 | 1,585 | 1,105 | 435 | 1,505 | 1,055 | 400 |
| HOSPITAL BENEFITS | TARIFF % | BENEFITS |
|---|---|---|
| TOTAL ALL-INCLUSIVE OVERALL ANNUAL LIMIT | Part of the Overall Annual Limit | |
| HOSPITAL BENEFIT GROUP (Subject to clinical risk management protocols) | Part of the Overall Annual Limit | |
| Private hospital (Including medicines, materials, hospital apparatus and seven days Take-Out Medication) | 100% | Part of the Overall Annual Limit |
| Accommodation in private wards | 100% | N$ 10, 000 per family N$ 5, 000 per beneficiary |
| State hospitals (Including medicines, materials, hospital apparatus & seven days, Take-Out Medication) | 100% | Part of the Overall Annual Limit |
| Sub-acute facility ward fees. (Admission in lieu of hospitalisation). | 100% | |
| Consultations including treatment and services. | 180% | |
| Blood transfusion | 100% | |
| Radiology and Pathology | 100% | |
| Physiotherapy. | 100% | |
| Post Operative Extended Benefit (Following major surgery). Part of pre-authorisation and clinical protocols | 100% | Following surgery limited to 6 weeks treatment or 12 sessions |
| SURGICAL PROCEDURES DONE IN ROOMS / UNATTACHED THEATRES | Part of the Overall Annual Limit | |
| Doctors’ rooms - Selective surgical and endoscopic procedures, circumcisions. Inclusive benefit - Admissions, surgery, treatment and services. Part of pre-authorisation and clinical protocols | 180% | Part of the Overall Annual Limit |
| Admission to unattached operating theatres and sub-acute facilities | 100% | |
| Selective surgical and endoscopic procedures, circumcisions - unattached operating theatres, doctors’ rooms and subacute facilities. Including surgery, treatment and services. Part of pre-authorisation and clinical protocols. | 180% | |
| MRI / CT / PET SCAN / BONE DENSITY (In- and Out-of-Hospital) | N$ 16, 500 per family N$ 8, 300 per beneficiary | |
| In- and Out-of-Hospital Benefit. Part of pre-authorisation and clinical protocols. | 100% | Part of the sub-limit |
| MAXILLOFACIAL AND DENTAL SURGERY (In- and Out-of-Hospital) | N$ 28, 100 per family N$ 18, 700 per beneficiary | |
| Non-elective maxillofacial / oral surgery - Trauma, including dental extractions of more than three teeth or multiple fillings in children under the age of ten and disabled dependants / removal of impacted wisdom teeth. (All-inclusive benefit - surgery, treatment and services). Part of clinical protocols. | 180% | Part of the sub-limit |
| DENTAL AND ORAL SURGERY | N$ 4, 700 per family N$ 3, 100 per beneficiary | |
| Admission | 100% | Part of the sub-limit |
| Elective dental and oral surgery, including dental implant surgery, excluding the cost of the dental implant. (All-inclusive benefit - surgery, treatment and services). Part of clinical protocols and applicable Medical Aid Fund Rules. | 180% | |
| EYE SURGERY | Part of the Overall Annual Limit | |
| Admission | 100% | Part of the Overall Annual Limit |
| Including cataract surgery, glaucoma surgery, eye muscle surgery, corneal surgery, eye removal, vitreo-retinal surgery, etc. (Allinclusive benefit - admission, surgery, treatment and services). Part of clinical protocols and twelve month waiting period. | 180% | |
| Excimer laser and radial keratotomy only after two years membership. (All-inclusive benefit - admissions, surgery, treatment and services). Part of clinical protocols. | N$ 7, 600 per family N$ 5, 000 per beneficiary | |
| RECONSTRUCTIVE SURGERY | N$ 9, 200 per family N$ 6, 000 per beneficiary | |
| Admission | 100% | Part of the sub-limit |
| Reconstructive Surgery - After two years membership, including breast reductions. (All-inclusive benefit - admissions, surgery, treatment and services). Part of clinical protocols | 180% | |
| ALTERNATIVE SERVICES | N$ 22, 500 per family N$ 15, 000 per beneficiary | |
| In- and Out-of-Hospital Benefit including occupational therapy, private nursing, palliative care (end stage terminal diseases) and frail care. | 100% | Part of the sub-limit |
| MENTAL HEALTH | 21 days per beneficiary | |
| In- and Out-of-Hospital treatment and services, including psychiatric hospital accommodation, treatment and services, alcohol & drug addiction, addiction therapy and related pathology. (Part of treatment plan protocols). Excluding auxiliary services, which is part of the day to day benefit limits. | 100% | 21 days per beneficiary |
| INTERNAL PROSTHESIS | Subject to RHMAF protocol | |
| Internal prosthesis - example: knee / hip / pacemakers. Part of pre-authorisation and clinical risk management protocols. | 100% | Subject to RHMAF protocol |
| TRAUMA TREATMENT | Part of the Overall Annual Limit | |
| Oncology (Including chemo and radiation treatment), organ transplant, acute renal and peritoneal dialysis (In hospital). | 180% | Part of the Overall Annual Limit |
| Oncology (Including chemo and radiation treatment), organ transplant, acute renal and peritoneal dialysis (Out of hospital). | 180% | |
| Motor Vehicle Accidents (MVA) | 180% | |
| HEALTH IS VITAL | Part of the Overall Annual Limit | |
| Hospital and treatment. | 100% | Part of the Overall Annual Limit |
| HIV / AIDS visits. | 100% | N$ 3, 500 per family |
| HIV / AIDS pathology | 100% | N$ 12, 700 per family |
| HIV / AIDS medication. | 100% NRP | N$ 41, 600 per family |
| HIV counselling | 100% | N$ 4, 900 per family |
| DAY TO DAY BENEFITS | TARIFF % | BENEFITS |
|---|---|---|
| PROFESSIONAL SERVICES | N$ 15, 700 per family N$ 7, 900 per beneficiary | |
| General Practitioner, specialist consultations and primary healthcare consultations. | 100% | Part of Professional Service limit |
| General Practitioner and specialist administration fee for chronic patient applications and medical reports | Agreed Tariff | |
| Pharmacist and telephone consultations | 100% | |
| General Practitioner / primary and specialist procedures in rooms including equipment, materials and injections. | 100% | |
| Psychiatric treatment. | 100% | |
| Radiology | 100% | |
| Pathology | 100% | |
| PARAMEDICAL SERVICES | N$ 4, 500 per family N$ 3, 000 per beneficiary | |
| Including physiotherapy, social workers, speech therapy, audiology, acousticians, dieticians, occupational therapy, clinical psychology, biokinetics, homeo / chiro / osteopathy, podiatry, acupuncture, etc | 100% | Part of the sub-limit |
| Auxiliary services - Biokinetics, homeo / chiro / osteopathy, podiatry, acupuncture, etc. | 100% | |
| EXTERNAL PROSTHESIS AND MEDICAL APPLIANCES | N$ 12, 200 per family N$ 8, 100 per beneficiary | |
| Prosthesis external - Artificial arms / legs / eyes every two years. Part of pre-authorisation and approval. | 100% of cost | Part of the sub-limit |
| Special external medical appliances - Wheelchairs every three years; hearing aids apparatus every two years. Part of pre-authorisation and approval. | 90% of cost | |
| General external medical appliances - Including glucometers, blood pressure monitors, stockings, braces etc. Part of pre-authorisation and approval. | 80% of cost | |
| OPTICAL BENEFIT | N$ 2, 200 per family N$ 1, 500 per beneficiary | |
| Eye tests. | 100% | Part of the sub-limit |
| Lenses / contact lenses | 100% | |
| Frames, once every two years | 100% | N$ 750 per beneficiary |
| DENTISTRY BENEFIT | N$ 5, 300 per family N$ 3, 600 per beneficiary | |
| Conservative dentistry - Fillings, extractions and oral hygiene | 100% | Part of the sub-limit |
| Special dentistry - Dental implants, crowns, bridges, dentures and orthodontic treatments. Part of preauthorisation and approved treatment plan. | 100% | |
| MEDICATION BENEFIT | N$ 10, 700 per family N$ 5, 400 per beneficiary | |
| Acute medication - Preferred and non-preferred. | 80% NRP | Part of Medication Benefit sub-limit |
| Pharmacy initiated therapy and OTC medication. Maximum of N$ 180 per script. | 80% NRP | N$ 1, 400 per beneficiary |
| Homeopathic medication. | 80% NRP | Part of Acute Medication sub-limit |
| Primary health scripts | 80% NRP | |
| Chronic medication - Preferred and non-preferred. | Preferred 90% Non-preferred 80% | Part of Medication Benefit sub-limit |
| EXTENDED MEDICATION BENEFIT | N$ 68, 700 per family | |
| In- and Out-of-Hospital: Extended Medication Benefit cover for oncology, renal care and organ transplant (excluding chemo and radiation therapy and treatment). Part of registration and treatment plan protocols. Chronic medication related to severe illness conditions may be extended to this benefit, where Medication Benefit has been depleted. Part of registration and treatment plan protocols. | Part of the sub-limit | |
| Preferred medication | 90% NRP | |
| Non preferred medication | 80% NRP | |
| Specialised medicines such as biologicals (In terms of defined conditions and part of managed care protocols - excluding off-label medication. In- and Out-of-Hospital). | 80% NRP |
| MATERNITY BENEFITS | TARIFF % | BENEFITS |
|---|---|---|
| MATERNITY AND BABY BENEFIT | Unlimited | |
| Gynaecology / obstetric - In hospital. | 180% | Normal birth / Caesarean Section |
| Gynaecology / obstetric - Out of hospital. | 100% | Part of the Overall Annual Limit |
| Maternity scans. | 100% | 2 scans per beneficiary |
| Antenatal visits. | 100% | 12 visits per beneficiary |
| Amniocentesis - AHB excluded. | 100% | Part of the Overall Annual Limit |
| Neonatal ICU / ward fees. | 100% | |
| Paediatrician visits - Postnatal. | 100% | 2 visits per family, per annum |
| WELLNESS BENEFITS | TARIFF % | BENEFITS |
|---|---|---|
| WELLNESS MANAGEMENT | N$ 10, 000 per family | |
| PREVENTATIVE HEALTH BENEFIT (Members may earn benefit rewards for participation) | Part of Wellness Management | |
| Blood sugar test, cholesterol test, BMI and blood pressure measurement | 100% | 1 per beneficiary, per annum |
| Dental examinations. | 100% | |
| Mammogram (inclusive DEXA bone density scan) - Radiology. | 100% | 1 per female, over 40 years, per annum |
| Pap smear. Pathology including general practitioner / gynaecology visits. | 100% | 1 per female, over 20 years, per annum |
| HIV test all ages | 100% | 1 per beneficiary |
| Prostate screening. Pathology prostate specific antigen test | 100% | 1 screen per male beneficiary over the age of 50 years, per annum |
| Chronic disease wellness management - Follow-up test in the management of selective chronic diseases including: chronic renal failure, diabetes mellitus type 1 & 2, HIV / Aids, hyperlipidemia and multiple sclerosis (MS) - Excluding specialised radiology, which will be payable from the available MRI / CT Benefit | 100% | Part of Wellness Management sub-limit. In accordance with an approved clinical treatment plan, for routine follow-up tests when required. |
| WELLNESS REWARD - BENEFIT WALLET ALLOCATION FOR PREVENTATIVE HEALTH BEHAVIOUR | Benefit Wallet Reward Points | |
| Blood sugar test, cholesterol test, BMI and blood pressure measurement. | 100 | |
| Dental examinations | 100 | |
| Mammogram (inclusive DEXA bone density scan) - Radiology | 150 | |
| Pap smear. Pathology including general practitioner / gynaecology visits. | 100 | |
| HIV test, all ages. | 100 | |
| Prostate screening. Pathology prostate specific antigen test. | 150 | |
| Chronic medication compliance | 150 | |
| IMMUNISATION (Vaccines only) | Part of Wellness Management | |
| Flu vaccines | 100% NRP | 1 flu vaccination per beneficiary, per annum |
| Pneumococcal vaccine | 100% NRP | 1 per beneficiary, over 65 years, per annum |
| Baby immunisations 0 - 7 years. | 100% NRP | Vaccinations for children 0 - 7 years |
| HPV vaccine - Females between 9 - 30 years | 100% NRP | 3 injections during the course of a year, once per lifetime |
| PREVENTATIVE REHABILITATION TREATMENT | Part of Preventative Benefit sub-limit | |
| Orthopaedic rehabilitation and treatment relating to Chronic disease management - Part of approved treatment plans, pre-authorisation and clinical risk management. (Note - Biokinetic treatment plans for orthopaedic rehabilitation and chronic members disease management - may first be approved and payable from the normal day to day Paramedical Services Benefit - additional required treatment sessions may be considered for approval from the Preventative Rehabilitation Treatment Benefit - subject to available treatment sessions). | 100% | No benefit |
| COMPLIMENTARY | TARIFF % | BENEFITS |
|---|---|---|
| PREMIUM PROTECTION | Period | |
| Covers monthly Medical Aid Fund contributions on the life of the Principal Member. | 100% | 3 months |
| TRAVEL AND ACCOMMODATION BENEFIT | ||
| Transport cost when referred for specialist services not available in the area of residence. | 100% of cost | N$ 3, 900 per family |
| BENEFIT REWARDS | Low claiming threshold levels | |
| Principal Member N$ 1, 700 Adult Dependant N$ 1, 200 Child Dependant N$ 600 | |
| BENEFIT WALLET | ||
| Accumulated Benefit Wallet benefits may be used for purchasing of medical treatment and services in terms of the Medical Aid Funds Act, provided that the member pays first and claims back from the Benefit Wallet within the 4 month claiming period. Allow Provider payments for excess of Benefit and tariff rejections | 100% of cost | Subject to availability of Benefit Wallet benefits, medical treatment and services obtained from a registered medical facility |
| LONGSTANDING MEMBERSHIP REWARDS | Group Rate 1 Contributions | |
| A member who is 65 or older and has been with the Fund for more than 20 years may qualify for Group Rate 1 contribution | Provided the member is not already on a Group Rate status | |
| INTERNATIONAL RESCUE ME & ASSISTANCE (In addition to the Overall Annual Limit) | N$ 10, 000, 000 per family | |
| Emergency evacuation and ambulance services (air or road). | 100% | Terms and conditions |
| Repatriation (SADC) - Return after emergency or return of mortal remains. | 100% | Related to emergency evacuation |
| Medical treatment | 100% | Terms and conditions |
| Evacuation, repatriation, return of children. | 100% | Terms and conditions |